Effects of sodium tetradecyl sulfate endoscopic variceal sclerotherapy on the esophagus. A prospective clinical and histopathologic study

A prospective clinical, endoscopic, and histopathologic study of the esophagus was carried out in 24 patients with advanced liver disease who underwent esophageal variceal sclerotherapy (EVS) and who eventually came to autopsy. Patients were arbitrarily divided into three groups: acute (group I), intermediate (group II), and chronic (group III) based on the interval between the first EVS and death. EVS with sodium tetradecyl sulphate (STS) initially produced thrombosis with varying degrees of necrosis and inflammation followed by ulceration, recanalization, and eventually fibrosis with obliteration of varices. Recurrent variceal hemorrhage (VH) leading to death was highest in the acute group since all patients died of uncontrollable VH (100%); it ranged between 50-60% in both the intermediate and chronic groups. Despite variceal obliteration, recurrent hemorrhage developed in the chronic group due to gastric varices or other venous channels in the esophagus or stomach. Additionally, we describe findings not previously reported, such as the presence of sclerosant outside the varices after intravariceal injection, thrombosis of gastric varices after esophageal injections, and the development of muscular wall thickening.

A new method for typing haptoglobin in bloodstains using immobilized allo A lectin

Allo A lectin from the beetle, which is beta-D-galactose specific, reacts to haptoglobin but not to hemoglobin. The use of allo A-Sepharose for typing haptoglobin in bloodstains helped eliminate hemoglobin from the bloodstain extract and presented highly resolved haptoglobin patterns by disc gel electrophoresis. This method is simple and rapid for typing haptoglobin in bloodstains and can be easily used in forensic science laboratories.

[Clinicohistopathological and immunohistochemical studies on intrapancreatic spread of pancreatic carcinoma]

Clinicohistopathological and immunohistochemical studies on intrapancreatic spread of pancreatic carcinoma were performed on 30 cases with total pancreatectomy accompanied by portal vein resection. In the observation of HE stained tissue sections of 25 cases of carcinoma of head of the pancreas, the intrapancreatic spread from the head to body or tail was observed in 9 out of 25 cases (36%). However, by the immunostaining of CEA, CA19-9 and Dupan 2, small cancer nests surrounded by fibrous tissues could be easily detected and intrapancreatic continuous spread from the head to body or tail was observed in 15 out of 25 cases (60%). The intrapancreatic spread of the carcinoma correlated with portal invasion of carcinoma, hardness of the body and tail, obstruction of main pancreatic duct and irregular pancreaticogram. The intraoperative quick immunostaining on the cryostat sections of the pancreatic tissue, together with the HE staining, is useful to determine the intrapancreatic spread of the carcinoma. The indication of total pancreatectomy for pancreatic carcinoma can be determined by these results.

[Preparation of an antithrombogenic bypass-catheter of the portal vein and its application to extended radical surgery in pancreatic cancer]

The curative resectability of pancreatic cancer has been considered to be extremely low. One of the reasons for this is invasion of the pancreatic cancer cells into the portal vein, and resection of the portal vein in the usual manner would bring create various problems following acute portal vein occlusion. Sudden occlusion of the portal vein has been shown to cause profound and fatal shock in animal experiments. Now, however, with our newly developed procedure of bypassing the portal blood into the systemic circulation or intrahepatic portal vein using an antithrombogenic bypass-catheter, made from heparinized hydrophilic polymer (Toray, Anthron), combined resection of the portal vein can be performed with safety and ease. Using the catheter-bypass method, 55 pancreatectomies accompanied by portal vein resection have been safely performed, mostly in patients with pancreatic cancer. Occlusion time of the portal vein ranged from 20-302 minutes (mean, 94 minutes). No side effects of the catheter were observed. The rate of occurrence of postoperative thrombosis of the portal vein was 1.8% (1/55) and operative mortality was 7.3% (4/55). Resectability rate for pancreatic cancer was 11.2% (5/42) between 1971 and 1980, but this has been remarkably improved to over 60% (53/87) in the period between 1981 and August 1986 by the application of the catheter-bypass method. This method is recommended not only for pancreatic cancer operations but also for hepatobiliary surgery.

Nodular regenerative hyperplasia of the liver with and without portal hypertension: a comparison

The clinical and the pathologic features of seven patients with nodular regenerative hyperplasia of the liver are analyzed and compared with those of 37 patients reported in the literature in an attempt to distinguish the features of those with portal hypertension from those without. Severe degrees of obliterative portal venopathy usually associated with the portal hypertension were found among the various pathological features. The association of nodular regenerative hyperplasia with a variety of chronic diseases suggests a heterogeneous group of pathogenic mechanisms. Our study reveals that only some of these mechanisms lead to the hepatic changes that cause portal hypertension.

