A case of intrahepatic mass-forming portal biliopathy mimicking intrahepatic cholangiocarcinoma

A 75-year-old man was referred to our department because of an enlarging intrahepatic mass detected on magnetic resonance imaging (MRI) follow-up for another disease. MRI showed hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging in liver segment 4. Abdominal plain computed tomography (CT) indicated a low-density lesion with an unclear boundary, measuring approximately 4 cm × 3 cm in liver segment 4. Dynamic CT showed early rim enhancement and gradual central enhancement. Contrast-enhanced CT also showed occlusion of the portal vein in segment 4. As the possibility of intrahepatic cholangiocarcinoma could not be excluded on imaging studies, we performed laparoscopic left medial sectionectomy. Histologically, the lesion showed diminished numbers of hepatocytes with increased collagen fibers compared with normal, with no patent portal vein. We considered this lesion a reactive lesion caused by collapse of the liver parenchyma owing to localized obstruction and loss of the portal vein. This lesion was pathologically diagnosed as portal biliopathy. We experienced an extremely rare case of intrahepatic mass-forming portal biliopathy that mimicked a hepatic tumor, which was diagnosed by laparoscopic resection. Portal biliopathy rarely forms intrahepatic mass lesions and must be distinguished from a malignant hepatic tumor.

Robotic spleen-preserving distal pancreatectomy using the first domestic surgical robot platform (the hinotori™ Surgical Robot System): a case report

BACKGROUND

Robotic pancreatectomy has been performed worldwide mainly using the da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Recently, because of the death of some patents related to the da Vinci® system, new surgical robot systems have been introduced that are characterized by unique technical refinements. In Japan, the hinotori™ Surgical Robot System (Medicaroid Corporation, Kobe, Japan) was approved for use in gastroenterological surgery in October 2022. Since then, we have attempted complicated procedures using this robot. In this report, we report our first experience performing spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein using this first Japanese domestic surgical robot.

CASE PRESENTATION

The patient was a 58-year-old woman with a mass in the pancreatic tail identified during medical screening. Further examinations resulted in a diagnosis of a pancreatic neuroendocrine tumor. The patient consented to surgical resection, and we planned robotic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein, using the hinotori™. Five trocars, including one port for the assistant surgeon, were placed in the upper abdomen. The operating unit was rolled in from the patient's right side. The pivot position was set for each robotic arm, and this setting was specific to the hinotori™. The cockpit surgeon performed all surgical procedures, excluding port placement and pancreatic transection. There were no unrecoverable device errors during the operation. The operation time was 531 min, and blood loss was 192 ml. The postoperative course was uneventful. We were able to safely perform this highly complicated surgery for a pancreatic tumor using the first Japanese domestic surgical robot platform.

CONCLUSIONS

The first Japanese domestic surgical robot platform, hinotori™, has different features from those of the da Vinci® and performed sufficiently as a surgical robot system in highly advanced pancreatic surgery.

Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single-center, observational cohort study

BACKGROUND

Pancreas transplantation (PT) is a radical treatment for diabetes mellitus (DM). Although the results of PT have been improving, surgical complications remain. Few reports have focused on complications associated with pancreatic fluid (CAPF) after PT. We aimed to investigate the risk factors and predictors for CAPF after PT.

METHODS

Sixty-nine patients, who underwent deceased-donor PT for type 1 DM at our institution from August 2001 to May 2020, were retrospectively studied. We identified CAPF from those with Clavien-Dindo Classification ≥grade III and assessed risk factors by univariate and multivariate analyses using logistic regression.

RESULTS

Twenty-one (30.4%) patients had complications with Clavien-Dindo Classification ≥grade III. Eleven (16.0%) patients were diagnosed with CAPF. Median serum pancreatic amylase (P-AMY) levels with CAPF on postoperative day (POD)1 and POD2 were significantly higher than those without CAPF (P = .019 and P = .027, respectively). In multivariable analysis, serum P-AMY levels on POD1 were an independent predictive factor for CAPF (odds ratio 1.83, 95% confidence interval 1.07-3.14, P = .008).

