The accumulation and energy load of exogenous lipids in cirrhotic rat liver after partial hepatectomy

BACKGROUND

The suitability of three energy substrates, glucose, medium-chain triglycerides (MCT) and long-chain triglycerides (LCT), was studied in cirrhotic rats after a partial hepatectomy.

METHODS

Rats with thioacetamide-induced cirrhosis underwent a 70% hepatectomy, and were divided into three groups. Each group was then injected with 14C-labeled glucose, 14C-labeled MCT or 14C-labeled LCT, respectively. The subsequent tissue distribution of 14C and the cumulative amount of expired 14CO2 were determined. In a second experiment, the 70%-hepatectomized cirrhotic rats received total parenteral nutrition (TPN). The source of the nonprotein calories was 100% glucose (glucose group), 60% MCT + 40% glucose (MCT group), and 60% LCT + 40% glucose (LCT group). The adenylate energy charge and the glycogen content in the liver remnant were determined.

RESULTS

The tissue distribution of 14C revealed that the fat emulsions accumulated preferentially in the liver. One hour after the partial hepatectomy, the concentration of 14C-labeled MCT in the liver remnants was threefold higher than in sham-operated controls. Similarly, the concentration of 14C-labeled LCT was twofold higher. The adenylate energy charge in the glucose group with TPN recovered to preoperative levels within 1-hour after the partial hepatectomy, whereas the LCT group with TPN showed a 24-hour delay in their recovery. The MCT group with TPN exhibited an intermediate time course.

CONCLUSIONS

It is suggested that the specific accumulation of MCT and especially LCT emulsions in the cirrhotic liver remnant acts as an energy load rather than an energy substrate.

Gastric mucosal phosphatidylcholine hydroperoxide increases during cold water-immersion restraint stress in rats

To know the role of lipid peroxidation in the pathogenesis of stress-induced gastric mucosal lesions, we performed the present study. Both gastric mucosal lesions and gastric mucosal phosphatidylcholine hydroperoxides (PCOOH) levels during cold water-immersion restraint (CWIR) stress were measured by the chemiluminecence-HPLC method in Sprague-Dawley rats. Ulcer indices increased time-dependently during the stress. Gastric mucosal PCOOH levels also significantly increased and reached a peak level (250% of untreated level) after 2 hr of stress. These results suggest that lipid peroxidation may play an important role in the pathogenesis of gastric mucosal lesions induced CWIR stress.

[Computed tomography with continuous transport and continuous scanner rotation for laparoscopic cholecystectomy]

We investigated the 58 cases of cholecystolithiasis including 8 cases of choledocholithiasis treated with laparoscopic cholecystectomy. All patients received spiral CT scanning with drip infusion cholangiography (DIC-SCT), and 1.6 patients received endoscopic retrograde cholangiography (ERC), and the detection rates of the gallbladder, the bile duct and the cystic duct were compared. The gallbladder could be seen in 86.2% of cases with DIC-SCT and in 63.8% of cases with conventional DIC. The junction between the cystic duct and the common bile duct could be seen in 18 of 58 cases with DIC and in 49 of 58 cases with DIC-SCT. The DIC-SCT showed significantly superior anatomical details compared with images with conventional DIC. A comparison of DIC, ERC and DIC-SCT revealed that the junction between the cystic duct and the common bile duct could be identified in 14 of 16 cases undergoing ERC, in 13 of 16 cases receiving DIC-SCT and in 4 of 16 cases receiving DIC. Significant differences were noted among DIC-SCT, ERC and conventional DIC. We concluded that DIC-SCT is easy, non-invasive and useful for the preoperative assessment of laparoscopic cholecystectomy and also helpful for avoiding damage to the bile duct.

Use of technetium 99m diethylenetriamine-pentaacetic acid-galactosyl-human serum albumin liver scintigraphy in the evaluation of preoperative and postoperative hepatic functional reserve for hepatectomy

BACKGROUND

Technetium 99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) is a new liver scintigraphy agent that binds to the asialoglycoprotein receptors. We evaluated the clinical use of 99mTc-GSA for the perioperative assessment of hepatectomy.

METHODS

Thirty-six patients with hepatocellular carcinoma were admitted for elective hepatectomy. 99mTc-GSA scintigraphy was obtained after the intravenous injection of 99mTc-GSA, and a modified receptor index (MRI) was calculated. 99mTc-GSA scintigraphy, conventional liver function, the plasma disappearance rate, and the 15-minute retention rate of indocyanine green (ICGR15) were carried out before operation and every 1 to 3 months after operation. The relationships between several systemic hemodynamic parameters, histologic activity index (HAI), plasma disappearance rate, and ICGR15 or MRI values were estimated.

RESULTS

A significant correlation was obtained between the MRI and ICGR15 (r = 0.6231, p < 0.001). Plasma disappearance rates correlated well with systolic volume and left cardiac work, whereas MRI values did not correlate with these systemic hemodynamics. Preoperative discrepancies between the values of MRI and ICGR15 were seen in eight cases. In these cases the MRI values correlated well with HAI scores (p < 0.05) but there was no significant correlation between ICGR15 values and the HAI scores.

CONCLUSIONS

These results suggested the use of 99mTc-GSA scintigraphy as a easy and reliable method for determining liver functional reserve.

