Abdominal wall closure after selective aponeurotic incision and undermining

The tension required to pull the anterior and the posterior rectus sheaths toward the midline was studied in 20 fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: (1) prior to any aponeurotic undermining, (2) after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath, and (3) after additionally releasing and undermining the external oblique muscle. A significant decrease in aponeurotic resistance was observed after each dissection. The anterior sheath showed higher resistance to traction compared with the posterior sheath on both levels. No statistical difference was noted in the comparison of the values of the aponeurosis above and below the umbilicus. These results suggest that these procedures are effective in assisting in the closure of abdominal wall defects because these maneuvers decrease substantially the tension required for advancement of the aponeurotic edges.

Rescue of angiotensinogen-knockout mice

Angiotensinogen, the precursor of angiotensins I and II, is a critical component of the renin-angiotensin system that plays an important role in regulating blood pressure and electrolyte homeostasis. Genetically altered mice lacking angiotensinogen (Agt-KO) showed an expected phenotype, such as marked hypotension, but unexpected ones including abnormal kidney morphology, reduced survival rates of newborns, and impaired blood-brain barrier function after cold injury. To examine whether disruption of the angiotensinogen gene is responsible for the observed phenotypes, we generated a line of mice heterozygous for the mouse angiotensinogen gene under the control of a mouse metallothionein-I promoter (MT-Agt) and crossmated transgenic mice with Agt-KO mice. The resulting mice (MT-Agt(+/-)/Agt(-/-):MT-Agt/KO) produced the plasma level of angiotensin I comparable to that of wild-type mice, and the mutant phenotypes were rescued. These results indicated that the resultant phenotypes due to the genetic deficiency of mouse angiotensinogen can be corrected by restoring angiotensinogen and angiotensin I in the circulation.

Sonographic and color Doppler findings of rupture of liver tumors

We present six cases of ruptured liver tumor (hepatocellular carcinoma, five cases; liver metastasis, one case) in which gray-scale sonography revealed an ascites containing constantly moving dense high-echo spots, leading to a high suspicion of acutely developing hemoperitoneum. Color Doppler sonography helped in detecting the rupture site by demonstrating a high-velocity jet flow from it. Although four of six patients were dead within 3 months, detection of the rupture site by color Doppler sonography made the initial transarterial embolization therapy easy and prompt.

Splenic artery aneurysm: value of color Doppler and the limitation of gray-scale ultrasonography

BACKGROUND

To reevaluate the advantages and limitations of gray-scale and color Doppler sonography in the diagnosis of splenic artery (Sp-A) aneurysm.

METHODS

We reviewed the gray-scale and color Doppler sonograms of five cases with Sp-A aneurysm (four patients with portal hypertension and one patient without portal hypertension). Color Doppler sonography was performed in all five patients, and power Doppler sonography was performed in three.

RESULTS

Gray-scale sonography failed to detect the aneurysm in four of five cases because of a surrounding splenorenal (Sp-R) shunt in three patients and marked calcification of the aneurysmal wall in one patient. Pulsed Doppler sonography showed a slightly turbulent pulsatile flow along the aneurysmal wall, which immediately led to the diagnosis in four cases, including the three cases with Sp-R shunt. In one case, color Doppler sonography failed to detect the aneurysm because of a markedly calcified aneurysmal wall, although power Doppler sonography could visualize the aneurysm.

CONCLUSIONS

Gray-scale sonography is not a useful diagnostic tool for Sp-A aneurysm. Clinicians should use color Doppler sonography in the evaluation of the splenic hilus in patients with Sp-R shunt to find a small Sp-A aneurysm. The addition of power Doppler sonography is helpful in visualizing calcified Sp-A aneurysms.

Sonographic and color Doppler findings of gastrointestinal myogenic tumors with a marked extraluminal growth

We present five cases with gastro (four cases) and intestinal (one case) myogenic tumors with a marked extraluminal growth. In all cases, incidental discovery of an asymptomatic mass prompted further examination. One of three cases with a pedunculated growth mimicked a gallbladder cancer. The mass of a jejunal leiomyoma case changed markedly in location under probe compression. Color Doppler sonography confirmed not only the hypervascular nature of the mass but also feeding and draining vessels.

