Acta Medica Nagasakiensia Vol. 60(2015) No. 4
ACTA MEDICA NAGASAKIENSIA

To evaluate pancreatic elasticity and tumor diagnosis, we preoperatively investigated the elasticity calculated by a new ultrasonography (US) technique, acoustic radiation force impulse (ARFI). Materials and Methods: We examined ARFI in non-tumorous and tumor regions by push pulse of probe in 30 patients with pancreatic malignancies undergoing pancreatectomy. Measurement of stiffness was indicated as the Vs (mm/sec). Results: The Vs in the non-tumor region was measured in the pancreas head in 17 and in the body in 13 patients. The Vs of pancreatic tumors was measured in 14 of 22 patients (64%). The Vs in pancreatic tumors (2.17±0.95 m/sec.) was significantly higher than that in the non-tumorous pancreas (1.41±0.47 m/sec.) (p‹0.01). The Vs of the non-pancreatic regions in the pancreas head and body were not significantly different. The Vs of the non-tumorous pancreas was not associated with patient demographics, laboratory data, the hardness of the pancreatic tissue, or postoperative morbidity. The Vs of the resected pancreatic tumors was not associated with any tumor-related parameters. Conclusions: ARFI imaging elastography can be used to evaluate pancreatic malignant tumor lesion in comparison with the non-tumor lesion.

Conclusions: It is suggested that oxygen consumption by bacteria could be a cause of the negative middle ear pressure in ears with otitis media. Objective: To determine whether oxygen consumption and production of carbon dioxide by bacteria could be a cause of negative pressure in ears with otitis media.Methods: Hermetically-sealed tubes (2ml of volume) containing 1 ml of culture media with Streptococcus pneumoniae leaving 1 ml of airspace were connected to a micro-pressure sensor, and were maintained at 37 degree centigrade in a water bath. Chronological changes of air pressure in the tube were monitored for 15 hours (bacterial group), and were compared with those in the tubes containing culture media only (controls). Also, partial pressures of oxygen and carbon dioxide in the culture media of those bottles were measured. Results: The pressure of the bacterial group were significantly lower than that of controls (bacterial group; -94.6±92mmH₂O, control group; 4.6±11.1mmH₂O, 2 way-ANOVA, P <0.001). The partial pressures of oxygen were lower (bacterial group; -86.0±22.1mmHg, control group; -34.6±7.93mmHg, 2 way-ANOVA, P <0.0001) and those of carbon dioxide were significantly higher in the bacterial group than in the control group (bacterial group; 11.8±3.8mmHg, control group; -0.23±0.41mmHg, 2 wayANOVA, P <0.0001).

Background: Although peritoneal dialysis (PD) is beneficial for patients with end-stage renal diseases (ESRD), there are some critical complications. PD-related peritonitis accounts for about 30% of all cases of catheter removal and transition to hemodialysis. We investigated the incidence, causative bacteria, and risk factors of PD-related peritonitis and peritonitis-related withdrawal in patients treated in the Nagasaki University Hospital. Methods: Subjects were 43 PD patients in the Nagasaki University Hospital observed between January 1, 2008 and December 31, 2012. We established the incidence of PD-related peritonitis, investigated causative bacteria and culture-negative peritonitis rates, and examined potential risk factors, including laboratory data obtained at the commencement of PD. Results: 20 episodes of peritonitis occurred in 12 patients during the observation period, and the incidence of PD-related peritonitis was one episode per 62 patient-months. The culture-negative peritonitis rate was 10%. In the isolated causative bacteria, 55% were Gram-positive cocci and 25% were Gram-negative rods. Two episodes were associated with methicillin-resistant Staphylococcus aureus (MRSA), and each episode was accompanied with an exit-site infection. PD catheter removal caused by PD-related peritonitis occurred in 4 patients. As a result of investigation for association between PD-related peritonitis and patient’s factors including laboratory data, sex, age, and cause of ESRD, the patients who experienced PD-related peritonitis had significantly lower hemoglobin levels at the initiation of PD. Conclusions: PD-related peritonitis remains an important complication of PD. We found that low hemoglobin level at the commencement of PD was a risk factor of PD-related peritonitis. In addition, MRSA peritonitis was a risk factor of peritonitis-related withdrawal. Thus, improvement in anemia might be important to prevent PD-related peritonitis. It is also important to prevent MRSA-associated peritonitis to avoid technical failure of PD.

Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. Compounded human ghrelin (CHG) is a candidate drug to improve the nutritional status after pancreatic surgery. However, adverse influences of ghrelin in terms of pancreatic fistula (PF) via the stimulation of exocrine secretion after pancreatectomy are a concern. The present study showed the influences of the administration of CHG with PF after distal pancreatectomy in a mouse model. Distal pancreatectomy was performed on 10-week-old male Wistar rats and 3 µg/kg or 30 µg/kg CHG was injected into the inferior vena cava during laparotomy. Ten rats were divided into two groups: a control group (no injection; n=5) and a CHG group (n=5 for each of 3 µg/kg and 30 µg/kg). Changes of body weight, amount of ascites, and the serum and ascetic amylase and lipase levels were examined on days 1, 3, and 7. In the case of administration of 3 µg/kg ghrelin, changes of body weight, amount of ascites, and serum amylase level were not significantly different between the groups during 7 days. Amylase level in ascites in the ghrelin administration group tended to be lower than that in the control group on day 3 (p=0.083), but there was no difference on days 1 and 7. In the case of a high dose of 30 µg/kg ghrelin, levels of weight loss were not significantly different between the groups. Although the lipase level in the serum and ascites tended to be lower in the ghrelin group than in the control group (p=0.08), the amylase levels in serum and ascites were not significantly different between the groups. There was also no remarkable difference in histological appearance between the groups during 7 days after surgery. The administration of CHG did not induce PF after distal pancreatectomy, which might inhibit lipase secretion in ascites. CHG injection can be safely performed after surgery.

Xanthoma is frequently observed in patients with endocrine and metabolic diseases. Intraosseous xanthoma is an extremely rare lesion. In cases in which associations with systemic metabolic diseases and lipid diseases are ruled out, intraosseous xanthoma is termed primary xanthoma. We herein report an extremely rare case of primary xanthoma of the mandible in a 27-year-old woman. Lower third molar extraction and extirpation of the tumor was performed under general anesthesia following a clinical diagnosis of a benign tumor in the left mandible. Her previous medical history was not contributory, except for ovarian cystoma. A final diagnosis of primary xanthoma was established. Her last follow-up 4 years after surgery showed no sign of recurrence in clinical and radiological examinations.