Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy.

BACKGROUND: The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). METHODS: A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction. RESULTS: The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups. CONCLUSIONS: Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery.

PURPOSE: Transabdominal preperitoneal (TAPP) repair for obturator hernia (OH) is not well established. Therefore, we evaluated the efficacy of TAPP for OH repair compared with open surgery. METHODS: We retrospectively analyzed patients who underwent surgery for OH at our hospital between 2006 and 2011. Since 2009, we have used TAPP repair for OH instead of open surgery. The clinical results of TAPP repair were compared with those of open surgery performed before 2008. RESULTS: Six patients with OH were treated by TAPP repair; occult contralateral OH was found by laparoscopic exploration in three (50 %) patients and was simultaneously repaired. Bowel incarceration was reduced by water pressure through Nelaton catheter in all but one patient. Bowel resection was performed in two patients after the laparoscopic assessment. For incarcerated OH, five of six cases were repaired using synthetic mesh, and the remaining case was addressed with simple peritoneal closure. Before 2008, six patients with OH underwent open surgery. The background of patients was comparable in the TAPP group and the open surgery group. There were no deaths in either group, but one metachronous contralateral OH occurred in the open surgery group within a short time frame, whereas none occurred in the TAPP group. CONCLUSIONS: TAPP repair, including the inspection of the viability of the incarcerated intestine and protective reduction and assessment of the entire groin area is an effective and minimally invasive strategy for OH patients.

Prevalence of Salmonella, Yersinia and Campylobacter spp. in feral raccoons (Procyon lotor) and masked palm civets (Paguma larvata) in Japan.

To estimate the public and animal health risk that alien species pose, the prevalence of Salmonella, Yersinia, and Campylobacter spp. in feral raccoons (Procyon lotor, n=459) and masked palm civets (Paguma larvata, n=153), which are abundant alien species in Japan, was investigated in urban and suburban areas of Japan. Salmonella enterica was detected from 29 samples [26 raccoons, 5.7%, 95% confidence interval (CI) 7.8-3.5%; three masked palm civets, 2.0%, 95% CI 4.2-0%]. Many of the isolates belonged to serovars that are commonly isolated from human gastroenteritis patients (e.g. S. Infantis, S. Typhimurium, and S. Thompson). The antimicrobial susceptibility test showed that 26.9 % of the isolates from raccoons were resistant to at least one antimicrobial agent, whereas none of the isolates from masked palm civets were resistant. Yersinia sp. was detected from 193 samples (177 raccoons, 38.6%, 95% CI 43.0-34.1%; 16 masked palm civets, 10.5%, 95% CI 15.3-5.6%). All virulent Yersinia strains belonged to Yersinia pseudotuberculosis, which was isolated from seven (1.5%, 95% CI 2.6-0.4%) raccoons and six (3.9%, 95% CI 7.0-0.8%) masked palm civets. According to the detection of virulence factors, all the Y. pseudotuberculosis isolates belonged to the Far Eastern systemic pathogenicity type. Campylobacter spp. was detected from 17 samples (six raccoons, 1.3%, 95% CI 2.3-0.3%; 11 masked palm civets, 7.2%, 95% CI 11.3-3.1%). Among these, three isolates from raccoons were identified as C. jejuni. These results showed that these pathogens can be transmitted by human activities, other wild animals, and the environment to feral raccoons and masked palm civets, and vice versa. As these animals have omnivorous behaviour and a wide range of habitats, they can play an important role in the transmission of the enteric pathogens.

Histologic changes in thyroid glands from great cormorant (Phalacrocorax carbo) in Tokyo Bay, Japan: possible association with environmental contaminants.

We compared morphologic changes in thyroid glands of great cormorants (Phalacrocorax carbo) from the Tokyo Bay and Lake Biwa areas in Japan with presence of residues of polychlorinated dibenzo-dioxins (PCDDs), polychlorinated dibenzo-furans (PCDFs), and coplanar polychlorinated biphenyls (Co-PCBs). Prominent morphologic changes in thyroid glands included increased density of small follicles and increased number of epithelial cells surrounding follicular lumens. The extent of morphologic changes in the thyroid gland was higher in cormorants captured from Tokyo Bay than in those captured from Lake Biwa. Increased thyroid change in cormorants from the Tokyo Bay area was associated with significantly higher levels of PCDFs and Co-PCBs. Thus, we suggest that morphologic changes in thyroid glands from the cormorants are associated with increased levels of dioxin contamination in Japan.

Multiple early bronchioloalveolar carcinomas in both lungs.

