Effect of fluvastatin sodium on the smooth muscle cells in atherosclerotic plaques. In vivo study using low-density lipoprotein receptor deficient Watanabe heritable hyperlipidemic (WHHL) rabbits

The effects of fluvastatin sodium (CAS 93957-55-2, XU 62-320), an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, on the smooth muscle cells in the atherosclerotic plaques of Watanabe heritable hyperlipidemic (WHHL) rabbits, a low density lipoprotein (LDL) receptor deficient animal model, were examined. Fluvastatin was administered to WHHL rabbits for 32 weeks at a dose of 50 mg/kg of body weight. The control WHHL rabbits were administered distilled water as placebo. Compared to the control group, the total cholesterol levels in the sera, very low density lipoprotein, intermediate density lipoprotein, and LDL decreased by 34%, 72%, 63%, and 25%, respectively. Although the surface lesion area of the aorta in the treated group was not different from that in the control group, intimal thickening in the treated group was significantly lower than that in the control group. Of the lesional components of atherosclerosis, the relative area of smooth muscle cells, collagen fibers, and extracellular lipid deposits in the treated group decreased significantly. It is concluded that fluvastatin decreased in the smooth muscle cell content of the atherosclerotic plaques and delayed progression of the aortic atherosclerosis in addition to the potent hyperlipidemic effect.

Impaired cytosolic calcium mobilization and aggregation in response to collagen in platelets from Japanese black cattle with Chediak-Higashi syndrome

OBJECTIVE

To examine whether impaired aggregation of platelets from Japanese Black cattle with Chediak-Higashi syndrome (CHS) was attributable to mobilization of cytosolic Ca2+.

ANIMALS

4 healthy Japanese Black cattle and 3 Japanese Black cattle with CHS.

PROCEDURE

Aggregation and mobilization of cytosolic Ca2+ in response to various receptor agonists was measured in platelets from healthy cattle and cattle with CHS. Involvement of endogenous ADP and arachidonic acid in collagen-induced responses was examined. Cytosolic Ca2+ concentration was measured after platelets were loaded with the Ca2+ indicator fura-PE3. Platelet aggregation was measured with an aggregometer.

RESULTS

Collagen (3 to 15 micrograms/ml)-induced increases in cytosolic Ca2+ concentration and aggregation were markedly impaired for platelets from cattle with CHS, compared with values for platelets from healthy cattle. Although aggregation and the sustained phase of the cytosolic Ca2+ response to ADP were also decreased in platelets from cattle with CHS, these decreases were small, compared with those in response to collagen. A cyclooxygenase inhibitor and a phospholipase A2 inhibitor did not have any effect on peak cytosolic Ca2+ concentration or collagen-induced aggregation of platelets from healthy cattle. Responses to a P2 tau-purinoceptor antagonist suggested that decreased release of endogenous ADP was only partially involved in the impaired response to collagen among platelets from cattle with CHS.

CONCLUSIONS AND CLINICAL RELEVANCE

Marked inhibition of collagen-induced Ca2+ mobilization, rather than decreased release of endogenous substances, appeared to be the major cause of impaired platelet response to collagen and the hemorrhagic tendency in cattle with CHS.

Two-step portal bypass to reconstruct an invaded superior mesenteric vein in pancreatic cancer

Advanced cancer of the pancreatic head, especially in its caudal portion, has a limited surgical resectability due to its frequent invasion to the superior mesenteric vein (SMV). A patient with advanced carcinoma of the pancreatic head with vascular invasion to the major bifurcation of the SMV, underwent a pancreatico-duodenectomy under a two-step passive bypass of the portal flow. The marginal colic veins were dilated and formed a long collateral route to the inferior mesenteric vein and the splenic vein due to stenosis of the SMV. The venous flow in this vein was then easily interrupted with the surgical manipulation of the transverse colon. The first passive bypass was thus inserted into the accessory right colic vein to preserve the venous return from both the small intestine and the colon, and also to enable surgical dissection of the invaded SMV itself. After a thorough dissection of the invaded SMV, a second bypass was inserted into the main trunk of the SMV through the dissected vascular stump. Subsequently the passive bypass was maintained until the portal reconstruction with an interposition of the left common iliac vein could be performed. The patient recovered well from the surgery without any complications throughout the postoperative course. In summary, the two-step portal bypass describes, is thus considered a stable and safe procedure for the reconstruction of the superior mesenteric vein, during pancreatoduodenectomy for advanced carcinoma of the pancreatic head.

