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To perform complete mesocolic excision with central vessel ligation, it is important to recognize the vessel anomaly and the location of the tumor. For left-sided colon cancer, the variations in the course of the left colic artery and accessary middle colic artery must be recognized preoperatively. Here, we describe our experience with a 57-year-old man who was diagnosed with sigmoid colon cancer with complicated inter-mesenteric connections between the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA), possibly due to median arcuate ligament syndrome. We performed laparoscopic sigmoidectomy with low ligation of the IMA to preserve the extremely enlarged left colic artery. The total operative time was 155 minutes, and the estimated total blood loss was 10 mL. The patient was discharged on postoperative day 9 without any postoperative complications. For patients with vascular anomalies in the left-sided mesocolon, preoperatively ruling out SMA stenosis by using angiography and 3-D CT might be important.

Background The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a “Goal” that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach. Case presentation A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota’s fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a “Goal” at the inferior border of the pancreas for safe resection of the Gerota’s fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota’s fascia, and the resection margin was negative for cancer. Conclusions The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota’s fascia.

Background Subtotal cholecystectomy is an effective surgical method to decrease the risk of complications for gallbladders that are difficult to remove. However, there is a risk for postoperative refractory bile leakage through the gallbladder stump. Here, we report a new management technique involving the use of argon plasma coagulation (APC) to stop bile leakage after a subtotal cholecystectomy. Case presentation A 74-year-old man was referred to our hospital for abdominal pain and fever. Contrast-enhanced computed tomography of the abdomen showed fluid collection, such as an abscess, surrounding the gallbladder and hepatic flexure colon. The patient was diagnosed with colonic perforative peritonitis, and he underwent emergency surgery. On laparotomy, the abscess was observed outside of the hepatic flexure colon and gallbladder necrosis was detected. The neck of the gallbladder and the area close to the hepatoduodenal ligament was severely inflamed prohibiting dissection. The hepatic flexure colon was part of the abscess wall, and resection was needed. A subtotal cholecystectomy and right hemicolectomy confirmed peritonitis caused by cholecystic perforation. The mucous membrane of the gallbladder neck that remained was necrotic or detached. Therefore, the stump of the gallbladder was closed by primary sutures without cauterization of the mucosa. On postoperative day 6, bile leakage from the gallbladder stump was revealed. Percutaneous and endoscopic retrograde cholangiography drainage were performed. However, the liquid, which seemed to be secreted from the mucosa of the remnant gallbladder, was continuously obtained. We used APC to cauterize the gallbladder mucosa through the fistula of the abdominal drainage tube. Bile leakage and mucus discharge were improved after three rounds of APC cauterization. Conclusions APC effectively treated refractory bile leakage from a gallbladder stump after subtotal cholecystectomy for severe cholecystitis.

The feasibility and safety of laparoscopic surgery for locally advanced colorectal cancer remain controversial due to the high rate of incomplete resection and conversion to open surgery. Especially for T4 colorectal cancer, laparoscopic techniques are still demanding mainly because of the difficulty in distinguishing between inflammation and tumor involvement, which often lead surgeons to do overtreatment in surgery. We believe laparoscopic magnified and multidirectional approach might be useful for pathologically complete resection and minimizing an unnecessary extended surgery for these cases. A 49-year-old man was diagnosed with locally advanced T4 sigmoid colon cancer invading the urinary bladder and ureter. We performed laparoscopic anterior resection with en bloc resection of the urinary bladder and the left ureter. Total operative time was 462 min, and the estimated blood loss was 50 ml. This patient was discharged on the 28th day after surgery without any ostomies and urinary functional disorders. The magnified view by laparoscopic techniques from multiple directions would enable surgeons to set surgical landmarks for another approach, which is the key for safe and feasible laparoscopic surgery in patients with locally advanced T4 colorectal cancer.

