Congenital biliary tract dilatation and anomalous junction of the pancreatico-biliary ductal system

Anomalous junction of the pancreaticobiliary ductal system (AJPBDS) was found not only in 6 of 28 children with congenital dilatation of the bile duct, but in 3 of 57 children with congenital biliary atresia, in 2 of 17 children with infantile hepatitis and in one child with chronic pancreatitis during the past 17 yr at the Kagoshima University Hospital. A new technique of selective choledochopancreatography has been developed in which the mid-choledochus is clamped and dye is selectively injected into the distal choledochus to demonstrate the pathology of the bile duct. This technique has been successful even in small children when other cholangiographic techniques have failed to show AJPBDS. AJPBDS can be divided into two main types: (1) with biliary tract dilatation and (2) without biliary tract dilatation. The preferred treatment for type 1 is considered to be Roux-en-Y limb hepaticojejunostomy with primary excision of the choledochal cyst in order to prevent reflux of pancreatic juice flow into the choledochus, postoperative gall stone formation, or cancer from arising in the remaining choledochal cyst. Hepatic portocholecystostomy for biliary atresia with patency between gall bladder and papilla duodeni associated with AJPBDS can not be recommended since it may cause dilatation or obstruction of the bile duct postoperatively. Further studies concerning the etiology or therapy for AJPBDS are necessary.

Cardia lymph in electrical ventricular fibrillation: an experimental study

The flow velocity of cardiac lymph during electrical ventricular fibrillation under normothermic cardiopulmonary bypass was studied experimentally in dogs. The time needed for the cardiac lymph node to become stained after injection of dye into the apex myocardium of the left ventricle was measured as an indicator in determining flow velocity of cardiac lymph. The flow velocity was markedly decelerated immediately after the commencement of electrical ventricular fibrillation. It was accelerated, however, after 2 hours of continuous electrical ventricular fibrillation. The difference between the two values was significant (p less than 0.01). Absent contractility of the heart influenced the deceleration of flow velocity of cardiac lymph immediately after the commencement of electrical ventricular fibrillation. Acceleration after 2 hours involved stasis of cardiac lymph as a result of absent contractility and increment of lymph production due to the nonphysiological condition of the myocardium.

[The reliable diagnosis for an early stage of hereditary muscular dystrophy of mice (author's transl)]

The methods to find hereditary muscular dystrophy mice (dy-mice) were described. One was to observe whether or not mice dragged their hind limbs immediately after they were dropped onto a table following their suspension by their tails. The other was to observe dragging their hind limbs immediately after they were restored to a normal position from a supine one. This limbs-dragging induced by these methods were characteristic of dy-mice. Among 437 mice checked by these methods, 76 showed the drag during 14-23 days after birth (18.3 days on the average) and later they were confirmed to be dy-mice without exception. Therefore, it was concluded that these methods were useful for the accurate diagnosis of dy-mice at an early stage.

Flow velocity of cardiac lymph and contractility of the heart: an experimental study

The flow velocity of cardiac lymph in various abnormal conditions of the heart and in control situations was studied experimentally in dogs. The time needed for the cardiac lymph node to become stained after injection of contrast medium into the muscle layer of the left ventricular apex was measured as an indicator in determining flow velocity of cardiac lymph. Left ventricular contractility was studied simultaneously. The hypoxic dogs had a short staining time with a vigorous cardiac beat. (Short staining time means accelerated lymph flow through the heart). The hearts in which the coronary sinus was ligated revealed the shortest staining time with an insignificant contractile change. The exsanguinating dogs had a long staining time with reduced contractility. The dogs with ventricular fibrillation had the longest staining time. When the heart rate was fixed by pacing, the staining time reflected contractile change. The contractile force of the heart plays an important role in the flow velocity of cardiac lymph.

Patch closure of the ductus arteriosus: an improved method

An improved surgical procedure for patch closure of the ductus arteriosus under cardiopulmonary bypass is presented. A patch with a Fogarty catheter inserted through its center is used. The catheter is insinuated into the aorta through a pulmonary arteriotomy under normothermic cardiopulmonary bypass. An inflated intraaortic balloon is made to plug the orifice of the ductus using gentle traction on the catheter. The catheter may be slanted in any direction that is convenient to provide satisfactory visualization of the operative field.