VOLUME 76 NUMBER 3,4 August 2014

Current Issue

ISSN 2186-3326
(Online ISSN)
ISSN 0027-7622
(Print ISSN--v.72no.3/4)

Impact Factor(2019)
 0.762

Review Article

Metabolism of Iron Stores

HIROSHI SAITO
pg(s) 235 - 254

<Abstract> - < PDF >

Remarkable progress was recently achieved in the studies on molecular regulators of iron metabolism. Among the main regulators, storage iron, iron absorption, erythropoiesis and hepcidin interact in keeping iron homeostasis. Diseases with gene-mutations resulting in iron overload, iron deficiency, and local iron deposition have been introduced in relation to the regulators of storage iron metabolism. On the other hand, the research on storage iron metabolism has not advanced since the pioneering research by Shoden in 1953. However, we recently developed a new method for determining ferritin iron and hemosiderin iron by computer-assisted serum ferritin kinetics. Serum ferritin increase or decrease curves were measured in patients with normal storage iron levels (chronic hepatitis C and iron deficiency anemia treated by intravenous iron injection), and iron overload (hereditary hemochromatosis and transfusion dependent anemia). We thereby confirmed the existence of two iron pathways where iron flows followed the numbered order (1) labile iron, (2) ferritin and (3) hemosiderin in iron deposition and mobilization among many previously proposed but mostly unproven routes. We also demonstrated the increasing and decreasing phases of ferritin iron and hemosiderin iron in iron deposition and mobilization. The author first demonstrated here the change in proportion between pre-existing ferritin iron and new ferritin iron synthesized by removing iron from hemosiderin in the course of iron removal. In addition, the author disclosed the cause of underestimation of storage iron turnover rate which had been reported by previous investigators in estimating storage iron turnover rate of normal subjects.

Original Papers

Hypertension-Related Knowledge, Practice and Drug Adherence among Inpatients of a Hospital in Samarkand, Uzbekistan

AMONOV MALIK, YOSHITOKU YOSHIDA, TOIROV ERKIN, DAVLATOV SALIM, and NOBUYUKI HAMAJIMA
pg(s) 255 - 263

<Abstract> - < PDF >

Hypertension is one of the most important preventable causes of premature morbidity and mortality in the world. Many people with hypertension both in developing and developed countries have no adequate control of their blood pressure (BP). Hypertension-related knowledge and practice of patients play an important role in controlling hypertension and in preventing its long-term complications. The objective here was to study hypertension-related knowledge, practice and drug adherence of inpatients, and to examine an association between the knowledge regarding hypertension with BP control status and drug adherence. We studied hypertension-related knowledge, practice and drug adherence of patients in a hospital setting. A cross-sectional study was conducted among 209 patients with the diagnosis of primary hypertension at the Samarkand State Medical Institute. The study was conducted from June to September 2012. Drug adherence was studied using the Morisky 4-item self-report measure of medication-taking behavior. The reasons for drug non-adherence were assessed using a self-administered questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by a logistic model. The BP control rate and drug adherence of the patients were suboptimal (24.4% and 36.8%, respectively). Overall, 64.6% of patients had good or adequate and 35.5% had inadequate knowledge about hypertension. Good knowledge of patients was significantly associated with controlled BP (OR=5.4, 95% CI, 1.7–16.2) and drug adherence (OR=3.8, 95% CI, 1.4–10.8). In conclusion, the inpatients of the secondary hospital had sufficient general knowledge about hypertension, but they had inadequate knowledge about specific issues such as treatment for and symptoms of hypertension. Both drug adherence and BP control rate were suboptimal and significantly associated with hypertension knowledge. This study specifies potential areas of hypertension education that could be improved by patients’ knowledge of hypertension.
Cardiac Counterclockwise Rotation is a Risk Factor for High-Dose Irradiation to the Left Anterior Descending Coronary Artery in Patients with Left-Sided Breast Cancer Who Receiving Adjuvant Radiotherapy after Breast-Conserving Surgery