CONCLUSIONS

Complications associated with pancreatic fluid after PT is associated with high serum P-AMY in the early postoperative period. Serum pancreatic enzymes in the first few postoperative days after PT may be a significant predictive factor for CAPF.

Combined preoperative measurement of three inferior alveolar canal factors using computed tomography predicts the risk of inferior alveolar nerve injury during lower third molar extraction

A retrospective cohort study was performed to assess the clinical usefulness of combination assessment using computed tomography (CT) images in patients undergoing third molar extraction. This study included 85 patients (124 extraction sites). The relationship between cortication status, buccolingual position, and shape of the inferior alveolar canal (IAC) on CT images and the incidence of inferior alveolar nerve (IAN) injury after third molar extraction was evaluated. IAN injury was observed at eight of the 124 sites (6.5%), and in five of 19 sites (26.3%) in which cortication was absent+the IAC had a lingual position+the IAC had a dumbbell shape. Significant relationships were found between IAN injury and the three IAC factors (cortication status, IAC position, and IAC shape; P=0.0001). In patients with the three IAC factors, logistic regression analysis indicated a strong association between these factors and IAN injury (P=0.007). An absence of cortication, a lingually positioned IAC, and a dumbbell-shaped IAC are considered to indicate a high risk of IAN injury according to the logistic regression analysis (P=0.007). These results suggest that a combined assessment of these three IAC factors could be useful for the improved prediction of IAN injury.

In vitro synergistic effects of zoledronic acid and calcium on viability of human epithelial cells

OBJECTIVE

Bisphosphonate-related osteonecrosis of the jaw is a common complication with defective wound healing of oral mucosa and frequently occurs in patients receiving zoledronic acid (ZA). The aim of this in vitro study was to investigate whether ZA has a cytotoxic effect at clinically relevant concentrations on epithelial cells when calcium conditions are altered.

METHODS

HaCaT human keratinocyte cells were treated with ZA in the presence of various concentrations of calcium. The concentrations of ZA included submicromolar ones, which are comparable with those found in the plasma of patients. Cell viability and apoptosis were assessed using MTT assay and annexin V flow cytometry.

RESULTS

Under standard culture conditions, cell growth was inhibited at 1 μM of ZA or above, but was unaffected by lower concentrations. However, when calcium concentrations were moderately increased, cell viability was decreased and apoptosis was induced at 0.2-0.3 μM of ZA. Moreover, a 50% reduction in serum in the hypercalcemic medium resulted in a significant decrease in cell viability at a much lower concentration (0.05 μM).

CONCLUSION

These results suggest that clinically relevant concentrations of ZA, which alone have little effects, can be toxic to the epithelial cells depending on the conditions of extracellular calcium.

Sensory requirements for noncontact penile erection in the rat

Physical contact is not necessary for male rats to display penile erection when placed in the vicinity of females in estrus (noncontact erection, NCE). The modality and reception of sensory stimuli for the induction of NCE were analyzed. Olfactory bulbectomy eliminated NCE, and destruction of olfactory mucosa by zinc sulfate solution caused a significant suppression of NCE, whereas removal of the vomeronasal organ had no effect. Fresh urine collected from estrous females, but not fresh feces, induced NCE. Neither devocalization of estrous females by cutting the inferior laryngeal nerve nor deprivation of visual cues by placing an opaque barrier between the subjects and stimulus females disrupted NCE. The results indicate that olfactory cues emitted by estrous females induce NCE via the olfactory epithelium. Contrary to what had been suggested by previous experiments, vomeronasal inputs are not indispensable for the induction of NCE.

