Dilated main pancreatic duct can be a negative predictor of pancreatitis related to biliary SEMS insertion across the papilla.

OBJECTIVES: Post-ERCP pancreatitis (PEP) after self-expandable metallic stent (SEMS) insertion across the papilla of Vater is an important adverse event that affects the patient's quality of life (QOL). We examined the predictive factors of PEP after SEMS insertion to treat obstructive jaundice due to malignancy. METHODS: Ninety patients who underwent biliary SEMS insertion for biliary obstruction due to malignancy at Iwata City Hospital between 2010 and 2018 were reviewed. We evaluated the relationship between the incidence of PEP after biliary SEMS insertion and clinical factors. We measured the thickness of the pancreatic parenchyma and diameter of the main pancreatic duct (MPD) at the left side of the corpus vertebrae. RESULTS: Mild and severe PEP were diagnosed in 10 (11.1%) and 1 (1.1%) patients, respectively. Only the thickness of the pancreatic parenchyma and diameter of MPD significantly differed between the PEP and non-PEP groups. The incidence of PEP among patients whose thickness of the pancreatic parenchyma at the left side of the corpus vertebrae was less than 9.5 mm (0%) on computed tomography was lower than that in patients whose thickness was 9.5 mm or greater (34.4%). Similarly, a wider (5 mm or more) diameter of MPD (4.3%) reduced the incidence of PEP compared with a narrower diameter (40.0%). Logistic regression analysis revealed that the probability of PEP decreases 3.91 times for every 1-mm increase in MPD diameter (95% CI 1.23-12.4, p = .02). CONCLUSION: Based on our study, a dilated MPD is a negative predictive factor of pancreatitis related to biliary SEMS insertion.

[Schistosomiasis japonica in a patient who emigrated from China: a case report].

A 37-year-old woman exhibited abnormal liver enzyme levels without any symptoms at a medical check-up. She was born and raised in Hubei, China, and had immigrated to Japan in her mid-thirties. Ultrasonography revealed an enlarged caudate lobe of the liver and a wide moniliform portal vein, whereas computed tomography revealed lined calcification on the surface of the liver and on the collateral vein of the portal vein. Although imaging studies provided no critical findings, the crucial information that led to diagnosis was gained through the interview with the patient. Schistosomiasis japonica was known to be prevalent in her hometown, and she reported that her father's past infection was due to Schistosoma japonicum. Serological analysis demonstrated high levels of anti-S. japonicum antibodies, which were reduced using praziquantel administration.

Acid suppressive therapy improved symptoms due to circumferential cervical inlet patch with proton pumps (H+/K+-ATPase).

Cervical inlet patch (CIP), also referred to as esophageal heterotopic gastric mucosa, is regarded as the residue of columnar epithelium of the embryonic esophagus. Narrow band imaging increases the detection rate of CIP. Herein, we present a 55-year-old man with symptomatic circumferential inlet patch. He exhibited globus and dysphagia, and esophagogastroduodenoscopy found cir-cumferential CIP, where im-munohistochemistry revealed the existence of pro-ton pumps (H+, K+-ATPase). His throat symptoms were relieved by acid suppressive therapy with pump inhibitors. This case indicated that CIP should be considered as a differential diagnosis for the cause of globus symptoms in rare cases.

Pancreatic schwannoma revealed contrast by contrast-enhanced ultrasonography: a case report.

An asymptomatic pancreatic tumor was discovered in a 77-year-old man during a medical check-up. An abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a cystic mass containing a septum-like solid portion in the head of the pancreas, measuring 3.5cm in diameter. Additionally, abdominal contrast-enhanced ultrasonography (US) revealed increased flow in the solid portion and a tumor capsule in its early phase. We preoperatively diagnosed the lesion as a cystic-degenerated pancreatic neuroendocrine tumor or solid-pseudopapillary tumor and performed a pancreatoduodenectomy. Histopathological examination revealed a cystic pancreatic mass consisting of spindle-shaped cells, with S-100-positive and SMA-negative immunohistochemical stainings. This lesion was diagnosed as a pancreatic schwannoma from these findings.

[Enterococcal meningitis due to strongyloidiasis with HTLV-1 carrier].

A 40-year-old Japanese Brazilian admitted to our hospital because of headache and fever. He came to Japan 16 years ago and underwent treatment of strongyloidiasis 3 years ago. He showed neck stiffness. CRP was highly elevated, and anti-HTLV-1 antibody was positive. Examination of CSF demonstrated pleocytosis, and neutrophils were dominant. Culture of CSF yielded Enterococcus faecalis, and we diagnosed his condition as enterococcal meningitis. Enterococcal meningitis was cured by administration of ampicillin and ceftriaxone. Enhanced abdominal CT scan was performed in order to detect the infectious focus which induced enterococcal meningitis. It showed wall thickening, wall enhancement and fluid collection in duodenum and upper jejunum. Strongyloides stercoralis was detected in stool and duodenal juice and mucosa. It turned out that strongyloidiasis had persisted. Strongyloidiasis was cured by administration of ivermectin. We supposed that enteric enterococcus invaded the blood by dissemination of Strongyloides stercoralis, and meningitis was induced by hematogenous infection.