Radiation enterocolitis: overview of the past 15 years

From April 1980 to April 1995 a total of 54 patients (53 women, 1 man) were hospitalized in our department for the surgical treatment of radiation enterocolitis. Two surgical protocols were applied for these patients: intestinal decompression procedures alone (intestinal bypass, colostomy, or both; n = 18) or an intestinal resection in addition to decompression (n = 36). The clinical factors contributing to survival after irradiation were retrospectively reviewed by a multiple variate proportional hazards model. As a result, patients treated with decompression procedures alone had an 11 times higher risk for death than those treated with the addition of intestinal resection. In the former group, 5 of 18 patients died of bleeding from the remaining intestine after operation. We concluded that surgical resection of the diseased intestine is a useful procedure for treating radiation enterocolitis to reduce intestinal bleeding from the irradiated intestine.

Successful gene transfer to the porcine liver in vivo with an adenoviral vector

In vivo gene transfer to the porcine liver was tested with adenoviral vector to achieve molecular biological graft modulation. In adult female pigs immunosuppressed with cyclophosphamide, cyclosporine, and prednisolone, the liver was surgically isolated and flushed out with cold lactate Ringer solution (4 degrees C), by means of a pump-controlled bypass of the portal vein and the inferior vena cava in Groups A and D. In Group A (n = 4), 2 x 1011 pfu of the adenoviral vectors (pAdexCALacZ) were injected through the left hepatic artery during cold ischemia. In Group (n = 4), 2 x 1011 pfu of adenovirus vectors were injected through the auricular vein in a one-shot manner without a laparotomy. In Group C (n = 4), 2 x 1011 pfu/ml of adenoviral vectors were injected through the hepatic artery in a one-shot manner, without a surgical isolation of the liver. Group D (n = 4) animals received the same protocol as Group A except for the fact that they did not receive the immunosuppressive regimen. In a polymerase chain reaction, a transfected LacZ sequence was detected until POD 28 in Group A, but not in the other groups. In 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside (X-gal) staining, only the Group A animals revealed apparent staining predominantly in the portal area at POD 2, which then continued to be recognized until POD 28. The in situ perfusion of the liver combined with immunosuppression is thought to provide an ideal environment for the liver-directed adenovirus-mediated gene transfer to the porcine liver, by enabling a long contact with a high titer of the adenoviral vector.

Multicystic cavernous hemangioma of the liver: report of a case including diagnostic imaging and pathologic correlation

The case of a multicystic hemangioma in the liver of a 78-year-old woman is reported. The patient complained of upper abdominal pain and had been seen at a local hospital a few months prior to this admission. An endoscopic examination of the stomach revealed an active gastric ulcer, and ultrasonography (US) of the upper abdomen also incidentally detected a liver tumor. After treating the gastric ulcer, she was then referred to Ryukyu University Hospital in January 1997. US revealed a 3.5-cm, oval-shaped, echogenic tumor with multiple cystic areas in the right lobe of the liver. A CT scan demonstrated a hypodense tumor, that was not enhanced on dynamic CT. Angiography showed a hypovascular tumor that appeared to be a multicystic tumor of heterogeneous high intensity on T2-weighted MRI. The tumor measured 3.5 cm x 3.5 cm in size and was multicystic with a fibrous septum and serous fluid. Histologically the tumor was determined to be cavernous hemangioma of the liver. Atypical hemangiomas should be included in the differential diagnosis when hemangiomas show multicystic features.

