A possible manifestation of pancreas divisum-pancreatic pseudocyst in an infant with no apparent history of pancreatitis: a case report.

BACKGROUND: Pancreas divisum (PD), the most common pancreatic anomaly, is caused by the failure of pancreatic bud fusion in the embryo. Although most cases are asymptomatic, it can cause pancreatitis or epigastric pain. We report an unusual case of PD in an infant. CASE PRESENTATION: The patient was a 9-month-old girl with no pertinent medical history. She had suffered vomiting and diarrhea for 1 week before transfer to our hospital. Her general condition was poor, and abdominal distention was noted. Blood tests revealed microcytic anemia with normal chemical markers. The parents reported no episode of pancreatitis. Ultrasonography revealed massive ascites, which was later found to be bloody. Enhanced computed tomography and magnetic resonance imaging depicted a cystic lesion, approximately 2 cm in size, anterior to the second portion of the duodenum. During exploratory laparotomy, a pinhole was identified on the cyst wall, which was mistakenly identified as a duodenal perforation, and direct closure was performed. Postoperative levels of serum amylase and inflammation markers were elevated, and the amount of ascites increased, impairing oral feeding. The level of pancreatic enzymes in the ascites was high. Imaging studies were repeated, but the cause of pancreatic fistula was not identified. Conservative therapy, including administration of total parenteral nutrition, antibiotics, and octreotide, was initiated, but the situation did not improve. Three months after admission, endoscopic retrograde cholangiopancreatography showed a thick dorsal pancreatic duct communicating with a hypoplastic ventral duct, which was indicative of PD. Contrast medium leaking from the dorsal duct near the minor ampulla revealed the presence of a pseudocyst. Stenting via the minor papilla was impossible because the minor papilla was obstructed. Instead, a stent was inserted into the ventral pancreatic duct. Endoscopic transgastric drainage of the cyst was effective, and the patient was discharged, 7 months after admission. The patient is healthy, but the gastric stent needs to be replaced regularly. CONCLUSION: In children, PD can manifest with pancreatic pseudocyst that causes pancreatic ascites, even in the absence of pancreatitis. This may be a previously unrecognized manifestation of PD in children, and clinicians need to be aware of it.

A case of immunoglobulin G4-related retroperitoneal fibrosis and hypophysitis with antecedent respiratory disease followed by spontaneous remission and recurrence.

A 65-year-old man presented with apparent bronchopneumonia. After treatment with antibiotics, he showed eosinophilia. Computed tomography (CT) imaging revealed bilateral consolidation, ground-glass opacities with nodular consolidations, and pleural effusion. Lung biopsy showed organising pneumonia with lymphoplasmacytic infiltration in the alveolar septa and in the thickened pleura and interlobular septa. All pulmonary abnormalities spontaneously went into remission within 12 months. At 73 years old, a follow-up CT scan revealed small nodules in both lungs and the review of the head CT scan showed thickening of the pituitary stalk in studying prolonged headache. Two years later, he visited the hospital complaining of severe oedema on the lower extremities with high serum immunoglobulin (Ig)G4 186 mg/dl. A whole-body CT scan showed retroperitoneal mass surrounding aortic bifurcation and compressing inferior vena cava, pituitary stalk thickening and gland swelling, and enlarged pulmonary nodules. Anterior pituitary stimulation tests showed central hypothyroidism, central hypogonadism, and adult growth hormone deficiency with partial primary hypoadrenocorticism. Retroperitoneal mass biopsy showed storiform fibrosis and obliterative phlebitis with marked lymphoplasmacytic infiltration with moderate IgG4-positivity. Immunostaining of the former lung specimen revealed dense interstitial infiltration of IgG4-positive cells. These findings indicated metachronous development of IgG4-related disease in lung, hypophysis, and retroperitoneum, according to the recent comprehensive diagnostic criteria of IgG4-related disease. Glucocorticoid therapy ameliorated oedema, on the other hand, unmasked partial diabetes insipidus at the initial dose of the treatment. Hypothyroidism and retroperitoneal mass regressed at 6 months of the treatment. This case warns us that long-term follow-up from prodromal to remission is necessary for the treatment of IgG4-related disease.