Three-dimensional reconstruction of the biliary tract using spiral computed tomography

Spiral computed tomography (SCT) is a recently introduced technique which enables scanning of one large volume with no interscan intervals. Three-dimensional reconstruction using this technique is emerging as an effective means of identifying complex anatomical relationships. Ninety-two patients with cholecystolithiasis including ten with choledocholithiasis were investigated. All underwent SCT after oral and intravenous infusion cholangiography (IVC-SCT) and 22 were also examined by endoscopic retrograde cholangiography (ERC). IVC-SCT showed significantly more anatomical detail than conventional intravenous infusion cholangiography (IVC). The junction between the cystic duct and the common bile duct could be identified before surgery in 19 of 22 patients undergoing ERC, in 18 of 22 receiving IVC-SCT and in five of 22 undergoing IVC. Significant differences were noted between IVC-SCT, ERC and conventional IVC. Three-dimensional surface reconstruction of the biliary tract is useful in the evaluation of anatomical relationships between the cystic duct and the common bile duct (clearly seen in 86 per cent of cases). Three-dimensional reconstruction using SCT scanning is useful for anatomical assessment before laparoscopic cholecystectomy.

[Effects of dantrolene on histological and behavioral outcome in rat CA1 hippocampus after global transient cerebral ischemia]

Evidence suggests that ischemic neuronal necrosis may ultimately be the result of excessive intracellular calcium accumulation. In principle, abnormal calcium concentrations during ischemia are derived from three main sources: exaggerated influx via (a) voltage-operated channels, (b) receptor-controlled channels (f. ex. NMDA) and (c) the release of intracellular calcium ion stores. Previous studies using either calcium channel blockers or NMDA antagonists have demonstrated only limited protective effects of these agents in global transient cerebral ischemia, whereas little or no attention has been paid to the calcium sources listed under (c). Dantrolene has been shown to block the increase in free intracellular calcium ion stimulated by either NMDA or glutamate. Thus we postulated that dantrolene might improve neuronal survival in vulnerable regions to ischemia such as the CA1 hippocampus. Male Sprague-Dawley rats (300 approximately 400 g) were prepared for a four-vessel occlusion model of cerebral ischemia. Complete cerebral ischemia was induced by snaring the carotid arteries for 15 mins and maintaining mean arterial pressure at 80 mmHg. Strict attention was paid to keep normal blood gas values. Following ischemia halothane anesthesia was discontinued, and rats were extubated and when stable transferred to cages with free access to water and food. Rats survived for 7 days under close supervision, after which they were anesthetized with pentobarbital and perfused transcardially with 4% paraformaldehyde/sodium-phosphate buffer. The brain was removed and placed in fresh fixatives for another 7 days, after which 40 microns sections were cut and silver-stained.(ABSTRACT TRUNCATED AT 250 WORDS)

Importance of mechanical damage to urinary red blood cells by the glomerular basement membrane

The reasons for morphological changes of urinary red blood cells (RBC) in patients with glomerulonephritis are still controversial. In order to evaluate the importance of mechanical damage by the glomerular basement membrane (GBM), we examined urinary RBC taken from the patients with two different diseases which have characteristic GBM changes. Urinary RBC taken from 20 patients with Alport syndrome and nine with thin GBM disease were examined using a scanning electron microscope. Nineteen out of the 20 patients (95.0%) with Alport syndrome showed 'glomerular type', while five of the nine patients (55.6%) with thin GBM disease showed 'glomerular type'. These results suggest that more complicated GBM abnormalities cause more severe RBC distortion. Therefore, we conclude that mechanical damage by the GBM may be the major factor in dysmorphism of urinary RBC.

Effect of hepatocyte volume on energy status in the cirrhotic rat liver

To evaluate the effect of reduced hepatocyte volume on liver energy status, the relationship between the morphologically quantified hepatocyte volume and biochemical parameters, and the difference in nuclear density between the parenchyma and stroma were assessed in rat livers with thioacetamide-induced cirrhosis. The ratio of hepatocytes to whole liver tissue, defined as the 'hepatocyte area ratio', and the nuclear densities of the parenchyma and stroma were calculated microscopically with an image analysing system. Adenine nucleotide, protein and DNA contents, and the ornithine carbamoyltransferase activity in the liver were assayed. In the cirrhotic group, adenine nucleotide content, protein content and ornithine carbamoyltransferase activity were positively correlated with the hepatocyte area ratio, whereas DNA content was negatively correlated with this ratio. The adenylate energy charge of the cirrhotic liver was maintained at a constant level regardless of the ratio. Adenine nucleotide content, protein content and ornithine carbamoyltransferase activity per fractional 'hepatocyte area ratio' in cirrhotic livers were significantly lower than in control livers. The nuclear density of the stroma was significantly greater than that of the parenchyma. These results suggest that the lowered energy status in the cirrhotic liver is not caused by reduced hepatocyte volume but rather by impaired hepatocyte metabolism. In addition, the morphological measurement with an image analysing system was found to be useful for evaluating the effects of decreased hepatocyte volume on biochemical derangements in cirrhotic tissue.

Gallbladder cancer with double pancreatic ducts--a case report

Various forms of anomalous pancreatic ducts may be encountered. We treated a patient with very rare courses of pancreatic ducts associated with gallbladder cancer. The patient, a 65-year-old female, attended our hospital with epigastric pain and general malaise. Abdominal sonography and a CT scan led to the diagnosis of gallbladder cancer. Endoscopic retrograde cholangiopancreatography revealed two main pancreatic ducts that followed a parallel course and joined the end of the common bile duct to form a common duct. The common duct opened at the ampulla of Vater. Thus, duplicated ducts of Wirsung served as the main pancreatic ducts, with no duct of Santorini. The embryonal mechanism and the clinical significance of double pancreatic ducts remains unknown, and our case is very rare.

