The weight of computer mouse affects the wrist motion and forearm muscle activity during fast operation speed task.

The frequent use of the computer mouse was reported to be associated with the development of the musculoskeletal disorders in the wrist, forearm, and shoulder regions. This study was to examine the effect of the mouse weights and operation speeds on the wrist motion and muscle activity. 25 subjects (20 males and 5 females) were instructed to repetitively point-and-click the mouse between two targets displaced in the monitor with five different weighted mice (weights around 70, 100, 130, 160, and 190 g) at the fast (50 repetition/min) and slow (25 repetition/min) operation speeds. Surface electromyographic activity of the extensor carpi radialis, extensor carpi ulnaris, extensor digitorum, and upper trapezius muscles were recorded, and the electrogoniometer was used to register the wrist motions. The results showed that the maximal ulnar deviation was not significantly different among the examined conditions. The wrist movement range and the forearm muscle activities showed a V-shape tendency with the lowest value in the mouse weight of 130 g. This tendency was diminished during the slow speed tasks. The results suggested that the proper mouse weight could benefit the users in terms of increasing the movement efficiency and decreasing the muscular costs.

Leishmania infection and blood sources analysis in Phlebotomus chinensis (Diptera: Psychodidae) along extension region of the loess plateau, China.

BACKGROUND: Visceral leishmaniasis (VL) was one of the most important parasitic diseases in China, caused by Leishmania protozoans and transmitted by sand flies. Recently VL cases have reappeared in China, including the extension region of the Loess Plateau. The purpose of this study was to collect fundamental data on the host-vector VL system in the Loess Plateau to assist in the development of prevention and control measures. METHODS: Sand flies were collected by light traps from rural areas in Shanxian, Henan, China in 2015, as well as in Wuxiang and Yangquan, Shanxi, China in 2017. The blood sources of sand flies were analyzed by PCR detecting the host-specific mitochondrial cytochrome b (mtDNA cyt b) gene fragments. Leishmania infection in sand flies was detected by amplifying and sequencing ribosomal DNA internal transcribed spacer 1 (ITS1). The Leishmania specific antibodies in the sera of local dogs were detected by ELISA kit. RESULTS: Blood sources showed diversity in the extension region of the Loess Plateau, including human, chicken, dog, cattle, pig and goat. Multiple blood sources within a sand fly were observed in samples from Yangquan (17/118, 14.4%) and Wuxiang (12/108, 11.1%). Leishmania DNA was detected in sand flies collected from Yangquan with minimum infection rate of 1.00%. The ITS1 sequences were conserved with the Leishmania donovani complex. The positive rate of Leishmania specific antibodies in dogs was 5.97%. CONCLUSIONS: This study detected the blood sources and Leishmania parasites infection of sand flies by molecular methods in the extension region of Loess Plateau, China. A high epidemic risk of leishmaniasis is currently indicated by the results as the infection of Leishmania in sand flies, the extensive blood sources of sand flies including humans, and positive antibody of Leishmania in local dog sera. Given the recent increase of VL cases, asymptomatic patients, dogs and other potential infected animals should be screened and treated. Furthermore, the density of sand flies needs to be controlled and personal protection should be strengthened.

Phylogeny of certain members of Hyrcanus group (Diptera: Culicidae) in China based on mitochondrial genome fragments.

BACKGROUND: Species of the Anopheles hyrcanus group are widely distributed in Palearctic and Oriental regions and some of them are important malaria vectors. The cryptic species of An. hyrcanus group was almost impossible to identify based only on their morphology. The phylogenetic relationship of An. hyrcanus group was also not clear. METHODS: Five members of An. hyrcanus group were identified by rDNA ITS2 sequencing as An. yatsushiroensis, An. belenrae, An. kleini, An. lesteri and An. sineroides. The mitochondrial genome fragments were sequenced and annotated using the mitochondrial genome of An. sinensis as reference. Based on the four segments and Joint Data sequences of these species, and other four anopheline species downloaded from GenBank, intraspecific as well as interspecific genetic distances were calculated and the phylogenetic trees were reconstructed by the methods of neighbor joining, maximum parsimony, minimum evolution and maximum likelihood. FINDINGS: Four parts of mitochondrial genomes, which were partial fragments COI + tRNA + COII (F5), ATP6 + COIII(F7 + F8), ND1(F19) and lrRNA (F21), were obtained. All fragments were connected as one sequence (referred as Joint Data), which had a total length of 3393 bp. All fragment sequences were highly conservative within species, with the maximum p distance (0.026) calculated by F19 of An. belenrae. The pairwise interspecific p distance calculated by each fragment showed minor or even no difference among An. sinensis, An. kleini and An. belenrae. However, interspecific p distances calculated by the Joint Data sequence ranged from 0.004 (An. belenrae vs An. kleini) to 0.089 (An. sineroides vs An. minimus), and the p distances of the six members of An. hyrcanus group were all less than 0.029. The phylogenetic tree showed two major clades: all subgenus Anopheles species (including six members of An. hyrcanus group, An. atroparvus and An. quadrimaculatus A) and subgenus Cellia (including An. dirus and An. minimus). The An. hyrcanus group was divided into two clusters as ((An. lesteri, An. sineroides) An. yatsushiroensis) and ((An. belenrae, An. sinensis) An. kleini)). CONCLUSIONS: The An. hyrcanus group in this study could be divided into two clusters, in one of which An. belenrae, An. sinensis and An. kleini were most closely related. More molecular markers would make greater contribution to phylogenetic analysis.