We treated a 49-year-old woman with synchronous multiple bronchioloalveolar carcinomas (BAC). Multiple bilateral 'ground-glass' opacities were detected by computed tomography (CT). We performed partial lung resection, and the pathologic diagnosis was atypical adenomatous hyperplasia. Two and one-half years later, a lesion showed enlargement, and was resected along with some others. The histopathologic diagnosis was multiple early BAC. High-resolution CT is likely to detect increasing numbers of similar cases.

Polychlorinated dibenzo-p-dioxins, dibenzofurans, and dioxin-like polychlorinated biphenyls in livers of birds from Japan.

Concentrations of 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and non- and mono-ortho-chlorine-substituted polychlorinated biphenyls (dioxin-like PCBs) were measured in livers of 17 species of birds collected from Japan. Birds were grouped according to their feeding habits as granivores, piscivores, omnivores, and predators for discussions. Livers of granivores contained relatively low concentrations of PCDD/DFs (80-660 pg/g) followed in increasing order by omnivores (2,300-8,000 pg/g), piscivores (61-12,000 pg/g) and predators (480-490,000 pg/g on a fat weight basis). Especially, one species of predatory bird (mountain hawk eagle) contained elevated concentrations of PCDDs, PCDFs, and dioxin-like PCBs, and the measured concentration is one of the highest reported to date. Homolog and congener patterns of PCDDs and PCDFs varied among species; hence, the results suggested that feeding habits, specific elimination, and metabolism influence contamination pattern. Concentrations of dioxin-like PCBs were in the order of granivores (32-83 ng/g) < predators [excluding mountain hawk eagle] (32-2,500 ng/g) < piscivore (61-12,000 ng/g) < omnivores (1,800-67,000 ng/g on a fat weight basis). Mountain hawk eagle contained the highest concentration of dioxin-like PCBs (55,000 ng/g fat weight). 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) toxic equivalents (TEQs) ranged from 53-450,000 pg/g fat weight. 23478-PeCDF, 2378-TCDD/TCDF, and PCB congeners IUPAC 126 and 77 were major contributors to TEQs in birds. To our knowledge, this is the first study of PCDD/DFs and dioxin-like PCBs in livers of several species of Japanese birds.

Chlorinated persistent organic pollutants in black-tailed gulls (Larus crassirostris) from Hokkaido, Japan.

Concentrations and patterns of several chlorinated persistent organic pollutants (POPs) including polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs) and biphenyls (PCBs) and DDTs, HCHs, CHLs and HCB were determined in black-tailed gulls (Larus crassirostris) from breeding grounds in Hokkaido, Japan. Subcutaneous fat of five adult gulls was analyzed, which had different concentrations of target compounds, whereas gull eggs contained similar concentrations of target compounds. Similar congener profiles were found between adult gulls and eggs. The concentrations of non-ortho PCBs varied from 3.4 to 13.5 ng/g lipid weight (lw) in the fat of black-tailed gulls and from 2.4 to 7.4 ng/g lw in their eggs. 2,3,7,8-PCDD/Fs occurred at relatively lower concentrations than non-ortho PCB congeners in both adult gulls and eggs. The total TEQs (toxic equivalents, PCDD/Fs+ non-ortho PCB) ranged from 0.26 to 1.0 ng/g lw in adult gulls and ranged from 0.19 to 0.58 ng/g lw in eggs.

Prevalence of dirofilarial infection in raccoon dogs in Japan.

The raccoon dog (Nyctereutes procyonoides viverrinus) is known to acquire canine heartworm (Dirofilaria immitis) infection. We surveyed the prevalence of heartworm infection in free-ranging raccoon dogs in the Nishi-Tama (Tokyo) and Kanagawa areas of Japan. A total of 75 raccoon dog carcasses, including 29 animals from the Nishi-Tama area and 46 from the Kanagawa area, were necropsied between 1992 and 1993. Eight out of 75 raccoon dogs were found to be infected (overall 10.7%). The prevalence of infection was 6 and 16% in Nishi-Tama and Kanagawa, respectively. Microfilarial production was observed in the uterus of one female adult dog.

Postcranial skeleton of a macaque trained for bipedal standing and walking and implications for functional adaptation.

The postcranial skeleton of a Japanese macaque that had been trained for bipedalism over an 11-year period was studied. Considerable modifications in the hindlimb bones caused by bipedal postural and locomotor behaviour were observed. Changes occurred in joint morphology, articular dimensions and shape-dependent strength of long bones, reflecting the causal relationship between function and morphology. However, the conditions under which the modifications are developed are somewhat different from those in humans, as the monkey's bipedalism is distinct from that of humans. The modifications seem to result from a compromise between functional requirements and the genetically determined anatomy of the essentially quadrupedal monkey.