Adenylate energy charge of rat and human cultured hepatocytes

A simple and rapid method for the assay of adenine nucleotides (ATP, ADP, and AMP) was established to evaluate the adenylate energy charge (ATP+ADP/2)/(ATP+ADP+AMP) of cultured hepatocytes. The effects of inhibitors of glycolysis, fatty acid oxidation, or oxidative phosphorylation on the energy charge were examined. The energy charges of cultured hepatocytes in rats and human were almost identical and were maintained at a high level between 6 and 24 h after changing the media (rat: 0.908 +/- 0.008 n = 9, human: 0.918 +/- 0.014 n = 6, mean +/- SD). Inhibition of glycolysis with sodium fluoride or oxidative phosphorylation with antimycin A irreversibly reduced both the adenine nucleotide contents and the energy charge. However, the inhibition of fatty acid oxidation with 2-tetradecylglycidic acid did not affect the nucleotide contents, and the energy charge only decreased transiently to recover within 8 h. When the inhibitor of oxidative phosphorylation was removed, the recovery in the energy charge preceded the recovery in the adenine nucleotide contents. These findings suggest that the adenylate energy charge is a more sensitive measure of the changes in energy metabolism than the adenine nucleotide contents. Furthermore, energy charge regulates adenine nucleotide contents in cultured hepatocytes. It is important to confirm that the high energy charge of the cultured hepatocytes is maintained when these cells are used for metabolic studies.

Enzymatic synthesis of hydroquinone beta-xyloside from xylooligosaccharides

beta-Xylosidase of Aspergillus pulverulentus catalyzes a transxylosylation reaction from xylooligosaccharides to acceptor hydroquinone. Two transfer products were purified and their structures were examined. These were identified as hydroquinone beta-(1-->4)-xyloside and hydroquinone 4-O-(beta-xylosyl)-beta-xyloside. The hydrolysis of these glycosides apparently took place accompanying the synthesis of the transfer products.

Prevention of pleural effusion after hepatectomy using fibrin sealant

Retention of pleural effusion after hepatectomy is an important complication that may affect the postoperative course. However, there are few reports on its pathogenesis or preventive measures. We evaluated the mechanism of the development of this complication and preventive measures against it. During the past 4-year period, hepatectomy was performed in 77 patients, of whom 64 underwent liver mobilization by transecting the hepatic ligaments. A fibrin sealant was sprayed on the cut surface of the hepatic ligaments in randomly selected 25 of the 64 patients to determine whether this application can prevent postoperative retention of pleural effusion. Post-operative pleural effusion was not observed in any patient treated by fibrin sealant spraying but was observed in 13 (30%) of the other 39 patients treated with this sealant (p < 0.05). In addition, none of the 23 patients in whom the liver was not mobilized during hepatectomy showed postoperative pleural effusion. These results suggest that severance of the hepatic ligaments is a major cause of pleural effusion, and application of a fibrin sealant to the undersurface of the diaphragm around the insertion of the liver ligaments is useful for preventing this complication.

The favourable effect of cyclophosphamide pulse therapy in the treatment of massive pulmonary haemorrhage in systemic lupus erythematosus

Pulmonary haemorrhage (PH) is a rare but very serious complication of systemic lupus erythematosus (SLE) and the treatment is still controversial. Some authors showed the effectiveness of methylprednisolone pulse therapy for PH, although its effect was often transient. A 12-year-old Japanese girl with lupus nephritis and recurrent massive PH in SLE was treated with methylprednisolone pulse therapy. The effect on PH was transient and she needed three cycles within a month and side-effects developed. Pulse therapy with cyclophosphamide, synchronized with plasmapheresis, was tried. Thereafter she did not experience PH for 7 months, whereas lupus nephritis did not improve. Pulse cyclophosphamide would be effective for life threatening massive PH in SLE patients.

The peritoneal equilibration test variables in pediatric CAPD patients

The peritoneal equilibration test (PET) is generally accepted as a valuable tool in individualizing continuous ambulatory peritoneal dialysis (CAPD) treatment schedules in adults. However, the classification of peritoneal permeability as described by Twardowski is not available for children due to differences in peritoneal transport abilities. In this paper, we report the results of the PET for 20 patients aged from 1.5 to 24 years (mean 10.3 years), who started CAPD therapy at age 0-15 years, using Twardowski's standardized technique. D/P creatinine (dialysate to plasma ratio of creatinine at 4 h), D/D0 glucose (the ratio of dialysate glucose at 4 h dwell time to dialysate glucose at 0 dwell time), and the residual volume (RV) in the abdominal cavity were calculated. The mean and standard deviation values for D/P creatinine and D/D0 glucose were of a higher permeability level than those reported in Twardowski's data. Furthermore, a significant correlation of creatinine and glucose with fluid drainage ability of the peritoneum were observed. A large amount of RV (425 +/- 125 mL/m2) was detected in the patients' peritoneal cavity and this had a significant correlation with dialysate leak occurrences. The authors suggest that the RV would be an indicator for leaks and especially latent leaks. The cause of a large RV is unknown, but there is a probability that drainage volume and transport rates of metabolites decrease because the concentration of the instilled dialysate is immediately diluted by a large RV within the peritoneum.

Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B)

Remifentanil is a newly synthesized 4-anilido-piperidine with an ester side chain susceptible to esterase metabolism. We evaluated the safety, analgesic efficacy, and pharmacokinetics of remifentanil in 48 male volunteers. Volunteers were randomized to receive increasing doses of remifentanil, alfentanil, or placebo. Analgesic efficacy was evaluated by increasing tolerance to a spring-loaded rod measured at the tibia and sternum at multiple time points. Respiratory depression was measured by changes in arterial blood gas tensions and peripheral hemoglobin oxygen saturation. Hemodynamics were continuously monitored by means of an intra-arterial catheter. Both remifentanil and alfentanil produced a dose-dependent increase in analgesia and respiratory depression. Remifentanil was 20 to 30 times more potent (milligram to milligram) than alfentanil when assessed by either analgesic efficacy or respiratory measures. The pharmacokinetics of remifentanil were best described by a biexponential decay curve. Remifentanil had a small volume of distribution of 0.39 (SD, +/- 0.25) L/kg (alfentanil, 0.52 +/- 2 L/kg), with a rapid distribution phase of 0.94 (SD, +/- 0.57) min and an extremely short elimination half-life of 9.5 (SD, +/- 4) min compared with an elimination half-life of alfentanil of 58 (SD, +/- 7.6) min. The t1/2 ke0 (half-time for equilibration between plasma and the effect compartment) of remifentanil for analgesia was calculated as 1.3 min. Thus, remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short-lasting pharmacokinetics, which is likely to make it a very useful opioid for clinical practice.