Background Segmental arterial mediolysis is a rare nonarteriosclerotic and noninflammatory vascular disease that may cause intraperitoneal bleeding. Scleroderma renal crisis is a rare complication of systemic sclerosis, leading to severe hypertension and renal dysfunction. To the best of our knowledge, this is the first reported case of a patient with concurrent systemic sclerosis with scleroderma renal crisis and pathologically confirmed segmental arterial mediolysis. Case presentation We report a case of a 68-year-old Chinese woman diagnosed with systemic sclerosis who was found to have coexisting segmental arterial mediolysis. She presented with back pain, and massive intraperitoneal bleeding was detected by computed tomography. She underwent laparotomy, and the bleeding was found to originate from the gastroepiploic artery. The pathological examination demonstrated gastroepiploic arterial dissection caused by segmental arterial mediolysis. After surgery, she developed severe hypertension with hyperreninemia and progressive renal dysfunction. Given the risk factors of corticosteroid administration and the presence of anti-ribonucleic acid polymerase III antibody, she was diagnosed with scleroderma renal crisis. The patient was proved to have a very rare case of coexisting scleroderma renal crisis and segmental arterial mediolysis. Conclusions There is no known etiological connection between segmental arterial mediolysis and systemic sclerosis or scleroderma renal crisis, but it is possible that coexisting segmental arterial mediolysis and scleroderma renal crisis may have interacted to trigger the development of the other in our patient.

Ventral midbrain cavernous malformations are rare, and annual bleeding rate is higher than supratentorial lesions. Rebleeding rate is also high if surgical resection is incomplete. The ventral midbrain is deeply located and surrounded by many perforators, which make the approach to this region difficult. We experienced two cases of ventral midbrain cavernous malformations successfully removed via orbitozygomatic interpeduncular approach. In these cases, most parts of the lesions exist behind the cerebral peduncle extending interpeduncular fossa. In the first case involving a 15-year-old girl, we removed the lesion completely through an ipsilateral orbitozygomatic interpeduncular approach with minimum sacrifice of the right cerebral peduncle. However, in the second case involving a 43-year-old man, the same approach did not reach the lesion behind the ipsilateral cerebral peduncle. At the second operation, a contralateral orbitozygomatic interpeduncular approach was used to remove the residual lesion completely. Ipsilateral and contralateral orbitozygomatic interpeduncular approaches with minimum destruction of the cerebral peduncle are options for the lesions which exist in the interpeduncular fossa and behind the cerebral peduncle.

For the purpose of developing a vibration-isolation table with flexibility and/or scalability (which means “with adaptability to desired load specification”), this study investigates a self-identification method with regard to positions or arrangement and effective pressure areas of pneumatic actuators which support a vibration-isolation table. The proposed identification method is a fundamental technique necessary to construct a scalable vibration-isolation table in which the actuators supporting the table can be added or removed flexibly according to the load demand, easily, and in a short period of time. First, this study constructs a mathematical model for a vibration-isolation table supported by a redundant number of actuators and a type 1 digital servo controller to control the position and inclination angles of the table. Next, we derive the identification method for obtaining the position of the added pneumatic actuator and the effective pressure areas of the pneumatic actuators. We then demonstrate the proposed identification method by numerical simulations using our detailed mathematical model. Finally, this study shows an example of the application of the proposed identification method coupled with a force redistribution technique by addition of an actuator into the vibration-isolation table system during continuous operation. The validation and success of our method was confirmed by the displacement and pressure responses of the vibration-isolation table.

We propose a wireless power distribution system (WPDS) operating at 2.45 GHz CW in buildings instead of wired power distribution in order to reduce the initial cost of the building. Required technologies for the WPDS are (a) low-cost and low-loss deck plate waveguide, (b) variable microwave power distributor for the waveguide, and (c) high-power (>100 W) rectifier at the outlet. We developed and tested the deck plate waveguide, power distributor, and high-power rectenna consisting of 256 Si Schottky barrier diodes and newly developed GaN diodes. Finally, a test WPDS was built and microwave power transmission experiments were conducted. The total efficiency of the test WPDS was estimated to be 52%.

An electromagnetic field leaked from WPT systems might cause a false operation of other electronic devices. We have measured and simulated it by using the WPT leakage emulator so far. In this paper, the electromagnetic field is evaluated on the assumption that several WPT systems are located in the residential house and operate simultaneously. It is shown that the simulated results coincide with the measured results approximately, and the validity of the simulation method is confirmed.

The present study proposes a simple numerical simulation technique for the split Hopkinson pressure bar (SHPB) and then investigates the experimental conditions for composite materials in a tensile-loading SHPB. The following issues were investigated through experiment and numerical simulation: (i) the effects of the cross section and acoustic mismatch between the jig with a slit and screw and the input/output bars on the loading condition and (ii) the effects of the duration time of the applied load and the acoustic impedance mismatch on the stress–strain curve obtained by SHPB testing. From the numerical simulation results, the following conclusions were found: (i) the proposed jig with a slit and screw can apply an ideal one-dimensional displacement to a specimen and (ii) the material characterization of a composite material by SHPB testing might be possible by optimizing a longer duration time if the acoustic mismatch is greater.

