Intraductal papillary mucinous neoplasm (IPMN) is a spectrum of neoplasia in the pancreatic duct epithelium characterized by cystic dilation of the main and/or branch pancreatic duct. According to the site of involvement IPMNs are classified into three categories, i.e., main duct type, branch duct type, and combined type. Most branch duct IPMNs are benign, whereas the other two types are often malignant. A large size of branch duct IPMN and marked dilation of the main pancreatic duct indicate the presence of adenoma at least. The additional existence of large mural nodules increases the possibility of malignancy in all types. Of recent interest is the relatively high prevalence of synchronous and/or metachronous malignancy in various organs, including the pancreas. The prognosis is favorable after complete resection of benign and noninvasive malignant IPMNs. Malignant IPMNs acquiring aggressiveness after parenchymal invasion necessitate adequate lymph node dissection. On the other hand, asymptomatic branch duct IPMNs without mural nodules can be observed without resection for a considerably long time. This review addresses available data, current understanding, controversy, and future directions.

We conclude that the size criteria (> or =30 mm) to predict malignancy proposed in the international consensus guidelines is appropriate and resection or meticulous follow-up using cytological examination and MPD dilatation is needed in patients with flat branch duct IPMNs.

Eye-hand coordination skill of the nondominant hand, but not the dominant hand, measured using the LAP Mentor was able to differentiate between subjects with different laparoscopic experience. This study also provides evidence of construct validity for eye-hand coordination skill on the LAP Mentor.

The mating type, allozyme genotypes of malic enzyme, glucose-6-phosphate isomerase and peptidase loci, and metalaxyl sensitivity of 336 Phytophthora infestans isolates collected in Korea, India, Taiwan, Indonesia, Thailand, Nepal, and China between 1992 and 1997 were determined. Only A1 mating type isolates were detected in India and Taiwan, and only A2 isolates in Korea and Indonesia, while both mating type isolates were detected in Thailand, Nepal, and China. The isolates from Korea, India, Taiwan, and Indonesia had a single allozyme genotype respectively, while the isolates from Thailand, Nepal, and China had two or three allozyme genotypes. Isolates that were highly resistant to metalaxyl were found in Korea, Indonesia, and China. All of the isolates from Taiwan and India, and some of the isolates from Thailand, Nepal, and northern and southern areas of China, belonged to the old population of P. infestans, which was predominant worldwide until the appearance of A2 isolates outside central Mexico. Some of the isolates from Thailand and Nepal were from new populations that have been discovered since the appearance of A2 isolates outside central Mexico. All of the isolates from Korea and Indonesia and most of the isolates from China belonged to two specific populations, which have been rarely detected elsewhere. The occurrence of these separate populations in Asia suggests that they followed a different migration pathway, or that they are better adapted to Asian conditions than to those elsewhere in the world.

The A2 mating type of Phytophthora infestans has been found in Japan. Oospores, within oogonia bearing amphigynous antheridia, were formed in a great abundance when compatible isolates were mated. When 207 isolates were tested for their mating types, 65 were A1, 141 were A2 and one was self-fertile in single culture. Both A1 and A2 isolates were detected among samples from many locations in Japan, but the A2 type was found to be predominant in all districts except Tohoku district. All A1 isolates except two were isolated from potato cultivars lacking R genes, while A2 isolates were isolated from a large number of cultivars having or lacking R genes. Most of the A2 isolates formed oospores in single aged cultures. There is a possibility that oospores have been formed in the fields of Japan.

The clinical course of patients with carcinoma of the pancreas, especially of the body-tail, remains dismal despite recent advances in diagnostic and therapeutic procedures. We present three case reports to evaluate the role of the Appleby operation in the treatment of pancreatic body-tail cancer. Care 1 was a 55-year-old Japanese woman who underwent the Appleby operation for mucinous cystadenocarcinoma of the body and tail of the pancreas invading the stomach, celiac axis, superior mesenteric and splenic arteries, and the splenic, superior mesenteric, and portal veins. Local recurrence and peritoneal dissemination with malignant ascites were found 7 months later and she died 10 months after the operation. Case 2 was a 61-year-old Japanese man who underwent the Appleby operation with 20 Gy radiation therapy for invasive ductal carcinoma of the body of the pancreas involving the celiac axis, common hepatic, splenic, and left gastric arteries, and the splenic vein. Peritoneal dissemination with malignant ascites was evident 5 months later and he died 14 months after the operation. Case 3 was a 50-year-old Japanese man who underwent the Appleby operation with 20 Gy radiation therapy for invasive ductal carcinoma of the body of the pancreas invading the stomach, splenic artery, celiac axis, and splenic vein. Multiple hepatic metastases were found 2 months later and the patient died 8 months after the operation. Based on our experience of these three cases, we conclude that the indications for the Appleby operation to treat locally advanced pancreatic body carcinoma are still limited because it does not improve quality of life or clinical outcome.

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