An assessment of percutaneous transhepatic biliary drainage in the correction of the metabolic capacity of the jaundiced liver by hippurate-synthesizing test

Hippurate-synthesizing ability was investigated in patients with jaundice with percutaneous transhepatic biliary drainage (PTBD) in relation to hepatic metabolic capacity. In 16 patients with PTBD because of obstructive jaundice and 11 patients without hepatic disease, 1.77 grams of sodium benzoate was injected and the amount of hippurate synthesized and excreted in the urine collected at 30, 60, 120 and 180 minutes was measured (hippurate test). In patients with jaundice and patients in the control group, an almost linear increase was observed in the level of urinary hippurate after benzoate loading. However, the values of the patients with jaundice at one and two hours after the benzoate loading were significantly lower than those of the patients in the control group. Serum levels of glutamate oxaloacetic transaminase, glutamate pyruvate transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin and direct bilirubin were significantly decreased during PTBD (p < 0.05). Bilirubin levels were closely correlated with hippurate test values (r = 0.567, p < 0.05). Values were also correlated with the period of PTBD before the hippurate test was performed (r = 0.632, p < 0.05). Recovery in hippurate synthesizing ability was observed when the total bilirubin levels decreased to less than 5 milligrams per deciliter or PTBD was maintained for more than three weeks. Because hippurate synthesis is dependent on adenosine triphosphate supply in the hepatic mitochondria, the value of the hippurate test reflects the metabolic viability of the liver in relation to energy metabolism. It is also suggested that the steady maintenance of PTBD for three weeks or more with a decrease in total bilirubin level less than 5 milligrams per deciliter is necessary for full recovery of the metabolic capacity of the jaundiced liver.

Stimulation of glycogen degradation by prostaglandin E2 in primary cultured rat hepatocytes

Hepatocytes isolated from rats by the collagenase perfusion method were cultured as monolayers at concentrations of 0.4-1.1 x 10(6) attached cells/dish (9 cm2) for 1-3 days and the effect of prostaglandins on their glycogenolysis was studied. By use of [14C]glycogen-labeled cells, prostaglandin E2 (PGE2) was found to have a stimulatory effect on glycogen degradation at high cell density (more than 0.8 x 10(6) cells/dish) in 1-day cultures. PGE2 was maximally effective at 10(-7) M, increasing [14C]release from cellular [14C]glycogen to 2-3 times the basal level after 1 h incubation, and to plateau level within 2 h. PGE1, 16,16-dimethyl PGE2 and PGF2 alpha had similar effects, but PGD2 and dinor-PGE1 (a metabolite of PGE1 and PGE2 in hepatocytes) had no effect. This prostaglandin-induced glycogen degradation was observed in 1-day cultures, with a maximum between 20-30 h, but not in 2-day and later cultures. Treatment of hepatocytes with pertussis toxin potentiated PGE2-stimulated glycogen degradation, indicating that the effect involves a different pathway from that for inhibition of glucagon- and epinephrine-stimulated glycogenolysis by E series prostaglandins reported previously.

[A case report of condyloma acuminatum of urethral meatus in a boy]

A 4-year-old boy was referred for treatment of papillary tumor at the urethral meatus. He was well until December 1990, when his mother noticed a tumor at the urethral meatus. The tumor was resected elsewhere. However, a similar tumor was noted again at the urethral meatus in May, 1991. The patient was admitted on September 16, 1991. Retraction of the phimotic foreskin revealed a well-demarcated papillary mass, approximately 2 x 2 mm in diameter, at the urethral meatus. There were no tumors on foreskin or glans. Under general anesthesia endoscopy was performed to locate other tumors at the urethra and bladder. No tumors were found elsewhere. Then the meatal tumor was resected surgically. Pathology was condyloma acuminatum. There was no recurrence one year after surgery. We also reviewed 24 boys with condyloma acuminatum, including 13 boys with a solitary condyloma at the urethral meatus, reported in Japan.

[Influence of epinephrine infusion on the metabolism of exogenous lipid emulsions after 70% hepatectomy in the rat]

We investigated the effects of epinephrine on the metabolism of a lipid emulsion administrated to rats after 70% hepatectomy. Sprague-Dawley rats were underwent 70% hepatectomy and then were given lipid total parenteral nutrition (lipid-TPN) for 96 h. To increase catabolism after hepatectomy, epinephrine (Bosmine) infused continuously with the lipid-TPN. With increasing doses of the epinephrine, weight loss and the increased urinary excretion of nitrogen and 3 methyl histidine were observed. This indicated that administration of epinephrine after hepatectomy produced a model of increased surgical stress. As the epinephrine dose increased the linoleic acid content of the hepatic phospholipids increased and the arachidonic acid decreased at 96 h after hepatectomy. Epinephrine apparently inhibited the activity of the delta 5.6 desaturase involved in the biosynthesis of polyunsaturated fatty acids, leading to changes of the cell membrane fatty acid composition that could possibly influence membrane function. Thus, the fatty acid composition of lipid emulsions for TPN should be tailored according to the severity of surgical stress, because the pattern of secretion of stress hormone is dependent on the degree of such stress.

