Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013.

Background: The Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC.

Extreme dilatation of the interposed jejunal pouch after proximal gastrectomy associated with portal venous gas: A case report.

Introduction: The jejunal pouch interposition (JPI) after proximal gastrectomy (PG) was proposed as a reconstructive procedure to provide a gastric reservoir substitute and prevent postgastrectomy syndrome. However, food residue remaining in some of the pouches resulted in the adverse effect of abdominal bloating, thereby body weight loss. Here, we report a rare case with an extreme dilation of the interposed jejunal pouch (JP) 8 years after PG, requiring pouch resection.

Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.

Background: The Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial.

Methods: Sixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy (group A) and non-difficult cholecystectomy (group B). Patients who had one of these conditions were placed in group A: 1) conversion from laparoscopic to open cholecystectomy; 2) subtotal cholecystectomy and/or mucoclasis; 3) necrotizing cholecystitis or pericholecystic abscess formation; 4) tight adhesions around the gallbladder neck; and 5) unsuccessfully treated using PTGBD.

E-PASS comprehensive risk score is a good predictor of postsurgical mortality from comorbid disease in elderly gastric cancer patients.

Background And Objectives: The long-term prognosis of elderly gastric cancer patients is poor because of the cancer and unrelated comorbidities. We investigated the risk factors for mortality after gastrectomy to aid surgeons in deciding the correct operative procedure for elderly gastric cancer patients.

Methods: A total of 414 gastric cancer patients surgically treated between 2002 and 2012 were divided into two groups A (≥75 years) and B (<75 years).

[A case of liver cirrhosis due to non-alcoholic steatohepatitis complicated by myotonic dystrophy].

A female in her 50s with a four-year history of myotonic dystrophy was admitted to our hospital with hematochezia. She was diagnosed with synchronous colonic cancer of the transverse and sigmoid colon, for which she underwent partial transverse and sigmoid colectomy, respectively. Postoperative respiratory failure resulted in prolonged stay in the intensive care unit.

[A case of huge papillary adenocarcinoma of the gallbladder with marked necrosis].

A 71-year-old woman was admitted to our hospital for evaluation of a right upper abdominal tumor. A contrast-CT scan demonstrated a huge tumor extending from the hepatic hilum to the pelvic space. The rim of tumor was enhanced.

Criteria for the glucagon provocative test in the diagnosis of gastrinoma.

Introduction: The glucagon provocative test is useful for the diagnosis of gastrinoma. The aim of this study was to determine the criteria for the glucagon provocative test.

Methods: This study reviewed 8 patients that underwent the glucagon provocative test preoperatively and in whom the diagnosis was confirmed as gastrinoma histologically.

Role of selective arterial secretin injection test in treatment of gastrinoma.

Background/aims: To study whether use of the selective arterial secretin injection test increased the rate of tumor localization and curative resection in patients with gastrinoma.

Methodology: Nine patients with gastrinoma were divided into 2 groups, before and after introduction of selective arterial secretin injection test; 4 patients before 1987 (Group 1) and 5 patients after 1988 (Group 2). Clinical results were compared retrospectively between groups.

Aldosterone enhances 11beta-hydroxysteroid dehydrogenase type 2 expression in colonic epithelial cells in vivo.

Objective: [corrected] 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) metabolizes glucocorticoids, thus enabling aldosterone to bind to the mineralocorticoid receptor. However, little is known about the regulatory mechanism of epithelial 11beta-HSD2 expression in the gut.

Materials And Methods: Sprague-Dawley rats were maintained on a sodium-depleted diet or subjected to continuous aldosterone infusion for 4 weeks.

Renal expression of the essential genes associated with sodium transport following a total proctocolectomy in rats.

The water and electrolyte balance is regulated by the renin-angiotensin-aldosterone system in the kidney. We previously reported that the levels of circulating aldosterone dramatically increased following a total proctocolectomy in rats. However, there is no direct evidence regarding whether renal adaptation is accelerated by the induction of aldosterone-associated molecules.

Comparative study of epithelial gene expression in the small intestine among total proctocolectomized, dietary sodium-depleted, and aldosterone-infused rats.

We previously demonstrated enhanced plasma aldosterone, ileal activation of epithelial sodium channel (ENaC), and induction of 11 beta-hydroxysteroid dehydrogenase type 2 after total proctocolectomies in rats. However, factors other than circulating aldosterone may cause molecular induction associated with sodium transport. Sprague-Dawley rats were treated with sodium-deficient diets or subcutaneous aldosterone infusion for 4 weeks.

Induction of 11beta-hydroxysteroid dehydrogenase type 2 and hyperaldosteronism are essential for enhanced sodium absorption after total colectomy in rats.

Background: Patients who undergo total colectomy with ileopouch anal reconstruction often have persistent diarrhea and frequent bowel movements. Analysis of the intestinal adaptation after total colectomy may lead to developing novel therapies for postoperative diarrhea.

Methods: Sprague-Dawley rats underwent total colectomy with ileoanal reconstruction and were sacrificed 4 and 8 weeks later.

Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial.