HIDEKAZU TANAKA, SHINYA HAYASHI, and HIROAKI HOSHI
pg(s) 265 - 272

<Abstract> - < PDF >

Patients irradiated for left-sided breast cancer have higher incidence of cardiovascular disease than those receiving irradiation for right-sided breast cancer. Most abnormalities were in the left anterior descending (LAD) coronary artery territory. We analyzed the relationships between preoperative examination results and irradiation dose to the LAD artery in patients with left-sided breast cancer. Seventy-one patients receiving breast radiotherapy were analyzed. The heart may rotate around longitudinal axis, showing either clockwise or counterclockwise rotation (CCWR). On electrocardiography, the transition zone (TZ) was judged in precordial leads. CCWR was considered to be present if TZ was at or to the right of V3. The prescribed dose was 50 Gy in 25 fractions. The maximum (Dmax) and mean (Dmean) doses to the LAD artery and the volumes of the LAD artery receiving at least 20 Gy, 30 Gy and 40 Gy (V20Gy, V30Gy and V40Gy, respectively) were significantly higher in CCWR than in the non-CCWR patients. On multivariate analysis, TZ was significantly associated with Dmax, Dmean, V20Gy, V30Gy, and V40Gy. CCWR is a risk factor for high-dose irradiation to the LAD artery. Electrocardiography is useful for evaluating the cardiovascular risk of high-dose irradiation to the LAD artery.
Undergraduate Nursing Education to Address Patients’ Concerns about Sexual Health: The Perceived Learning Needs of Senior Traditional Four-Year and Two-Year Recurrent Education (Rn-Bsn) Undergraduate Nursing Students in Taiwan

LI-YA TSAI, CHENG-YI HUANG, FEN-FEN SHIH, CHI-RONG LI, and TE-JEN LAI
pg(s) 273 - 284

<Abstract> - < PDF >

The aims of this study were to identify learning needs among traditional four-year and two-year recurrent education (RN-BSN) undergraduate nursing students in Taiwan with regard to patients’ concerns about sexual health. A 24-item instrument (Learning Needs for Addressing Patients’ Sexual Health Concerns) was used to collect data. Compared to RN-BSN undergraduate nursing students, traditional four-year undergraduate nursing students had more learning needs in the aspects of sexuality in health and illness (2.19 ± 0.66 vs. 1.80 ± 0.89, P = 0.005) and approaches to sexual health care (2.03 ± 0.72 vs. 1.76 ± 0.86, P = 0.033). After adjustment for other variables by the backward selection approach, those with experience in assessing patient’s sexual functioning had fewer learning needs in sexuality in health and illness (β = –0.375, P = 0.001), communication about patient’s intimate relationships (β = –0.242, P = 0.031), and approaches to sexual health care (β = –0.288, P = 0.013); those who agreed that sexual health care was a nursing role also expressed greater needs to learn about these 3 aspects (all P < 0.01). Content related to sexuality in health and illness and approaches to sexual health care should be strengthened in the traditional undergraduate nursing curriculum in order to support sexual health related competence, build a positive attitude regarding sexual health care as a nursing role, and strengthen the experience of assessing patient’s sexual functioning. A different, simplified program may be more suitable for those with clinical experience.
Visualization of Brain White Matter Tracts Using Heavily T2-Weighted Three-Dimensional Fluid- Attenuated Inversion-Recovery Magnetic Resonance Imaging

MASAHIRO YAMAZAKI, SHINJI NAGANAWA, KIMINORI BOKURA, and HISASHI KAWAI
pg(s) 285 - 291

<Abstract> - < PDF >

The purpose of this study was to elucidate which white matter (WM)-tracts are visualized on heavily T2-weighted three-dimensional fluid-attenuated inversion-recovery (hT2w-3D-FLAIR) images. Records of seven patients who underwent hT2w-3D-FLAIR and diffusion tensor imaging (DTI) of the head at 3 Tesla were analyzed. Two neuroradiologists determined WM-tracts visualized on hT2w-3D-FLAIR and identified anatomical points through which they ran. A third neuroradiologist determined the WM-tracts running through those points on DTI. Correspondence between hT2w-3D-FLAIR and DTI WM-tracts was used to confirm technique validity. As a result, the corticospinal tract (CST), medial lemniscus (ML), and superior cerebellar peduncle (SCP) were visualized as high intensity on hT2w-3D-FLAIR and ran through the following points: CST, 20 mm lateral from the lateral margin of the third ventricle at the thalamic level; ML, 6 mm anterior to the anterior margin of the fourth ventricle at the trigeminal nerve level; and SCP, just lateral to the fourth ventricle at the trigeminal nerve level. The third neuroradiologist determined that the WM-tracts ran through those points on DTI in all patients. Consequently, WM-tracts determined on hT2w-3D-FLAIR and DTI completely corresponded. In conclusion, the CST, ML, and SCP were visualized as high intensity on hT2w-3D-FLAIR. This technique is a potentially supplemental DTI neurographic modality.
RhoF Promotes Murine Marginal Zone B Cell Development