Identification of deoxy-D-fructosyl phosphatidylethanolamine as a non-enzymic glycation product of phosphatidylethanolamine and its occurrence in human blood plasma and red blood cells

The amino-carbonyl reaction (Maillard reaction), also known as glycation, of egg-yolk phosphatidylethanolamine (PE) was induced by incubating PE (50 mg/ml) with D-glucose (222 mM) in a methanol medium containing 2,6-ditert-butyl-p-cresol as an antioxidant at 37 degrees C for 4 days. The resultant product, glycated PE (gPE), was then isolated from the reaction mixture by two-step normal and reversed-phase high-performance liquid chromatography with UV diode array detection and was characterized as having a 1:1:1 elemental ratio of phosphorus:nitrogen:sugar. The Fourier transform-nuclear magnetic resonance spectrum and infrared absorbance spectrum indicate the isolated gPE to have been deoxy-D-fructosyl PE, which is an Amadori product of PE. The fast atom bombardmentmass spectrometric data for the glycation product of authentic dioleoyl PE (1,2-di-9-octadecenoyl-sn-glycero-3-phosphoethanolamine) show that the molecular weight of gPE corresponds to that of glucose-conjugated PE in the form of an Amadori product. This Amadori product formation was also confirmed in PE/phosphate buffer dispersions and in phosphatidylcholine-PE liposome/phosphate buffer suspensions in the presence of D-glucose at 37 degrees C. gPE was degraded by phospholipase A2, C and D. Freshly spiked blood plasma and red blood cells (RBC) from nomal human volunteers contained substantial levels of gPE, the concentration corresponding to at least 9 mol% of PE. Remarkable formation of gPE, up to 15-45 mol% of PE in human blood plasma and RBC, was further confirmed by prolonged incubation with 5-45 mM D-glucose. The gPE formation in RBC was found to be proportional to the glycated hemoglobin formation.

Surgical treatment for proximal bile duct carcinoma

BACKGROUND

The surgical management of proximal bile duct carcinoma is controversial. There is no consensus among surgeons as to the indications for radical resection. This article described personal experience with the different surgical procedures for patients with proximal bile duct carcinoma.

METHODS

The medical records of fifty-two consecutive patients undergoing surgical resection over a 20-year period were retrospectively analysed in terms of pathology, perioperative mortality, clinical course, and overall survival.

RESULTS

The 1-, 3- and 5-year survivals for the entire group were 63.3%, 24.5%, and 21.0%, respectively. The results for local resection of the extrahepatic bile duct in 35 cases were unsatisfactory. Radical resection that included the right extended hepatic lobe, caudate lobe, and extrahepatic bile duct was performed in 9 patients and demonstrated an excellent 5 year survival rate of 44.4%. However, hospital mortality was 22.2%. There was no significant difference among the operative procedures for patients with advanced disease.

CONCLUSION

Radical resection remains the procedure of choice in proximal bile duct carcinoma. However, results with surgical therapy alone remain unsatisfactory. Multimodality treatment that also includes radiotherapy and/or chemotherapy is recommended.

Morphologic and mucin histochemical analysis of transitional zones in advanced ulcerated colorectal carcinomas: potential prognostic indicators

BACKGROUND AND OBJECTIVES

The transitional zone, which is normal-appearing mucosa that surrounds a primary colorectal carcinoma, has characteristic histologic features, and an increased amount of sialomucin in the transitional zone have been associated with a poorer prognosis. To clarify the prognostic effects of changes in the transitional zone we studied the transitional zone in cancers of the colon and rectum.

METHODS

A total of 105 specimens resected for advanced colorectal carcinoma were studied to identify the effectiveness of evaluating morphologic types (polypoid or nonpolypoid growth type) and mucin expression (sulfomucin or sialomucin type) of the transitional zone as a prognostic indicator.

RESULTS AND CONCLUSIONS

Nonpolypoid carcinomas were likely to have invaded the deeper layers and lymphatic vessels and go on to develop advanced disease. Sulfomucin-type tumors were predominantly found in the right side colon and followed a relatively favorable course. Our results indicate that the morphologic and mucin components of the transitional zone may be prognostic indicators for advanced colorectal carcinoma.

