Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy

A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

Regulating migration of esophageal stents-management using a Sengstaken-Blakemore tube:A case report and review of literature

Stent migration, which causes issues in stent therapy for esophageal perforations, can counteract the therapeutic effects and lead to complications. Therefore, techniques to regulate stent migration are important and lead to effective stent therapy. Here, in these cases, we placed a removable fully covered self-expandable metallic stent(FSEMS) in a 52-year-old man with suture failure after surgery to treat Boerhaave syndrome, and in a 53-yearold man with a perforation in the lower esophagus due to acute esophageal necrosis. At the same time, we nasally inserted a Sengstaken-Blakemore tube(SBT), passing it through the stent lumen. By inflating a gastric balloon, the lower end of the stent was supported. When the stent migration was confirmed, the gastric balloon was lifted slightly toward the oral side to correct the stent migration. In this manner, the therapy was completed for these two patients. Using a FSEMS and SBT is a therapeutic method for correcting stent migration and regulating the complete migration of the stent into the stomach without the patient undergoing endoscopic rearrangement of the stent. It was effective for positioning a stent crossing the esophagogastric junction.

Surgical treatment for abdominal actinomycosis: A report of two cases

Since actinomycosis sometimes causes an abdominal tumor which mimics malignancy, treatment strategy varies from case to case. We herein report two cases which were treated with a combination of antibiotics and surgical intervention. Both patients presented with an intra-abdominal tumor lesion mimicking malignant disease after an appendectomy for acute appendicitis. Case 1 received surgical extirpation of the abdominal tumor in the liver and kidney twice since the clinical diagnosis of actinomycosis was not made. In contrast, case 2 was successfully treated by a combination of antibiotics and laparoscopic surgery following the experience of case 1. When a high probability diagnosis can be made, a laparoscopic approach is a useful and effective option to treat this condition.

Investigation of Patients with Spontaneous Rupture of the Urinary Bladder

Non-traumatic rupture of the urinary bladder is termed “spontaneous rupture of the urinary bladder”. Although this disorder is relatively rare, when the bladder ruptures into the abdominal cavity, urine leaking into the abdominal cavity leads to the development of urinary peritonitis. We encountered seven patients with spontaneous rupture of the urinary bladder at our institution between 1987 and 2012. Six of these patients were women, all of whom had undergone surgery and radiotherapy to treat malignant uterine tumor. All seven patients suddenly developed abdominal pain and ascites. Urea nitrogen (UN) and creatinine (Cre) levels were greater in ascites than in the blood in all patients. Although all patients were treated conservatively, recurrence was identified in three patients. Recurrence was observed in only one of the four patients who received hyperbaric oxygen therapy. Conclusion: Hyperbaric oxygen therapy may be effective for recurrence of spontaneous rupture of the urinary bladder.

A Case of Multiple Hemorrhagic Gastric Ulcers Developed via a Mechanism Similar to Water-Immersion Restraint Stress

In rats, water-immersion restraint stress is a model of experimental ulceration. We encountered a case in which multiple hemorrhagic gastric ulcers formed in the stomach in a setting similar to water-immersion restraint stress. The patient was a 54-year-old man who was found wet on a riverbank and transported by ambulance. Because of hypothermia and renal failure, hemodialysis was performed. Tarry stools were noted and endoscopy revealed the presence of multiple hemorrhagic gastric ulcers;thus, hemostasis was performed end oscopically. During the course, pseudo membranous colitis also developed and was ameliorated with vancomycin. Further, the renal failure and gastric ulcers improved, and the patient was discharged from hospital 25 days later. The reason why he survived more than 2 weeks was the hot summer season and he was not soaked in the river water throughout.

A Study of Mallory-Weiss Syndrome Secondary to Upper Gastrointestinal Bleeding

Background: In Mallory-Weiss Syndrome (MWS), vomiting causes the mucous membrane and submucosa near the esophagogastric mucosal junction to tear and bleed. Thus, MWS can arise after heavy drinking and as a complication of endoscopic upper gastrointestinal examinations or procedures. However, there has been no report of MWS secondary to upper gastrointestinal bleeding thus far. Case Subjects: Of 79 MWS cases over a 10-year period from 2002 to 2011, we identified and studied 6 cases, in which MWS was probably caused by another lesion causing upper gastrointestinal bleeding. Results: There were 2 cases, each of gastric ulcers, duodenal ulcers, and varicose veins. In 3 cases, MWS was discovered during treatment of the primary lesion and was simultaneously treated. In the other 3 cases, patients were treated for MWS according to endoscopic diagnosis, and the primary lesion was overlooked;in these cases, the primary lesion was identified and treated after the bleeding recurred. One patient with cirrhosis died of hepatic failure. Conclusion: Care should be taken when dealing with MWS because it can occur as a result of vomiting caused by hematemesis or as a complication of endoscopic examination and treatment. When assessing MWS, other hemorrhagic lesions may be overlooked.