[A case of pelvic arteriovenous malformation]

Congenital pelvic arteriovenous malformation (AVM) is an uncommon lesion. This disorder occurs in female frequently than in male. A 44 year-old male complained of right lower abdominal discomfort and hemorrhoids. He had neither history of abdominal trauma nor abdominal surgery. A pulsatile mass was palpable on rectal digital examination and bruit was heard at right lower abdominal quadrant. Pelvic computerized tomogram showed an abnormal mass with homogeneous density near the right side of the bladder. The mass was equally enhanced by the contrast medium. Digital subtraction angiogram revealed the pelvic AVM which originate from right hypogastric artery. Selective angiogram showed many feeding arteries and a dilated vein. Surgical procedure was performed with transabdominal approach because this AVM was localized. All feeding arteries and aneurysmally dilated vein were completely removed. Post operative course was uneventful. Follow up arteriogram after the surgery showed no further abnormal arteriovenous connections.

Two cases of gastric cancer-bearing double choledochus with ectopic drainage into the stomach

Two cases of double choledochus with ectopic drainage into the stomach associated with gastric carcinoma were reported. The stomachs were resected because of the presence of cancer, and the orifices of the ectopic bile duct were found in the oral side of the lesions. In these two cases, hyperplasia of gastric foveolas and atrophy of fundic gland, with its cystic dilatation, were observed around the orifices. A possible correlation between direct flow of bile juice into the stomach through the ectopic bile duct and the development of gastric cancer was discussed. The literature regarding double choledochus was reviewed.

Effect of blood pressure on the progression rate of renal impairment in chronic glomerulonephritis

An effect of high blood pressure on the progression of renal functional deterioration was studied in 23 cases of chronic glomerulonephritis, which showed progressive renal functional impairments during the long-term follow-up period. The slope-of-regression line, which was obtained from the relation between reciprocal serum creatinine concentration (1/Cr) and observation time, was expressed as a progression rate and was evaluated on an association with blood pressure level. The progression rate was found to correlate significantly with the level of diastolic blood pressure (p less than 0.001). It is concluded that the elevation of blood pressure is one of the factors that contribute to the progression of renal functional impairment in chronic glomerulonephritis.

[The clinical study of systemic hemodynamics after partial hepatectomy, with special reference to cirrhotic subjects]

To elucidate the pathophysiological role of partial hepatectomy on systemic hemodynamics, general hemodynamics were investigated in 29 patients pre and postoperatively. Twenty-five patients with smooth postoperative course were divided into two groups, non-cirrhotic (n = 15) and cirrhotic (n = 10). On the first postoperative day (p.o.d.), cardiac index (CI) increased significantly but arteriovenous oxygen content difference (C(a-v)O2) didn't increase in non-cirrhotics. While, increased in cirrhotics, CI increased only mildly and C(a-v)O2 increased. In both groups oxygen consumption (VO2) increased significantly. Since these characteristic pattern in cirrhotics were even clearer in patients with lower functional reserve of remnant liver, it was suggested that cardiac function was suppressed under decreased functional reserve of remnant liver. Four cirrhotics fell into hepatic failure during early postoperative period. On the first p.o.d., CI and C(a-v)O2 of these patients didn't increased, and VO2 decreased slightly. On the second p.o.d., CI increased but C(a-v)O2 and VO2 decreased extremely. It seemed likely that these disturbance of oxygen uptake and consumption affected function of remnant liver considerably.

[Diagnostic values of type III Procollagen N-terminal peptide and combination assay of type III procollagen N-terminal peptide with CEA and CA 19-9 in gastric cancer]

It is known that interstitial collagens are initially synthesized as precursors (procollagen), which possess extra peptide segments at both ends of the molecules. The authors attempted to detect the aminoterminal peptide of type III procollagen (type III-N-peptide) and also to measure the carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) together in sera of patients with gastric cancer. The results showed that: (1) mean serum levels and positive ratios of the type III-N-peptide increased as the clinical stage of the patients with gastric cancer advanced; (2) serum levels of the type III-N-peptide were not correlated either with those of CEA or CA 19-9; (3) positive ratios of type III-N-peptide, CEA and CA 19-9 were 51.7%, 44.8% and 48.3%, respectively: (4) positive ratio in combination of the type III-N-peptide with CEA was 69.3% and that in combination of the type III-N-peptide with CEA and CA 19-9 was 72.4%. These results suggest that type III-N-peptide is available for diagnosis of gastric cancer and, that the combination assay of type III-N-peptide with CEA and CA 19-9 is more effective than a single assay for diagnosis.