PIK3CA exon 20 mutation is independently associated with a poor prognosis in breast cancer patients.

BACKGROUND: Prognostic factors that could select breast cancer patients with poor survival, and influence clinical trials of targeted therapy, are needed. However, the reported observations regarding the impact of PI3KCA mutation on breast cancers are controversial. METHODS: We analyzed exons 4, 7, 9, and 20 of PI3KCA on a series of 158 patients. Clinicopathological characteristics were correlated with the mutation data. RESULTS: Among 152 patients who were available for follow-up (median follow-up time, 6.57 years), 26% had PIK3CA mutations, more than half of which occurred in exon 20. The five-year survival rate of patients with exon 20 mutations (46%) was significantly lower than that of patients without (75%) (p = 0.0054). Multivariate analysis showed that PIK3CA exon 20 mutations and nodal involvement were independent risk factors for overall survival. The relative risk of death in patients with PIK3CA exon 20 mutations was 2.881 (95% CI, 1.406-5.900; p = 0.0038). CONCLUSIONS: PIK3CA mutations are common in invasive ductal carcinomas of the breast. Our result suggests that PIK3CA exon 20 mutation is an independent risk factor for poor prognosis in breast cancer patients, indicating that differences in patient numbers with PIK3CA exon 20 mutations in study and control arms should be avoided in clinical trials of PI3K inhibitors.

Clinicopathologic features and predictors for survival of mucinous and non-mucinous appendiceal adenocarcinoma.

BACKGROUND/AIMS: We report a study in patients with mucinous and non-mucinous appendiceal adenocarcinoma treated surgically whose records were examined to elucidate their clinicopathologic features and prognostic factors for survival. METHODS: The medical records of 34 patients with mucinous and non-mucinous appendiceal adenocarcinoma (1991-2005) were retrospectively reviewed. RESULTS: There was no significant difference between mucinous and non-mucinous tumors in patient demographics, clinicopathologic features, type of operation and outcome. Non-mucinous tumors had a higher incidence of leukocytosis than mucinous ones. The overall 5-year survival rate for 34 patients with appendiceal adenocarcinoma was 35.8%. In the univariate analysis, predictors of survival were the type of operation, resectability, carcinomatosis and tumor stage. Tumor stage significantly influenced patient survival in the multivariate analysis. CONCLUSION: Mucinous appendiceal adenocarcinoma had clinicopathologic characteristics and a prognosis similar to non-mucinous, except that there was more leukocytosis in non-mucinous tumors. Tumor stage is an independent predictor for survival among patients with appendiceal adenocarcinoma.

Clinicopathologic features and outcomes following surgery for pancreatic adenosquamous carcinoma.