NMR study of the interaction between the B domain of staphylococcal protein A and the Fc portion of immunoglobulin G

The solution structure of the B domain of staphylococcal protein A (FB) complexed with the Fc fragment of immunoglobulin G (IgG) is reported. A previous NMR analysis has shown that in solution FB is composed of a bundle of three alpha-helices, helix I, helix II, and helix III [Gouda, H., Torigoe, H., Saito, A., Sato, M., Arata, Y., and Shimada, I. (1992) Biochemistry 31, 9665-9672]. In contrast, the crystal structure of FB in the FB-Fc complex lacks helix III. Uniformly 15N- and 15N/13C-labeled FB were prepared, and the backbone 13C resonances were assigned. The spectral data obtained in the present study indicated that in solution all three helices including helix III are preserved in the FB-Fc complex. The mode of interaction of FB with the Fc fragment was discussed on the basis of the combined data of hydrogen-deuterium exchange experiments and 1H-15N correlation spectroscopy. It was concluded that a contiguous surface shaped by F14, Y15, E16, L18, and H19 in helix I, and N29, Q33, L35, and K36 in helix II is responsible for the binding.

Synthesis and biological activity of novel 2-(alpha-alkoxyimino)benzylpyridine derivatives as K+ channel openers

The search for novel K+ channel openers with a non-benzopyran skeleton, unlike cromakalim, led to the discovery of a new series of (Z)-2-(alpha-alkoxyimino)benzylpryridine derivatives. Synthesis was achieved by using a (Z)-dominant condensation reaction of benzoylpyridines with O-alkylhydroxylamines, followed by m-chloroperbenzoic acid (m-CPBA) oxidation. The compounds were tested for their vasorelaxant activity in tetraethylammonium chloride (TEA) and BaCl2- and high KCl-induced contraction of rat aorta to identify potential K+ channel openers, and also for their effects on the coronary blood flow (CBF) after intracoronary injection in anesthetized dogs. A large number of the 2-(alpha-alkoxyimino)benzylpyridines strongly inhibited TEA and BaCl2-induced contraction, had no effect on 80 nM KCl-induced contraction, and increased the CBF to more than 200% of the basal flow at 10-30 micrograms/dog. In particular, (Z)-2-[5-bromo-alpha-(tert-butoxyimino)-4-fluoro-2-hydroxybenzyl]- 3- hydroxypyridine 1-oxide (7d) showed highly potent vasorelaxant activity (EC50 = 0.28 microM) comparable to that of levcromakalim (EC50 = 0.17 microM), and gave a significantly longer-lasting increase (T1/2 = 30 min) in the CBF compared to levcromakalim, nicorandil, nitroglycerin, or diltiazem (T1/2 = 5.2, 0.9, 0.4, and 2.2 min, respectively). It also exhibited a stable and long-lasting hypotensive effect (over 7 h) upon oral administration of 1 mg/kg in spontaneously hypertensive rats (SHRs).

Perforated diverticulum of the transverse colon

We report a case of perforated diverticulitis of the transverse colon. The preoperative diagnosis of perforated appendicitis was made on the basis of findings of both ultrasonography and CT. At surgery, an inflammatory mass resembling carcinoma was found in the transverse colon, and segmental resection was then performed. Diverticulitis of the transverse colon is rare, and there have been few reports in the English-language medical literature. This report describes a true diverticulum of the transverse colon that presented as acute diverticulitis.

Esophageal cancer in patients with head and neck cancers

Nine male patients with separate primary cancers of the esophagus and head and neck (pharynx, larynx) presented with a mean age of 56 years (41-69). They included 7 pharyngeal cancer patients and 2 laryngeal ones. Esophageal cancer was discovered synchronously in 6 patients and metachronously in 3 (1, 4, and 11 years later, respectively). The head and neck cancer was stage-I in one patient, stage-II in 4 and stage-IV in 4. The esophageal cancer was cervical in 2, thoracic in 6 and abdominal in 1. It was early cancer (stage-0) in 6 patients and advanced (stage-IV) in 3. The esophageal cancer was more advanced in the metachronous group, while it was early in the synchronous group. Since the head and neck cancer was advanced, all patients underwent a total laryngectomy for their head and neck cancers. As for esophageal surgery, a transhiatal esophagectomy was, in principle, performed for early cancers while a total thoracic esophagectomy was done for advanced cancers. For the reconstruction of the esophagus, a gastric tube was used. Four patients are still alive with a mean survival time of 25 months, whereas five died of cancer recurrence of either type a mean of 19 months after surgery. As compared with the survival rates of the patients with esophageal cancer alone, the 5-year survival rate was 18.2% for patients with double cancers in this series and 27.9% for those with esophageal cancer alone.