The Significance of Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Use in Sudden Cardiac Death

Objectives: To investigate the relationship between the use of angiotensin converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) and hyperkalemia in patients diagnosed with sudden cardiac death. Methods: We examined oral ACE inhibitor or ARB use among cardiopulmonary arrest patients brought by ambulance to our emergency room during a 5-year period from January 2012 to December 2016. The cause of death was determined to be sudden cardiac death, despite temporary return of spontaneous circulation after starting cardiopulmonary resuscitation. Subjects were dichotomized into 2 groups, those taking and those not taking an ACE inhibitor or ARB. Variables determined retrospectively included serum potassium, estimated glomerular filtration rate as an index of kidney function and time from cardiopulmonary arrest to return of spontaneous circulation. The Mann-Whitney U-test was used to compare continuous data, and the chi-square test to compare categorical data between groups. The results are expressed as the median plus range. Statistical significance was assumed at p Results: Thirty-five patients met the inclusion criteria. The mean age was 77.1 years (range, 35 - 93 years), and there were 26 males and 9 females. Eleven subjects were ACE inhibitor or ARB users, and 24 were non-users. The serum potassium level was significantly higher in users than non-users (median, 6.2 mEq/L (range, 4.5 - 10.0) vs. 5.2 mEq/L (range, 3.6 - 8.3);p = 0.001). The estimated glomerular filtration rate was significantly lower in users than non-users (median, 25.1 mL/min/1.73 m2 (range, 4.6 - 60.3) vs. 46.9 mL/min/1.73 m2 (range, 19.8 - 97.1);p = 0.009). There was no significant difference in time from cardiopulmonary arrest to return of spontaneous circulation between the 2 groups (median, 24 minutes (range, 3 - 111) vs. 29 minutes (range, 10 - 54);p = 0.355). Conclusion: It is possible that hyperkalemia induced by ACE inhibitor or ARB use is a cause of sudden cardiac death, especially in patients with chronic kidney disease.

Endoscopic Hemostasis of Nonvariceal Gastrointestinal Bleeding

We investigated 2668 patients with non-variceal upper gastrointestinal bleeding and 660 patients with lower gastrointestinal bleeding treated between 1987 and 2011 in our hospital. Upper gastrointestinal bleeding was associated with gastric ulcer, duodenal ulcer, Mallory-Weiss syndrome, esophageal disease, and others. Endoscopic hemostasis was performed in approximately 67% of all cases with upper gastrointestinal bleeding and approximately 90% of cases with ulcer. The hemostasis success rate was over 90% for ulcer bleeding, and was also generally high for other diseases. The total number of patients with lower gastrointestinal bleeding was lower, with it being approximately 20% of those with upper gastrointestinal bleeding. Endoscopic hemostasis was performed in approximately 30% of the patients with lower gastrointestinal bleeding. The hemostasis success rate was generally high, but treatment switch to surgery or interventional radiology (IVR) was observed in some cases with colorectal diverticular bleeding.

Effect of Silver-Loaded Zeolite on the Susceptibility of <i>Escherichia Coli</i>Against Antibiotics

We investigated the effect of silver-loaded zeolite (Ag-Z) on antibacterial activity of some antibiotics against Es-cherichia coli against antibiotics. We treated the bacterial suspension of E. coli by Ag-Z to be the level which the decrease of viable cell count was not observed. Susceptibility test of E. coli treated with Ag-Z was carried out against four antibiotics with different mode of action. Apparent increase in susceptibility was found in the case of rifampicin, not in others. The result suggests that application of Ag-Z to ward environment might give a good outcome at the treatment with rifampicin and at the treatment for pathogenic microbe spread through the air, such as tubercle bacilli.

The East Japan Great Earthquake and Three Cases of Near-Drowning with Tsunami Due to the Earthquake

We encountered the Great East Japan Earthquake on March 11, 2011. The magnitude of the earthquake is 9.0 and it is one of the greatest from A.D. 1900 to now. The earthquake developed large tsunami and many people living on the pacific coast of east Japan died from lung disorder caused by near drowning with tsunami. We also encountered three cases of lung disorders caused by near drowning. All three were females, and two of them were old elderly. All segments of both lungs were involved in all the three patients, necessitating ICU admission and endotracheal intubation and mechanical ventilation. All three died within three weeks. In at least two cases, misswallowing of oil was suspected from the features noted at the time of the detection. Many bacteria were detected from the phlegm of two cases.

Electrochemical Analysis of the Redox State of Silver Contained in Antibacterial Material

Introduction of silver into some inorganic material causes the resulting mixture to have antibacterial activity. Here, we investigated the role of silver in the bactericidal activity of silver-loaded zeolite, by measuring the effects of silver-loaded zeolite on Escherichia coli cell viability under conditions in which the oxidation state of the silver was controlled electrochemically. Bactericidal activity was observed when the sweeping voltage between 0 and 0.7 V was applied to the silver electrode. When nitrogen gas bubbling or reactive oxygen scavengers were added to the experimental system, bactericidal activity decreased. These results indicated that the redox cycle, Ag0 Ag+, caused the dissolved oxygen to form reactive oxygen species.