BACKGROUND: Pancreatic adenosquamous carcinoma (ASC) is a rare pancreatic malignancy subtype. We investigated the clinicopathological features and outcome of pancreatic ASC patients after surgery. METHODS: The medical records of 12 patients with pancreatic ASC undergoing surgical treatment (1993 to 2006) were retrospectively reviewed. Survival data of patients with stage IIB pancreatic adenocarcinoma and ASC undergoing surgical resection were compared. RESULTS: Symptoms included abdominal pain (91.7%), body weight loss (83.3%), anorexia (41.7%) and jaundice (25.0%). Tumors were located at pancreatic head in 5 (41.7%) patients, tail in 5 (41.7%), and body in 4 (33.3%). Median tumor size was 6.3 cm. Surgical resection was performed on 7 patients, bypass surgery on 3, and exploratory laparotomy with biopsy on 2. No surgical mortality was identified. Seven (58.3%) and 11 (91.7%) patients died within 6 and 12 months of operation, respectively. Median survival of 12 patients was 4.41 months. Seven patients receiving surgical resection had median survival of 6.51 months. Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma. CONCLUSION: Aggressive surgical management does not appear effective in treating pancreatic ASC patients. Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

Correlation between adult pyrethroid resistance and knockdown resistance (kdr) mutations in Aedes albopictus (Diptera: Culicidae) field populations in China.

BACKGROUND: Arboviral disease transmitted by Aedes albopictus such as dengue fever is an important threat to human health. Pyrethroid resistance raises a great challenge for mosquito control. A systematic assessment of Ae. albopictus resistance status in China is urgently needed, and the study of correlation between pyrethroid resistance and knockdown resistance (kdr) mutations would provide information to guide the control of the Ae. albopictus vector. METHODS: Five field populations of Ae. albopictus were collected from Jinan (JN), Hangzhou (HZ), Baoshan (BS), Yangpu (YP) and Haikou (HK), China in 2017. Insecticide-impregnated papers were prepared with four pyrethroid chemicals, deltamethrin, permethrin, beta-cypermethrin and lambda-cyhalothrin. The susceptibility of Ae. albopictus to pyrethroids was tested by the WHO tube assay. Kdr mutations were identified by PCR and sequencing. Moreover, the correlation analysis between kdr alleles and pyrethroid resistance was performed. RESULTS: All five populations of Ae. albopictus showed resistance to four pyrethroid insecticides. One kdr mutant allele at codon 1532 and three at 1534 were detected with frequency of 5.33% (I1532T), 44.20% (F1534S), 1.83% (F1534 L) and 0.87% (F1534C), respectively. Both 1532 and 1534 mutation mosquitoes were found in the BS and YP populations. Allele I1532T was negatively correlated with deltamethrin resistance phenotype (OR < 1), while F1534S mutation was positively correlated with deltamethrin and permethrin resistance (OR > 1). CONCLUSIONS: The five field populations of Ae. albopictus adults were all resistant to deltamethrin, permethrin, beta-cypermethrin and lambda-cyhalothrin. Mutant F1534S was clearly associated with pyrethroid resistance phenotype in Ae. albopictus and this could be developed as a molecular marker to monitor the pyrethroid resistance problem in China.

The effect on forearm and shoulder muscle activity in using different slanted computer mice.

BACKGROUND: Frequently using non-slanted computer mice will cause musculoskeletal discomfort and symptoms in forearms and shoulders. Ergonomic mice with different slanted angles may have various effects on forearm and shoulder muscle activity. METHODS: All of the twelve subjects performed the same text-editing task with the five different slanted mice. The muscle activity of extensor carpi ulnaris, extensor digitorum, pronator teres and upper trapezius muscles was recorded by surface electromyography and analyzed by a non-parametric method. FINDINGS: As the slanted angles increased, the surface electromyography levels in terms of extensor carpi ulnaris, pronator teres and upper trapezius muscles decreased. However, increasing the slanted angles resulted in larger wrist extension and higher muscle activity in terms of the extensor digitorum muscle. INTERPRETATION: Working with mice which have suitable slanted angles provides users more neutral hand positions, so forearm and shoulder muscle activity and the risk of musculoskeletal disorders will reduce.

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis.

BACKGROUND: A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH) in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. METHODS: The medical records of 9 patients (8 males and 1 female; age range, 28-71 years; median, 36 years) with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78%) was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7), computed tomographic (4/7), ultrasound (2/5), and surgical (2/2) findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4-87 months). RESULTS: Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%). Angiography determined correct diagnosis in 7 patients (7/7, 100%). The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4) or elective (n = 3) surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5) and 89% (8/9). Five patients developed pseudocysts before treatment (n = 3) or following intervention (n = 2). Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality rate was 11% (1/9). Surgery-related mortality was 0%. CONCLUSION: Angiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.

Combined resection and multi-agent adjuvant chemotherapy for desmoplastic small round cell tumor arising in the abdominal cavity: report of a case.

