Pancreatic fistula is a major form of morbidity following pancreatic resection. We conducted a nonrandomized clinical trial comparing the sealing and sandwich techniques of spraying fibrin glue to prevent pancreatic fistula following distal pancreatectomy. The pancreas was transected with a scalpel to identify and suture the main pancreatic duct and its small branches. In the sealing group, fibrin glue was sprayed over the closed pancreatic stump and sutures. Alternatively, in the sandwich group fibrin glue was sprayed so as to cover and join the cut surface of the pancreatic remnant, which was then held closed with sutures. Altogether 111 patients were included in the study (90 with gastric cancer, 10 with esophageal cancer, and 11 with pancreatic cancer). Patients were nonrandomly assigned to the sandwich or the sealing group. Morbidity was 21.8% for the patients in the sandwich group versus 33.9% in the sealing group. Pancreatic fistulas occurred in 9.0% of the sandwich group versus 26.8% of the sealing group. The incidence of fistula was thus significantly lower in the sandwich group. The incidence of fistula was also significantly lower in the sandwich group for gastric malignancy patients undergoing extended radical lymphadenectomy down to the paraaortic lymph nodes combined with left adrenalectomy. Of the patients with gastric malignancy, pancreatic fistulas occurred in 9.3% of the sandwich group versus 25.5% of the sealing group. The fibrin glue sandwich technique is simple and reliable and should be valuable for complementing other prophylactic methods of preventing pancreatic fistula.

Abstract. Fecal samples from suckling (n 5 153) and weaned (n 5 116) piglets with diarrhea in Japan were examined for shedding of viral, bacterial, and parasitic pathogens using culture, microscopic, and polymerase chain reaction methods. In suckling piglets, diarrhea was attributed to infection with a single etiologic agent in 60.8% of cases and with combinations of agents in 22.2%. In weaned piglets, diarrhea was attributed to a single etiologic agent in 43.1% and to combinations of agents in 47.4% of cases. Rotavirus was the most prevalent agent in suckling (67.3%) and weaned (65.5%) piglets. The detection of other pathogens was associated with age of the animals examined. Coccidia were predominantly isolated from suckling piglets, whereas Escherichia coli was found predominantly in weaned piglets. Although a relationship was not observed between detection rate of rotavirus and age of piglets, a single group of rotavirus was detected in 87.5% of suckling piglets whereas multiple groups were detected in 51.6% of weaned piglets. The results of this study confirm that diarrhea in piglets can, to a variable degree, be causally associated with multiple agents. Additionally, these results suggest reasons why this syndrome can be difficult to control.

The X-ray binary pulsar Cen X-3 was observed with the ASCA satellite over an entire binary eclipse. With unprecedented energy resolution at the iron K-energy band (FWHM ∼ 2%), three iron emission lines at 6.4 keV, 6.7 keV, and 6.97 keV were clearly resolved. At lower energies, lines from hydrogenic ions of Ne, Mg, Si, and S were also observed. Spectral variations over the eclipse were studied, in particular variations of the iron emission lines. Although the intensity of the 6.4 keV line, which is due to fluorescence from low ionized iron, decreased about one order of magnitude during the eclipse, the intensity drop of the 6.7 and 6.97 keV lines, which are respectively from Fe XXV and Fe XXVI, was at most a factor of three. This, confirming the conjecture by Nagase et al. (1992, AAA56.117.175), indicates that the 6.4 keV fluorescent line is emitted from the region close to the neutron star while the highly photoionized plasma which emits 6.7 and 6.97 keV lines is more extended than the size of the companion star (∼ 12 R⊙). The 6.4 keV line equivalent-width did not show a large variation over the eclipse, and was 75–145 eV. The dense Alfvén shell or an optically thick accretion disk is a likely candidate for reprocessing the fluorescent iron line. From the intensity ratio of the 6.7 and 6.97 keV lines during the eclipse, the ionization parameter of the photoionized plasma is estimated as ξ ∼ 103.4. The size and the density of the plasma are estimated as ∼ 16 R⊙ and ∼ 1.3 × 1011 cm−3, respectively. It is suggested that a lower ionization state is dominated in the pre-eclipse phase, since the 6.7 and 6.97 keV lines were not clearly seen and other K-lines from lighter elements were strong.

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