Akira Toki

Clinical features of pancreaticobiliary maljunction: update analysis of 2nd Japan-nationwide survey.

IntroductionPancreaticobiliary maljunction (PBM) is a congenital anomaly, which can be defined as a union of the pancreatic and biliary ducts located outside off the duodenal wall. We herein investigate clinical features of PBM including as the 2nd report of a Japanese nationwide survey.Patients and methodsDuring a period of 18xa0years (from 1990 to 2007), 2,561 patients with PBM were registered at 141 medical institutions in Japan. Among them, eligible patients (nxa0=xa02,529) were divided into two groups: adult (nxa0=xa01,511) and pediatric patients (nxa0=xa01,018). Comparisons of clinical features including associated biliary cancers were performed according to the biliary dilatation (BD), age factor, and time era.ResultsOnly one case in pediatric patients with BD combined with a bile duct cancer (0.1xa0%). In adult patients, the bile duct cancer and the gallbladder cancer was seen in 6.9 and 13.4xa0% patients with BD and in 3.1 and 37.4xa0% patients without BD, respectively. In adult patients with BD, the occurrence rates of biliary cancers were increased in latter period (00’–07’) compared with former period (90’–99’). The ratio of biliary cancer localization was changed between former and latter period, and the bile duct cancer was increased in latter period (from 5.5 to 9.3xa0%).ConclusionsThe largest series of PBM were evaluated to clarify the clinical features including the associated biliary cancer in this Japan-nationwide survey. This report could be widely used in the future as a reference data for diagnosis and treatment of PBM.

Colorectal screening with single scan CT colonography in children

The purpose of this study was to evaluate the feasibility of single scan CT colonography (CTC) using polyethylene glycol electrolyte solution with contrast medium (PEG-C) bowel preparation in children. Seven patients suspected of colorectal elevated lesions were subjected to CTC. All patients underwent bowel preparation using polyethylene glycol electrolyte solution (PEG) at a dose of 32xa0±xa03xa0ml/kgBW before the day of CTC. The water-soluble contrast agent was given to the patients at a dose of 0.6xa0±xa00.1xa0ml/kgBW the next morning. After colonic air insufflation, the patient was scanned axially with a single run. After evaluation of multiplanar reformation images, 3-dimensional images (CT enema and virtual endoscopy image) were reconstructed. CT enema image was composed from air image and contrast-medium image. All studies were performed without complications. CTC showed the entire colon without blind spots in all patients with only single scan. In conclusion, the single scan CTC using PEG-C preparation is safe and less invasive compared to conventional CTC due to the shorter examination time and lower radiation dose.

Beneficial effects of (−)-epigallocatechin gallate on ischemia-reperfusion testicular injury in rats

BACKGROUND/PURPOSEnThe purpose of the study was to determine the effect of (-)-epigallocatechin gallate (EGCG) on testicular ischemia-reperfusion injury in rats.nnnMETHODSnForty male Wistar rats were assigned to 5 groups. A sham operation was performed on the animals in group 1. In group 2, after 4 hours of unilateral testicular ischemia, 4 hours of testicular reperfusion was performed with EGCG administered 1 hour before reperfusion. In group 3, the same surgical procedure as in group 2 was performed, but without EGCG. Serum superoxide dismutase activity, creatine kinase, and lactate dehydrogenase were then measured in blood samples from groups 1 to 3. In group 4, after 4 hours of unilateral testicular ischemia, testicular reperfusion was performed. In group 5, the same procedure as in group 4 was performed, but with EGCG administered 1 hour before reperfusion. For groups 4 and 5, bilateral orchiectomy was performed for histologic examination 4 weeks after reperfusion was started.nnnRESULTSnSerum superoxide dismutase activity was significantly higher in group 2 than in group 3. The ratios of bilateral testicular weight, mean seminiferous tubule diameter, and germinal epithelial cell thickness were significantly higher in group 5 than in group 4.nnnCONCLUSIONSnTherapy with EGCG before reperfusion might exert protective effects via antioxidant activities in a rat experimental model of testicular ischemia-reperfusion injury.

Ectopic pancreas as a cause of jejunal obstruction in a neonate

This report describes a case of symptomatic ectopic pancreas in the jejunum. A review of the literature revealed no other case of ectopic pancreas manifesting as jejunal stenosis during the neonatal period. Ectopic pancreas should be excised in consideration of the potential late complications.

