Isolated intrapancreatic Ig G4-related sclerosing cholangitis

Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is frequently associated with type 1 autoimmune pancreatitis(AIP). Association with AIP can be utilized in the diagnosis of Ig G4-SC. However, some cases of Ig G4-SC are isolated from AIP, which complicates the diagnosis. Most of the reported cases of isolated Ig G4-SC displayed hilar biliary strictures, whereas isolated Ig G4-SC with intrapancreatic biliary stricture is very rare. Recently, we have encountered 5 isolated intrapancreatic Ig G4-SC cases that were not associated with AIP, three of which were pathologically investigated after surgical operation. They all were males with a mean age of 74.2 years. The pancreas was not enlarged in any of these cases. No irregular narrowing of the main pancreatic duct was found. Bile duct wall thickening in lesions without luminal stenosis was detected by abdominal computed tomography in all five cases, by endoscopic ultrasonography in two out of four cases and by intraductal ultrasonography in all three cases. In three cases, serum Ig G4 levels were within the normal limits. The mean serum Ig G4 level measured before surgery was 202.1 mg/d L(4 cases). Isolated intrapancreatic Ig G4-SC is difficult to diagnose, especially if the Ig G4 level remains normal. Thus, this type of Ig G4-SC should be suspected in addition to cholangiocarcinoma and pancreatic cancer if stenosis of intrapancreatic bile duct is present.

Effects of dry and mist saunas on circulatory and thermoregulatory functions in humans

To test the hypothesis that mist sauna is a safer way of bathing than dry sauna, we compared changes in circulatory and thermoregulatory functions during 10 min sauna bathing in mist sauna at 40℃ with relative humidity of 100%, and in dry sauna by infrared ray at 70℃ with relative humidity of 15%. Subjects were seven healthy young men aged 29 ± 6 yrs (mean ± SD). We measured blood pressure, heart rate, skin temperatures at chest, forearm, thigh, and leg, tympanic temperature (Tty) by thermistors, skin blood flow at forearm by laser Doppler flowmetry, and sweat rate by ventilated capsule method at 1 min intervals throughout the experiment. Total sweating and change of hematocrit were also measured for dehydration analysis. Blood pressure was elevated more and changes in heart rate and total sweating were larger in dry sauna than mist. A significant hematocrit increase was observed in dry sauna bathing only. Mean skin temperature and Tty in dry sauna were elevated higher than those in mist. Heat stress of the dry sauna may be stronger than that of the mist, leading to dehydration and hypovolemia by sweating. Percent plasma volume loss was significantly larger in the dry than mist sauna. Changes in skin blood flow and sweat rate/Tty during mist sauna were significantly larger than those during dry sauna bathing despite heat stress of the mist sauna. The mist sauna bathing may thus be safer physiologically, and provide more effective vascular dilatation and sweating than the dry sauna bathing.