Current Status of Antimicrobial Drug Use in Japanese Companion Animal Clinics and the Factors Associated With Their Use.

The Japanese National Action Plan on Antimicrobial Resistance (AMR) was adopted to strengthen AMR surveillance and monitoring in companion animals. The Japanese Veterinary Antimicrobial Resistance Monitoring (JVARM) system monitors the sale of veterinary antimicrobial drugs by pharmaceutical companies, and the sale of human drugs by principal wholesale companies to companion animal (dogs and cats) clinics. However, the data do not include sales by local drug suppliers and personal importation to companion animal clinics in Japan. The purposes of this study were to estimate total antimicrobial drug use by companion animal clinics in Japan and to identify the factors associated with their use. In 2018, questionnaires gathering data on attributes of the clinic and volumes of antimicrobial drugs used were sent to 212 clinics across Japan by the Japan Veterinary Medical Association. Out of the clinics, 170 valid questionnaires were returned (80.2% response rate). Antimicrobial drugs were categorized first as human, veterinary, or imported drugs and then further categorized as important drugs (critically important drugs for humans and second-choice veterinary drugs) or others. Total antimicrobial drug use was estimated based on the number of clinics reported in 2016. The relationships between antimicrobial drug use and various questionnaire items were analyzed using non-parametric regression analysis. Total antimicrobial drug use was estimated at 29.9t, which was 2.1 times higher than reported by the JVARM survey on the sales of antimicrobial drugs. In terms of total use, important drugs and human drugs accounted for 12.6 and 61.8%, respectively. Clinic income per veterinarian was associated with total antimicrobial use per veterinarian. The proportion of important drugs among all antimicrobial drugs used in a clinic was high in recently established clinics with middle-aged and older directors.

Treatment strategy for pediatric giant mucinous cystadenoma: A case report.

Because of their rarity, the treatment strategy for pediatric ovarian epithelial tumors is controversial, especially for a giant cystadenoma. We report the largest mucinous cystadenoma (MCA) case in the pediatric literature thus far. A 12-year-old girl had abdominal distention and visited our hospital. She had a multilocular cyst with some protuberance on the inside and high values of CA 19-9 and CA-125. We diagnosed her with a left MCA and performed a left oophorectomy. The tumor was the stage IA borderline malignant MCA and weighed 11.8 kg. Five years have passed, the patient has not experienced recurrence or metastasis. The resection of giant tumors can affect respiration and circulation. However, pre- or intra-operative drainage may lead to dissemination and adhesion. When we treat pediatric giant ovarian epithelial tumors, we must understand the findings that suggest the possibility of malignancy to decide appropriately as to whether drainage should be performed.

Two cases of cytomegalovirus panuveitis in immunocompetent patients.

PURPOSE: To report two cases of panuveitis in immunocompetent patients in which cytomegalovirus was involved. OBSERVATION: Case 1 was a 46-year-old man who had a history of recurrent anterior chamber inflammations in his left eye. After Nd:YAG laser posterior capsulotomy, he developed panuveitis with vitreous haze and periphlebitis. Polymerase chain reaction (PCR) examination revealed the presence of cytomegalovirus (CMV) DNA in the anterior chamber (AC). He responded well to a series of intravitreal injections of ganciclovir (GCV). Case 2 was a 63-year-old woman who had a history of recurrent anterior uveitis in her left eye. Two years after cataract surgery, AC inflammation, diffuse vitreous haze, and periphlebitis had developed. CMV DNA was detected in the AC. Intravitreal injections of GCV and oral valganciclovir were administered, and ocular inflammation finally improved. CONCLUSIONS: and importance: We experienced two cases of CMV panuveitis in immunocompetent adults, both of which responded well to anti-viral therapies.