MAYUKO KISHIMOTO, TAKENORI MATSUDA, SHOuGO YANASE, AKIRA KATSUMI, NOBUAKI SUZUKI, MAKOTO IKEJIRI, AKIRA TAKAGI, MASAHITO IKAWA, TETSUHITO KOJIMA, SHINJI KUNISHIMA, HITOSHI KIYOI, TOMOKI NAOE, TADASHI MATSUSHITA, and MITSUO MARUYAMA
pg(s) 293 - 305

<Abstract> - < PDF >

RhoF is a member of the Rho GTPase family that has been implicated in various cell functions including long filopodia formation, adhesion, and migration of cells. Although RhoF is expressed in lymphoid tissues, the roles of RhoF in B cell development remain largely unclear. On the other hand, other members of the Rho GTPase family, such as Cdc42, RhoA, and Rac, have been intensively studied and are known to be required for B cell development in the bone marrow and spleen. We hypothesized that RhoF is also involved in B cell development. To examine our hypothesis, we analyzed B cell development in RhoF knockout (KO) mice and found a significant reduction in marginal zone (MZ) B cells in the spleen, although T cell development in the thymus and spleen was not affected. Consistent with these results, the width of the MZ B cell region in the spleen was significantly reduced in the RhoF KO mice. However, the antigen-specific antibody titer of IgM and IgG3 after MZ B cell-specific antigen (T cell-independent antigen, type I) stimulation was not affected by RhoF deletion. Furthermore, we demonstrated that RhoF was dispensable for stromal cell-derived factor-1α- and B lymphocyte chemoattractant-induced B cell migration. These results suggest that RhoF promotes MZ B cell development in the spleen.
Combined Posterior-Anterior Surgery for Osteoporotic Delayed Vertebral Fracture with Neurologic Deficit

HIROAKI NAKASHIMA, YASUTSUGU YUKAWA, KEIGO ITO, MASAAKI MACHINO, NAOKI ISHIGURO, and FUMIHIKO KATO
pg(s) 307 - 314

<Abstract> - < PDF >

With the aging of society, osteoporotic thoracolumbar compression fracture is a concern. This fracture occurs occasionally; however, some cases progress to neural compromise due to delayed vertebral body collapse requiring surgery. Surgical treatment and postoperative care are difficult because of patients’ serious comorbidities and poor bone quality, and hence, optimum treatment is not clear, even though some surgical approaches have been reported. There were 35 consecutive patients (5 males and 30 females) with osteoporotic delayed vertebral fractures and associated neurological deficit. Mean age at surgery was 70.7 years (range 60–84 years). Average postoperative follow-up was 3.8 years (range 0.6–11.3 years). All patients experienced a single vertebra collapse, except for 1 with a 2-level collapse of lumbar vertebrae. One thoracic (Th7), 19 thoracolumbar (Th12-L1), and 16 lumbar (L2-5) fractures were treated with combined posterior-anterior surgery. The American Spinal Injury Association (ASIA) impairment scale, activities of daily living (ADL) status, and local sagittal angle were evaluated both before and after surgery. Forty-six percent of all patients showed an improvement of more than 1 grade postoperatively on the ASIA impairment scale, and 74% demonstrated an improvement in ADL status. No deterioration was observed in neurological or ADL status after surgery. With regard to sagittal alignment, preoperative kyphosis of 18.4 degrees was corrected to 2.4 degrees of kyphosis postoperatively. However, 11.5 degrees loss of correction was observed at final follow-up observation. Combined posterior-anterior surgery could provide reliable improvement in both neurological and ADL status, although maintenance of postoperative alignment was difficult to achieve in some cases.
An Awareness Survey of Surgeons Involved in Breast Cancer Treatment Regarding Their Patients Returning to Work

KAZUHISA AKAHANE, NOBUYUKI TSUNODA, TORU MURATA, MASAHIRO FUJII, YOSHITAKA FUWA, KOJI WADA, KOJI ODA, and MASATO NAGINO
pg(s) 315 - 322