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive malignancy with distinctive histological features: a nesting pattern of cellular growth within dense desmoplastic stroma, occurring in young population with male predominance. The mean survival period is only about 1.5-2.5 years. The tumor has co-expressed epithelial, muscle, and neural markers in immunohistochemical studies. This work reports a 27-year-old man presenting with hematemesis and chronic constipation. Serial studies including endoscopy, upper gastrointestinal series, abdominal computed tomography and barium enema study showed disseminated involvement of visceral organs. The patient underwent aggressive surgery and received postoperative adjuvant chemotherapy consisting of 5-fluorouracil, cyclophosphamide, etoposide, doxorubicin, and cisplatin. He survived without any disease for 20 mo after the surgery. No standard treatment protocol has been established. Aggressive surgery combined with postoperative multi-agent adjuvant chemotherapy is justified not only to relieve symptoms but also to try to improve the outcome in this advanced DSRCT young patient.

Effects of dopexamine on regional blood flow and leukotriene production in multiple splanchnic sites in endotoxemic rats.

BACKGROUND/AIMS: This work examines the effects of lipopolysaccharide (LPS) on splanchnic blood flow and tests the potential effect of dopexamine in preventing LPS-induced decrease in splanchnic blood flow, also analyzing its influence on regional leukotriene production. METHODOLOGY: Male Sprague-Dawley rats were grouped and subjected to i.v. administration (time 0) of the lipopolysaccharide (10mg/kg) or vehicles with some rats receiving dopexamine (2microg/kg/min) (times 2 hrs to 6 hrs) infusion and compared. Microdialysis collection for analyzing leukotrienes concentrations and direct splanchnic laser Doppler flowmetry were started at times 0 to 6 hrs. RESULTS: Mean arterial pressure decreased markedly in LPS-injected animals and it decreased further gradually during observation period. A marked increase in mean arterial pressure was noted following concomitant administration of dopexamine with LPS. CONCLUSIONS: Impaired splanchnic blood flow in the stomach, jejunum and ileum after LPS injection has been attenuated following infusion of dopexamine. The changes in regional blood flow in the specific splanchnic area correlate closely with the systemic mean arterial pressure in this early sepsis model. Increased leukotriene production following LPS injection also has been attenuated in the stomach, jejunum and ileum following dopexamine infusion, and the increase of leukotriene production also correlates closely with systemic mean arterial pressure.

Actinomycosis mimicking recurrent carcinoma after Whipple's operation.

Actinomycosis is a rare, chronic, spreading, suppurative, granulomatous and fibrosing infection. Actinomyces are normal inhabitants of the oral cavity and gastrointestinal tract. They rarely cause disease and are seldom reported as pathogens. Herein, we reported on a 69-year-old male patient who had undergone Whipple's operation due to ampulla Vater carcinoma, and became infected with actinomycosis at the pancreaticojejunostomy, which mimicked a recurrent malignancy. He was treated with radical resection of the mass at the pancreaticojejunostomy and had an uneventful postoperative course.

Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding.

Primary splenic angiosarcoma is a very rare, aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

Outcome of pancreaticoduodenectomy for chronic pancreatitis.

BACKGROUND AND PURPOSE: Some patients with chronic pancreatitis may require surgery, mainly because of disabling medically intractable pain, suspicion of malignancy or complications related to chronic pancreatitis. This study analyzed the efficacy of pancreaticoduodenectomy (PD) for patients with chronic pancreatitis in terms of pain relief, control of local complications and pancreatic endocrine/exocrine function. METHODS: This retrospective analysis included 24 consecutive patients with chronic pancreatitis who received PD from April 1995 to March 2003. There were 21 men and 3 women. The age of the patients ranged from 21 years to 73 years, with a mean age of 44 years. Alcohol abuse, found in 14 patients (58.3%), was the most common predisposing factor. Local complications included stenosis of the pancreatic duct in 15 patients, biliary obstruction in 9, duodenal obstruction in 4 and left-sided portal hypertension in 1. The surgical indications were recurrent intractable pain (n=16), local complications (n=18), and suspicion of malignancy (n=6). Endocrine pancreatic function was assessed by the need to treat diabetes mellitus with dietary modification, oral hypoglycemic agents or insulin. Pancreatic exocrine function was assessed based on clinical symptoms. Pain severity was evaluated using a scoring system based on the use of analgesic medication. The mean duration of follow-up in 22 of 24 patients was 31 months, with a range of 4 to 90 months. RESULTS: Preoperatively, pancreatic exocrine insufficiency was detected in 3 patients (3/24, 12.5%), exocrine insufficiency in 5 (5/24, 20.8%) and intractable abdominal pain requiring morphine injection in 16 (16/24, 66.7%). After PD, 4 patients had 5 complications, resulting in a morbidity rate of 17% and a mortality rate of 4%. Postoperative diabetes mellitus developed de novo in 3 patients (3/20, 15%) and postoperative pancreatic exocrine insufficiency was detected in 14 patients (14/22, 63.6%). Complete pain relief after surgery was noted in 12 patients (12/14, 85.7%). CONCLUSIONS: In selected patients with chronic pancreatitis, PD is a safe procedure and can effectively relieve pain and control local complications. Deterioration of pancreatic endocrine function after PD was mainly related to disease progression. Pancreatic resection plays an important role in progressing pancreatic exocrine function.