[A survival case of intraoperative pulmonary embolism diagnosed early by transesophageal echocardiography]

An otherwise healthy 36-year-old housewife was diagnosed with advanced cancer of the stomach 5 months after her third parturition. Surgery was performed with the patient under total intravenous anesthesia combined with continuous epidural anesthesia. The course of anesthesia and the operative course were uneventful until the abdominal skin was sutured, when unexplained severe circulatory collapse developed. A widely dissociated PETCO2- PaCO2 suggested pulmonary embolism, and the findings of transesophageal echocardiography corroborated the diagnosis. Infusion of 480,000 units of urokinase in 30 minutes was immediately started via a Swan-Ganz catheter, and intravenous heparin 10,000 units in 24 hours, was administrated continuously. The pulmonary circulation was restored 30 minutes after the start of therapy, resulting in rapid recovery of the patient's systemic circulatory and acid-base status. The patient was safely extubated 19 hours postoperatively.

Extracellular glutamate and dopamine measured by microdialysis in the rat striatum during blockade of synaptic transmission in anesthetized and awake rats

We investigated the effect of high dose tetrodotoxin (TTX) on microdialysis measurements of extracellular striatal glutamate and dopamine in normal female rats. Both halothane-anesthetized rats with acutely implanted microdialysis probes and awake rats with microdialysis probes implanted for 24 h were tested. Glutamate levels in awake rats were 45% higher than those of anesthetized rats. Extracellular glutamate remained TTX-insensitive regardless of TTX concentration, anesthesia, or time lapsed after probe implantation. In contrast, TTX reduced dialysate dopamine in all TTX concentrations tested. We speculate that the lower glutamate levels in anesthetized rats reflect the effect of anesthesia. Because glutamate is involved, either as a reactant or a product in a variety of reactions critical to intermediary metabolism in the brain, basal dialysate glutamate levels might indirectly reflect brain metabolism. Further, we conclude that extracellular glutamate collected during non-stimulated conditions is TTX-insensitive. The fact that glutamate levels are TTX-independent does not rule out that glutamate is synaptic in origin but rather demonstrates that it is not nerve impulse-dependent. However, the brain interstitial glutamate pool accessible to the microdialysis probe during control conditions is most likely isolated from the synapse, and therefore does not impose a neurotoxic potential.

Involvement of endothelin in graft-versus-host disease after rat small bowel transplantation

Endothelin (ET-1) expression was evaluated by radioimmunoassay in both plasma and various tissue specimens serially obtained from LBN-F1 recipients of LEW heterotopic small bowel allografts. The recipients showed graft-versus-host disease (GVHD), which histologically became apparent on postoperative day (POD) 13. The ET-1 levels peaked on POD 9 in the kidney, lung, and host intestine at 51.0 +/- 21.1, 90.9 +/- 59.6, and 25.4 +/- 11.8 pg/g wet, respectively, and peaked on POD 11 in the plasma at 7.7 +/- 3.2 pg/ml; thereafter, they decreased to basal levels in both the plasma and tissue specimens on POD 13. An immunohistochemical study of these organs showed a corresponding increase in ET-1 staining in both the endothelial and epithelial cells on PODs 5 and 9, and a reduction in staining on POD 13. In conclusion, ET-1 was found to be increasingly released from the target cells of GVHD before any histological changes became apparent, thus suggesting the pathophysiological involvement of ET-1 in intestinal GVHD.

