A case in which the tip of a plastic stent placed to prevent recurrence of walled‐off necrosis penetrated the bile duct and formed a stent–stone complex

A woman in her 60s underwent endoscopic sphincterotomy for choledocholithiasis. Unfortunately, post‐endoscopic retrograde cholangiopancreatography pancreatitis occurred. In addition, huge walled‐off necrosis (WON) appeared as a late complication. For the infected WON, endoscopic ultrasound‐guided fistuloplasty and endoscopic necrosectomy were performed, and a double pigtail plastic stent (PS) (7Fr, 7 cm) was placed to prevent a recurrence. Plain computed tomography conducted two years later showed that the stent implanted for WON had deviated. The distal end of the stent was found to have migrated into the bile duct. In addition, common bile duct stones with stents as nuclei were observed. Upon performing endoscopic retrograde cholangiography, it was revealed that the stent tip perforated the distal bile duct just above the papilla. After removal of the stent using grasping forceps, we made an incision between the duodenal – bile duct fistula and bile duct orifice using a sphincterotome. Then, the stone was removed by a balloon catheter. Although such late adverse events are rare occurrences, placement of long‐term PS after treatment of WON should be followed up regularly with imaging examination, and if there is no recurrence for several months, removal of the PS at that point may be considered.

Molecular genetic evidence of a unifocal origin for human serous ovarian carcinomas

The hypothesis that ovarian cancer is multifocal in origin was examined using molecular genetic techniques. Patterns of allelic deletion on chromosome 17 were studied in 16 informative cases of Stage III serous epithelial ovarian carcinoma. DNA was extracted from specimens collected from the omentum and both ovaries, and the specific alleles and chromosomal loci involved in the deletion were identified and compared. In all cases, the patterns of allelic deletion were identical for the tumors that had been collected from different sites in the same patients. In addition, 4 of the 16 cases were heterozygous for the hypoxanthine phosphoribosyl transferase (HPRT) gene on the X-chromosome and were examined for methylation status. In all 4, the same parental allele of the HPRT gene was methylated in tumor cells collected from both ovarian and omental sites, suggesting that the patterns of inactivation of the X-chromosome are identical. This pattern of allelic deletion and HPRT-gene methylation in tumor samples collected from different sites implies that ovarian carcinomas have a unifocal origin.

Involvement of p53 gene in the allelic deletion of chromosome 17p in human ovarian tumors

Previous reports have shown that one copy of the chromosome 17 was frequently lost in human ovarian cancers (1). The position of the allelic deletion has not been mapped and involvement of p53 gene has not been determined. In this study, we have shown that in human ovarian carcinoma, the commonest region of allelic loss in chromosome 17p is 17p 13.3 (65%) and 17p13.1 (63.7%; 6 out of 9 informative cases). Allelic loss was also observed at region 17p12 - 11.1 but at a lower frequency (38.6% to 37.5%). The pattern of allelic loss of p53 gene was consistent in both primary and secondary metastatic tumors of the same patient. No gross rearrangement of p53 was however observed at the remaining allele using Southern blot analysis. Allelic loss of p53 gene was closely associated with 17p 13.3, the terminal portion of chromosome 17p. The high frequency of allelic loss of p53 gene in ovarian carcinomas conformed with recent findings in cancers of colon, breast, lung and brain suggesting inactivation of p53 gene play a rate limiting step in pathogenesis of human malignancies.

[A study on the endometrial movement and serum hormonal level in connection with uterine contraction]

By means of transvaginal ultrasonography, endometrial activity was investigated in its relationship with uterine contraction and ovarian hormones. The following results were obtained. (1) Endometrial movements were classified into two types: Peristaltic movements and undistinguished ones. Peristaltic movements were rhythmic and mainly found in the proliferative stage, directed from the internal uterine os to the fundus. (2) The detection rate and the frequency of peristaltic movements increased towards ovulation, with the highest values at 88% and 3.9/min, respectively. (3) Peristaltic movements rapidly ceased soon after ovulation and there were practically none after the mid-secretory stage. (4) All endometrial movements decreased in the secretory stage and became markedly quiescent after the mid-secretory stage. (5) In the proliferative stage, a positive correlation was found between the frequency of peristaltic movements and the serum estradiol level (p less than 0.001). In the secretory stage, the detection rate was lowered significantly when the serum progesterone level was more than 3.8 ng/ml (p less than 0.01). (6) Peristaltic movements coincided with uterine contractions both in rhythm and duration. As stated above, endometrial movements were strongly affected by hormonal condition, so they could be of value in the prediction and confirmation of ovulation and in the diagnosis of luteal insufficiency and dysfunctional bleeding as well.