A case of cleft palate in a Kuril seal (Phoca vitulina stejnegeri), from Hokkaido, Japan.

A male pup Kuril seal (Phoca vitulina stejnegeri) from Hokkaido, Japan, was observed with a unilateral and total cleft of the primary palate. Complications included a supernumerary tooth, hypoplasia and asymmetry of the face, and deformation of the eyeball and external auditory meatus. An accompanying pneumonia may have resulted from water flowing into the respiratory system due to imperfect closure of the nostril by the cleft. No other abnormalities were found.

Monkey performance: the development of bipedalism in trained Japanese monkeys.

A series of studies collaborated by the Suo-sarumawashi (Japanese Monkey Performance) revealed the potential for bipedalism in Japanese monkey. The long-term training which aimed at stable upright posture introduced marked lumbar lordosis in monkeys. This feature is comparable to the humans' condition not only morphologically, but also functionally. The developed lordosis was retained even in normal pronograde posture of the monkeys. Bone remodeling in the postcranial skeleton also evidenced functional adaptations for stresses induced by sustained bipedalism. Postcrania of a trained monkey showed highly increased structural strength of bones and relatively large articular dimensions. Despite such adaptations, modifications of hindlimb bones were rather distinctive from humans' condition. This indicates a compromise between functional necessity and genetically determined anatomy. The hindlimb of Japanese monkey seemed to be more specialized for quadrupedal locomotion in many aspects compared to the vertebral column.

Immunophenotypic difference of keratin expression in normal mammary glandular cells from five different species.

The immunohistochemical reactivity of human, monkey, shrew, rat and mouse normal mammary glands was examined using methacarn-fixed paraffin-embedded specimens and acetone-fixed frozen sections using the avidinbiotin-peroxidase method for cell phenotype comparison. Actin was visualized using anti-smooth muscle actin antibody and keratin expression was determined by employing 12 different monoclonal antibodies. All these antibodies cross-reacted specifically with the species examined. Basal (myoepithelial) cells from all species showed muscle-specific actin according to reactivity with HHF35 monoclonal antibody. Keratin expression showed significant phenotypic differences among species. In human and monkey, AEL-KS2, KL1, CK8.13, AE3 and 34BE12 stained luminal cells as well as basal cells. AE1, RPN1165, CK4.62, 35BE11, M20 and RPN1162 labeled only luminal cells whereas 312C8-1 preferentially bound to basal cells. In shrews, AEL-KS2, CK8.13 and AE3 reacted to both cell types, AE1 reacted only with luminal cells, and 35BE12 and 312C8-1 selectively stained basal cells. In rodents, AEL-KS2 reacted to both cell types, CK8.13, AE3, 34BE12 and 312C8-1 stained rat basal cells, and 34BE12 and 312C8-1 reacted to mouse basal cells. The data represents cytoskeletal differences among species.

Curvature of the lumbar spine as a consequence of mechanical necessities in Japanese macaques trained for bipedalism.

If trained to walk bipedally at a juvenile age and over periods of some months or years, Japanese monkeys gradually acquire a pronounced lordosis of the lumbar spine. This lordosis persists even in the 'normal', pronograde posture of these animals. It is due to a relative increase of the ventral lengths of the vertebral bodies. This morphological change is clearly an adaptation to the mechanical necessities of the upright body posture. Our result is in complete accordance with the development of a lordosis in human children between 1 and 5 years, as described recently by others.

Three-dimensional analysis of the arterial pattern of the upper limbs in Lorisiformes (Prosimiae, Primates).

A study of the arterial patterns of the upper limbs in Lorisiformes (Prosimiae), especially those of the rete mirabile and their correlating arteries, was carried out by three-dimensional arteriographic analysis. The rete displayed at least two types of plexiform distribution: (1) a vascular bundle in Lorisidae, which consists of a division of the main artery into a principal trunk surrounded upwards by about 50 small arteries, and (2) a simple network pattern in Galagidae, which, at most, is composed of simple vascular networks of the nature of a few widely scattered anastomoses. The arterial patterns of the upper limb in Lorisiformes are basically the same, but the position of divergence and the number and size of the vessels in the rete differ. The arterial patterns of the upper limbs in Lorisiformes closely resemble the development of the vessels in the 21- to 23-mm stages of human embryonic growth. In this study, we observed some similarity in the patterns between the rete mirabile and the superficial brachial artery in man.