Anterior abdominal wall pathologies detected by high-frequency annular array

AIM AND METHODS

In 1850 patients, high-frequency (HF: 7.5-10 MHz) annular array US examination was performed to evaluate the value of HF annular US in the detection of pathologies of the anterior abdominal wall.

RESULTS

HF annular US revealed pathological lesions (metastasis, benign tumor, lymphoma, hematoma, fistula, hernia, abscess) in 37 patients. The lesions were detected by conventional medium-frequency (3.5-3.75 MHz) US in only 8 of 37 cases (21.6%). HF annular US added information that altered clinical management in 19 cases (51.4%), predominantly in cases with tumors and fistulas.

CONCLUSION

The addition of HF annular US to a conventional US examination increases the detectability of small, but clinically important pathologies in the anterior abdominal wall.

Small bowel varices: report of two cases

Two cases of small bowel (S-B) varices associated with portal hypertension, one with liver cirrhosis and one with portal thrombus, are reported. Detection of S-B varices has been a challenging task and several invasive diagnostic techniques have been used for this purpose. However, in our cases, color Doppler sonography revealed the S-B varices supplied by the superior mesenteric vein and draining to the iliac (one case) or ovarian vein (other case), which helped to establish an early appropriate diagnostic and treatment plan.

Intrahepatic venous collaterals

BACKGROUND

The aim of this study was to reevaluate the causes and sites of intrahepatic venous collaterals and to determine the role of color Doppler sonography in the diagnosis of this relatively rare vascular abnormality.

METHODS

Real-time color Doppler sonography was used to study 21 patients with intrahepatic venous collaterals. The cause, distribution, and clinical manifestations of collaterals were determined, and Doppler waveforms obtained from the collaterals were also analyzed.

RESULTS

First, the causes of intrahepatic venous collaterals were divided roughly into two groups according to the presence or absence of veno-occlusions. The former group included liver tumors (six cases), primary Budd-Chiari syndrome (five cases), and metastatic adrenal tumors invading the inferior vena cava (two cases). The latter group consisted of diaphragmatic hernia (three cases), Osler-Weber-Rendu disease (two cases), and congestive liver (one case). The cause was not determined in two cases. Second, venous collaterals were distributed throughout the entire liver in primary Budd-Chiari syndrome but localized in the other cases. Third, Doppler waveforms of the collaterals were divided into two patterns: flat flow and multiphasic flow. Flat flow pattern was seen in patients with veno-occlusive diseases, and multiphasic flow pattern was seen in patients without veno-occlusive disease.

CONCLUSION

The relationship between intrahepatic venous collaterals and veno-occlusive diseases has been emphasized in the literature, but the results of our series showed that they occurred under a wide variety of conditions, even without veno-occlusive diseases, including diaphragmatic hernia and Osler-Weber-Rendu disease. The analysis of the Doppler waveforms of the collaterals was useful in differentiating those due to veno-occlusive diseases and those not.

Lobar atrophy of the liver

Lobar atrophy of the liver due to causes other than liver tumor or liver cirrhosis is a relatively rare pathological condition, and there are only a few reports in the literature. We report six such cases and try to evaluate the relationship between lobar atrophy and portal flow disturbance. The patients could be divided into two groups according to the site of the atrophy: those with atrophy of the left lobe (two cases) and those with atrophy of the right lobe (four cases). The two cases with atrophy of the right lobe had hepatholithiasis in the involved segments, but the cause was not determined in the remaining four cases. In all six cases, portal flow disturbance was noted, including invisibility of the portal vein in four cases, narrowing in one case, and portal thrombus in one case. Collateral circulation was not recognized in any of our cases. Of interest is the mode of lobar atrophy. Atrophy of the right lobe was always associated with marked enlargement of the left lobe, but that of the left lobe did not induce an enlargement of the right lobe.

