Enhanced renal susceptibility to ischemia-reperfusion injury in the rat with obstructive jaundice

BACKGROUND/AIMS

To investigate the susceptibility of kidneys to ischemia-reperfusion injury under obstructive jaundice.

MATERIALS AND METHODS

Bile ducts of male rats were ligated for five days, right kidneys were removed, and vascular clamps were placed across left renal arteries for 30 minutes.

RESULTS

Twenty-four hours later, ischemia-reperfusion produced renal injury in jaundiced rats as shown by increased serum creatinine and urea nitrogen levels. Histological observation showed tubular damages. These changes were minimal after ischemia-reperfusion in control rats. Renal thiobarbituric acid reactive substance contents were increased after bile duct ligation, which did not change after ischemia-reperfusion. On the other hand, ischemia-reperfusion produced a significant increase in renal thiobarbituric acid reactive substance contents in control rats. Renal glutathione contents were increased two fold after bile duct ligation and they were significantly decreased by ischemia-reperfusion.

CONCLUSIONS

Kidneys in obstructive jaundice appear to be susceptible to ischemia-reperfusion injury. Although protective roles of GSH is suggested, the role of oxygen radicals in this type of renal injury remains to be further elucidated.

Choledochal cyst with adenocarcinoma in the cystically dilated intrahepatic bile duct

A rare case of choledochal cyst complicated by papillary adenocarcinoma in the cystically dilated intrahepatic bile duct is reported. The tumor was located in the neck of the cystic lesion, and imaging modalities failed to show communication between the cystic lesion and the bile ducts.

Ischemic hepatitis in cirrhosis. clinical features and prognostic implications

To characterize liver dysfunction in patients with cirrhosis after variceal bleeding, we analyzed 50 cirrhotic patients who had bleeding esophageal varices with or without shock. Increases in serum total bilirubin levels by 1.5 times were observed within 24 h in 11 of 12 patients with shock who died > 4 days after hemorrhage but in only one of eight patients with shock who survived (p < 0.01). Increases in serum aspartate aminotransferase and alanine aminotransferase by 2.5 times were observed in six patients in the former group but in none of the latter (p < 0.05). In postmortem livers, hepatocellular degeneration with minimal inflammatory cell infiltration was observed. Ischemic hepatitis is frequently noted in cirrhotic patients with ruptured esophageal varices. Patients with increases in the serum level of total bilirubin and/or aminotransferases within 24 h from onset of hemorrhage should be carefully treated even if hemorrhage is controlled.

Systemic hypotension and diuresis by L-arginine in cirrhotic patients with ascites: role of nitric oxide

To investigate the role of nitric oxide in renal function and hemodynamics in cirrhotic patients with ascites, L-arginine (30 g in 300 mL of distilled water), a substrate for nitric oxide synthase, was infused into six cirrhotic patients with ascites, and the effects were compared with those of saline infusion. Healthy controls (n = 5) were also studied under the same conditions. In the patients, L-arginine infusion significantly decreased systolic and diastolic blood pressures while markedly increasing urinary flow and urinary sodium excretion; no significant changes were seen with saline infusion. In controls, only diastolic blood pressure was decreased by L-arginine infusion, whereas urinary flow and urinary sodium excretion were increased by both L-arginine and saline infusion. In both groups, a similar increase of plasma atrial natriuretic factor (ANF) was seen with L-arginine and saline infusions; endothelin and catecholamines were not affected by either infusion. In both groups, plasma levels of vasopressin were increased by L-arginine infusion. In the cirrhotic patients, urinary excretions of cyclic guanosine monophosphate (cGMP) and nitrates/nitrites (NOx) were significantly increased by L-arginine infusion, whereas no significant changes were seen with saline infusion. In controls, only the excretion of cGMP was increased by L-arginine infusion. In summary, L-arginine infusion induces diuresis and natriuresis accompanied by increased excretions of cGMP and NOx in cirrhotic patients with ascites. This differs from the response in controls, where the increase in urinary sodium excretion is not accompanied by an increase in markers of increased nitric oxide synthesis.

Increased renal susceptibility to gentamicin in the rat with obstructive jaundice. Role of lipid peroxidation

To study whether renal susceptibility to nephrotoxic stimuli is increased in obstructive jaundice, the effect of gentamicin on the renal function in bile duct-ligated rats was investigated. Gentamicin (50 mg/kg/day, subcutaneously) or saline was given to bile duct-ligated rats or sham-operated rats for six days. Mortality in the bile duct-ligated group that received gentamicin was 64% whereas that in the other groups was 0%. In the bile duct-ligated group, although serum creatinine and blood urea nitrogen were minimally affected, focal granulo-vacuolar degeneration in the proximal tubule was observed, which was accompanied by an increase in renal malondialdehyde. Gentamicin significantly increased serum creatinine and blood urea nitrogen levels and caused marked degeneration in the proximal tubule in the bile duct-ligated group, which was accompanied by a further increase in renal malondialdehyde, while these changes were not observed in the sham group. The kidney in obstructive jaundice appears to be susceptible to gentamicin. Enhanced production of oxygen radicals may be responsible for this effect.