Microdialysis measurements of PGD2, TXB2 and 6-KETO-PGF1 alpha in rat CA1 hippocampus during transient cerebral ischemia

We measured hippocampal CA1 concentrations of PGD2, TxB2 and 6-keto-PGF1 alpha in 18 anesthetized rats with stereotaxically implanted microdialysis probes before, during and after 20 min of global cerebral ischemia. The insertion of the microdialysis probe did not appear to cause a continuous major disturbance of arachidonic acid (AA) metabolism because stable eicosanoid concentrations were obtained prior to ischemia. During reperfusion all three eicosanoids increased significantly reaching a peak after 30-60 min and then gradually declined to baseline levels over the next 2-3 h. The ratio of average peak concentrations for PGD2, TxB2 and 6-keto-PGF1 alpha were approximately 80:2:1, respectively. The results extend previous work by demonstrating the time course of eicosanoid release in a distinct brain region and confirm the role of PGD2 as the major PG metabolite in brain. We conclude that future studies employing microdialysis may be able to provide a more detailed understanding of the role of AA metabolites in ischemic brain.

White matter change on CT associated with superior vena cava syndrome: a case report

An 11-year-old Japanese girl with nephrotic syndrome developed superior vena cava syndrome associated with hypercoagulability and an indwelling catheter. Cranial CT revealed diffuse low-density lesions in paraventricular white matter. Thrombectomy brought prompt relief of symptoms and correction of CT abnormalities.

Anxiety disorders and pediatric continuous ambulatory peritoneal dialysis

This paper compared 23 children with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis to a matched sample of healthy children. The rate of separation anxiety disorder was significantly higher in the children with ESRD. In their family environments, mothers of ESRD children reported significantly lower independence and achievement orientation than mothers of control children.

Clinical evaluation of a low junction of the cystic duct

The point of the junction of the cystic duct with the common hepatic duct was studied by means of various preoperative and intraoperative cholangiographic procedures and by gross intraoperative examinations in 468 surgical patients with biliary diseases. The cystic duct entered the hepatic duct at a very low position and was consequently long in 39 patients. The clinical significance of this abnormally low junction of the cystic duct was studied in comparison with 358 patients with gallstones with a normal cystic duct-hepatic duct junction. In the low-junction group with a short common bile duct several complications, including gallstone pancreatitis (7 patients), the Mirizzi syndrome (7), confluence stones (2), gallbladder cancer (3), and congenital dilation of the cystic duct (1), were demonstrated preoperatively. The anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct, producing a choledochopancreatic ductal junction and posing difficulties at surgery.

[Disappearance of lung metastases from hepatocellular carcinoma following bronchial arterial infusion of CDDP and MMC]

A 58-year-old man was admitted to our department because he had been diagnosed as hepatocellular carcinoma, which was located at S6 segment, and posterior segmentectomy was performed. After 6 months, right lung metastases of HCC were found and right bronchial arterial infusion of CDDP and MMC was performed twice. Dramatic effects were obtained such as disappearance of lung metastases. We emphasize the useful effect of CDDP and MMC for metastases of HCC.

Clinical application of arterialization of portal vein in living related donor partial liver transplantation

Arterialization of the portal vein was employed during hepatic arterial reconstruction in our first few clinical experiences of partial liver transplantation using liver grafts obtained from living related donors. This procedure reduced the time required for revascularization of the grafts to about 25 min, and could in fact reduce the ischemic phase of the grafts. Repeated practice of the clinical transplantation technique has shortened the time needed to complete vascular reconstruction, eliminating the need for this procedure in most of our subsequent cases. In many clinical cases, however, there may be emergency situations which require vascular reconstruction, resulting in a prolongation of ischemic phase and the deterioration of the cellular viability of the graft. In such situations, arterialization of the portal vein can be a useful way to prevent the prolongation of the ischemic phase and to rescue the graft.

Pituitary hemorrhage in hemolytic uremic syndrome

A 5-year-old girl with hemolytic uremic syndrome is reported with pituitary hemorrhage in the acute phase. Seizures, hemiplegia, and transient blindness were observed. These symptoms cannot be attributed to the pituitary hemorrhage; however, pituitary hemorrhage should be added to the list of neurologic lesions that can occur in hemolytic uremic syndrome.

Metabolic correction of plasma aminogram by pig or baboon liver cross-hemodialysis with an interposed membrane

Our previous reports have shown that the patients with both grade 4 hepatic coma and arterial blood ketone body ratio (BKBR) of over 0.25 became fully alert after treatment by pig or baboon liver cross-hemodialysis, while those with BKBR below 0.25 died of hepatic coma without increase of BKBR. The present study shows the changes in plasma amino acids (AA) in 8 patients after treatment by cross-hemodialysis and itnravenous infusion of Fisher's solution. In all patients, the ratio of tyrosine plus phenylalanine to total AA concentration decreased (p = 0.012), and the AA molar ratio increased significantly (p = 0.007). In unrecovered patients, total AA and branched chain AA increased after cross-hemodialysis, while in the recovered patients total AA did not increase significantly. It is suggested that this metabolic support is effective in reducing the plasma levels of aromatic AA mainly oxidized in the liver, as long as BKBR remained over 0.25.

[Effect of total biliary diversion (cholecysto-jejuno-cystostomy) on gut hormone release and pancreatic structure in dogs]

In order to elucidate the effect to total biliary diversion (TBD) on gut hormone release and pancreatic structure, we performed cholecysto-jejuno-cystostomy (CJC) in 6 mongrel dogs using a small interposed intestinal segment between the gallbladder and the urinary bladder with ligation of the common bile duct. Twelve weeks after CJC, CJC was converted into cholecysto-jejuno-duodenostomy (CJD) to normalize luminal bile flow. Fat rich meal loading tests were carried out before and after these procedures. Plasma concentrations of GI hormones (CCK, PP, GIP) were measured by radioimmunoassay and morphological changes of the pancreas were evaluated by light and electron microscopic study. CJC significantly enhanced the basal levels and fat-stimulated release of both CCK and PP, however after CJD, these changes returned to the normal levels. Following CJC, fat-stimulated GIP release was completely inhibited, but recovered after CJD. Following CJC, hypertrophy of pancreatic acinar cells with profuse and dilated rough endoplasmic reticulum was observed, while after CJD this change returned to the pre-operative state. These results suggest that a feedback regulation may exist between luminal bile flow and CCK secretion, and pancreatic hypertrophy after TBD is, at least partly, due to the increased plasma CCK levels.