Simultaneous determination of urinary catecholamines and 5-hydroxyindoleamines by high-performance liquid chromatography with fluorescence detection

A simple, selective and sensitive high-performance liquid chromatographic method with fluorescence detection is described for the simultaneous determination of catecholamines and 5-hydroxyindoleamines. The method is based on the derivatization of the amines with benzylamine in the presence of potassium hexacyanoferrate(III) under mild conditions. The resulting fluorescent derivatives are separated on a reversed-phase column, Cosmosil 5C18, using a mixture of acetonitrile and 10 mmol l-1 acetate buffer (pH 6.0) (35 + 65 v/v) as mobile phase, and are detected spectrofluorimetrically at 480 nm with excitation at 345 nm. The detection limits (signal-to-noise ratio = 3) for the amines are 2.8-236.0 fmol for an injection volume of 50 microliters. The method was successfully applied to the determination of 5-hydroxyindol-3-ylacetic acid, serotonin, norepinephrine and epinephrine in human urine. The method is simple and does not require clean-up of urine samples.

Sonographic findings of anomalous position of the gallbladder

Anomalous position of the gallbladder is relatively rare and has been reported only in isolated case reports. We tried to determine its ultrasound (US) findings on the basis of 18 such patients. In the left-side gallbladder group (nine patients), the gallbladder was imaged as an oval cystic mass in front of the pancreas. In all patients, the narrow neck of the gallbladder was clearly detected by US in the usual location before the main portal vein. Four of nine patients had small gallbladder stones. The retrohepatic gallbladder group (four patients) showed marked atrophy of the right lobe of the liver. Two patients had multiple gallstones in the bile ducts of the right lobe. All patients in the suprahepatic retrohepatic gallbladder group (four patients) were cirrhotic, and the anterior segment of the right lobe was markedly atrophied. In the intercostal scan, the gallbladder mimicked a perihepatic fluid. In the floating gallbladder group (one patient), the gallbladder was imaged as a cystic mass in the anterior abdominal wall. Surgical intervention showed a severely inflamed gallbladder, with small stones adhered into the anterior abdominal wall and partially ruptured. Knowledge of the wide range of US findings of malposition of the gallbladder helps in avoiding misdiagnosis.

Radiometric Measurement Comparison Using the Ocean Color Temperature Scanner (OCTS) Visible and Near Infrared Integrating Sphere

As a part of the pre-flight calibration and validation activities for the Ocean Color and Temperature Scanner (OCTS) and the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) ocean color satellite instruments, a radiometric measurement comparison was held in February 1995 at the NEC Corporation in Yokohama, Japan. Researchers from the National Institute of Standards and Technology (NIST), the National Aeronautics and Space Administration/Goddard Space Flight Center (NASA/GSFC), the University of Arizona Optical Sciences Center (UA), and the National Research Laboratory of Metrology (NRLM) in Tsukuba, Japan used their portable radiometers to measure the spectral radiance of the OCTS visible and near-infrared integrating sphere at four radiance levels. These four levels corresponded to the configuration of the OCTS integrating sphere when the calibration coefficients for five of the eight spectral channels, or bands, of the OCTS instrument were determined. The measurements of the four radiometers differed by -2.7 % to 3.9 % when compared to the NEC calibration of the sphere and the overall agreement was within the combined measurement uncertainties. A comparison of the measurements from the participating radiometers also resulted in agreement within the combined measurement uncertainties. These results are encouraging and demonstrate the utility of comparisons using laboratory calibration integrating sphere sources. Other comparisons will focus on instruments that are scheduled for spacecraft in the NASA study of climate change, the Earth Observing System (EOS).