Sensory requirements for noncontact penile erection in the rat

Physical contact is not necessary for male rats to display penile erection when placed in the vicinity of females in estrus (noncontact erection, NCE). The modality and reception of sensory stimuli for the induction of NCE were analyzed. Olfactory bulbectomy eliminated NCE, and destruction of olfactory mucosa by zinc sulfate solution caused a significant suppression of NCE, whereas removal of the vomeronasal organ had no effect. Fresh urine collected from estrous females, but not fresh feces, induced NCE. Neither devocalization of estrous females by cutting the inferior laryngeal nerve nor deprivation of visual cues by placing an opaque barrier between the subjects and stimulus females disrupted NCE. The results indicate that olfactory cues emitted by estrous females induce NCE via the olfactory epithelium. Contrary to what had been suggested by previous experiments, vomeronasal inputs are not indispensable for the induction of NCE.

[An active part of female mice in sexual interaction]

Proceptive behavior, according to Beach (1976), maintains and accelerates sexual interactions toward the end goal. Such distinctive type of proceptive behavior as darting or hopping of female rats is not apparent in mice. Nevertheless, it seems more reasonable that females may take an active part as much as their male partners also in this species. Twenty sexually experienced females in estrus were paired with 20 naive males of the same strain (ICR/JCL) and the pairs were observed for 6 hours. Eleven males of the 20 pairs successfully ejaculated. Females exhibited lordosis more frequently when they actively approached the male partners than when they were approached and mounted by males. This indicated that the rate of mating success was higher in the case of female's approach. Female's approaching behavior thus possibly plays a role as a proceptive behavior in mice.

[Cerebrospinal fluid transfer of cefotiam (CTM). Its relationship to CT]

Drip intravenous infusion of cefotiam (CTM) was made on patients who underwent cerebrospinal fluid (CSF) drainage and study was made on CSF transfer of CTM and at the same time on the relationship between CSF transfer of iodine contrast medium and CT scan findings. This study was made on 11 cases of cisternal drainage and 8 cases of ventricular drainage. Cisternal drainage cases were all postoperative cases of ruptured cerebral aneurysm. Cases of ventricular drainage included 4 postoperative cases of ruptured cerebral aneurysm, 1 case of CSF rhinorrhea, 2 cases of brain tumor, and 1 case of ventricular hemorrhage. Drip intravenous infusion of 1.0 g of CTM was made in one hour and at given periods thereafter CSF was collected and measured. CTM transferred to the CSF in cistern at a comparatively high concentration (16.3-0.7 microgram/ml). Hardly any transfer of CTM to the CSF in ventricle was seen in one case of cerebral aneurysm, CSF rhinorrhea, and brain tumor, but transfer was observed in one case of cerebral aneurysm, one case of brain tumor, and case of ventricular hemorrhage. Transfer of iodine contrast medium showed the positive correlation to the transfer of CTM. In cases of brain tumor and ventricular hemorrhage with transfer of CTM with ventricular drainage, enhancement effect of the ventricular wall by the contrast medium could be observed by CT scan. From the foregoing, the following results were obtained. There was good transfer of CTM to the CSF in cistern in postoperative cases of ruptured aneurysm. CTM did not transfer to CSF in the normal ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

[Two cases of spina bifida cystica with congenital dermal sinus]

Spina bifida cystica and congenital dermal sinus are congenital anomalies which are called dysraphic states. Numerous reports of congenital dermal sinus can be seen in Europe and America, but in this country we have been able to find no more than six reported cases. Also in this country, to the best of our knowledge, only two cases of combined spina bifida cystica and congenital dermal sinus have been seen. The small incidence of reported cases may be due to the fact that congenital dermal sinus tends to go unnoticed except when infection develops. Consequently when dermal sinus is asymptomatic, even in both combined cases, it probably is thought to be only spina bifida. We have seen the combination with congenital dermal sinus in two among twenty cases of spina bifida cystica which we have observed during the past seven years. We report on this and discuss it in relation to the other literature.