[Surgical results in Crohn's disease--an analysis in view of cumulative risk or recurrence and reoperation]

Forty nine cases with Crohn's disease operated at our department were analyzed in view of cumulative risk of reoperation and recurrence. Cumulative risk of reoperation was 22% at five years and 40% at ten years. Cumulative risk of recurrence after "curative" resection in thirty four cases was 53% at five years and 73% at ten years. Both risks were the highest in ileal type and the lowest in colonic type. Cumulative risk of relapse in ileocolic type after non-"curative" resection was 67% at five and ten years, which showed no significant difference with cumulative risk of recurrence after "curative" resection. Cumulative risk of recurrence after "curative" resection with proximal resection margin longer than 10 cm had no significant difference from the group with shorter margin. Cumulative risk of recurrence and reoperation after reoperation was a little higher than after initial operation, but they showed no statistical difference. In conclusion, there is no need to stick to "curative" resection, and it is enough to have the resection margin no longer than 10 cm. It is essential not to spoil the quality of life by excessive resection.

[Effect of obstructive jaundice on the electrophysiological characteristics of the gastric mucosa and gastric acid secretion in rats]

To elucidate the effect of jaundice on the electrophysiological characteristics of the gastric mucosa and gastric acid secretion, gastric mucosal potential difference (PD) and gastric acid secretion were measured in rats with obstructive jaundice. Also transepithelial potential difference (TEPD), short circuit current (Isc) and transepithelial electrical resistance (Rt) were measured in the isolated gastric mucosa of rats with obstructive jaundice. Secondly, to confirm whether the alteration of these parameters were induced by jaundice and increased serum bile acids in the jaundiced rats, the effects of biliary drainage on the electrophysiological characteristics and gastric acid secretion, and the effects of bile acid (TCA) on TEPD, Isc, Rt were evaluated. PD, TEPD, Isc and gastric acid secretion were reduced in the jaundiced rats, and tended to recover after biliary drainage. TEPD and Isc were reduced significantly by TCA administration. These results suggest that active ion transport in the gastric mucosal cells and gastric acid secretion are impaired in jaundiced rats and the increased serum bile acid in jaundiced rats may cause these dysfunctions and the impaired active ionic transport function is improved by biliary drainage.

Pyridine nucleotide fluorometry in preserved porcine liver with fluorocarbon emulsion

Oxidation-reduction changes in pyridine nucleotide fluorescence were investigated in perfused and preserved porcine liver. A fluorocarbon emulsion (FC-43) was administered to the perfusate as an oxygen carrier to obtain full oxidation level by portal perfusion at a physiological low flow rate. A satisfactory reading was obtained by portal perfusion with EuroCollins' solution containing 10% v/v FC-43 at a rate of 0.5 ml/min/g liver. The amplitude (R x A) and the changing velocity (R x V) from full oxidation to full reduction were determined in the resultant trace curve. Both R x A and R x V decreased in inverse proportion to the duration of preservation period (3, 6, 12 hr). Adenine nucleotide content, hepatic energy charge level, and ketone body ratio in the tissue were simultaneously measured, and they also decreased proportionally to the duration of preservation. There were close positive correlations between R x A and total adenine nucleotide concentration (r = 0.841, P less than 0.01), between R x V and energy charge (r = 0.787, P less than 0.01), and between R x V and tissue ketone body ratio (r = 0.881, P less than 0.01). These results suggest that pyridine nucleotide fluorometry can accurately follow the cellular function of isolated porcine liver by administration of FC-43 in perfusate. This fluorometry may also have potential application in evaluating viability of a large organ like the human liver graft.

The effects of PGI2 analog (OP-41483) on perfused porcine liver

The effects of a prostacyclin analog OP-41483 on energy metabolism were studied in an isolated porcine liver perfused with human blood for 8 h. OP-41483 was administered intravenously at a rate of 0.3 microgram/kg/min during the procurement and into the perfusate at a rate of 1.0 microgram/min during perfusion. Acetoacetate, beta-hydroxybutyrate, lactate, and pyruvate were measured before perfusion and at 1, 2, 3, 5, and 8 h after perfusion, from which values the ketone body ration (acetoacetate/beta-hydroxybutyrate, KBR), reflecting the redox state of liver mitochondria, was calculated. In the OP-41483 group, KBR increased rapidly from 0.34 to 0.95, 1.61, 1.51, 2.35, and 2.04, and lactate decreased rapidly from 9.81 to 6.30, 4.51, 3.22, 2.39, and 1.33 mmol/L at the respective hours after perfusion. There were significant differences after 3 h of perfusion as compared with the control group (p less than 0.05). These results suggest that administration of OP-41483 causes an increase in mitochondrial NAD+/NADH ratio (oxidized and reduced forms of free nicotinamide-adenine dinucleotides), leading to an enhancement of the metabolic capacity of the perfused liver.

