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Background: Selective biliary cannulation (SBC) is the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially for trainees, and a rotatable sphincterotome may be useful to guide the directional axis of the scope and SBC.Methods: We performed a prospective randomized single-center trial, enrolling 200 patients with a native papilla who required therapeutic biliary ERCP. Patients were randomly assigned to the rotatable sphincterotome group (n = 100) or the conventional sphincterotome group (n = 100). The primary endpoint was successful SBC by the trainees within 10 minutes.Results: The early and late cannulation success rates did not differ significantly between the groups (P = 0.46 and P > 0.99, respectively). For the patients in whom trainees failed to achieve SBC, the rotatable sphincterotome was used as a rescue cannulation technique in four patients from the conventional group; in no patients in the rotatable group was the conventional sphincterotome used for SBC. Post-ERCP pancreatitis (PEP) occurred in 11 patients (5.5 %; 6 mild, 5 moderate); the incidence did not differ significantly between the two groups (rotatable group 3 %, conventional group 8 %; P = 0.21). The two groups were thus combined for evaluation of the factors relating to cannulation difficulty for trainees, which revealed that orientation of the papilla was a significant factor (P < 0.001).Conclusions: The type of sphincterotome used did not affect the success of SBC by trainees. However, orientation of the papilla was revealed to be a significant factor relating to cannulation difficulty for trainees overall. [ABSTRACT FROM AUTHOR]

Background: It has been reported that veno-venous extracorporeal membrane oxygenation is useful for treating patients with acute respiratory failure following severe thoracic trauma. However, the removal of an obstructive organized tracheo-bronchial clot under respiratory support using extracorporeal membrane oxygenation in a patient with trauma has never been reported. Case presentation: A teenage female was injured in a fall and experienced right open hemopneumothorax and bilateral lung contusions. Since she was in refractory shock due to bleeding into the right thoracic cavity, we performed right thoracotomy and resection of the lacerated right middle lobe. After hemorrhage control, her respiratory status could not be maintained under mechanical respiratory support. Therefore, we initiated veno-venous extracorporeal membrane oxygenation. Although her respiratory failure gradually improved, the removal of obstructing tracheo-bronchial organized blood clots using bronchoscopy was required daily. Because of the size and firm adherence of organized clots to the airway membrane, we performed a tracheostomy to remove organized clots directly through the incision under extracorporeal membrane oxygenation without any adverse events on day 9. The next day, she was successfully removed from extracorporeal membrane oxygenation. Conclusions: Extracorporeal membrane oxygenation could provide respiratory support not only for acute respiratory failure but also for removal of obstructing tracheo-bronchial organized clots in patients with severe lung injury following trauma. [ABSTRACT FROM AUTHOR]

The article discusses the study about the factors associated with workers' perceived helpfulness and the need for health consultations given by an occupational physician at a Japanese manufacturing plant. The study has aimed to clarify measures for improving the functionality of health consultations by occupational physicians, by examining factors associated with workers' perceived helpfulness and the need for consultations. It has showed that it is necessary to help employees realize the physicians' outstanding dedication and to convey to the workers the absolute assurance of their privacy protection.

Abstract: To improve the satisfaction of people who had periodical worksite health check-ups, we investigated the factors that influence overall satisfaction among participants of a periodical worksite health check-up program in Japan, in light of having and not having a medical history of serious disease. In both groups having and not having a medical history of serious disease, overall satisfaction was significantly associated with the factors related to physician and examination. In the group having a non-serious disease medical history, overall satisfaction was significantly associated with advancing age. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article related to endoscopic retrieval focused on proximally migrated pancreatic stent.

Objectives: To provide updated clinico-epidemiological information on chronic pancreatitis (CP) in Japan. Methods: We conducted a two-stage nationwide epidemiological survey; the number of CP patients was estimated in the first-stage survey, and their clinical features were examined in the second-stage survey. We surveyed patients with CP who had visited hospitals in 2016 and were diagnosed according to the Japanese diagnostic criteria 2009 (DC2009). Furthermore, we validated the new Japanese diagnostic criteria (DC2019) in patients with early CP diagnosed according to DC2009. Results: The number of patients with definite/probable CP in 2016 was 56,520 (prevalence, 44.5 per 100,000 persons), and that of early CP was 4470 (prevalence, 3.5 per 100,000 persons). We obtained detailed clinical information of 2150 patients with definite/probable CP and 249 patients with early CP. Compared with the early CP cases, the definite/probable CP cases had higher proportions of male (4.8 vs. 1.3), alcohol-related etiology (72.0% vs. 45.8%), smoking history (69.6% vs. 41.0%), diabetes mellitus (42.3% vs. 19.3%), and past history of acute pancreatitis (AP) (50.4% vs. 22.1%). Among the patients with early CP diagnosed according to DC2009, 93 (37.3%) were diagnosed with early CP according to DC2019, but the diagnosis of the remaining 156 (62.7%) patients was downgraded. Alcohol-related etiology, smoking history, early disease onset, and past history of AP were associated with the maintenance of early CP diagnosis in DC2019. Conclusion: We clarified the current status of CP in Japan. Further validation studies are warranted to clarify the diagnostic utility of DC2019. [ABSTRACT FROM AUTHOR]

Background: We aimed to construct a prognostic model to predict survival in patients with advanced pancreatic cancer (APC) receiving palliative chemotherapy using readily available pretreatment factors. Methods: The model was constructed using data from 306 consecutive patients with APC who received palliative chemotherapy between January 2006 and March 2013. The predictive accuracy of the model was assessed using a concordance index (c-index) and calibration curves. Results: Among the 12 potential prognostic factors investigated, multivariate analysis identified the following six independent negative prognostic factors-performance status (PS), the presence of distant metastatic disease, the status of initially unresectable disease, carcinoembryonic antigen (CEA) level, carbohydrate antigen 19-9 (CA19-9) level, and neutrophil-lymphocyte ratio (NLR). A prognostic index (PI) based on the coefficients of these factors was constructed as follows-PI = 2 (if PS 2-3) + 1 (if distant metastatic disease) + 1 (if initially unresectable disease) + 1 (if CEA level ≥5.0 ng/ml) + 1 (if CA 19-9 level ≥1,000 U/ml) + 2 (if NLR ≥5). The patients were classified into three prognostic groups-favorable (PI 0-1, n = 73), intermediate (PI 2-3, n = 145), and poor (PI 4-8, n = 88). The median overall survival times for each prognostic group were 16.5, 12.3, and 6.2 months, respectively ( P < 0.001). Bootstrapping verified the good fitness of this model for predicting 1-year survival, and the c-index was 0.658. Conclusions: This simple prognostic model could help clinicians to estimate survival in patients with APC who receive palliative chemotherapy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73 year old woman with hepatitis C virus (HCV). A single nodule in the fourth segment of the liver was found by the superparamagnetic iron-oxide-enhanced magnetic resonance imaging (MRI). She had a liver tumor and her B-cell lymphoma of the liver was diagnosed. She received three cycles of chemotherapy.The article discusses about the B-cell lymphoma and the HCV infections.

The article presents a case study of a 71-year-old woman with recurrent bile duct stones. Topics discussed include use of endoscopic papillary large-balloon dilation (EPLBD) treatment for removal of the stones, observation of bleeding after EPLBD, failure of balloon oppression and self-expandable metallic stent in hemostasis, presence of gastroduodenal artery pseudoaneurysm and extravasation into duodenum, and placement of coils for hemostasis. [ABSTRACT FROM AUTHOR]