Isolated splenic metastases

We analyzed the primary tumors, sonographic findings, clinical manifestations, and prognosis in five cases of isolated splenic metastases to determine in what situations these rare metastases should be suspected. The metastases were detected by ultrasonography in all five patients, and the primary tumors were colonic cancer in four patients and renal cancer in one patient. Splenectomy was performed and the postoperative course was uneventful in all patients. We conclude that preoperative and follow-up examinations must be performed with special attention given to the spleen in colonic or renal cancer patients.

3,4-Dimethoxybenzylamine as a sensitive pre-column fluorescence derivatization reagent for the determination of serotonin in human platelet-poor plasma

3,4-Dimethoxybenzylamine is shown to be a highly sensitive pre-column fluorescence derivatization reagent for the determination of serotonin in plasma by high-performance liquid chromatography. The reagent reacts selectively with 5-hydroxyindoles including serotonin in slightly alkaline media in the presence of potassium hexacyanoferrate(III) to give highly fluorescent derivatives. The derivatives of six standard 5-hydroxyindoles (5-hydroxytryptophan, 5-hydroxyindole-3-acetic acid, serotonin, 5-hydroxyindole-3-acetamide, N-acetyl-5-hydroxytryptamine and 5-hydroxytryptophol) are separated within 18 min by isocratic elution using acetonitrile-10 mM phosphate buffer (pH 6.0)-50 mM 1-hexanesulfonic acid on a Wakosil II 5C18RS reversed-phase column. The detection limits (signal-to-noise ratio=3) for the indoles were 1.0-5.7 fmol in a 100-microl injection volume. The method was applied to the measurement of serotonin in human platelet-poor plasma.

Hypertension induced in pregnant mice by placental renin and maternal angiotensinogen

Maternal hypertension is a common complication of pregnancy and its pathophysiology is poorly understood. This phenomenon was studied in an animal model by mating transgenic mice expressing components of the human renin-angiotensin system. When transgenic females expressing angiotensinogen were mated with transgenic males expressing renin, the pregnant females displayed a transient elevation of blood pressure in late pregnancy, due to secretion of placental human renin into the maternal circulation. Blood pressure returned to normal levels after delivery of the pups. Histopathologic examination revealed uniform enlargement of glomeruli associated with an increase in urinary protein excretion, myocardial hypertrophy, and necrosis and edema in the placenta. These mice may provide molecular insights into pregnancy-associated hypertension in humans.

High-performance liquid chromatographic determination of human serum albumin in plasma and urine by post-column fluorescence enhancement detection using 8-anilino-1-naphthalenesulfonic acid

A method for the quantitative determination of human serum albumin in plasma and urine by post-column high-performance liquid chromatography with fluorescence detection is presented. Human serum albumin in plasma and urine is separated by gel-permeation column chromatography, which is followed by fluorescence detection. The detection uses the fluorescence enhancement observed when 8-anilino-1-naphthalenesulfonic acid binds to human serum albumin. The method is rapid to perform and is highly sensitive (detection limit is 2.5 ng/injection volume at a signal-to-noise ratio of three.

Chromosomal mapping of human angiotensinogen gene and human renin gene by fluorescence in situ hybridization (FISH) in transgenic mice

We attempted to apply FISH to chromosomal mapping of the human angiotensinogen (hAG) and human renin (hRN) transgenes which are carried by the parental strains of the Tsukuba hypertensive mouse. We report here that the hAG gene is mapped in the C2 region of Chr 19 and the hRN gene in the A1 region of Chr 6.

Assay for tryptophan hydroxylase activity in rat brain by high-performance liquid chromatography with fluorescence detection

A highly sensitive and selective liquid chromatographic (HPLC) method with post-column fluorescence detection has been developed for the determination of tryptophan 5-monooxygenase activity in rat brain tissue homogenate. 5-Hydroxytryptophan, formed enzymatically from tryptophan (incubation time, 20 min), is extracted with perchloric acid and determined by HPLC. Detection is performed fluorometrically after post-column derivatization by a reaction with benzylamine in the presence of potassium hexacyanoferrate (III). The lower limit of detection for 5-hydroxytryptophan formed enzymatically is 100 fmol at a signal-to-noise ratio of three.

