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Pancreatic pseudocysts (PPs) often occur in association with acute pancreatitis or pancreatic trauma and are uncommon disorders in children. PPs require operative interventions in case they do not disappear spontaneously. There are several interventional treatments, and laparoscopic or endoscopic treatments have been recently reported as a less invasive procedure. However, these procedures are sometimes difficult to perform for small children. We describe a novel intragastric cystogastrostomy with mini-laparotomy for a 4-year-old female child. She presented with a PP caused by trauma. The PP failed to resolve after 6 weeks and we performed open cystogastrostomy. We made mini-laparotomy and inserted a wound retractor into the stomach and expanded both the abdominal and the gastric walls. This procedure created a good operative field and enabled intragastric cystogastrostomy even in small children. There were no complications. At 10-month postsurgery, a follow-up computed tomography showed no recurrence of PP. This novel intragastric cystogastrostomy for PP, which includes the insertion of a wound retractor, is a safe, minimally invasive, and technically feasible approach for younger children with PP. To the best of our knowledge, this is the first report to describe the intragastric cystogastrostomy with a wound retractor.

The intrarenal renin-angiotensin system (RAS) has many well-documented pathophysiologic functions in both blood pressure regulation and renal disease development. Angiotensin II (Ang II) is the major bioactive product of the RAS. It induces inflammation, renal cell growth, mitogenesis, apoptosis, migration, and differentiation. In addition, Ang II regulates the gene expression of bioactive substances and activates multiple intracellular signaling pathways that are involved in renal damage. Activation of the Ang II type 1 (AT1) receptor pathway results in the production of proinflammatory mediators, intracellular formation of reactive oxygen species, cell proliferation, and extracellular matrix synthesis, which in turn facilities renal injury. Involvement of angiotensinogen (AGT) in intrarenal RAS activation and development of renal disease has previously been reported. Moreover, studies have demonstrated that the urinary excretion rates of AGT provide a specific index of the intrarenal RAS status. Enhanced intrarenal AGT levels have been observed in experimental models of renal disease, supporting the concept that AGT plays an important role in the development and progression of renal disease. In this review, we focus on the role of intrarenal RAS activation in the pathophysiology of renal disease. Additionally, we explored the potential of urinary AGT as a novel biomarker of intrarenal RAS status in renal disease., Author(s): Maki Urushihara [sup.1] , Shoji Kagami [sup.1] Author Affiliations: (1) Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, 0000 0001 1092 3579, grid.267335.6, , Kuramoto-cho 3-18-15, [...]

For hereditary spherocytosis complicated by cholelithiasis, cholecystectomy is simultaneously performed with splenectomy. However, jaundice promptly disappears after removing the spleen, and the risk for recurrent cholelithiasis decreases in majority of cases; gallbladder-preserving cholecystolithotomy can be an option for such patients. We report a case of a 6-year-old boy with hereditary spherocytosis who was referred by a previous physician for the chief complaint of anemia (hemoglobin level, 7–8 g/dl). Abdominal ultrasound and CT revealed numerous small calculi in the spleen and gallbladder. The patient developed calculous cholecystitis twice. Hence, laparoscopic splenectomy and gallbladder-preserving cholecystolithotomy were simultaneously performed. The operating time was 2 h and 58 min, and the blood loss was 45 ml. No postoperative complication developed, and the patient was discharged 5 days after the operation. To date, i.e., a year after the operation, no recurrent cholelithiasis has been observed in the patient.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), severe drug reactions, are often misdiagnosed due to their rarity and lack of information on differential diagnosis. The objective of the study was to develop an electronic medical record (EMR)-based algorithm to identify patients with SJS/TEN for future application in database studies. From the EMRs of a university hospital, two dermatologists identified all 13 patients with SJS/TEN seen at the Department of Dermatology as the case group. Another 1472 patients who visited the Department of Dermatology were identified using the ICD-10 codes for diseases requiring differentiation from SJS/TEN. One hundred of these patients were then randomly sampled as controls. Based on clinical guidelines for SJS/TEN and the experience of the dermatologists, we tested 128 algorithms based on the use of ICD-10 codes, clinical courses for SJS/TEN, medical encounters for mucocutaneous lesions from SJS/TEN, and items to exclude paraneoplastic pemphigus. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) of each algorithm were calculated, and the optimal algorithm was defined as that with high PPV and maximal sensitivity and specificity. One algorithm, consisting of a combination of clinical course for SJS/TEN, medical encounters for mucocutaneous lesions from SJS/TEN, and items to exclude paraneoplastic pemphigus, but not ICD-10 codes, showed a sensitivity of 76.9%, specificity of 99.0%, PPV of 40.5%, NPV of 99.8%, and DOR of 330.00. We developed a potentially optimized algorithm for identifying SJS/TEN based on clinical practice records. The almost perfect specificity of this algorithm will prevent bias in estimating relative risks of SJS/TEN in database studies. Considering the small sample size, this algorithm should be further tested in different settings.

A motor shaft direct drive is known as a simple and low cost scheme for small toy vehicles, however the mechanism how it produces propelling force has not yet been explained nor discussed in detail. A trivial idea that a small dent is formed on the road surface just under the shaft end due to static weight takes us to the unexpected result. Brief calculus reveals that the propelling force vector of the system directs somewhat forward with respect to sagittal plane which includes motor shaft slant axis. It suggests that the motor alternative cw and/or ccw rotation generates gradual forward movement, i.e. the vehicle moves perpendicular direction with respect to that of right-left swinging motion. The forward motion is confirmed experimentally with single motor shaft direct drive vehicle, and also discussed in details.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease in which venous malformations (VMs) involve any body organ, most commonly the skin and the gastrointestinal (GI) tract. Treatment of BRBNS aims at preserving the GI tract as much as possible. Although there are several dozen case reports about BRBNS that describe short-term clinical courses, a few provide an account of long-term clinical course. Here, we report a case of BRBNS in a girl that required multiple abdominal surgeries due to the GI VMs and a recurrence at an interval of 14 years. The preferred approach for gastrointestinal VMs involves the complete resection of all lesions without residual VMs. It is important to bear in mind the possibility of delayed recurrence of GI VMs after surgical or endoscopic treatment.