A case of branch duct origin of solid type pancreatic ductal carcinoma is presented. Stepwise tissue sections of an entire specimen, including the carcinoma area, and mapping, with special reference to the relationship between the main duct and the carcinoma area, were performed. Carcinoma cells of the branch duct showed intraductal spread with minimal stromal invasion. No carcinoma tissue was observed in the main duct. Therefore this case was considered to be of branch duct origin. The finding of histologically identified branch duct origin of solid type pancreatic ductal carcinoma indicates a distinct advantage to be gained by giving special attention to both the main and branch ducts when using image diagnosis for early detection of carcinomas, and may represent the first reported surgically resected case.
Background: To our knowledge this is the first report describing the relation between the form of the duodenal papilla and the pancreaticobiliary maljunction (PBM). Methods: The duodenal papilla was studied endoscopically in 46 patients with PBM and in 80 patients without PBM. Results: The duodenal papilla was classified into three types by three independent endoscopists. Conclusion: The oral protrusion of the duodenal papilla in patients with PBM was shorter or absent compared with the duodenal papilla in patients without PBM.
New diagnostic methods of endoscopic retrograde cholangiopancreatography using a balloon catheter (balloon ERCP) and endoscopic Oddi's sphincter manometry were employed and investigated in 31 patients with an anomalous pancreaticobiliary junction (APBJ). Balloon ERCP was more comfortable for the patients and provided better visualization than conventional ERCP because this procedure allows free postural movement due to withdrawal of the duodenoscope and provides for an additional injection of contrast medium, if necessary. Endoscopic manometric study demonstrated that 1) although the patients with APBJ had a longer common channel, the length of the Oddi's sphincter segment showing phasic wave activity was not different from that of the controls, 2) the anomalous junction was located beyond the Oddi's sphincter segment and showed no phasic wave activity. These findings suggest that contractions of Oddi's sphincter in patients with APBJ may contribute to reflux between the pancreatic and bile ducts, leading to various pathologic conditions associated with this anomaly. Our balloon ERCP and manometric Oddi's sphincter study demonstrated new diagnostic means for determining morphological and functional aspects of APBJ. (Dig Endosc 1996 ; 8 : 205‐208)
Abstract Meniscal degeneration is defined by semi-quantitative assessment of multiple histological findings and has been implicated in biomechanical dysfunction, yet little is known about its relationship with biological properties. This paper aimed to quantitatively evaluate degenerative findings in human meniscus to examine their relationship with gene expression and biomechanical properties, and to extract histological findings that reflect biological properties like gene expression and cytokine secretion. This study included lateral menisci of 29 patients who underwent total knee arthroplasty. The menisci were divided into six samples. For each sample, Pauli's histological evaluation and corresponding quantitative assessment (surface roughness, DNA content, collagen orientation, and GAG content) were performed, with surface roughness showing the highest correlation with the histological evaluation in a single correlation analysis (r = 0.66, p < 0.0001) and multivariate analysis ( p < 0.0001). Furthermore, surface roughness was associated with gene expression related to meniscal degeneration and with tangent modulus which decreases with increasing degeneration (r = − 0.49, p = 0.0002). When meniscal tissue was classified by surface integrity, inflammatory cytokine secretion tended to be higher in severe degenerated menisci. These results suggest that the evaluation of meniscal surface texture could predict the degree of degeneration and inflammatory cytokine secretion.
Background: Pancreatic juice flows into the duodenum via two pancreatic ducts including Wirsung's duct (main pancreatic duct) and Santorini's duct (accessory pancreatic duct). In contrast to Wirsung's duct, the precise anatomy and functions of Santorini's duct are still obscure. Methods: We clinically examined the shape and the patency of Santorini's duct using a balloon endoscopic retrograde pancreatography compression study (balloon ERP‐CS) and analyzed 178 cases out of a total of 683 of balloon ERP‐CS cases according to our criteria. Results: We found the total patency ratio of Santorini's duct to be 78.1% (139 of 178 cases). The shape of Santorini's duct, as examined by balloon ERP‐CS, was classified into four types. The most common types were the Rod type (44%) and the Spindle type (25%). The Branch type comprised 22%. The most rare type was the Cystic type (9%). The Rod type and Spindle type showed a high patency ratio (more than 95%), but the Cystic type and Branch type showed lower levels (36 and 31%, respectively). Conclusions: Most cases with a poor flow of Santorini's duct were observed, especially in the Cystic and Branch types. In such cases, Santorini's duct could not function as a safety valve when a Wirsung's obstruction occurred in association with stones, tumors or edema in the papilla of Vater.