<Abstract> - < PDF >

Surgeons focus on the period of absence from work during the initial treatment of breast cancer. The aim of this study was to determine surgeons’ perceptions and awareness regarding the necessary period of absence from work during breast cancer treatment. We created a questionnaire for all surgeons involved in breast cancer treatment who are affiliated with the Department of Surgery at the Nagoya University Graduate School of Medicine and its associated facilities. The necessary leave of absence period for each treatment was considered, and the decision regarding whether patients should return to work was examined. The surgeons were instructed to assume that a ‘heavy load worker’ was a nurse or caregiver and that a ‘light load worker’ was a medical office worker. This study included 184 surgeons (response rate: 96.8%). More than half of the surgeons considered that light load workers could return to work within 2 weeks; 89.8% after conservative resection, 71.6% after total mastectomy, 50.3% after axillary dissection. In contrast, more than half of the surgeons considered that heavy load worker should wait returning to work more than 3 weeks; 49.4% after conservative resection, 73.3% after total mastectomy, 85.7% after axillary dissection. For patients treated with chemotherapy, three-quarters of the surgeons indicated that it would be difficult to work while receiving anthracycline regimens. The results suggest that surgeons can predict the approximate period of absence from work for patients who receive an initial treatment of breast cancer.
Involvement of Glial Activation in Trigeminal Ganglion in a Rat Model of Lower Gingival Cancer Pain.

KATSUNORI HIRONAKA, NORIYUKI OZAKI, HISASHI HATTORI, KENJIRO NAGAMINE, HIDEYUKI NAKASHIMA, MINORU UEDA, and YASUO SUGIURA
pg(s) 323 - 332

<Abstract> - < PDF >

Glial cells were investigated to elucidate their involvement in mechanisms underlying oral cancer pain. Squamous cell carcinoma (SCC-158) was inoculated into the lower gingiva of male Fisher rats. Pharmacological and immunohistochemical studies were performed to examine the roles played by TRPV1 and TRPV2 expressed in neurons and satellite glia in trigeminal ganglia (TG), and microglia and astrocytes in trigeminal spinal nucleus caudalis. Inoculation of SCC-158 into the lower gingiva induced marked mechanical allodynia in the whisker-pad skin area on days 16 through 28, and in the submandibular skin area on days 10 through 20. Cutaneous allodynia was diminished by systemic morphine administration. The number of TRPV1 and TRPV2-positive neurons in trigeminal ganglia increased in the medium and large cell groups on day 14 after tumor inoculation. The number of satellite glial cells encircling the medium and large trigeminal ganglion neurons increased on day 28 after tumor inoculation. In this gingival cancer pain model, microglia and astrocytes in trigeminal spinal nucleus caudalis were not activated, although they were reported to be activated in neuropathic and inflammatory pain models. These results suggest that TRPV1 and TRPV2 upregulation in trigeminal ganglion neurons may play an important role in inducing the mechanical allodynia observed in experimental models of oral squamous cell carcinoma. In addition, activation of satellite cells seems to be involved in the maintenance of mechanical allodynia, which could be the potential therapeutic target for oral cancer pain.

Short Communication

Associations between Body Mass Index and Serum Uric Acid Levels in a Japanese Population were Significantly Modified By Lrp2 rs2544390

SHINO SUMA, MARIKO NAITO, RIEKO OKADA, SAYO KAWAI, GUANG YIN, EMI MORITA, KENJI WAKAI, HIROTAKA MATSUO, and NOBUYUKI HAMAJIMA
pg(s) 333 - 339

<Abstract> - < PDF >

The genome-wide association study identified associations between the LRP2 polymorphism rs2544390 and serum uric acid (SUA) levels in a Japanese population. Our previous study on the LRP2 rs2544390 polymorphism identified an interaction between SUA and alcohol consumption. Here, we investigated an interaction with body mass index (BMI) using the same dataset. Subjects were 3,742 health checkup examinees (2,544 males and 1,198 females) aged 35–69 years. Those with the SLC22A12 258WW genotype, SLC2A9 rs11722228 C allele, and ABCG2 126QQ genotype and 141Q allele were selected for analysis to remove the strong influences of these genetic traits. In males, the odds ratio of BMI ≥25.0 relative to BMI <18.5 for hyperuricemia (SUA ≥7 mg/dL and/or under medication for hyperuricemia) was 6.58 (95% confidence interval [CI], 0.84–51.32) for CC, 10.08 (2.38–42.83) for CT, and 2.53 (0.54–11.78) for TT. The interaction was 0.59 (p=0.029) from the model including BMI (&t;25.0 and ≥25.0), genotype (CC/CT and TT), and the multiplicative interaction term between BMI ≥25.0 and the TT genotype. In females, the odds ratio of BMI ≥25.0 relative to BMI <18.5 for high SUA (≥5 mg/dL and/or under medication for hyperuricemia) was 6.35 (95%CI, 1.68–24.08) for CC, 4.55 (1.85–11.18) for CT, and 5.93 (1.97–17.90) for TT. The interaction term was significant in the opposite direction for females (OR=2.75, p=0.011). The association between BMI and SUA was therefore modified by the LRP2 polymorphism in this Japanese population.