Glicentin inhibits internalization of enteric bacteria by cultured INT-407 enterocytes

Glicentin, the main component of enteroglucagon, has trophic effects on intestinal mucosa. It may also have an inhibitory effect on extraintestinal invasion of enteric bacteria. We have established an in vitro bioassay system for determining the effects of recombinant human glicentin on bacterial internalization by confluent enterocytes. An INT-407 cell line was serum-deprived for 2xa0days and was then treated on transwell filters for 24xa0h with a medium containing one of the following: glicentin 100xa0ng–1xa0μg/ml, glucagons-like peptide-2 (GLP-2) 1xa0μg/ml, 10% fetal bovine serum (FCS), or without any growth factors. Pure cultures of Salmonella enteritidis, Escherichia coli, and Enterococcus faecalis were introduced to the upper chambers of the filter units. Following 2xa0h of incubation the numbers of bacteria in the lower chambers were measured. Pretreatment of enterocytes with glicentin inhibited bacterial internalization compared to untreated or GLP-2 enterocytes. Glicentin was associated with inhibition of enterocyte internalization of enteric bacteria by a mechanism that might be related to the integrity of the enterocyte adhesive junctions and tight junctions and to the production of sIgA. Glicentin seems to have a function as a barrier-sustaining agent that inhibits extraintestinal invasion of enteric bacteria.

Urethral caruncle in a 9-year-old girl: a case report and review of the literature

IntroductionUrethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in post-menopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present an unusual case of a pediatric patient with a urethral caruncle, along with a review of the literature.Case presentationA 9-year-old Mongolian girl was referred to our hospital with a 2-week history of frequent adherence of a small amount of blood to her underwear. We found a sessile smooth margin, a clear boundary and an elastic, soft red tumor over the entire circumference of the urethral meatus. At the beginning, because of the child’s age, urethral prolapse was suspected. There was no response after 3 weeks of conservative treatment with steroid ointment. With the patient under general anesthesia, a partial tumor resection was performed for the purpose of histological examination. The tumor excision was limited to about 1/2 laps of the urethral meatus to prevent the development of urethral stricture. On the basis of clinical and histopathological examinations, a diagnosis of a urethral caruncle was made. Post-operatively, steroid ointment application to residual masses was continued, and these disappeared about 6 months later. Our patient was free of recurrence and had had no complications after 3 years of follow-up.ConclusionsUrethral caruncles are rare in children, and the possibility of malignancy is slight during this period. Biopsy of the mass is not required for diagnosis. It should be indicated only if the mass has other characteristics that raise suspicion of malignancy. In previously reported cases, all of the tumor was removed. However, the trigger of the caruncle in childhood is chronic inflammation. Conservative therapy with steroid ointment should be the core treatment. However, it may be necessary to proceed to treatment because caruncles take a long time to heal. The case that we describe in this report will serve as an example for similar cases in the future.

Development of fatty acid calcium stone ileus after initiation of human milk fortifier.

We report a case who was born with extremely low birth weight infant and had experienced abdominal operation for necrotizing enterocolitis, eventually developed ileus due to fatty acid calcium stones after giving human milk fortifier. He had developed necrotizing enterocolitis on day 30 of his age, such that we performed enterectomy and ileostomy. He could not tolerate enteral feeding fully, because intestinal fistula infection was repeated. Although we administered hindmilk, he grew up slowly and he suffered cholestasis as well. We performed end‐to‐end anastomosis to prevent fistula infections on day 87. After this operation, breast milk feeding volume was increased easily. However, we started to add HMF of half‐strength on day 124, because his body weight gain remained very poor. And we confirmed to intensify the ratio of HMF full‐strength on day 128. After that his abdomen had distended on day 131. As there is no effect of conservative therapy to occlusive ileus, we did emergency laparotomy on day 139. Intestinal calculi were impacted at anastomic portion. Although all stones were removed, he died on 144 days due to disseminated intravascular coagulation and renal failure. Calculi analysis revealed that all of them were fatty acid calcium stones. There is no report about like our case. We speculate that the construction of fatty acid calcium result from either high concentration of calcium/phosphorus or rapid increase in the fortification. We could have prevented this case happened by slower increment of fortification.

Markers of enteral adaptation in pediatric cases with short bowel syndrome

The aim of this study was to ascertain if prospective determination of specific gut hormones and growth factors could predict bowel adaptation in children with short bowel syndrome (SBS).

Enhanced Recovery After Surgery (ERAS) for Postoperative Pediatric Surgical Disorders

The purpose of ERAS protocol for children is less invasive operation, prevention of complication, promotion of recovery after surgery, and good mental, physical development. The most important factors of ERAS for children are avoidance of prolonged fasting, nonroutine use of tubes or drains, and early oral nutrition and mobilization. We described in detail about these important factors: n n(1) n nAvoidance of prolonged fasting: General fasting standards were 2 h for clear fluids, 4 h for breast milk, 6 h for nonhuman milk/cow milk and solid substances, and 8 h for meat/fried or fatty foods. However, the Japanese guideline does not clearly show fasting time. n n n n n(2) n nNonroutine use of tubes and drains: The non-drainage patients after large volume intraperitoneal lavage for perforated appendicitis were found to have a faster postoperative recovery. Reasons given were a control of bacterial proliferation due to physical reduction in intraperitoneal bacteria count and faster wound healing since a drainage tube is not inserted. n n n n n(3) n nEarly oral nutrition and mobilization: Postoperative management for infants has changed from intravenous nutrition to early oral nutrition. We describe about dietary fiber as important nutrient.

Definition of PBM and CBD

The criteria defined PBM as “a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall”. This definition was formulated from an anatomical perspective and does not include functional elements.