Thoracoscopic thoracic splanchnicectomy for chronic pancreatitis with intractable abdominal pain

The therapeutic advantages of a thoracoscopic thoracic splanchnicectomy (TTS) to relieve the pain of chronic pancreatitis patients was evaluated. The TTS procedure (four bilateral and five unilateral TTS), was performed on nine patients from April 1993 to October 1995. Based on radiographic images, the pancreatic duct of seven cases were diagnosed as being "nondilated" (<3 mm), whereas two cases were "dilated" (> or = 3 mm). A 5-mm thoracoscope was introduced through the fifth intercostal space on the anterior axillary line, and an additional two cannulas were introduced under direct thoracoscopic vision. The sympathetic chain, at a level from Th 5 to 9, was then resected and electrocoagulated. We performed a unilateral TTS corresponding to the symptomatic side; however, if pain relief was insufficient, an additional sympathectomy was done on the other side. The early postoperative course was uneventful, and immediate pain-relief was normally possible after TTS except for three patients who demonstrated minor intercostal neuralgia at the site of the trocars inserted for TTS. Six of nine patients were able to return to their preoperative work of lifestyle at a maximum follow-up of 24 months (the median and mean durations were 15.0 and 13.7 months, respectively). In addition, no postoperative deterioration of either the endocrine or exocrine function of the pancreas was observed. In conclusion, TTS proved to be a safe and reliable procedure for the pain relief of the chronic pancreatitis.

Villous adenoma of the gallbladder: a case report

A 76-year-old female with villous adenoma of the gallbladder is herein reported. She presented complaining of upper abdominal pain for some months prior to admission. No tumor mass could be detected by transabdominal ultrasonography, but CT scan demonstrated a sessile tumor measuring some 2 cm in diameter. A simple cholecystectomy was thus performed. The resected gallbladder was filled with mucinous material, and showed a sessile tumor with finger-like processes in the fundus. Both the macro- and microscopical findings of the lesion were almost identical to a typical villous adenoma of the colon. Little information is available on villous adenoma of the gallbladder, because such cases are extremely rare. In this paper, is described e a rare villous adenoma lesion while paying special attention to the morphological findings.

Role of exogenous L-arginine in hepatic ischemia-reperfusion injury

Plasma L-arginine is usually deficient immediately after hepatic reperfusion in orthotopic liver transplantation, which may also contribute to the occurrence of either hepatic ischemia-reperfusion injury or pulmonary hypertension. In this study, exogenous L-arginine was thus experimentally used to reverse the deficient status of the L-arginine/NO pathway. An in vivo model of 1 hr hepatic ischemia and reperfusion was thus tested in both rats (Experiment A) and pigs (Experiment B). In Experiment A, 10 mg/kg of L-arginine (group 1, n = 7), D-arginine (group 2, n = 7), or saline (group 3, n = 7) was administered through the portal vein. The hepatic tissue blood flow, at 20 min after reperfusion, improved in group 1 (70.7 +/- 7.0% of the preclamp levels) compared to groups 2 and 3. The serum glutamate oxaloacetate transaminase levels at 24 hr after reperfusion were also lower in group 1 (320 +/- 22.2 IU/L) than in either group 2 or group 3. The intrahepatic NO levels showed a temporal burst (> 15,000 pA current) after reperfusion only in group 1. In Experiment B, 10 mg/kg of L-arginine (group 4, n = 5), D-arginine (group 5, n = 5), or 10 ml of saline (group 6, n = 5) was administered through the portal vein. In group 4, the MPAP (mean pulmonary arterial pressure)/MAP (mean arterial pressure) was lower than that observed in groups 5 and 6. In conclusion, exogenous L-arginine administered from the portal vein was thus found to be effective in mitigating both portal hypertension and reperfusion injury by producing an increased amount of NO immediately after reperfusion.

Pharmacological analysis of the inflammatory exudate-induced histamine production in bone marrow cells