Case Reports

The Surgical Treatment Method for an Adult Posttraumatic Thoracolumbar Kyphosis Patient with Osteogenesis Imperfecta

NORIMITSU WAKAO, MIKINOBU TAKEUCHI, MITSUHIRO KAMIYA, ATSUHIKO HIRASAWA, KATSUHISA KAWANAMI, KEIJI SATO, and MASAKAZU TAKAYASU
pg(s) 341 - 348

<Abstract> - < PDF >

Osteogenesis imperfecta (OI) is an inheritable bone disorder characterized by osseous fragility and ligamentous laxity. It is sometimes difficult to obtain bone union in patients with OI. The purpose of this report is to present a rare case of posttraumatic kyphosis due to a L1 burst fracture in a patient with OI, and to discuss how to treat it to achieve an adequate correction and circumferential fusion. The patient was a 29-year-old man with OI (Sillence type-IA) who had sustained an L1 fracture when he dived head first into a river. After 3 months of conservative therapy with a body cast, he showed disability at work because of his persistent low back pain and fatigue in his whole back. He showed no neurological disorder. Diagnostic imaging revealed localized kyphotic deformity at L1. Therefore, lumbar lordosis and thoracic kyphosis worsened. Anterior release and fusion, and posterior fusion were conducted. Three months after surgical treatment, circumferential fusion was obtained. His low back pain and fatigue in the whole back disappeared, and he could resume work without any difficulty. From the bone union standpoint, the surgical strategy for spinal correction in OI patients is still controversial because of the intractableness of bone union and fragility of the bone itself. The authors achieved circumferential union using anterior fusion and posterior fusion, in which wide bone bed is available owing to spared posterior elements of the spinal column.
Primary Cauda Equina Lymphoma: Case Report and Literature Review

HIROAKI NAKASHIMA, SHIRO IMAGAMA, ZENYA ITO, KEI ANDO, KAZUYOSHI KOBAYASHI, JUNICHI UKAI, AKIO MURAMOTO, RYUICHI SHINJYO, TOMOHIRO MATSUMOTO, IPPEI YAMAUCHI, AKIRA SATOU, and NAOKI ISHIGURO
pg(s) 349 - 354

<Abstract> - < PDF >

The central nervous system, in particular the spinal cord, is a rare site for primary lymphoma occurrence, with very few published cases. We report an extremely rare primary lymphoma in the cauda equina in a single case with literature review. An immunocompetent 59-year-old male, who complained of progressive low back and bilateral leg pain for 7 months, was studied. Magnetic resonance imaging (MRI) revealed an intradural space-occupying lesion from T12 to S1, poorly demarcated to the normal cauda equina. The intradural lesion showed T1 low intensity, T2 low isointensity, and marked homogeneous enhancement with gadolinium-diethylenetriaminepentaacetic acid on MRI. We performed spinal tap to obtain additional information about the intradural lesion. Large-sized atypical lymphoid cells were found during pathological examination. Fluorodeoxyglucose accumulation was found only in the lumbar area, which corresponded with the MRI findings, and the primary lymphoma site was defined as the cauda equina area. For further detailed pathological diagnosis, we performed surgical biopsy of the cauda equina. Morphological and immunohistochemical assessment made a diagnosis of diffuse large B-cell lymphoma of the cauda equina. The patient received radiotherapy to the lumbosacral area (50 Gy) and methotrexate (MTX) therapy after surgery. The patient was able to walk without help after the therapies. Follow-up MRI performed 1 year after biopsy showed remission of the lesion. MRI and spinal tap were effective tools for the early definitive diagnosis of cauda equina lymphoma. Combined treatment with radiotherapy and MTX should be performed as early as possible.
A Rare Case of Middle Ear Adenoma