Role of prostacyclin on microcirculation in endotoxin-induced gastroprotection in rats: a microdialysis study.

Numerous mechanisms relating to lipopolysaccharide- (LPS) induced gastroprotection have been proposed. The prostaglandin (PG) system is a promising candidate that has received considerable attention. However, the role of prostacyclin (PGI2) remains unclear. Adult, male Sprague-Dawley rats were divided into four groups: (1) control, n = 6; (2) LPS (LPS, 10 mg/kg, i.v.), n = 7; (3) LPS + indomethacin (Indo) (LPS, 10 mg/kg and indomethacin 5 mg/kg, i.v.), n = 7; and (4) Indo (indomethacin 5 mg/kg, i.v.), n = 7. Additionally, gastric microcirculation was investigated using in vivo microscopy. Tissue malondialdehyde (MDA) and glutathione levels were measured at the conclusion of the experiment. Specifically, microdialysis was used to measure the 6-keto-PGF1alpha, a stable metabolite of PGI2, while flow cytometry was used to measure the CD11b/CD18 expression of circulating neutrophils. Compared with LPS alone, LPS with Indo significantly impaired gastric microcirculation and systemic hemodynamics. LPS-induced gastroprotection was lost, as evidenced by the increased adherent leukocyte count, decreased flow velocity in the post-capillary venules, and increased tissue MDA production. Meanwhile, the luminal glucose and protein contents that comprised the gastric mucosa injury index were significantly increased. These effects of Indo are directly associated with the levels of PGI2 in gastric tissue, which increased with LPS alone and significantly decreased with a combination of LPS and Indo. This work demonstrates that PGI2 contributes to LPS-induced gastroprotection.

Ductal adenocarcinoma of the pancreas with huge cystic degeneration: a lesion to be distinguished from pseudocyst and mucinous cystadenocarcinoma.

Cystic neoplasms of the pancreas are rare and often mistaken for pseudocyst by imaging studies and macroscopic examination. We describe an unusual tumor of the pancreas composed of a mural nodule of anaplastic carcinoma arising from a huge ductal adenocarcinoma undergoing cystic degeneration. The cyst measured 27 x 13 x 4 cm. Light microscopy showed that the cyst was partly lined by a single layer of cuboidal to columnar tumor cells with focal mucin production and was surrounded by hyalinized connective tissue. Most lining epithelial cells were absent owing to extensive degenerative process. Immunohistochemical studies showed positive staining of cytokeratin and vimentin for pleomorphic giant tumor cells, which were negative for leukocyte common antigen (CD45), KP-1 (CD68), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA). The ductal adenocarcinoma stained strongly positive for cytokeratin and EMA, and negative for vimentin, CD45, CD68, and CEA. The clinical course of the current case was extremely poor and the prognosis resembled that of an anaplastic carcinoma. Therefore, we like to emphasize the importance of complete excision and extensive sampling of any cystic neoplasms in the pancreas including those with large cystic component to avoid missing the malignant elements.

Malignancy in choledochal cysts.