Origin of Boundary Populations in Medaka (Oryzias latipes Species Complex).

The Japanese wild population of the medaka fish (Oryzias latipes species complex) comprises two genetically distinct groups, the Northern and the Southern Populations, with boundary populations having a unique genotype. It is thought that the boundary populations have been formed through introgressive hybridization between the two groups, because they are fixed with the Northern alleles at two allozymic loci, with the Southern alleles at two other loci, and have a unique allele at one locus. In this study, we examined the genetic population structure of the boundary populations using genome-wide single nucleotide polymorphism (SNP) data. Most SNPs of the Toyooka population, a typical boundary population, were shared with the Northern Population, some were shared with the Southern Population, and the remaining SNPs were unique to this population, suggesting that the boundary populations originated and diverged from the Northern Population. Further analyses of different populations using SNPs at eight genomic loci indicated that the boundary populations at different locations share similar genomic constitutions, and can be genetically distinguished from typical Northern Populations by unique SNPs. In addition, the boundary populations in the Maruyama River Basin had Northern mitochondrial DNA (mtDNA), while others, from the Fukuda and Kishida River Basins and from the Kumihama Bay area, had Southern mtDNA. These findings suggested that the boundary populations originated from the Northern Population, and then their genomes diverged as a result of geographical isolation, followed by mtDNA introgression from the Southern Population that occurred independently in some populations.

Control of the development and prevalence of antimicrobial resistance in bacteria of food animal origin in Japan: a new approach for risk management of antimicrobial veterinary medicinal products in Japan.

Antimicrobial agents are essential for controlling bacterial disease in food-producing animals and contribute to the stable production of safe animal products. The use of antimicrobial agents in these animals affects the emergence and prevalence of antimicrobial resistance in bacteria isolated from animals and animal products. As disease-causing bacteria are often transferred from food-producing animals to humans, the food chain is considered a route of transmission for the resistant bacteria and/or resistance genes. The Food Safety Commission of Japan (FSC) has been assessing the risk posed to human health by the transmission of antimicrobial-resistant bacteria from livestock products via the food chain. In addition to the FSC's risk assessments, the Japanese Ministry of Agriculture, Forestry and Fisheries has developed risk-management guidelines to determine feasible risk-management options for the use of antimicrobial veterinary medicinal products during farming practices. This report includes information on risk assessment and novel approaches for risk management of antimicrobial veterinary medicinal products for mitigating the risk of development and prevalence of antimicrobial resistance in bacteria originating from food-producing animals in Japan.

The complete mitochondrial genome of Dugesia japonica (Platyhelminthes; order Tricladida).

We used two sequencing methods, namely long polymerase chain reaction (PCR) and primer walking, to determine the complete mitochondrial DNA (mtDNA) sequence of Dugesia japonica and most of the mtDNA sequence of Dugesia ryukyuensis. The genome of D. japonica contained 36 genes including 12 of the 13 protein-coding genes characteristic of metazoan mitochondrial genomes, two ribosomal RNA genes, and 22 transfer RNA genes. The genome of D. ryukyuensis contained 33 genes, including 12 protein-coding genes, two ribosomal RNA genes, and 19 transfer RNA genes. The gene order of the mitochondrial genome from the Dugesia species showed no clear homology with either the Neodermata or other free-living Rhabditophora. This indicates that the platyhelminths exhibit great variability in mitochondrial gene order. This is the first complete sequence analysis of the mitochondrial genome of a free-living member of Rhabditophora, which will facilitate further studies on the population genetics and genomic evolution of the Platyhelminthes.

[Fundamental study of three-dimensional coherent oscillatory state acquisition for the manipulation of image contrast: 3D-COSMIC in the spinal region].