We examined depth perception effects on a moving automobile with static perspective method and dynamic perspective method by monocular HUD, WARP. Both methods have met the specification of within 70% accuracy. In addition, the dynamic perspective method provided stronger depth perception

Spontaneous intradural vertebral artery dissections may cause subarachnoid hemorrhage and often result in devastating damage. Increased use of noninvasive imaging studies has allowed larger numbers of patients to be diagnosed. In addition, intracranial vertebral artery dissection tends to induce multiple lesions affecting both intracranial vertebral arteries recurrently. Although unruptured dissections in this area usually have a benign nature, some authors have reported on the incidence of rupture from this lesion. Once hemorrhage from a dissecting vessel wall has occurred, it needs to be treated in the acute phase because of the high risk of rebleeding resulting in high morbidity and mortality. From December 2004 to July 2010, we managed 47 patients with spontaneous vertebral artery dissection, 31 patients were ruptured and 16 were unruptured. All patients who suffered from subarachnoid hemorrhage were treated with endovascular procedures. Most of the patients with unruptured dissection received medical therapy, but if the aneurysmal dilatation persisted or grew, surgical interventions were performed. Stenting with or without coils was deployed for 13 patients with posterior inferior cerebellar artery involvement at the site of dissection and/or were affected on the dominant side. In some patients, stenting was performed even if they were in the acute phase. For other ruptured patients, internal coil trappings were performed. Six patients died due to severe initial subarachnoid hemorrhage and one patient, who underwent stent deployment with coils for the dominant vertebral artery, with bilateral dissection continuing to the basilar artery died due to rerupture while the next additional coiling was planning. There were two cases of complications related to the intervention. During the follow-up period no bleeding occurred in any of the patients except for the previously mentioned patient. In conclusion, internal coil trapping or stent placement with or without coils was effective in preventing rebleeding of ruptured vertebral artery dissection. If the dissection is unruptured, it is necessary to detect the risk of bleeding with careful watching and when progress appears to be made, patients should be treated promptly. Stent-assisted therapy for preserving the patency of the parent artery and major branches is a promising treatment for vertebral artery dissection, even in the acute stage of subarachnoid hemorrhage. However, the risk of acute rerupture and recurrence remains even with the porous stent placement with or without coils.

We developed a compact, 2-liter, monocular head-up display that is WARP-mountable on an automobile. We proposed a novel depth-perception-controllable method and examined the depth perception enhancement characteristics under real space conditions. We confirmed depth perception was controlled as far as 60 meters and true AR was achieved.

A 15-year-old girl developed a rare case of subdural hygroma after foramen magnum decompression for Chiari type 1 malformation manifesting as rapid symptom deterioration around 10 days after uncomplicated operation with uneventful immediate postoperative course. Progressive enlargement of the subdural hygroma in both supra- and infratentorial spaces was followed by the development of hydrocephalus. Syringomyelia improved shortly after the first operation but then deteriorated with massive presyrinx formation. Reoperation with wide opening of the arachnoid membrane lead to a rapid resolution of the hydrocephalus and the presyrinx. The present case shows that wide opening of the arachnoid membrane is an effective therapeutic option.

症例1は直腸癌術後再発による神経障害性疼痛に対し緩和ケアチーム (palliative care team: 以下PCT) が介入した。オキシコドン徐放製剤の増量，鎮痛補助薬の変更，ベタメタゾン投与を行なった。またオキシコドン徐放製剤を1日2回投与から3回投与とし症状緩和が得られた。経過中cetuximab療法を2回施行した。症例2は乳癌術後再発による上肢痛と呼吸困難に対しPCTが介入した。モルヒネ硫酸塩水和物製剤と鎮痛補助薬を追加投与した。フェンタニル経皮吸収型製剤の貼付3日目に疼痛増強があったため3日毎交換から2日毎交換とした。経過中FEC100療法を2回施行した。この2症例ではPCTが積極的に介入し，速やかな症状緩和が得られたため，化学療法を問題なく施行することができた。PCTが積極的に介入するためには主治医の信頼を得ることが最も大切である。