The aim of the present study was to compare in a prospective, multicenter trial the results early and late after pylorus-preserving gastrectomy (PPG) versus conventional distal gastrectomy (CDG) with Billroth I anastomosis for early gastric cancer. Eighty-one patients with early gastric cancer were randomized and then underwent either PPG or CDG. Duration of operation, intraoperative blood loss, days until removal of the nasogastric tube, days until start of oral intake, and decrease in body weight were studied as parameters for outcomes early after the surgery.

Effect of ileo-jejunal transposition on ileal longitudinal smooth muscle contractility in vitro in rats.

The aim of the present paper was to study the effects of ileo-jejunal transposition (IJT) on ileal contractile activity in vitro in rats. Male Sprague-Dawley rats were divided into three groups: control, IJT, and sham. In rats with IJT, the distal ileum was interposed isoperistaltically into the proximal jejunum.

In vivo induction of prostasin mRNA in colonic epithelial cells by dietary sodium depletion and aldosterone infusion in rats.

Background: Parallel induction of prostasin, a novel serine protease, together with epithelial sodium channel (ENaC) in the colon, may be essential for physiological response to increased circulating aldosterone. The aim of the present study was to investigate whether aldosterone induces prostasin mRNA in parallel with enhanced expression of ENaC in colonic epithelial cells.

Methods: Sprague-Dawley rats were maintained on a sodium-depleted diet or subjected to continuous aldosterone infusion up to 4 weeks.

Long-term bile diversion enhances basal and duodenal oleate-stimulated pancreatic exocrine secretion in dogs.

There have been no previous reports whether long-term bile diversion enhances pancreatic exocrine secretion. The aim of this study was to elucidate the effect of long-term bile diversion on pancreatic exocrine secretion. Four mongrel dogs were prepared for chronic gastric and pancreatic fistulas and received intraduodenal sodium oleate infusion (controls).

New reconstructive procedure after intestinal resection for Crohn's disease: modified side-to-side isoperistaltic anastomosis with double Heineke-Mikulicz procedure.

Although side-to-side isoperistaltic anastomosis is a useful strictureplasty technique when long segments of intestinal stenosis complicate Crohn's disease, concerns have been raised regarding disease recurrence adjacent to the anastomosis. We performed side-to-side isoperistaltic anastomosis without spatulated intestinal ends as a method of reconstruction after intestinal resection for Crohn's disease; both intestinal ends were transversely closed like a Heineke-Mikulicz-type strictureplasty. With this procedure, the luminal diameter proximal and distal to the anastomosis became wider than the original diameter of the intestine.

Effect of intra-arterial cisplatin on multiple liver metastases from rectal cancer associated with ulcerative colitis.

We report a patient with synchronous multiple liver metastases from rectal cancer associated with ulcerative colitis. Because the liver tumors were unresectable, we performed total proctocolectomy and hepatic intra-arterial cisplatin infusion with systemic oral administration of fluorouracil. A complete response was obtained.

Octreotide in control of multiple liver metastases from gastrinoma.

The somatostatin analogue octreotide was effective in controlling systemic effects related to multiple liver metastases from a gastrinoma. A 61-year-old man underwent distal gastrectomy for gastrinoma in the duodenum, because a curative resection was not feasible due to metastases found in paraaortic lymph nodes during operation. Multiple liver metastases, associated with an increase in serum gastrin concentration, were found by magnetic resonance imaging 16 months after the operation.

Increased expression of HIP/PAP and regenerating gene III in human inflammatory bowel disease and a murine bacterial reconstitution model.

Although microorganisms play a role in gut inflammation, it remains uncertain which epithelial genes are expressed in response to luminal flora and whether these molecules are also involved in pathologic mucosal inflammation. Germ-free mice were orally challenged with a bacterial suspension prepared from conventionally housed mice (bacterial reconstitution). Thereafter, the differential gene expression in gut epithelial cells was identified by differential display.

Measurement of phosphatidylcholine hydroperoxide in mild ischemia-reperfusion injury in rat intestine.

In the pathogenesis of intestinal ischemia-reperfusion injury, the measurement of lipid peroxides needs to be established. Sprague-Dawley rat intestines were assessed after 30 minutes of occlusion of the superior mesenteric artery followed by reperfusion at 30, 60, 120, 180, 360 minutes. Grade of the mucosal injury, accumulation of the activated neutrophils and ICAM-1 expression were transiently increased after reperfusion.

Surgical treatment of chronic intestinal pseudo-obstruction: report of three cases.

We report the cases of three patients with chronic intestinal pseudo-obstruction (CIP) whose quality of life (QOL) was improved by palliative surgery in combination with home parenteral nutrition (HPN). Loop enterostomy and shortening of the gastrointestinal tract was performed with good results in all three patients to relieve abdominal distension that was progressive despite treatment with prokinetic drugs. Oral intake was also improved after surgical treatment in one patient who underwent massive resection of the jejunoileum.

Intraileal capsaicin inhibits gastrointestinal contractions via a neural reflex in conscious dogs.

Background & Aims: The aim of the present study was to determine the effect of intraileal administration of capsaicin on gastrointestinal motility.

Methods: Mongrel dogs equipped with strain gauge force transducers on the stomach, small intestine, and colon were used. We studied the effects of intraileal capsaicin on gastrointestinal contractions with or without pharmacologic antagonists.