Balanced sequence, three-dimensional fast imaging employ steady state acquisition (3D-FIESTA) as an example, was often used for colangiopancretography and aortagraphy in the chest and the aorta, and venography in the extremity and other body parts, because this had the high signal to noise ratio and the short acquisition time. 3D-coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC) developed recently is a sequence thought about based on 3D-FIESTA. We investigated the basic property of 3D-COSMIC compared with 3D-FIESTA in phantom and volunteer scan image study. At result, 3D-COSMIC was superior to 3D-FIESTA at signal to noise ratio and contrast on phantom image, contrast and visual evaluation on volunteer scan image of detection of tissue on spinal region. 3D-COSMIC was useful sequence in spinal region.

May-Thurner syndrome resulting in acute iliofemoral deep vein thrombosis during the second trimester of pregnancy.

Described is a 27-year-old pregnant woman with May-Thurner syndrome who experienced extensive pelvic and lower extremity thromboses during the antepartum period. The patient was referred for a symptomatic deep venous thrombosis at 23 weeks of gestation. Ultrasonography demonstrated a massive thrombus in the left iliofemoral vein. Heparin was given intravenously. Due to the possibility of pulmonary embolism during or immediately after delivery, a temporary inferior vena cava filter was inserted at 36 weeks of gestation. Labor was induced at 37 + 5 weeks of gestation; labor proceeded uneventfully and a male infant was born. Postpartum computed tomography (CT) demonstrated compression of the left common iliac vein by the right common iliac artery and lumbar vertebra. CT venogram demonstrated poor flow through the common iliac vein and well-developed collateral vessels. Critical stenosis at the origin of the left common iliac vein was consistent with a diagnosis of May-Thurner syndrome.

Optimal temperature range for low-temperature preservation of dissociated neonatal rat cardiomyocytes.

The increase in demand for primary cardiomyocytes necessitates advanced methods for their stable supply. In this study, we investigated the optimal temperature range for preserving dissociated cardiomyocytes for 72 h while maintaining their normal growth and beating functions. Neonatal rat cardiomyocytes dissociated by collagenase and suspended in the culture medium were preserved at temperatures from -2 to 35°C for 72 h. The cardiomyocytes preserved at temperatures below 20°C maintained the initial dispersed states, whereas they aggregated robustly at higher temperatures. The viability of the dispersed cells after preservation was more than 80%. After the preservation, the microscopic observations during the 7-days cultivation indicated that these dispersed cardiomyocytes grew normally to form a confluent monolayer, and beat spontaneously and regularly during culture, as did the fresh cells. These systematic evaluations indicated that the optimal temperature ranged from 3 to 20°C. Below this optimal temperature range, the cell activities decreased slightly with temperature. The robustly aggregated cardiomyocytes exhibited weak growth and low beating rates, although some cardiomyocytes still survived. The optimal conditions, which consist of a wider temperature range and longer preservation period than the present commercially used conditions, allowed milder temperature control and thus more economical transportation for the dissociated primary cardiomyocytes.

Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 edition.

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction in burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C has been prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' is weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan.

Successful management of pregnancy and delivery in a woman with multiple coronary stenoses of unknown cause.

We describe the case of a 30-year-old primiparous woman who had multiple coronary stenoses of unknown cause, and discuss causes and risks in pregnancy in a patient with coronary stenoses and the management and outcome. At 13 years of age, the patient was diagnosed as having multiple coronary stenoses and percutaneous transluminal coronary angioplasty was performed. At the age of 30, coronary arteriography demonstrated multiple severe stenoses. Her previous physician had permitted her to become pregnant. At 32 weeks' gestation, due to uncontrollable uterine contractions, magnesium sulfate was administered. At 37 weeks' gestation, a cesarean section was performed because of breech presentation, and she delivered a healthy female infant. During cesarean section, oxytocin was given at a slower rate. There has been no recurrence of cardiac events during and after pregnancy. Multiple coronary stenoses during pregnancy need a multidisciplinary approach.

