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The patient was a 76-year-old man who had 3 times previously undergone laparotomies, including distal gastrectomy with a Billroth Ⅰ operation. In the current case, a total gastrectomy, end-to-side esophagojejunostomy, and a Roux-en-Y anastomosis for adenocarcinoma of the remnant stomach were performed. On postoperative day (POD) 7, he complained of epigastralgia. Abdominal CT revealed a markedly dilated duodenum, and a diagnosis of acute afferent loop obstruction was made. Emergency endoscopy revealed edematous stenosis of the Y-anastomotic site. A nasal endoscope could not pass the stricture, but an endoscopic nasobiliary drainage (ENBD) catheter was successfully inserted into the duodenum. Epigastralgia decreased after drainage. Stenosis of the Y-anastomotic site was still observed 18 days after onset; therefore, we inserted 1 endoscopic retrograde biliary drainage (ERBD) tube, in addition to the ENBD catheter. Twenty-five days after onset, slight improvement of the stenosis was observed. By inserting 2 more ERBD tubes, the ENBD catheter could be removed. On day 28, abdominal CT revealed reduced dilatation of the duodenum. On day 29, oral intake was initiated, and the patient was discharged from the hospital on POD 66. During the early post-operative phase, the use of nasal endoscope drainage is an effective, minimally invasive, and safe procedure for decompression of the duodenum in afferent loop obstruction.

Closure of post-endoscopic submucosal dissection (ESD) duodenal artificial ulcer is not common in the clinical setting. We consider that post-ESD ulcer closure by an over-the-scope-clip (OTSC) method is one of the most effective ways to prevent delayed perforation. We report here two cases of mucosal duodenal cancer in a 65-year-old woman and in a 78-year-old man. Pathological examinations of the resected specimens revealed well-differentiated adenocarcinomas. In these two clinical cases, we successfully carried out complete closures of post-ESD duodenal ulcer using OTSC without any complications., (© 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.)

Although the hemodynamics during orthotopic liver transplantation is unstable, it is very important for new liver to get well-controlled hemodynamics. Thus hemodynamic changes were studied, especially in relation to the influence of anesthetic agents and bypass flow in orthotopic liver transplantation in pig. Hemodynamic changes associated with NLA, GOS (sevoflurane) and GOF anesthesia were evaluated. It was difficult to maintain arterial pressure and to recover cardiac output with NLA after the bypass was removed. GOS, with which the hemodynamic condition was best maintained and no hepatotoxicity was manifest, proved the most useful of the three anesthetic agents. Hemodynamic studies based on bypass flow were made by comparing two groups, a high flow (31 +/- 4ml/kg/min) and a low flow (19 +/- 2ml/kg/min) groups, following the bypass model study conducted by 20, 30 and 40ml/kg/min. flow rates with the fixed infusion speed. In the high flow group, cardiac output and pulmonary arterial pressure were better maintained during the anhepatic phase and at the removal of the bypass. It is estimated that the low flow group was within the limits permitted, but beyond safety limits, also from the bypass model study. It is suggested that approximately 30ml/kg/min was the appropriate flow rate in pig.

We have assayed both estrogen and androgen receptors in hepatocellular carcinomas, in the surrounding noncancerous liver tissue, and in normal liver tissue. Estrogen receptors (ERs) were detected in 5 out of 22 HCC tissues, 14 out of 22 surrounding noncancerous tissues, and in 5 out of 6 normal liver tissues. Androgen receptors (Ars) were detected in 4 out of 21 HCC tissues, in 7 out of 21 surrounding noncancerous tissues, and in 2 out of 5 normal liver tissues. These results suggest that the pathogenesis of some HCC may be dependent on estrogen or androgen. Hence, it may be beneficial to provide hormonal therapy for HCC, especially in cases that show high concentrations of ER and/or AR.