Ryo Sugiura

Field information system using an agricultural helicopter towards precision farming

The objective of this study is to develop the system that can generate a map regarding field information such as crop status and land topographical feature obtained by an imaging sensor and laser range finder mounted on an unmanned helicopter. To generate a precise map, accurate measurement of helicopters position and posture are essential, because the geometric distortions occur in the image taken from the helicopter due to variations of the sensing position and posture. In the research, an RTK-GPS was adopted as a positioning sensor and the helicopters posture was obtained by an INS. Furthermore, the encoders can measure the imaging sensors motion. The transformation method to generate a map using these parameters was developed. And a topographic map of a field was generated by adopting laser range finder as another sensor.

The Development of Remote Sensing System Using Unmanned Helicopter

The objective of this study is to develop the system that can generate a map regarding crop statusobtained by the imaging sensor mounted on an unmanned helicopter. As for the unmannedhelicopter used in this research, an RTK-GPS was adopted as positioning sensor, and an inertialsensor that provides posture (roll and pitch angles) is installed in the helicopter. Moreover, ageomagnetic direction sensor (GDS) that outputs an absolute direction is also attached in thehelicopter. When obtaining the image by the image sensor on the helicopter, some distortionscaused by change of helicopter’s posture arise in the image. In order to remove this distortion,geometric correction by converting from image coordinate to global coordinate is badly needed.But there are some errors in posture data, particularly large GDS error was caused by warp ofgeomagnetism surrounding the helicopter. Therefore the method of correction of GDS errors wasdeveloped in the study. As the result, it was possible to generate a map including 41 cm error usingthe image taken by the helicopter.

Direct puncture of the ampulla as a modified Endoscopic ultrasound-guided rendezvous technique

Title Direct puncture of the ampulla as a modified Endoscopic ultrasound-guided rendezvous technique Author(s) Kawakubo, Kazumichi; Kuwatani, Masaki; Kato, Shin; Sugiura, Ryo; Sano, Itsuki; Sakamoto, Naoya Citation Endoscopic Ultrasound, 7(2), 133-134 https://doi.org/10.4103/eus.eus_31_17 Issue Date 2018-03 Doc URL http://hdl.handle.net/2115/71166 Rights(URL) http://creativecommons.org/licenses/by-nc-sa/3.0/ Type article File Information EndoscUltrasound72133-2596543_071245.pdf

Development of 3-D GIS Map Generation System Using an Unmanned Helicopter

The objective of this study is to generate a 3D-GIS map of farm field. The survey system was developed based on an unmanned helicopter. An RTK-GPS was adopted as a positioning sensor, and an inertial sensor that provides posture (roll and pitch angles) was installed on the helicopter. Moreover, a geomagnetic direction sensor (GDS) that outputs absolute direction is also equipped with the helicopter. And a laser scanner was adopted to detect the distances between a helicopter and ground. This leaser scanner provides a two-dimensional range data.Tthe sensor was attached on a pan-head can rotate in pan and tilt directions. Pan-head angles can be measured by two rotary encoders with 0.001 rad of resolution. Therefore, field elevation was sensed by rotating the pan head during hovering of an unmanned helicopter. In order to develop the precise survey system, the offset due to misalignment of sensor attachment was identified by measuring already measured position. And, because the GDS is influenced by a magnetic field surrounding the GDS, the direction data includes significant error. The GDS bias was also compensated by a FOG. Finally, the developed system accuracy was evaluated by the field test and express a farm field with 3D-GIS map. The 3D-GIS map was generated by transforming a laser scanner coordinate to global coordinate using a helicopter position and posture data.

Hepatobiliary and Pancreatic: Pancreatic cancer with elevated serum IgG4 level due to multiple myeloma mimicking localized autoimmune pancreatitis: Hepatobiliary and Pancreatic: Pancreatic cancer with elevated serum IgG4 level due to multiple myeloma mimicking localized autoimmune pancreatitis