Advanced Evolved Universal Terrestrial Radio Access (Advanced E-UTRA), called LTE-Advanced, has been standardized in the 3rd Generation Partnership Project (3GPP) as a candidate for IMT-Advanced. LTE-Advanced supports spatial orthogonal-resource transmit diversity (SORTD) [1], [2] for ACK/NACK signals and scheduling requests (SRs), which are used to control downlink hybrid automatic repeat requests (HARQs) and manage uplink radio resources based on uplink data traffic, respectively. Both ACK/NACK signals and SRs are carried via a physical uplink control channel (PUCCH) [3], and a common PUCCH format is used for both ACK/NACK signals and SRs. If SORTD is used, the base station assigns mutually orthogonal resources to each antenna included in the user equipment (UE) for ACK/NACK signals and SRs; hence, the number of required resources increases with the number of transmitting antennas in the UE. In this paper, we study the resource reduction method for ACK/NACK signal and SR in case of SORTD using the concept of common resource. In addition, we investigate a phase rotation scheme for common resources to improve the SR detection performance.

40歳，女性．平成19年4月頃から腹痛出現．貧血のみの指摘で，他に検査異常は認めなかったが，症状維持するため，精査目的で紹介となった．初診時Hb 7.9g/dl，腫瘍マーカーは基準値内であった．内視鏡検査で十二指腸水平部に全周性腫瘍を認め，生検結果はGroup Vであった．腹部CTで7cm×9cmの巨大腫瘍を認め，膵・左腎・上腸間膜動脈（SMA），大動脈壁に接していた．膨張性に発育していると考え，開腹手術を行った．十二指腸水平部に径7.2×5.7cmの巨大な腫瘍を認めた．周囲臓器へ接していたが剥離可能であり，膵鉤部合併切除にて，腫瘍を完全切除することができた．術後頻回の下痢を認めたが経過良好で第31病日に軽快退院となった．術後補助化学療法を施行．術後12カ月にリンパ節転移再発を認めた．十二指腸癌は稀で，切除しえても高率に再発を認める．生存期間の延長に期待できることから切除の可能性を検討すべきである．

長期透析患者の透析アミロイドーシスによる小腸穿孔のまれな1例を経験した．症例は79歳の女性で，17年間の血液透析歴がある．透析導入後，右手根幹症候群手術2回，S状結腸憩室出血手術を受け，狭心症，急性心不全，肺結核の治療を受けていた．外傷歴のない右大腿骨頸部骨折にて入院し，手術を受けた．術直後より腹痛と下痢を認め，術後2日目に腹痛が増強した．CT上，腹腔内の遊離ガス像と腹水貯留を認め緊急手術を施行した．小腸に穿孔部を2か所認めたため切除吻合を行った．病理学的に穿孔部周囲の粘膜下層の小血管壁にアミロイドの沈着を認めた．術後，創感染，深在性真菌症，難治性下痢，急性心不全を発症したが保存的治療で改善し，緊急術後78日目に軽快退院した．

The main aim of this study is to investigate the pharmacokinetics of infliximab and Fcgamma receptor (FcgammaR) polymorphism in two patients with rheumatoid arthritis (RA) who were well controlled by low-dose infliximab. A 57-year-old woman (Patient 1) and a 67-year-old woman (Patient 2) had active RA despite methotrexate and prednisolone treatments. They improved after the addition of infliximab (3 mg/kg), but developed pneumonia and sepsis, respectively. Although the infliximab doses were reduced to 1.5 mg/kg and 1 mg/kg, respectively, clinical improvements were maintained. Blood samples were obtained at 1 h after infliximab administration and at eight weeks (just before the next dose). The elimination half-life was determined by the serum concentration of infliximab. We also analyzed the polymorphisms of FcgammaRIIA, FcgammaRIIIA, and FcgammaRIIIB for the genomic DNA samples from the two patients and three controls. Amplification of the FcgammaR-genomic regions in allotype-specific polymerase chain reactions was used to distinguish the genotypes. Decresed clearance of infliximab was proven by a pharmacokinetic study of these patients under low-dose infliximab therapy. 131H/H (FcgammaRIIA) and 176F/F (FcgammaRIIIA) were detected in both patients. NA1/NA2 and NA2/NA2 (FcgammaRIIIB) were detected in Patients 1 and 2, respectively. These patients were well controlled over the long term by low-dose infliximab. The mechanism of the reduced clearance of infliximab might possibly be explained in part by the FcgammaR polymorphisms.