Pheochromocytoma-related cardiomyopathy during the antepartum period in a preterm pregnant woman.

We report a rare case of pheochromocytoma-related cardiomyopathy during the preterm period. The patient was a 33-year-old woman who was referred to our hospital at 34 weeks' gestation. Her pulse was 130 beats/min, blood pressure of 186/90 mmHg and oxygen saturation was 30-40%. Fetal bradycardia prompted an emergency cesarean section and, nine minutes after admission, a boy weighing 2774 g was delivered with Apgar scores of 2 at 1 min and 5 at 5 min. A preoperative echocardiogram showed reduced fractional shortening of 19%. At 8 h after the operation, cardiac arrest developed. An intra-aortic balloon pump and percutaneous cardiopulmonary support were inserted, and continuous hemodiafiltration was also commenced, after which her cardiac function and respiratory function gradually improved. Urinary catecholamine levels were elevated and abdominal computerized tomography confirmed the presence of a right suprarenal mass. Four months after delivery, she underwent a laparoscopic adrenalectomy and the mass was found to be a pheochromocytoma.

Rhabdomyolysis caused by tocolytic therapy with oral ritodrine hydrochloride in a pregnant woman with placenta previa.

Oral-ritodrine-hydrochloride-induced rhabdomyolysis is rare. We report a case of oral-ritodrine-hydrochloride-induced rhabdomyolysis in a pregnant woman with placenta previa without neuromuscular disorders. The patient was a 30-year-old, Japanese primigravida woman, who became pregnant spontaneously. At 23 gestational weeks, she was diagnosed as having placenta previa and prophylactic oral ritodrine hydrochloride (15 mg/day) was initiated. At 29 1/7 gestational weeks, she was referred to our hospital for perinatal management of placenta previa. Two days thereafter, vaginal bleeding accompanied by frequent uterine contractions occurred and she was admitted. On admission, laboratory tests revealed an abnormal increase of blood creatine kinase (CK) value of 7200 IU/L. CK-MB isoenzyme was 208 IU/L. Aspartate transaminase (163 IU/L), alanine transaminase (74 IU/L) and lactate dehydrogenase (536 IU/L) levels were also increased. The patient started to complain of extreme muscle pain in her upper and lower limbs and general weakness. The next day, laboratory tests revealed a tremendous increase of blood CK level of 87,300 IU/L, a blood myoglobin level of 11,200 ng/mL, and a urinary myoglobin level of 615 ng/mL. An emergency cesarean section was carried out. After delivery, the laboratory data improved gradually with the CK levels at 107 IU/L. If patients complain of muscular symptoms following oral ritodrine hydrochloride use, physicians should consider rhabdomyolysis.

[Effect of continuous intravenous infusion of flurbiprofen axetil and tramadol hydrochloride for postoperative pain management of laparoscopic colectomy].

BACKGROUND: In this study, we evaluated the efficacy of continuous intravenous infusion of flurbiprofen axetil (FA) combined with tramadol hydrochloride (TH) for postoperative pain control after laparoscopic colectomy. METHODS: Fifty patients scheduled for laparoscopic colectomy were randomly assigned to one of the following three groups : the saline group which received saline, the FA alone group which received FA 4 mg kg-1 . 24hr-1, and the FA plus TH group which received FA 4 mg kg-1 . 24 hr-1 and TH 2 mg kg-1 . 24 hr-1 intravenously after bolus injection of FA 50 mg immediately before the end of the operation. We examined the pain scores at 4 and 24 hr, and postoperative analgesic medication use during 0-4, 4-24, and 24-48 hours. RESULTS: Although no significant difference was observed among pain scores for these three groups, the FA plus TH group required the lowest dose of analgesic medication. For lower abdominal incision, the FA plus TH group required the least analgesic medication in 4-48 hr. No significant difference concerning analgesic medication was observed among the three groups for upper abdominal incision. CONCLUSIONS: Continuous intravenous injection of FA plus TH is more effective than FA alone for postoperative pain management after laparoscopic colectomy.