The inflammatory exudate at the post-anaphylaxis phase of allergic inflammation in rats has an ability to enhance histamine production by bone marrow cells. To analyze the mechanism of the inflammatory exudate-induced histamine production pharmacologically, the effects of several drugs were examined in cultures of bone marrow cells. Incubation of the bone marrow cells in the presence of the inflammatory exudate that had been centrifuged and dialyzed against Hanks' balanced salt solution increased histidine decarboxylase activity in the cells and histamine concentration in the conditioned medium. The induction of histamine production by the inflammatory exudate was inhibited by actinomycin D (0.01-1 microM), an inhibitor of RNA synthesis, and cycloheximide (0.1-10 microM), a protein synthesis inhibitor. The protein kinase C inhibitors staurosporine (2-20 nM), K-252a (6-200 nM), and H-7 (10.3-103 microM) also inhibited the inflammatory exudate-induced histamine production in a concentration-dependent manner. The tyrosine kinase inhibitor genistein (3.7-37 microM) also inhibited the inflammatory exudate-induced histamine production, but the protein kinase A inhibitor H-89 (0.2 microM), and the adenylate cyclase activator forskolin (0.1 microM) showed no effect. These findings suggest that histamine production induced by the inflammatory exudate is mediated by the de novo synthesis of histidine decarboxylase and by the activation of protein kinase C and tyrosine kinase.

Vascular reconstruction for intraoperative major vascular injuries

BACKGROUND

The purpose of this study was to find an effective and precise surgical procedure to cope with the major vascular injuries that might be encountered during hepato-biliary and pancreatic surgery.

MATERIALS AND METHODS

Among the 220 cases of hepato-biliary and pancreatic surgery from 1991 to 1995 in our department, 8 patients who sustained 13 different instances of vascular injury were reviewed retrospectively.

RESULTS

Five injuries occurred in the portal vein (PV), 4 in the hepatic artery (HA), and 2 in the inferior vena cava (IVC). The repair procedures consisted of 2 direct closures, 2 resections of the injured sites followed by the end to end anastomosis, 2 autologous venous grafts and 1 artificial vascular graft implantation, and 2 diversions of the arterial bloodflow of the middle colic artery and the gastroepiploic artery to the injured HA. The reconstructed vessels showed postoperative obstructions in 2 cases, in which artificial vascular graft implantation and direct closure were used for the reconstruction.

CONCLUSIONS

Based on the above findings, the use of an artificial graft and a direct closure all contributed to the early postoperative obstruction of the reconstructed vessels. However, a diversion of the arterial bloodflow to the injured hepatic arteries was found to maintain a good postoperative patency in these cases.

The use of intraoperative ultrasonography for detecting tumor extension in bile duct carcinoma

The purpose of this study was to investigate the clinical feasibility of using intraoperative ultrasonography (IOUS) to detect tumor extension in bile duct carcinoma, especially longitudinal invasion along the bile ducts into either the hepatic parenchyma or adjacent hilar vessels.

MATERIALS AND METHODS

The medical records of 14 patients with bile duct carcinoma who underwent surgical treatment at the First Department of Surgery, University of the Ryukyus, were retrospectively analyzed. All patients were examined by IOUS during the operation. The resected specimens were processed in order to compare the ultrasound images with the histological findings.

RESULTS

The echo level of the primary lesion was not consistent. Specific echo patterns, such as a thickening of the echogenic layer (TEL) adjacent to the main tumor showing cancerous invasion, were observed in ten patients, 71.4% (nodular invasive 7, invasive 3) which were later confirmed by microscopic examinations and ultrasonic findings. The detection rate of TEL was 87.5% in nodular invasive type and 100% in invasive type, respectively. The TEL histologically coincided with a layer of fibrotic hypertrophy around the infiltrating tumor cells. The intramural invasion beyond the edge of TEL was detected in only 2 out of 11 patients. The accurate detection rate of the involvement of the portal vein and the hepatic artery by IOUS was 83.3% and 60%, respectively. Based on the above findings, IOUS is thus considered to be essential for evaluating tumor extension along the bile ducts, and also greatly helps in selection of the most appropriate operative procedure, especially in hilar cholangiocarcinoma.

Charcot knee arthropathy with articular amyloid deposition in familial amyloidotic polyneuropathy

An extremely rare case of familial amyloidotic polyneuropathy (FAP) complicated by neuroarthropathy (Charcot joint) in the left knee joint and by intra-articular deposits of amyloid was observed. FAP-specific variant transthyretin (TTR) was found in the synovial fluid and amyloid deposits were confirmed in the synovium, cartilage and bone by Congo red staining and immuno-staining.