The purpose of this study is to determine the levels of urinary 3-phenoxybenzoic acid (3-PBA) among general populations in rural and suburban areas and employees of pest control firms to evaluate the differences in the level of environmental or occupational pyrethroid (PYR) pesticides to which those populations are exposed.Spot urine specimens were collected from male residents in a rural area (n = 143) and male residents in a suburban area (n = 66) in August of 2005 and 2007, respectively. Male employees of pest control firms, who also provided their urine specimens at the time of a health-checkup in August 2007, were classified either as sprayers (n = 14) or as non-sprayers (n = 16) according to the presence of spraying during the pre-checkup week. Urinary concentrations of 3-PBA were determined using gas chromatography-mass spectrometry and corrected for the urinary creatinine concentrations. An analysis of covariance was used to examine the statistical difference in 3-PBA concentrations between these four groups after adjustment for age, body mass index, and current smoking/drinking habits.Multiple comparisons indicated no differences in adjusted 3-PBA concentrations between the groups of general residents from the rural areas (0.33 microg/g cre in geometric mean) and suburban area (0.51 microg/g cre). The group of sprayers showed a much higher level of 3-PBA concentrations (25.0 microg/g cre) than the other three groups. A statistically significant difference, though to a lesser extent, was also exhibited in 3-PBA concentrations between the group of non-sprayers (5.6 microg/g cre) and that of general residents.The results indicated that the levels of background low-dose exposure to PYRs are not likely to differ evidently among general populations according to the area of residence. Moreover, employees of pest control firms, who have been away from PYR spraying operations for a week or more, still retain much higher urinary 3-PBA concentrations than general populations.

Nagoya University, Department of Medical Technology, 金沢大学附属病院薬剤部, Limited data are available on the background levels of exposure to synthetic pyrethroid (PYR) in Japan, despite their frequent application for agriculture and indoor extermination and possible effects of chronic and/or low-dose PYR exposure on human health. This study was conducted to describe the level and distribution of one of the major PYR metabolites, 3-phenoxybenzoic acid (3-PBA), in urine samples collected from a general population in Japan. The subjects were 535 individuals (184 men and 351 women; 61.5±9.8 years of age, mean±S.D.) residing in a town in Hokkaido, a dairy and agricultural area. Urinary 3-PBA was found detectable in 98% of samples above the limit of detection of 0.02 μg/l. The geometric mean values of urinary 3-PBA in occupationally exposed farmers (n=87) and the remaining general group without occupational exposure (n=448) were 0.38 and 0.29 μg/l, respectively, ranging from

肛門周囲膿瘍は，日常診療で比較的よく遭遇するが，鼠径部に膿瘍を形成することは非常に稀な病態であり，検索したかぎり1例も認めない．症例は45歳の男性で，既往は特に認めない．肛門痛を主訴に来院し，肛門周囲膿瘍の診断で同日切開排膿を施行した．切開後，痛みは一時軽快したが，発熱が持続し，切開排膿から12日目に右鼠径部痛を自覚するようになった．骨盤部造影CTでは右鼠径部にガスを含んだ液体貯留を認め，前立腺や膀胱の左側の瘻孔の存在を疑わせるガス像と連続していた．注腸造影X線検査では，肛門管から瘻孔が造影され，膿瘍も造影された．以上から，肛門周囲膿瘍から鼠径部膿瘍を形成したと診断し，膿瘍切開，人工肛門造設を施行した．術後経過は良好で入院から49日目に退院した．6カ月後の注腸造影X線検査で瘻孔は消失していたため，人工肛門を閉鎖した．その後2年経過するが，再発は認めない．