[The effect of celiac plexus block on splanchnic circulation; changes in systemic hemodynamics and tissue blood flow of the liver and kidney in rabbits]

The effects of the celiac plexus block (CPB) on the hepatic and renal tissue blood flow (TBF) were investigated in 45 rabbits. Together with this, the effects of drugs (phenylephrine: PE, norepinephrine: NE, dopamine: DA, 6% hydroxyethyl starch: HES) used to increase mean blood pressure (MBP) up to control level were also investigated. TBF was measured by the hydrogen clearance method. Following CPB, MBP and heart rate decreased significantly. TBF of the liver and kidney both decreased significantly for 14.3% and 25.9% respectively. A correlation was observed between the decreases of MBP and renal TBF. An increase in hepatic TBF beyond the control level was observed in DA group, and in both hepatic and renal TBF in the HES group after adjustment of MBP. In other groups, both hepatic and renal TBF tended to decrease. It was concluded that hepatic and renal TBF decreased because of hemodynamic suppression following CPB. The results also suggest that both TBFs would have increased if systemic hemodynamic change was not so great.

Changes in serum bile acid composition in relation to histological findings after liver transplantation in piglets

Changes in the composition of serum bile acids were investigated after orthotopic liver transplantation in piglets. Serum levels of all bile acid components rapidly increased during the anhepatic phase and then quickly decreased, returning to the preoperative state within 6 h of revascularization of the allograft. In the animals in which extrahepatic biliary stenosis was a complication, serum total bile acids (TBA) increased remarkably. A marked increase of hyocholic acid and marked decrease of hyodeoxycholic acid were noted; as percentages of TBA, the average levels per day were 91.3 +/- 1.3 and 5.0 +/- 1.3%, respectively. No change in chenodeoxycholic acid (CDCA) was observed. In the animals suffering acute rejection without extrahepatic biliary stenosis, serum TBA increased slightly and the percentage of CDCA rose, the average level being 29.6 +/- 1.5%. These results suggest that the measurement of the composition of serum bile acids may serve as a useful means of assessing allograft function after liver transplantation.

Taurocholate-induced gastric damage in rats with obstructive jaundice

We examined the severity of taurocholate-induced gastric mucosal damage in rats with obstructive jaundice. Oral administration of 100 mM taurocholate induced severer gastric mucosal damage in rats with jaundice than in intact rats. Pretreatment with 5 mM taurocholate significantly protected the gastric mucosa against 100 mM taurocholate-induced damage, suggesting adaptive cytoprotection in rats with jaundice. The reductions in the gastric mucosal potential difference and hexosamine contents in the gastric mucosa in response to 100 mM taurocholate were significantly attenuated by prior administration of 5 mM taurocholate in both intact rats and rats with jaundice.

Effects of partial deprivation of portal blood on arterial blood ketone body ratio in rabbits

To examine the effects of portal blood deprivation on energy metabolism of the liver, we studied: (1) the ketone body ratio (acetoacetate/beta-hydroxybutyrate) in liver tissue, which is in equilibrium with the free NAD+/NADH ratio in liver mitochondria, in the ligated lobe (LL) and nonligated lobe (NLL), (2) the hepatic energy charge [EC = (ATP + 1/2 ADP)/(ATP + ADP + AMP)] in both LL and NLL, and (3) the arterial blood ketone body ratio (BKBR) after left portal vein branch ligation (PBL) in rabbits. As found in LL after PBL, portal blood deprivation decreased the tissue ketone body ratio. The EC in LL significantly decreased after PBL, but recovered 7 days after PBL since the LL became atrophic. The BKBR remained within the normal range, even when 60% of the total liver was deprived of portal blood.

Deleterious effects of splanchnic congestion on hepatic energy metabolism following repeated portal triad cross-clamping in dogs

Thirty minutes of warm hepatic ischemia produced by portal triad cross-clamping was repeated five times at 30-minute intervals in three groups of five dogs each: Group A was subjected only to portal triad cross-clamping; Group B received simultaneous clamping of the celiac axis and the superior mesenteric artery; and Group C had a simultaneous splenojugular shunt. The arterial blood ketone body ratio (acetoacetate/beta-hydroxybutyrate: KBR), reflecting the NAD+/NADH ratio in liver mitochondria, decreased significantly after each cross-clamping in all groups. After the first declamping, there was no significant difference in the recovery rate of the KBR among the three groups. After the second declamping, the recovery rate in Group A decreased significantly compared with the rates of Groups B and C (P less than 0.05). After the fourth declamping, the recovery rate in Group B was significantly lower than that of Group C (P less than 0.05). The hepatic energy charge [(ATP + 1/2ADP)/(ATP + ADP + AMP)] 30 minutes after the fifth declamping decreased significantly to 0.75 +/- 0.01 in Group A, compared with 0.84 +/- 0.01 in Group C (P less than 0.01). The lactate and total free plasma amino acid levels in the arterial blood increased significantly in the order of Groups A, B, and C. It is suggested that the inflow of stagnant portal venous blood to ischemic liver impairs hepatic energy metabolism.

[Pathophysiology following biliary reconstruction procedures, with special reference to gastric acid secretion, peptic ulcer, metabolism of carbohydrate and fat, and gastrointestinal hormone release]

Pathophysiological effects following biliary tract reconstruction for benign biliary diseases were investigated from the standpoint of gastric acid secretion, metabolism of nutrients and gastrointestinal hormone release. Patients undergoing Roux-Y hepaticojejunostomy showed a significant increase in maximum acid output at follow-up, although only one case of peptic ulcer was observed. In addition, the frequency of cases showing gastric acid hypersecretion was higher than for jejunal interposition hepaticoduodenostomy. Two kinds of test meals (carbohydrate-rich or fat-rich) were given, on different days, to each patient before and about four weeks after surgery. Plasma concentrations of gastrointestinal hormones and glucose or triglyceride were determined. Fasting concentrations of gut hormones (gastrin, GIP, insulin and GLI) were similar to those before surgery, and increased after the ingestion of the test meals. Gastrin and total GLI levels tended to be higher in the Roux-Y than in the interposition group, and vice versa for both insulin and GIP. The changes in plasma glucose and triglyceride, following the Roux-Y procedure, suggest disturbances in carbohydrate tolerance, fat digestion, and in the anabolic phase of absorbed fat. Patients undergoing the Roux-Y procedure should be carefully followed up, since gastric acid hypersecretion induced by a postprandial augmented release of gastrin was observed.

