Susumu Fujioka

A decreased serum concentration of nitrite/nitrate correlates with an increased plasma concentration of lactate during and after major surgery

A decrease in the production of nitric oxide (NO) due to surgical stress has been reported. We investigated whether this decrease in NO production was related to cytokine induction and/or other clinical parameters. We therefore measured the concentrations of serum nitrite/nitrate (a stable end product of NO), serum interleukin (IL)-6, and standard clinical parameters in 13 patients undergoing major upper abdominal and thracoabdominal surgery at preanesthesia (PRE), 2h after a surgical incision (2H), at the end of surgery (END), and on the morning of postoperative days 1 (POD 1) and 3 (POD 3). The serum concentration of nitrite/nitrate was thus found to have significantly decreased at END, POD 1, and POD 3 compared with PRE. In addition, the serum nitrite/nitrate concentration correlated negatively with the plasma lactate level, and no relationship was observed between the serum nitrite/nitrate level and either the serum IL-6 level or any other clinical parameters. Our findings thus suggest that the decrease in the serum nitrite/nitrate level might therefore be related to tissue hypoperfusion both during and after major surgery.

Multiple myeloma mimicking bone metastasis from breast cancer: Report of a case

A 72-year-old woman with a history of early breast cancer suffered a fracture of the eighth thoracic vertebra resulting in paraplegia. Magnetic resonance imaging (MRI) showed spinal cord compression by a tumor between the ninth and tenth thoracic vertebrae. Local radiotherapy was begun under the diagnosis of metastatic breast cancer, but bone marrow aspiration and biopsy subsequently revealed plasma-cell proliferation rather than adenocarcinoma. This case report serves to demonstrate that clinicians should consider multiple myeloma as a cause of lytic bone lesions without extraskeletal metastases even in patients with a history of breast cancer.

The relationship between plasma concentration of mature adrenomedullin and jugular venous oxygen saturation during and after cardiopulmonary bypass.

Adrenomedullin (AM), a vasodilatory peptide, increases during cardiac surgery. However, the physiological role of AM during cardiac surgery remains unclear. AM dilates cerebral arterioles and increases cerebral blood flow in rats. Therefore, we investigated whether AM is related to cerebral oxygen balance during cardiac surgery. In nine patients undergoing coronary artery bypass grafts, plasma concentrations of mature AM from the radial artery (mAMa) and jugular bulb (mAMj) were measured, and jugular venous oxygen saturation was obtained before surgery (baseline), before aortic cross-clamp (preclamp), after aortic declamp (postclamp), and 20 min after weaning from the cardiopulmonary bypass (post-CPB). Plasma concentrations of mAMa and mAMj were significantly increased at postclamp (P < 0.01 for both) and post-CPB (P < 0.01 for both) compared with baseline values. Sjo2 correlated with plasma mAMj concentrations at preclamp (r = 0.79, P < 0.01), postclamp (r = 0.71, P < 0.05), and post-CPB (r = 0.72, P < 0.05), as well as with mAMa concentrations at preclamp (r = 0.79, P < 0.01) and postclamp (r = 0.72, P < 0.05). This suggests a relationship between AM and cerebral oxygen balance during cardiac surgery.

A Case Report of Long-term Survival after Radiotherapy for a Solitary Brain Metastasis from Breast Cancer.

This is the report of a patient with a solitary brain metastasis from breast cancer who survived more than 8 years after the first brain metastasis. The brain metastasis was treated with partial removal followed by 30 Gy/l5 fructions of whole brain irradiation plus 20 Gy/l0 fructions of local boost irradiation for 5 weeks. Brain metastases from breast cancer are usually a sign of rapid systemic tumor progression and long-term survivors are extremely rare. However, this case demonstrated the possibility of long-term survival in rare cases of brain metastases from breast cancer. This suggests a need for aggressive therapy in patients with a solitary brain metastasis.

A Case of Somatostatinoma of the Pancreas, Accompanied with Pancreas Divisum, that was Found at a Time of Acute Pancreatitis

Somatostatinomaは膵臓あるいは十二指腸に好発するまれな内分泌腫瘍である, 今回, 我々は膵癒合不全のため膵液の主排出路となっていた副膵管がsomatostatinomaにより閉塞し急性膵炎を発症した症例を経験した. 症例は65歳の男性で, 上腹部痛を主訴に来院し, 急性膵炎と診断された. 膵炎軽快後の内視鏡的逆行性膵管造影検査で背側膵管と腹側膵管が分枝のみで交通する膵管非癒合の所見を認め, また, 副膵管の途絶とその上流側膵管の拡張を認めた. 内視鏡所見では十二指腸下行脚副乳頭に一致する部位に潰瘍性腫瘍病変を認めた. 腫瘍により副膵管が閉塞し, その結果急性膵炎が発症したと考えられた. 急性膵炎の軽快した後に膵頭部癌の診断で膵頭十二指腸切除術を施行した. 病理組織学的に膵内分泌腫瘍と診断され, 免疫組織学的にsomatostatinで濃染された. 膵somatostatinomaと診断された.

A Case of Common Bile Duct Stricture due to Blunt Abdominal Trauma.

症例は37歳の女性. 夫に蹴られ上腹部を打撲. 受傷1週間後より腹痛, 背部痛が出現. 2週間後より黄疸を自覚し入院となった. 腹部CTでは, 膵頭部の軽度の腫大と肝内胆管, 総胆管, 胆嚢の拡張を認めた. ERCPでは, 膵内胆管の狭窄を認めるも主膵管に閉塞像を認めず, UGIでは十二指腸に狭窄を認めなかった. PTBDにて減黄を行い, 胆汁細胞診と狭窄部の擦過細胞診を行ったところ, いずれも悪性所見陰性で, 外傷性の総胆管狭窄を疑った. 総胆管は完全狭窄で内瘻化ができず, いったん外瘻のまま退院し, 後日内瘻化を行った. 発症より4か月後の胆管造影で胆管狭窄は改善し, 胆管tubeを抜去した. 現在, 血液生化学検査は正常で, 腹部CTでも膵頭部の腫大は軽減し再狭窄を疑わせる所見は認めていない. 外傷性総胆管狭窄は比較的まれであるが, 良性の可逆的病変であり, PTBDによる内瘻化は有用であると考えられた.