Determination of maprotiline in plasma by high-performance liquid chromatography with chemiluminescence detection

A simple and sensitive high-performance liquid chromatographic method is described for the determination of maprotiline, an antidepressant, in plasma. After a single-step extraction from plasma (100 microliters) with n-hexaneisoamylalcohol (19:1, v/v), the drug and desipramine (internal standard) are converted into their chemiluminescent derivatives by reaction with 6-isothiocyanatobenzo[g]phthalazine-1,4(2H,3H)-dione, a new chemiluminescence derivatization reagent for amines. The derivatives are separated within 60 min on a reversed-phase column, TSKgel ODS-80, using isocratic elution with acetonitrile-100 mM acetate buffer (pH 3.2), and produced chemiluminescence by reaction with hydrogen peroxide in the presence of potassium hexacyanoferrate(III) in alkaline medium. The detection limit for maprotiline added to plasma is 0.36 pmol (0.1 ng)/ml plasma (1.5 fmol on column), at a signal-to-noise ratio of 3.

Development of a novel luminol-related compound, 3-propyl-7,8-dihydropyridazino-[4,5-g]quinoxaline-2,6,9(1H)- trione, and its application to hydrogen peroxide and serum glucose assays

Manual and flow injection methods with chemiluminescence detection were developed for the determination of hydrogen peroxide (H2O2) using a novel luminol-related compound, 3-propyl-7,8-dihydropyridazino[4,5-g]quinoxaline-2,6,9(1H)-trione (PDIQ), having a higher efficiency than luminol. The methods are based on the chemiluminescence produced by the reaction of H2O2 with PDIQ in the presence of microperoxidase in alkaline media. Detection limits for manual and flow injection methods are 13 pmol per 100 microliter of test solution and 1.3 pmol per 100 microliter injection volume, respectively, at a ratio of chemiluminescence intensities (or peak heights) of test to blank of 2. The manual method was applied to the determination of glucose in human serum. The method correlated well with the conventional spectrophotometric method (4 = 0.998).

A study of cysts in the oral region. Cysts of the jaw

Clinical cases of cysts of the jaw treated in the Department of Oral Surgery of our university during the 10 y between 1980 and 1989 were studied clinically. Patients with radicular cyst, dentigerous cyst, odontogenic keratocyst and postoperative maxillary cyst, which were found at relatively high frequencies, were further analyzed with regard to age, sex and anatomical distribution. A diagnosis of cyst was established in 1,444 patients during the above period, and 1,234 (85.5%) of them had cysts of the jaw. According to a pathological classification by Ishikawa's method, these patients included 509 (41.2%) with radicular cyst, 259 (27.0%) with dentigerous cyst, 95 (7.7%) with odontogenic keratocyst and 267 (21.6%) with postoperative maxillary cyst. The pattern of age distribution in cases of radicular cyst, odontogenic keratocyst and postoperative maxillary cyst was similar to that found in previous studies. Among patients with dentigerous cyst, those aged under 20 y accounted for about 60%. Radicular cyst occurred most frequently in the maxillary lateral incisors, dentigerous cyst in the mandibular wisdom teeth, and odontogenic keratocyst in the region between the mandibular molar and the ramus of the mandible.

[Reduction mammoplasty with shortened scars: surgical technique]

Reduction mammaplasty is nowadays one of the most frequently performed plastic surgeries. The main purpose is the reduction of the volume of breasts, but the resulting scars can jeopardize the result of the operation. The Division of Plastic Surgery follows the modern tendency of reducing the length of the incisions and thus the resulting scars. A technique that incorporates this principle was developed with good results. The technique is simple enough to be used in a training program.

Secondary rhinoplasty: reconstitution of the allar cartilage by a rhinoplasty with an external incision

Presentation of 62 cases of secondary nasal deformities treated by external incision. Several types of endonasal deformities were observed, properly classified and repaired. When excessive resection was observed, local cartilage graft, septonasal or conchal types were employed.