Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%.

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Objective: This study aimed to determine whether fetal arm movements change when music is presented to the mother or directly to the fetus through the mother’s lower abdomen, and whether maternal mood influences changes in fetal arm movements. Methods: Using a diagnostic ultrasound apparatus, fetal arm movements were measured in 47 pregnant women in the 35-36th week of pregnancy. Subjects were divided into two groups: a maternal presentation group, in which the mothers listened to music through headphones; and a fetal presentation group, in which music was presented directly to the fetus through headphones placed on the mother’s abdomen. Fetal arm movements were observed and recorded by ultrasound for a total of 10 min (5 min without music followed by 5 min with music). The music used was Mozart’s Sonata for Two Pianos in D Major, K. 448. The Profile of Mood States–Brief Form (POMS) was used to investigate the influence of maternal mood on fetal arm movements. Results: In the maternal presentation group, changes in fetal arm movement did not differ between mothers with different moods. In the fetal presentation group, fetal arm movements increased when the mother was energetic and decreased when the mother lacked energy. Fetal arm movement also decreased when the mother had a high level of fatigue and increased when the mother had a low level of fatigue. Conclusion: Presenting music directly to the fetus while the mother is relaxed has the potential to increase fetal response to the music and may possibly promote fetal well-being.

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Ghrelin, an endogenous appetite hormone, is secreted from the gastro-intestinal tract, and the ghrelin-induced appetite is conveyed through the afferent vagus nerves. However, it has not been elucidated how the orexigenic sensation produced by ghrelin is transmitted to the afferent vagus nerves that innervate gastro-intestinal tract. To address this issue, ghrelin-induced food intake in Wister rats was evaluated in the presence or absence of vagal denervation or the administration of a type-3 serotonin receptor antagonist ramosetoron. Cumulative food intake was significantly increased 1 hr and 2 hr after the intraperitoneally-applied ghrelin (20 μg/kg). Desensitization of C-fiber of the afferent vagus nerves by intraperitoneally-applied capsaicin completely abolished the increases in the ghrelin-induced food intake. Surgical vagotomy of the hepatic or gastric branches markedly suppressed the ghrelin-evoked feeding. Furthermore, pretreatment with ramosetoron also significantly suppressed the ghrelin-evoked feeding. Stimulatory effects of ghrelin on the appetite were transient and the overall food intake was comparable after 24 hr among all groups. These data suggest that 1) exogenous ghrelin rapidly promotes feeding, but such feeding lasts no more than 2 hr; 2) afferent C-fiber of the hepatic or gastric vagus nerves appear to convey ghrelin-induced hungry sensation to the brain; 3) type-3 serotonin receptors at the nerve endings of the C-fiber of the gastric or hepatic afferent vagus nerves may involve in transmitting the ghrelin-evoked hungry sensation.

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Aims: Surgical resection is the only radical treatment option for duodenal ampullar carcinoma (AC) that results in an improved patient prognosis. Method: We examined the demographics, surgical records, and outcome in 23 patients with AC undergoing pancreaticoduodenectomy (PD). Results: Of 23 patients, 17 underwent pylorus preserving PD (PPPD) and 6 underwent PD, including subtotal stomach-preserving PD in 5. D2 lymphadenectomy was performed in 17 patients and D3 lymphadenectomy was performed in 6. The combined resection of the superior mesenteric vein was performed in 1 patient. Postoperative cancer recurrence was observed in 32%, and 6 patients died of cancer. The 3-year tumor-free survival rates were not different between the final stages (p=0.64) and the 5-year cancer-related overall survival rates were not different between stages either (p=0.28). Tumor size≥3cm resulted in significantly poorer survival rate compared to smaller tumors (p=0.032). Node metastasis at Group 2, and moderately or poorly differentiated adenocarcinoma were significantly associated with poor survival (p<0.05); however, cancer infiltration at cut-end margin, degree of node dissection and curability were not associated with overall prognosis. Conclusions: Radical surgical resection showed good patient prognosis; however, new adjuvant chemotherapy is a promising modality to improve patient survival in AC patients with poor prognostic factors.

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Oleuropein, the active constituent of olive leaf extract, possesses anti-oxidant, hypoglycemic, and hypolipidemic activities. We aimed to assess whether the effect of olive leaf extract on hepatic fat accumulation is preventive or therapeutic. Sprague- Dawley (SD) rats were fed a high-fat diet with (ODOD group) or without (HDHD group) olive leaf extract (1,000 mg/kg diet) for 38 weeks. Another group of rats were fed a high-fat diet for 23 weeks, followed by a high-fat diet with olive leaf extract (1,000 mg/kg diet) for 15 weeks (HDOD group). Serology, histopathology, anti-oxidative activity, and liver fatty acid synthesis were compared to those fed a standard diet (LDLD group) at 26 and 41 weeks of age. The serum levels of total cholesterol, triglyceride and aspartate aminotransferase tended to be lower in the ODOD group as compared to the HDHD and HDOD groups, although there were no significant differences. Histopathologically, hepatic steatosis tended to be less evident in the HDOD and ODOD groups as compared to the HDHD group, and lobular inflammation was not observed in the ODOD group at 26 weeks of age. Hepatic thioredoxin-1 staining tended to be less evident in the ODOD group than in the HDHD and HDOD groups at 41 weeks of age. There were no significant differences in hepatic lipogenic enzyme activities between the ODOD group and HDHD/HDOD groups. Our data suggest that olive leaf extract had a preventive, rather than therapeutic, effect on hepatic steatohepatitis in SD rats fed a high-fat diet.

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Background: On 26 December 2004, a large earthquake occurred off the coast of Sumatra, and a devastating tsunami struck surrounding countries. Sri Lanka was seriously affected, with more than 31,000 deaths and 4,000 people missing. Objective: To elucidate the relationship between factors of tsunami-related exposure and mental health conditions among the senior residents of tsunami-affected areas in southern Sri Lanka. Subjects: A total of 90 subjects (43 men, 47 women) aged 60 years or older who were living in the Matara district at the time of the tsunami attack. Methods: A survey by interview using a structured questionnaire was conducted in 2008. The collected information included demographic factors, tsunami-related exposure and mental health conditions. The Impact of Event Scale-Revised (IES-R) was used to assess their post-traumatic stress disorder symptoms. Results: The median of the IES-R score was significantly higher in those who were situated at home; those who saw anyone the dead or injured; those whose evacuations were delayed; those whose family member or friend was injured; those who were injured; those who lost their children, spouse or family members; those whose family member was missing; those who lost livelihood, compared with those who were not or those who did not. Multiple linear regression analysis showed that younger age and loss of or injury to family members due to the tsunami were significantly associated with an increase in IES-R score. Conclusion: The results indicate that tsunami-related exposures have affected elderly survivors’ mental health.

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