When pancreatic duct dilatation is found in the patient having undergone pancreatoduodenectomy (PD), observation is chosen in most cases. Similarly, recurrent tumor in the remnant pancreas of invasive ductal carcinoma (IDC) of the pancreas is seldom indicated for resection. We have aggressively performed repeated pancreatectomy for these cases and obtained good results. Repeated pancreatectomy after PD was performed for three types of circumstances: (1) pancreatodigestive anastomotic stricture; (2) neoplasm after intraductal papillary mucinous neoplasm (IPMN); and (3) recurrence of IDC of the pancreas. Resection of anastomosis and reanastomosis was performed for pancreatodigestive stricture in four patients. Symptoms derived from pancreatitis in three patients resolved by the second operation and did not recur during follow-up. None of the four patients required pancreatic enzyme substitution because of clinically overt malabsorption, and the defecation frequency of the four patients was within twice a day. Mild diabetes mellitus has been identified in only one patient who had diabetes mellitus before the second surgery. Completion pancreatectomy and pancreatic tail resection was performed for recurrence in two patients and IDC in one patient, respectively, after PD for IPMN. Intrapancreatic recurrences of IPMN in two patients existed in the main pancreatic ducts. As CT revealed pancreatic duct dilatation but not intraductal tumors, recurrences were not correctly diagnosed before the second operation. Completion pancreatectomy was performed for recurrence of IDC in two patients. One patient who underwent completion pancreatectomy for recurrence of IDC survived 66/44 months after the first/second operation. Repeated pancreatectomy should be performed for patients with pancreatodigestive anastomotic stricture to preserve remnant pancreatic function and for patients with neoplasm or pancreatic duct dilatation after PD for IPMN, and repeated pancreatectomy for recurrence of IDC might be indicated for selected patients.

The wireless power transfer (WPT) system has been actively developed in recent years. Since the electromagnetic field leaked from the WPT system may cause a false operation of other electronic devices, an analysis of the leaked electromagnetic field is significant issue for its practical realization. This paper presents that the electromagnetic field leaked from the WPT system installed in a case-study house is evaluated in the measurement and simulation. The WPT leakage emulator that can generate the electromagnetic field leaked from the WPT system is used in the measurement. The suitable calculation algorithms with respect to three frequency bands that cover the high-harmonic component of the leaked electromagnetic field are applied for the simulation. Moreover, the significant improvement of the simulation speed is achieved using the supercomputer. The evaluation results of the leaked electromagnetic field distributions at four positions in the case-study house show the validity of the simulation compared with the measurement.

Much of the immune system is situated in the gastrointestinal tract.1–4 Disruption of gut barrier function and intestinal microbial imbalance can result in systemic inflammation and ultimately induce septic complications after surgery.5–7 Despite improvements in surgical techniques and refinements in perioperative care, the high incidence of postoperative infectious complications in patients undergoing hepatobiliary resection for biliary cancer remains a major problem.8–12 Enteral feeding is one effective treatment among several strategies aiming to minimize postoperative septic complications concerning bacterial translocation.13–15 A recently proposed refinement of enteral feeding suggests dietary supplements including probiotics and prebiotics as having have a potential to prevent bacterial translocation.16–19 Probiotics, viable bacteria that benefit the host by improving intestinal microbial balance, now are used widely in food supplements.20 Prebiotics are nondigestable food constituents that selectively alter growth or activity of one or a limited number of bacterial species in the colon in a manner that potentially improves the health of the host.20–22 Used in combination, probiotics and prebiotics are called synbiotics.22 While synbiotic combinations are considered to have beneficial effects on human health, their clinical value in surgical patients remains unclear given a paucity of applicable clinical studies.23–25 We recently assessed clinical usefulness of synbiotics in biliary cancer patients who underwent hepatobiliary resection, finding that postoperative synbiotic administration reduced infectious complications after hepatectomy, mainly by correcting an intestinal microbial imbalance.26 Based on this observation, we hypothesized that additional preoperative administration of synbiotics should reduce infectious complications still more effectively. The present prospective randomized study was designed to investigate the effect of preand postoperative administration of synbiotics on intestinal permeability, integrity, immune responses, systemic inflammatory responses, and microflora, as well as surgical outcome, in a clinical setting.

Background Although dilated cardiomyopathic hamsters (TO-2) with mutation of the δ-sarcoglycan gene exhibit histological features of muscular dystrophy, it remains to be elucidated whether both myocardium and skeletal muscle are injured in a similar manner. Methods and Results The progression of myolysis in both myocardium and skeletal muscle were assessed biochemically and pathologically in TO-2 and F1B control hamsters. Left ventricular (LV) function was assessed by echocardiography and cardiac catheterization. Both the plasma concentration of cardiac troponin T and the plasma activity of α-hydroxybutyrate dehydrogenase (HBD) peaked at 8 weeks of age, and thereafter reduced greatly in TO-2 hamsters. Activity of creatine kinase (CK) in TO-2 hamsters was significantly greater than in controls throughout the observation period. Pathological findings of both nuclear chain and central nuclei in skeletal muscles were observed in TO-2 hamsters throughout the observation period, suggesting regeneration. LV dysfunction was first evident at 8 weeks of age and deteriorated thereafter in TO-2 hamsters. Treatment of TO-2 hamsters with diltiazem from 5 to 8 weeks of age could avert the LV functional deterioration and the increment in α-HBD activity, but CK activity was unchanged. Conclusions Despite myolysis in skeletal muscle occurring consistently throughout the observation period, cardiac myolysis occurred predominantly in the early phase. These initial cardiac events might involve coronary spasm and/or calcium overload in the myocardium. (Circ J 2006; 70: 1497 - 1502)