MASAYO BAKU, and HIROMI UEDA
pg(s) 355 - 360

<Abstract> - < PDF >

Middle ear adenoma is a rare disease that is thought to originate in the middle ear mucosa. It occurs over a wide age range, has no gender predilection, and is not characterized by specific symptoms or findings. The most frequent complaints are unilateral hearing loss and ear fullness. We report a 48-year-old woman with middle ear adenoma who had a history of unilateral ear fullness and hearing loss on the left side. Middle ear adenoma was suspected following a biopsy performed under local anesthesia. To remove the tumor, the patient underwent a left postauricular canal wall-up tympanoplasty type IIIc. Microscopic examination and immunohistochemistry confirmed a middle ear adenoma. In this case, we diagnosed the lesion as middle ear adenoma with neuroendocrine differentiation on the basis of the pathological findings. The patient has shown no recurrence for almost 5 years, but since this adenoma showed neuroendocrine differentiation, long-term observation is required.
Limbic Encephalitis Associated with Relapsing Polychondritis Responded to Infliximab and Maintained its Condition without Recurrence after Discontinuation: A Case Report and Review of the Literature

TAKESHI KONDO, MAMIKO FUKUTA, AYUMU TAKEMOTO, YUICHIRO TAKAMI, MOTOKI SATO, NORIYUKI TAKAHASHI, TOMIO SUZUKI, JUICHI SATO, NAOKI ATSUTA, GEN SOBUE, YUKITOSHI TAKAHASHI, and NOBUTARO BAN
pg(s) 361 - 368

<Abstract> - < PDF >

Central nervous system (CNS) manifestations are rare complications of relapsing polychondritis (RP). The majority of patients respond well to glucocorticoid therapy, but need to maintain it. Some patients are refractory to initial glucocorticoid therapy and to additional immunosuppressants, and end up with an outcome worse than at therapy initiation. The standardized therapeutic protocol for this condition has not been established. The effects of anti-tumor necrosis factor (TNF) -α agents have been reported recently. We experienced a patient with RP and limbic encephalitis who was refractory to initial high-dose glucocorticoid, but subsequently responded to infliximab and did not show deterioration of signs and symptoms after stopping therapy. We report this case together with a systematic literature review. This is the first case report of RP with CNS manifestations successfully treated by an anti-TNF-α agent without recurrence after discontinuation.
Three Cases with Active Bleeding from Radiation Enteritis that were Diagnosed with Video Capsule Endoscopy without Retention

MASANAO NAKAMURA, YOSHIKI HIROOKA, OSAMU WATANABE, TAKESHI YAMAMURA, KAZUHIRO FURUKAWA, KOHEI FUNASAKA, EIZABURO OHNO, RYOJI MIYAHARA, HIROKI KAWASHIMA, TAKAFUMI ANDO, NAOKI OHMIYA, and HIDEMI GOTO
pg(s) 369 - 374

<Abstract> - < PDF >

Endoscopic exploration of the small bowel after pelvic radiation has limitations related to strong abdominal adhesion. It is often difficult to demonstrate the findings of radiation enteritis endoscopically, even with video capsule endoscopy (VCE) or double-balloon enteroscopy (DBE). We present our experience with three cases of radiation enteritis that were diagnosed using VCE and DBE, including their effective aspects. Radiation enteritis has not been diagnosed using conventional methods, and DBE may not accomplish deeper insertion into the ileum, although it is capable of both diagnosis and hemostasis. Therefore, VCE is thought to be the initial tool for the diagnosis of radiation enteritis when small bowel stenosis has not been previously detected and the risk of retention has been discussed.
Full-Thickness Small Intestine Necrosis with Midgut Volvulus, Distributed in a Patchy Fashion, is Reversible with Moderate Blood Flow: Resumption of Normal Function to Non-Viable Intestine

HIZURU AMANO, HIROO UCHIDA, HIROSHI KAWASHIMA, YUJIRO TANAKA, and HIROSHI KISHIMOTO
pg(s) 375 - 380

<Abstract> - < PDF >

Midgut volvulus is a highly life-threatening condition that carries a high risk of short gut syndrome. We report a case of catastrophic neonatal midgut volvulus in which second-look laparotomy revealed apparently non-viable remnant small intestine but with a moderate blood supply. Full-thickness small intestine necrosis was distributed in a patchy fashion, with non-viable and necrotic areas distributed so widely that no portion of the intestine could be resected. A section of full-thickness necrotic intestine preserved at surgery was able to regenerate, and normal function was restored over a period of 1 month. This case indicated that intestinal resumption may be dependent on blood flow. Even when intestinal viability is questionable, preservation enables the chance of regeneration if moderate blood flow is present.