An 80-year-old Japanese woman was referred for examination of a pancreas head mass lesion. She was diagnosed with multiple myeloma (MM) at another hospital 2 years before referral. Laboratory tests revealed abnormal liver function test and elevated serum IgG, IgG4, (1560 mg/dL) and CA19-9 levels (154.2 U/mL). Initial computed tomography (CT) (Fig. 1a, arrow) and endoscopic ultrasonography (EUS) (Fig. 1b, arrowheads) showed a mass in the pancreas head that involved the distal bile duct (BD). EUS guided fine-needle aspiration of the mass found no evidence of malignancy or autoimmune pancreatitis (AIP). The biopsy specimen from the distal BD showed infiltration of few plasma cells without IgG4 staining. Based on the diagnosis of localized type 1 AIP by international consensus diagnostic criteria (indeterminate imaging, level 1S and level OOI), we started to administrate prednisolone at a dose of 30 mg/day. Eight weeks after prednisolone start, the serum CA19-9 level was sharply elevated (465 U/mL), whereas serum IgG and IgG4 levels had not decreased. Follow-up CT showed expansion of the pancreas head mass. Repeated biopsy of the distal BD stricture was performed and revealed adenocarcinoma (Fig. 2a, hematoxiline and eosin stain). According to the report from the previous hospital, this patient was diagnosed with IgG-type MM (Durie-salmon staging system; clinical stage II) from laboratory test results (IgG, 2752 mg/dL; IgA, 46 mg/dL; IgM, 30 mg/dL; κ/λ ratio, 8.28; Hb, 9.0 g/dL), bone marrow findings (Fig. 2b, hematoxiline and eosin stain; Fig. 2c,d, CD138), and serum immunoelectrophoresis, which showed a clear M peak on IgG. The previous and current serum laboratory findings (IgG, 2192 mg/dL; IgG4, 1560 mg/dL; κ/λ ratio, 8.97) indicated an increase in serum monoclonal IgG4. The final diagnosis was pancreatic ductal adenocarcinoma (PDAC) complicated by MM with increased monoclonal IgG4. The patient underwent best supportive care because of her poor performance status. In the two previous studies analyzing IgG subclass distribution in patients with MM, the proportion of patients with IgG4 M-protein was extremely low (6.5% and 8%, respectively). There has been no previous report of a case of PDAC complicated by MM with IgG4 M-protein. We described an extraordinary case of PDAC that was initially misdiagnosed as localized AIP because of a markedly elevated serum IgG4 level affected by MM. Physicians should consider that the presence of MM with IgG4 M-protein could hinder a correct diagnosis of a pancreatic mass lesion.

Mixed ductal-neuroendocrine carcinoma with unique intraductal growth in the main pancreatic duct

A 64-year-old man was referred to our hospital for workup of a pancreatic mass. Ultrasonography revealed dilatation of the main pancreatic duct (MPD) in the body and tail of the pancreas [Figure 1a]. Abdominal computed tomography demonstrated a mass in the head of the pancreas with gradual enhancement [Figure 1b]. EUS showed a hypoechoic mass in MPD, measuring about 16 mm × 14 mm, with dilatation of MPD in the pancreatic body and tail [Figure 1c]. Endoscopic retrograde pancreatography showed obstruction of MPD in the head of the pancreas [Figure 1d], and we performed biopsy of the lesion. Histological examination of the biopsy specimen suggested combined carcinoma with both ductal and neuroendocrine features.

Successful endoscopic sphincterotomy for choledocholithiasis in a patient with severe hemophilia A and inhibitors

Endoscopic sphincterotomy (ES) is a standard procedure for bile duct stone removal. However, the safety of ES in patients with hemophilia remains unknown. We treated a 46-year-old man who had choledocholithiasis and severe hemophilia A with high-responding inhibitors during immune tolerance induction therapy. Since coagulation factor VIII inhibitors neutralize and inactivate endogenous and exogenous factor VIII, bleeding risk is higher in hemophilia A patients with inhibitors than in those without inhibitors. With adequate pre- and post-procedure monitoring of the clotting factor and supplemented clotting factor, the patient could safely undergo ES without bleeding complications. ES can be also an effective and safe first-line therapy for choledocholithiasis in patients with hemophilia and inhibitors under the condition of appropriate management.

Hepatobiliary and Pancreatic: A rare case of a well-differentiated neuroendocrine tumor in the bile duct with spontaneous regression diagnosed by EUS-FNA

