Early enteral feeding via gastrostomy accelerated jejunal anastomotic healing in comparison to parenteral feeding. This study clearly indicates that early oral feeding after upper gastrointestinal surgery leads to prompt anastomotic healing.
These results suggest that mechanical loading plays a key role in anastomotic healing. Further investigations are necessary to confirm this suggestion.
Background: Prevention of bile duct injury and vasculo-biliary injury while performing laparoscopic cholecystectomy (LC) is an unsolved problem. Clarifying the surgical difficulty using intraoperative findings can greatly contribute to the pursuit of best practices for acute cholecystitis. In this study, multiple evaluators assessed surgical difficulty items in unedited videos and then constructed a proposed surgical difficulty grading.
Methods:We previously assembled a library of typical video clips of the intraoperative findings for all LC surgical difficulty items in acute cholecystitis. Fiftyone experts on LC assessed unedited surgical videos. Inter-rater agreement was assessed by Fleiss's κ and Gwet's agreement coefficient (AC).Results: Except for one item ("edematous change"), κ or AC exceeded 0.5, so the typical videos were judged to be applicable. The conceivable surgical difficulty gradings were analyzed. According to the assessment of difficulty factors, we created a surgical difficulty grading system (agreement probability = 0.923, κ = 0.712, 90% CI: 0.587-0.837; AC 2 = 0.870, 90% CI: 0.768-0.972).
A 32-year-old Japanese woman was admitted to our hospital for the diagnosis and treatment of multiple liver tumors. She had been receiving 125 mg testosterone enanthate every 2 weeks following female-to-male gender identity disorder (GID) diagnosis at 20 years of age. Ultrasonography, computed tomography, and magnetic resonance imaging showed 11 hepatic nodular tumors with a maximum diameter of 28 mm. Liver tumors with hepatocellular adenoma (HCA) were diagnosed with needle biopsy. Segmentectomy of the left lateral lobe including two lesions, subsegmentectomy of S6 including two lesions, enucleation of each tumor in S5 and S7, and open surgical radiofrequency ablation for each tumor in S4 and S7 were performed. Immunohistochemical specimens showed that the tumor cells were diffusely and strongly positive for glutamine synthetase and that the nuclei were ectopically positive for β-catenin. Thus, the tumors were diagnosed as β-catenin-activated HCA (b-HCA). Transcatheter arterial chemoembolization plus subsequent radiofrequency ablation was performed for the 3 residual lesions in S4 and S8. Although testosterone enanthate was being continued for GID, no recurrence was observed until at least 22 months after the intensive treatments. HCA development in such patients receiving testosterone should be closely monitored using image inspection.
We reported a case of renal graft loss in cadaveric renal transplantation. An episode biopsy with renal dysfunction showed plasma cell predominant inflammatory infiltration in the interstitium without a finding of vascular or glomerular rejection, and was diagnosed as plasma cell-rich acute rejection (PCAR). Despite intensive immunosuppressive therapy, the renal histology of repeated biopsies showed persistent plasma cell infiltration and the graft was finally lost. Immunohistological staining and immunoglobulin gene rearrangement studies to estimate the clonality of inflammatory cells revealed that the infiltrating plasma cells were polyclonal in origin. Epstein-Barr virus was not detected by in situ hybridization. From these results, we excluded the possibility of post-transplant lymphoproliferative disorder (PTLD); however, a precise definition and differential diagnosis between PCAR and PTLD has not yet been fully determined. As therapeutic regimens for PCAR and PTLD are different, definite guidelines for diagnosis and treatments of PCAR need to be established.
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