Background Total parental nutrition (TPN) meets the metabolic needs of postoperative patients, but introduces potential complications, including intestinal mucosal atrophy. Surgical advances have increased the certainty of esophagoenteric anastomosis making early oral enteral feeding after surgery feasible. The objective of the current report is to compare the benefits of enteral nutrition (EN) and TPN in patients undergoing total gastrectomy for gastric cancer. Methods Forty-two patients who underwent total gastrectomy for gastrtic cancer were randomized to receive oral EN beginning on postoperative day (POD) 3 with peripheral supplements or TPN beginning on POD 3. Serum concentrations of albumin and retinol-binding protein (RBP) as nutritional parameters and diamine oxidase (DAO) activity, an enzyme reflecting mucosal integrity, were measured preoperatively and 1, 4, 7, and 14 days postoperatively and compared between the 2 groups. Complications, abdominal symptoms, duration of hospital stay, and treatment cost per hospitalization were also compared. Results Albumin and RBP concentrations changed little in either group. DAO activity decreased in both groups and recovered within 1 week in the EN group but not in the TPN group. Complications were similar in the 2 groups. Treatment cost was less and length of hospital stay was shorter in the EN group. Conclusions EN is an efficient way to provide nutrition to patients and possibly prevent intestinal atrophy in the patient who must endure prolonged postoperative fasting. Compared to TPN, EN reduces treatment cost and hospital length-of-stay.

Purpose: This study was designed to clarify the change of the cytokine levels in acute pancreatitis (AP), and investigate the concern over the cytokine storm in AP with its course of inflammatory attack, as well as the effect of continuous arterial infusion therapy (CAI). Subjects and methods: Twenty-seven patients with AP were subjected during latest 3 years. The serum cytokines were determined before and after the treatment. Results: (1) In all subjects, high levels pro-inflammatory cytokines (IL-6, IL-8) were observed at the day of admission. However, after receiving the intensive treatments, IL-6, IL-8 levels tended to decline. (2) According to the severity of AP, the levels of IL-6 and IL-8 in severe cases were significantly higher than those in moderate and mild cases. (3) In five severe cases with infections, renewed rising of serum IL-6 was observed. (4) Abnormally heightened IL-10 (anti-inflammatory cytokine) was observed in complicated cases with infections. (5) The serum IL-6 was decreased immediately in severe cases after CAI, more rapidly than those without CAI. Conclusions: High levels of cytokines resumed in most cases of AP; when inflammation occurred, cytokine storm was suddenly observed. These molecules appear to be valuable markers of severity and effects of CAI.

A referred cohort of 67 clinically defined PPA patients were compared to 99 AD patients with formal language and nonverbal cognitive tests in a case control design. Language fluency was determined at the first and last follow up visits. Quantitation of sulcal and ventricular atrophy on MRI was carried out in 46 PPA and 53 AD patients. Most PPA patients (57%) are relatively fluent when first examined. Visuospatial and memory functions are initially preserved. Aphemic, stuttering, “pure motor” presentation, or agrammatic aphasia are seen less frequently. Later most PPAs become logopenic and nonfluent, even those with semantic aphasia (dementia). In contrast, AD patients were more fluent and had relatively lower comprehension, but better overall language performance. MRI showed significant left sided atrophy in most PPA patients. Subsequent to PPA, 25 patients developed behavioral manifestations of frontotemporal dementia and 15 the corticobasal degeneration syndrome, indicating the substantial clinical overlap of these conditions. Language testing, particularly fluency scores supported by neuroimaging are helpful differentiating PPA from AD. The fluent–nonfluent dichotomy in PPA is mostly stage related. The aphemic-logopenic-agrammatic and semantic distinction is useful, but the outcomes converge. (JINS, 2003, 9, 710–719.)