BACKGROUND/AIMS: Malignancy in choledochal cysts is a rare condition. This study presents our experience with this condition, with emphasis on the clinical presentation, management and outcome. METHODOLOGY: Subjects included 80 adults with choledochal cysts treated from January 1979 to December 1995. Of these patients, eight were found to have malignancy in the cyst and formed the basis of this study. RESULTS: Four patients had synchronous and four had metachronous carcinoma lesions arising in the choledochal cyst. The clinical presentations were: biliary tract infection in 5 patients, gastric outlet obstruction in two and right upper quadrant pain and body weight loss in one. Operations for bile duct malignancy included total excision in two patients, choledochotomy with T-tube drainage in two patients, gastrojejunostomy in two patients, percutaneous transhepatic biliary drainage and gastrojejunostomy in one patient and metastatic lymph node biopsy only in one. One patient died due to septic shock within 30 days of operation (operative mortality). Postoperative survival time ranged from 4 to 9 months with a mean of 6.2 months. One of these patients was still alive at the time of writing (7 months). CONCLUSIONS: The frequency of malignancy in the choledochal cysts was 10% in our series. Malignancy in the choledochal cyst should be highly suspected in patients with cholangitis symptoms, body weight loss and anemia. Prognosis in this disease entity is poor.

Pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head: preoperative and postoperative functional assessment.

BACKGROUND/AIMS: In chronic pancreatitis patients with an inflammatory mass of the pancreatic head receiving pancreatoduodenectomy, postoperative quality of life, including nutritional status, has become important. Pre- and postoperative evaluation of pancreatic function is essential as an effective means of proper nutritional management of patients following pancreatoduodenectomy. METHODOLOGY: Fifteen patients with chronic pancreatitis and inflammatory mass of the pancreatic head who had received standard pancreatoduodenectomy were enrolled in this investigation. All patients had their biliary and pancreatic ducts reconstructed according to Child's arrangement. Furthermore, all patients had smooth postoperative courses and were assessed for the pancreatojejunostomy by magnetic resonance cholangiopancreatography at least a month after the initial operation. Exocrine pancreas functions were clinically assessed with various clinical items and two indirect pancreatic function tests: the fecal elastase test and the Bentiromide test. Endocrine pancreas functions were assessed using serum C-peptide level, HbA1 level and the need for hypoglycemic therapy. RESULTS: The results indicated that the pancreatojejunostomies of all patients are patent magnetic resonance cholangiopancreatography. All patients benefited from the selected symptom relief and various clinical parameters, including medications, dietary restrictions, body mass index and plasma albumin levels, experiencing pain relief and improved exocrine and endocrine functions. CONCLUSIONS: Pancreatic function did not deteriorate after pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head, while quality of life was significantly improved.

Peritoneal implanted hepatocellular carcinoma with rupture after TACE presented as acute appendicitis.

We are reporting a rare case of peritoneal implanted hepatocellular carcinoma with rupture after transarterial chemoembolization mimicking acute appendicitis. A 45-year-old male patient presented with fever and manifestations of acute appendicitis. He received transarterial chemoembolization for hepatocellular carcinoma two months before. Emergent exploratory laparotomy revealed a normal appendix, a ruptured nodule located at the serosal surface of the terminal ileum with hemoperitoneum, and ruptured hepatocellular carcinoma at the junction of segments 4 and 8 of the liver. There was no peritoneal carcinomatosis, direct invasion to the surrounding tissue, or lymph node involvement. Postoperative course was uneventful. Histopathological examination of the resected nodule revealed metastatic hepatocellular carcinoma.

Results of treating severe acute pancreatitis with gabexate is associated with neutrophil apoptosis activity.

BACKGROUND/AIMS: A delay in polymorphonuclear neutrophil apoptosis has been implicated in the pathogenesis of systemic inflammatory reactions in certain conditions. Gabexate mesilate has been proven effective in the treatment of severe acute pancreatitis with organ dysfunction. In this study, we attempted to answer the questions of whether neutrophil apoptosis is associated with the conditions of various major organs in patients with severe acute pancreatitis and receiving gabexate. METHODOLOGY: A total of 45 patients were included in this study. We divide the patients into two groups. Group A included patients with > or = 2 complications after one-week treatment (n = 31), and Group B included patients with < 2 complications after one-week treatment (n = 14). Serum interleukin-6 and interleukin-8 was detected at day 1, 3, and 7 of treatment using enzyme-linked immunosorbent assay kits. The neutrophil CD18 expression and apoptosis activity were evaluated flowcytometrically at day 1, 3, and 7 of treatment. RESULTS: At day 7 of treatment, interleukin-6 levels were significantly higher in Group B while interleukin-8 levels were not different. The neutrophil CD18 expression was significantly higher and delayed ex vivo apoptosis was significantly lower in the group B than that of group A at day 7 of treatment. CONCLUSIONS: In patients of severe acute pancreatitis with organ dysfunction and receiving gabexate treatment, neutrophil apoptosis is associated with the severity of organ dysfunction.