[Changes in palmar skin blood flow, perfusion index and temperature during endoscopic thoracic sympathectomy].

BACKGROUND: In endoscopic thoracic sympathectomy (ETS), it is required to perform accurate cautery of the sympathetic trunk. Monitoring of palmar skin blood flow and temperature has been used to assess the efficacy of ETS. This study investigated whether Perfusion Index (PI) is useful in assessing palmar skin blood flow and temperature in ETS. METHODS: We studied 5 patients (1 man, 4 women) with palmar hyperhidrosis who had undergone a total of 10 ETS procedures. We measured skin blood flow, temperature and PI during ETS and evaluated the results. RESULTS: Significant correlations were found between increases in skin blood flow and PI after ETS in cases with the palmar skin temperature just before ETS of below 35 degrees C. CONCLUSIONS: In these cases, we can substitute increases in PI with increases in skin blood flow during ETS.

Simultaneous analysis of D- and L-serine in cerebrospinal fluid by use of HPLC.

BACKGROUND: D-Serine is a coagonist for the glycine-binding site of the N-methyl-D-aspartate receptors and has been implicated in various neuropsychiatric functions such as learning, memory, and nociception, as well as schizophrenia and Alzheimer disease. We developed an HPLC method for D- and L-serine in cerebrospinal fluid (CSF). METHODS: The dabsylated racemic serine peak, automatically collected using a previously reported HPLC separation process for CSF amino acids, was desalted and subjected to a chiral resolution HPLC step with a Sumichiral column using an ultraviolet-visible detector. RESULTS: The limits of quantification (signal-to-noise ratio = 10) for D- and L-serine were 0.8 and 1.3 micromol/L, respectively. The mean imprecision values (CVs) for within-day measurements of D- and L-serine were 2.1% and 1.8%, respectively, and for between-day were 6.2% and 6.6%. Mean recovery of CSF serine (sum of D-serine + L-serine) applied to the Sumichiral column was 87%. The mean (SD) d-serine concentrations in 45 CSF samples obtained from 16 patients with chronic pain due to degenerative osteoarthritis of the knees, 16 with postherpetic neuralgia, and 13 with no pain were, respectively, 3.97 (0.44), 1.85 (0.21), and 2.72 (0.32) micromol/L. CONCLUSION: D- and L-serine can be quantified with ultraviolet-visible detection of dabsyl derivatives. The dabsyl derivatives are stable and allow duplicate analysis of CSF samples in multisample runs.

Extracellular matrix dermatopontin modulates prostate cell growth in vivo.

Dermatopontin is a tyrosine-rich acidic extracellular matrix protein of 22 kDa with possible functions in cell-matrix interactions and matrix assembly. We have previously isolated mRNAs expressed in hormone-refractory, but not in hormone-sensitive, mouse mammary cancer by comparing the mRNAs expressed in either tumor. A partial mRNA sequence isolated was later proven to be a part of mouse dermatopontin mRNA sequence. Transfectants of mouse dermatopontin cDNA into PC-3 human prostate cancer cells enhanced tumor growth when those were implanted subcutaneously in nude mice compared with the controls. Those transfectants showed a prominent stroma compared with the controls. Localization of the targets of a fusion protein of mouse dermatopontin and alkaline phosphatase was in the stroma of the PC-3 tumor tissues, but not in the tumor cells themselves. Additionally, we have established mouse dermatopontin transgenic mice under the control of the rat probasin promoter. The prostatic dorsal lobes of dermatopontin transgenic mouse showed prostate intra-epithelial neoplasia at the age of 11 months, but the control littermates did not. Epithelium of other prostatic lobes was not markedly different from that of the controls. In conclusion, dermatopontin may be involved in the pathogenesis and growth of the prostate cancer.