A 30-year-old woman with persistent epigastric discomfort and hiccups with mildly deranged liver function test (serum total bilirubin, 0.5mg/dL; serum aspartate transferase, 18 IU/L; serum alanine transferase, 18 IU/L; serum alkaline phosphatase, 246 IU/L; and serum γ-glutamyl transpeptidase, 72 IU/L). Contrast-enhanced computed tomography (CECT) revealed a round-shapedmass in the perihilar bile duct, measuring 28×20mm. The margin of the mass was strongly enhanced in an arterial phase, whereas the center of the mass was not enhanced (Fig. 1a). An endoscopic retrograde cholangiogram (ERC) also demonstrated a round-shaped deficit in the perihilar bile duct (Fig. 1b), which was initially diagnosed as adenocarcinoma by forceps biopsy at that time. Repeat CECT after 1 month revealed spontaneous regression of the mass (24 × 13mm in size) in the perihilar bile duct which is also apparent on ERCP (Fig. 1c,d). Endoscopic ultrasonography (EUS) showed a hypoechoic mass located on the lateral side of the bile duct wall with small anechoic components. EUS-guided fine needle aspiration biopsy revealed cell aggregates consisting of pleomorphic atypical cells with abundant cytoplasmic granules and anisonucleosis (Fig. 1e). Immunohistochemical staining showed positivity for synaptophysin, chromogranin A, and CD56 (Fig. 1e). We made a definitive diagnosis of welldifferentiated neuroendocrine tumor of the bile duct. She underwent extrahepatic bile duct resection, and the surgical specimen showed almost the same findings as EUS-FNA specimens in which the Ki-67 labeling index was 6.6%. The final pathological diagnosis was well-differentiated neuroendocrine tumor of the bile duct, G2. The postoperative course was uneventful and she was discharged on the 18th postoperative day. A neuroendocrine tumor in the common bile duct is extremely rare, and no case of a bile duct lesion diagnosed by EUS-FNA has been reported. Thus, this is the first report of successful diagnosis by EUSFNA of a well-differentiated neuroendocrine tumor in the bile duct. In the present case, CECT showed an unusual phenomenon: spontaneous regression of the neuroendocrine tumor after the initial ERC and forceps biopsy. There have been some reports regarding spontaneous regression of neuroendocrine tumors including carcinoids in the lung, stomach, and pelvis, for which the immunological mechanism was proposed. In one report of pheochromocytoma, which is analogous to neuroendocrine tumor, spontaneous remission after avascular necrosis of pheochromocytoma was described. Considering the aforementioned image findings, spontaneous regression of the tumor in our case would have been caused by the latter mechanism, namely central necrosis of the tumor.

Rescue technique using a diathermic dilator for an unremovable stent in malignant perihilar biliary obstruction

Endoscopic biliary stenting is a useful and safe technique for malignant biliary obstructions. A plastic stent is frequently used because of its low cost and ease of deployment. However, it is occasionally difficult to remove a plastic stent because of severe stricture. We describe a rescue technique for immovable plastic stents, using a diathermic dilator in a case of perihilar biliary obstruction. A 63-year-old woman with jaundice due to hilar biliary obstruction was referred to our hospital. A diagnosis of gallbladder cancer was made from findings of a thickened gallbladder wall and massive ascites revealed by computed tomography (▶Fig. 1) and magnetic resonance cholangiopancreatography (▶Fig. 2). For biliary decompression and pathological confirmation, endoscopic retrograde cholangiography (ERC) was performed, and a 7-Fr plastic stent was placed (▶Fig. 3, ▶Video1). The patient underwent a second ERC 4 days later because of elevated biliary enzymes. The plastic stent could not be removed using forceps and snares, and the torn-off stent was left in place (▶Fig. 4). Although needle-knife sphincterotomy was performed to expose the residual plastic stent, the stent could not be grasped. A 0.025-inch guidewire could be advanced alongside the plastic stent, but a sphincterotome (CleverCut 3V; Olympus, Tokyo, Japan) could not. Successful dilation of the perihilar biliary stricture was achieved by advancing a 6-Fr wire-guided diathermic dilator (Cysto-Gastro-Set; Endo-Flex GmbH, Voerde, Germany) (▶Fig. 5). However, the remaining plastic stent also migrated. Thus, a 10-mm lumen partially covered, self-expandable, metallic stent (WallFlex biliary stent; Boston Scientific Japan, Tokyo, Japan) was deployed alongside the plastic stent (▶Fig. 6). In cases of malignant biliary stricture, removal of a plastic stent is time-consuming and might cause complications. The VIDEO 1

Effect of endoscopic transpapillary biliary drainage with/without endoscopic sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with biliary stricture (E-BEST): a protocol for a multicentre randomised controlled trial

Introduction The effect of endoscopic sphincterotomy prior to endoscopic biliary stenting to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis remains to be fully elucidated. The aim of this study is to prospectively evaluate the non-inferiority of non-endoscopic sphincterotomy prior to stenting for naïve major duodenal papilla compared with endoscopic sphincterotomy prior to stenting in patients with biliary stricture. Methods and analysis We designed a multicentre randomised controlled trial, for which we will recruit 370 patients with biliary stricture requiring endoscopic biliary stenting from 26 high-volume institutions in Japan. Patients will be randomly allocated to the endoscopic sphincterotomy group or the non-endoscopic sphincterotomy group. The main outcome measure is the incidence of pancreatitis within 2 days of initial transpapillary biliary drainage. Data will be analysed on completion of the study. We will calculate the 95% confidence intervals (CIs) of the incidence of pancreatitis in each group and analyse weather the difference in both groups with 95% CIs is within the non-inferiority margin (6%) using the Wald method. Ethics and dissemination This study has been approved by the institutional review board of Hokkaido University Hospital (IRB: 016–0181). Results will be submitted for presentation at an international medical conference and published in a peer-reviewed journal. Trial registration number The University Hospital Medical Information Network ID: UMIN000025727 Pre-results.