Yukihiro Tatekawa

A new evaluation of pancreatic function after pancreatoduodenectomy using secretin magnetic resonance cholangiopancreatography

BACKGROUND The remnant pancreatic function after pancreatoduodenectomy influences greatly postoperative quality of life. However, it has been difficult to evaluate the exocrine remnant pancreatic function postoperatively. The aim of this study was to assess the usefulness of secretin-stimulated magnetic resonance cholangiopancreatography (secretin MRCP) in evaluating the remnant pancreatic function and ascertaining the anastomotic patency after pancreatoduodenectomy. METHODS Thirty-four patients who underwent pancreatoduodenectomy were evaluated with secretin MRCP. The results of MRCP were determined by the amount of exocrine pancreatic secretion, and were graded as follows: grade I (poor secretion), grade II (moderate secretion), and grade III (good secretion). RESULTS Secretin MRCP could visualize the pancreatic secretion dynamically. MRCP grades were grade I in 11 patients, grade II in 12, and grade III in 11. There was a significant correlation between MRCP grade and glucose tolerance. We confirmed visually the patency of the anastomotic site in 24 patients (71%). MRCP grades correlated significantly with clinical symptoms. CONCLUSION Our results demonstrated secretin MRCP was feasible for evaluating the remnant pancreatic function after pancreatoduodenectomy.

Duodenal Atresia Associated with “Apple Peel” Small Bowel Without Deletion of Fibroblast Growth Factor-10 or Fibroblast Growth Factor Receptor 2IIIb: Report of a Case

We report a case of duodenal membranous atresia associated with “apple peel” small bowel in a baby girl. The patients mother and sibling had also undergone surgery for duodenal atresia. Familial duodenal atresia is sometimes the result of genetic, inherited abnormalities. Fibroblast growth factor (FGF) receptor 2IIIb (Fgfr2b) and Fgf10 are known regulatory molecules relevant to mesenchymal-epithelial interactions. The involvement of the Fgf10/Fgfr2b pathway in the pathogenesis of intestinal atresia are related to tissue-specific transcription factors, which regulate the expression of Fgf10 according to the organ system and the stage of gestation. Furthermore, a spontaneous somatic mutation or a point mutation of Fgf10 early in development would result in a genetic mosaic pattern. Fluorescent in situ hybridization did not show homozygous or heterozygous deletion of the Fgf10 or Fgfr2b gene in this case. It is necessary to study the occurrence of duodenal atresia in posterity and investigate the deletion of the Fgfr2b or Fgf10 genes if possible.

Multistage Approach for Tracheobronchomalacia Caused by a Chest Deformity in the Setting of Severe Scoliosis

We present a case of tracheobronchomalacia caused by thoracic morphologic changes associated with severe scoliosis. The patient underwent fundoplication for gastroesophageal reflux. After the operation, the patient developed clinically significant tracheobronchomalacia. Tracheobronchial reinforcement and splinting with autologous cartilage grafts was initially performed to externally stent the trachea. Next, tracheopexy of the intrathoracic trachea and sternal elevation was performed using a pectus bar to correct the tracheal compression between the sternum and the spine. Because the cervical trachea was compressed between the innominate artery and the cervical spine, external stenting and tracheopexy of the cervical trachea as well as anterior suspension of the innominate artery were performed. At present, the patient has a Tracheostoma Retainer in place and is being followed as an outpatient without the need for mechanical ventilation. Multistaged techniques for tracheobronchomalacia because of an abnormal chest configuration therefore offer the potential to achieve the long-term release of airway obstruction.