Peptic ulcer and gastric acid secretion in patients with insulinoma

We evaluated the incidence of associated peptic ulcers and the gastric acid secretion in our 20 series of insulinoma, and obtained the following results: 1) Four out of 20 patients (20%) with insulinoma were associated with peptic ulcers. 2) Except for the maximum acid concentration, the preoperative gastric secretion tests, such as the basal acid output and maximum acid output, failed to indicate hyperacidity in those patients. And patients with a short duration of illness by insulinoma neither showed hyperacidity nor were associated with peptic ulcers. 3) A tendency of reduced gastric acid secretion and the amelioration of peptic ulcers was observed in those who underwent the extirpation of insulinoma. 4) In the most recent case received gastric analysis with continuous monitoring of blood glucose level, an increase of basal acid output was observed during the hypoglycemic period in which the blood glucose levels reduced to around 30 mg/100 ml. These results indicate that the low blood glucose level and the high gastric acid secretion produced under the condition on an empty stomach, may be important factors related to the high association rates of the peptic ulcers in patients with insulinoma.

Evaluation of cytoprotective drugs for liver preservation by pyridine nucleotide fluorometry

The cytoprotective effects of membrane-stabilizing drugs, such as chlorpromazine, allopurinol, dibucaine, phenoxybenzamine, and OP41483 (prostacyclin analogue), administered to perfusate and preservation medium were studied in rat liver, after 24 hours' preservation, by assessment of pyridine nucleotide fluorescence. On the fluorometric trace curve, amplitude (RxA) and velocity (RxV) from oxidation to reduction were determined. Percent decrease of RxA (%RxA) and that of RxV (%RxV) after 24 hours' preservation were calculated. At the end of preservation, the concentration of total adenine nucleotides of the liver, hepatic adenylate energy charge, and prepared mitochondrial oxidative phosphorylative activity were also measured. In the groups given phenoxybenzamine, dibucaine, and allopurinol, there was no significant difference among these parameters. In the chlorpromazine group, energy charge and %RxV were higher than in the drug-free group (p less than 0.05). In the OP41483 group, both energy charge and phosphorylation rate were significantly higher (p less than 0.05) and %RxV was significantly high (p less than 0.01) at concentrations of more than 3 nmol/L, compared with the values for those without drugs. These results suggest that the Redoximeter can provide accurate information on the effectiveness of cytoprotective drugs. It is also suggested that OP41483 has potential application for maintaining graft viability for human liver transplantation.

Effects of perfusion pressure during flushing on the viability of the procured liver using noninvasive fluorometry

The influence of perfusion pressure and flow rate on hepatic cellular viability was investigated in the procured liver using noninvasive pyridine nucleotide fluorometry, in relation to other metabolic indices such as nicotinamide adenine dinucleotide (NAD) concentration, adenine nucleotides, tissue ketone bodies, and mitochondrial phosphorylative activity. Rat liver was perfused at a controlled flow rate through the portal vein with a nonrecirculating open-end-design perfusion system driven by a roller pump using cooled oxygenized Euro-Collins' solution. The maximum pressures (mean pressure in parentheses) of experimental groups were 8 (5) mmHg, 15 (9) mmHg, 40 (25) mmHg, 80 (50) mmHg, 120 (73) mmHg, 240 (152) mmHg. The amplitude between oxidation and reduction levels (RxA) in the fluorometric trace, and the gradient or velocity of the trace curve from oxidation to reduction (RxV) were determined by the measurement of fluorescence from NAD phosphate, reduced form (NADPH) using a new fluorometric device. Other metabolic indices were measured after attainment of a fully oxygenated state. RxA decreased in accordance with the increase of pressure. Similar results were obtained in the changes of NAD concentration, total adenine nucleotides, and total tissue ketone bodies, possibly due to the wash-out of these metabolites. RxV decreased in inverse proportion to the increase of pressure. There were close positive correlations between RxV and tissue ketone body ratio (acetoacetate/3-hydroxybutyrate) (r = 0.793, less than 0.01), RxV and respiratory control ratio in isolated mitochondria (r = 0.617, P less than 0.05), RxV and state 3 respiration (r = 0.792, P less than 0.01), and RxV and phosphorylation rate (r = 0.833, P less than 0.01). These results suggest that perfusion pressure and flow rate can easily deteriorate the energy metabolism of the procured liver, and that the gravity-induced hydrostatic pressure presently used in procurement perfusion should be reevaluated on the basis of energy metabolism.

Determination of cytochromes in human liver contaminated with hemoglobin

A spectrophotometric method was developed to determine cytochromes in human liver mitochondria contaminated with hemoglobin. The influence of hemoglobin on the measurement was canceled by keeping hemoglobin in the carbon monoxide bound form throughout determination. Mitochondria were solubilized by 2% sodium cholate, and cytochromes were reduced enzymatically with glutamate and succinate as substrates to the maximal extent. The amount of cytochromes determined spectrophotometrically was linearly correlated with mitochondrial protein at least up to the extent of 8 mg/ml.

Amelioration of normothermic canine liver ischemia with prostacyclin

A model of hepatic ischemia was developed in dogs using a pump-driven splanchnic-to-jugular vein bypass during crossclamping of the portal triad. An LD50 was established with three hours of ischemia. PGI2 given for one hour before the ischemic insult ameliorated the ischemic injury and increased survival.