Avoiding an overdiagnosis of pancreatic pseudocysts.

BACKGROUND/AIMS: Thirty-six cases of pancreatic pseudocysts were retrospectively analyzed, to evaluate the clinical features of the pseudocysts which could not be differentiated from the neoplastic cysts until laparotomy. METHODOLOGY: Thirty-one out of 36 cases were diagnosed correctly to be a pseudocyst, in which 10 cases (32.3%) were treated by surgery. Five out of 36 cases were diagnosed to be neoplastic pancreatic cysts (mucinous cystadenoma or cystadenocarcinoma in 4 cases, serous cystadenoma in 1) in which all cases were treated by surgery (100%). To determine the clinical factors contributing to a correct or false diagnosis of pseudocysts, 14 clinical objects were categorized into several factors and analyzed using a contingency table. RESULTS: The clinical factors, including a "history of pancreatitis" (P = 0.070), "upper abdominal pain" (P = 0.083), an "age of less than 42 years" (P = 0.070), and an "elevated serum amylase level on admission" (> or = 200 IU/L, P = 0.067) were all thought to be helpful in establishing a correct diagnosis of pancreatic pseudocyst. In the morphological studies of computed tomography and ultrasonography, "multicystic lesions" (P = 0.045) and "nodular or irregular thickening of the cyst wall" (P = 0.006) significantly mislead us into making a diagnosis of a neoplastic cyst. CONCLUSIONS: In conclusion, the morphological features of a multicystic pattern, with either nodular or irregular thickening of the cyst wall, also belong to the common features of the pancreatic pseudocysts. Since these features tended to be diagnosed as neoplastic, other clinical factors should thus be referred to, in a comprehensive manner, to establish a correct diagnosis of pancreatic pseudocyst.

Surgical treatment of a sigmoid volvulus associated with megacolon: report of a case.

Sigmoid volvulus occurring concomitantly with megacolon is an uncommon cause of bowel obstruction, and various approaches to treatment have been proposed. We report herein a case of sigmoid volvulus with megacolon that was successfully treated by elective surgery following endoscopic reduction during the same hospital stay. A 70-year-old woman was admitted to our hospital with abdominal pain, distension, and severe constipation. Physical examination, plain abdominal X-ray, and barium enema confirmed a sigmoid volvulus and further examinations revealed concomitant megacolon. An elective sigmoid colectomy was performed following successful endoscopic decompression. The postoperative course was uneventful and there was no residual colonic dysmotility. Histologically, no aganglionic tissue was observed in the resected specimen.

Evidence for unconventional strong-coupling superconductivity in PrOs4Sb12: an Sb nuclear quadrupole resonance study.

We report Sb-NQR results which evidence a heavy-fermion (HF) behavior and an unconventional superconducting (SC) property in Pr(Os4Sb12 with T(c)=1.85 K. The temperature (T) dependence of nuclear-spin-lattice-relaxation rate, 1/T(1), and NQR frequency unravel a low-lying crystal-electric-field splitting below T0 approximately 10 K, associated with Pr3+(4f(2))-derived ground state. In the SC state, 1/T(1) shows neither a coherence peak just below T(c) K nor a T3-like power-law behavior observed for anisotropic HF superconductors with the line-node gap. The isotropic energy gap with its size Delta/k(B)=4.8 K seems to open up across T(c) below T(*) approximately 2.3 K. It is surprising that Pr(Os4Sb12 looks like an isotropic HF superconductor-it may indeed argue for Cooper pairing via quadrupolar fluctuations.

Evidence for a novel state of superconductivity in noncentrosymmetric CePt3Si: a 195Pt-NMR study.

We report on novel antiferromagnetic (AFM) and superconducting (SC) properties of noncentrosymmetric CePt3Si through measurements of the 195Pt nuclear spin-lattice relaxation rate 1/T(1). In the normal state, the temperature (T) dependence of 1/T(1) unraveled the existence of low-lying levels in crystal-electric-field multiplets and the formation of a heavy-fermion (HF) state. The coexistence of AFM and SC phases that emerge at T(N)=2.2 K and T(c)=0.75 K, respectively, takes place on a microscopic level. CePt3Si is the first HF superconductor that reveals a peak in 1/T(1) just below T(c) and, additionally, does not follow the T3 law that used to be reported for most unconventional HF superconductors. We remark that this unexpected SC characteristic may be related to the lack of an inversion center in its crystal structure.