Hyperosmolar hyperglycemic state secondary to neuroleptic malignant syndrome.

Neuroleptic malignant syndrome (NMS) is often considered to be a precipitating factor for diabetic coma, such as a hyperosmolar hyperglycemic state (HHS). The combination of NMS and a systemic illness such as HHS can be difficult to diagnose because NMS may mask the coexisting condition. Although this coexistence is rare, it may be fatal if not detected early.

[Nutritional support in various disease states. B. Nutritional support in severe infection].

Within one decade the concept of clinical nutritional support has changed. It was once thought that total parenteral nutrition was an all-purpose panacea, and then that role was played by enteral nutrition. Recently, however, immunonutrition has emerged as a new methodology for nutritional support.

Septic thrombophlebitis of the portal and superior mesenteric veins as a complication of appendicitis: report of a case.

Pylephlebitis is extremely rare and associated with high mortality, even in this modern era. It usually occurs secondary to infection in the region drained by the portal systems or in the structure contiguous to the portal vein. We report a case of septic thrombophlebitis of the portal and superior mesenteric veins (SMV) with multiple liver abscesses caused by acute appendicitis with an abscess of the mesoappendix.

Chronic outcome of proximal gastrectomy with jejunal pouch interposition in dogs.

Background: To prevent or minimize postgastrectomy complications, proximal gastrectomy with an interposed jejunal pouch has been advocated as an organ-preserving surgical strategy to improve quality of life for the patients. However, the utility of this surgical method has only been evaluated clinically and no reports have been published concerning animal studies. Therefore, we carried out an experiment in beagle dogs to investigate the utility of proximal gastrectomy with an interposed jejunal pouch.

Surgical influence on TH1/TH2 balance and monocyte surface antigen expression and its relation to infectious complications.

Malignancy and operation for it cause several alterations in immune function that are considered to be concerned with the development of infectious complications. Forty-three patients who underwent curative surgery for gastrointestinal malignancies were entered into this study and were divided into two groups, those with and those without postoperative infection. Changes in the proportion of Th1/Th2 subsets in CD4(+) T cells and the expression of human leukocyte antigen (HLA)-DR and CD16a molecules on monocytes were measured by flow cytometry before and after surgery.

Rapidly growing early gastric cancer with microsatellite instability.

A 77-year-old man underwent gastrointestinal endoscopy that revealed a small flat elevated lesion in the gastric antrum. Endoscopically, we assessed the tumor as intramucosal cancer or adenoma, and biopsy specimens were diagnosed as showing borderline malignancy. At the second examination, performed 6 months later, the elevated lesion had grown, showing remarkable changes in its appearance, and a diagnosis of adenocarcinoma was confirmed pathologically.

Evidence-based clinical practice guidelines for acute pancreatitis: proposals.

Background/purpose: To provide a framework for clinicians to manage acute pancreatitis, evidence-based guidelines have been developed by the Japanese Society of Abdominal Emergency Medicine.

Methods: Evidence was collected by a systematic search of MEDLINE and Japana Centra Revuo Medicina. A total of 1348 papers were reviewed and levels of evidence were assessed.

Obstructive jaundice due to internal herniation: a case report and review of the literature.

A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier.

Changes in serum levels of apolipoprotein A-1 as an indicator of protein metabolism after hepatectomy.

The clinical significance of serum apolipoprotein A-1 levels as an indicator of hepatic protein synthesis after hepatectomy was investigated. A total of 50 patients who had undergone hepatectomy at our department from 1997 to 1999 were selected for this study. The serum levels of apolipoprotein A-1, indocyanine green dye retention at 15 minutes, lectin-cholesterol acyltransferase, prealbumin, and high-density lipoprotein cholesterol were measured in these patients preoperatively and on postoperative days 7 and 14.