Choledochocele with obstructive jaundice: a case report and a review of the Japanese literature

A case of a 57-year-old farmer with a rare type of choledochal cyst (choledochocele; Alonso-Lej's type III) is described. The patient was admitted because of obstructive jaundice and acute biliary infection. Abdominal computed tomography scan showed a cystic lesion in the head of the pancreas, and endoscopic retrograde cholangiopancreatography disclosed cystic dilatation of the terminal portion of the common bile duct. It was suspected that the choledochocele could swell and compress the common bile duct, causing obstructive jaundice and acute cholangitis; therefore, it was surgically resected. We also reviewed 61 cases of choledochocele reported in Japan; the findings were similar to those reported in the English literature.

[A case of advanced gastric cancer with multiple liver metastases showing marked response to new combination chemotherapy using 5-FU, THP and MMC (FTM)]

A 67-year-old man with advanced gastric cancer with multiple liver metastases was treated by a new combination chemotherapy using 5-FU, THP and MMC (FTM). After the first course of FTM, both abnormal liver function and the elevated level of serum CA 19-9 were restored. After the second course of FTM, the primary lesion became a small ulcer around cardia. A partial response was recognized both in the primary lesion and in the liver metastases. No serious side effect was observed except for leukocytopenia, which was controlled by G-CSFS. This new combination chemotherapy (FTM) was suggested to be useful even for far advanced gastric cancer.

Role of lipid peroxidation in acetaminophen-induced hepatotoxicity: comparison with carbon tetrachloride

The effect of acetaminophen on lipid peroxidation in vivo and in vitro was studied in rat liver and the data were compared with those with carbon tetrachloride. Carbon tetrachloride increased diene conjugates in vivo and thiobarbituric acid reactive substance production in vitro in the liver microsomal incubation. These changes were further enhanced by ethanol that has previously been shown to increase carbon tetrachloride-induced hepatotoxicity. On the other hand, acetaminophen did not increase diene conjugates in vivo and inhibited thiobarbituric acid reactive substance production in vitro. These effects were minimally affected by ethanol which has previously been shown to inhibit acetaminophen-induced hepatotoxicity. Thus, lipid peroxidation may play a minimal role in acetaminophen-induced hepatotoxicity in contrast with carbon tetrachloride-induced hepatotoxicity.

Inhibition of acetaminophen hepatotoxicity by acetaldehyde in the rat

Since we have observed that acetaldehyde, an oxidative metabolite of ethanol, inhibits acetaminophen activation in rat liver microsomes, the in vivo effect of acetaldehyde on acetaminophen hepatotoxicity was tested. In vivo experiments in 3-methylcholanthrene-pretreated male Sprague-Dawley rats showed that administration of cyanamide (20 mg/kg, i.p.) and acetaldehyde (600 mg/kg, s.c.) given 3 and 1 h, respectively, prior to acetaminophen (500 mg/kg, i.p.) but not cyanamide alone prevented acetaminophen hepatotoxicity as assessed by serum transaminases and histology. Acetaldehyde may partly be responsible for the inhibitory effect of ethanol on acetaminophen hepatotoxicity.

Effects of caffeine on paracetamol activation in rat and mouse liver microsomes

1. The effects of caffeine on the NADPH-dependent production of paracetamol-glutathione conjugate were studied in rat and mouse liver microsomes. 2. In the presence of caffeine, glutathione conjugate production in rat microsomes was enhanced, whereas that in mouse microsomes was not affected significantly, showing an apparent species difference. 3. The data partly explain the species difference in the effects of caffeine on paracetamol hepatotoxicity.

Effects of tamoxifen, medroxyprogesterone acetate and estradiol on tumor growth and oncogene expression in MCF-7 breast cancer cell line transplanted into nude mice

The effects of three hormonal agents with a different mechanism of action (tamoxifen [TAM], medroxyprogesterone acetate [MPA] and estradiol [E2]) on tumor growth, differentiation and oncogene expression were evaluated using the estrogen-receptor positive human breast carcinoma cell line MCF-7 transplanted into nude mice. In MCF-7 tumors treated with E2, tumor incidence, mean weight of tumors, 3H-thymidine labelling index, differentiation antigen HMFGM (human milk-fat globule membrane) and ras p21, c-myc, neu oncogene products, the level was significantly increased. On the other hand MPA suppressed all of them. TAM increased the level of c-myc expression and HMFGM antigen, but suppressed the others. This evidence indicates that E2 induces both proliferation and differentiation of MCF-7 tumor cells. MPA suppresses both proliferation and differentiation, and TAM induces differentiation and suppresses proliferation.

Influence of hormones on proliferation of ER-positive cells and ER-negative cells of human breast cancer (MCF-7)

The influence of endocrine therapy on the proliferation of estrogen receptor (ER)-positive cells and ER-negative cells of human breast cancer (MFC-7) serially transplanted into nude mice was analyzed by tumor growth, dextran-coated charcoal (DCC) method, ER-immunocytochemical assay (ER-ICA) and ER-immunocytochemically stained 3H-thymidine autoradiography. In the tamoxifen (TAM) group and the medroxyprogesterone acetate (MPA) group, tumor growth was inhibited, but it was promoted in the 17-beta-estradiol dipropionate (E2) group. The ER level by the DCC method was significantly decreased in the TMA, the MPA and the E2 groups. The ER-ICA showed that the percentage of ER-positive cells was decreased in the TAM and the MPA group, but it was increased in E2 group. However, the ER-immunocytochemically stained 3H-thymidine autoradiography showed that not only the labelling index of ER-positive cells but also that of ER-negative cells was significantly decreased in the TAM and the MPA groups, while the labelling index was significantly increased in the E2 groups. Therefore, it was concluded that endocrine therapy affected the proliferation of both ER-positive cells and ER-negative cells of ER-positive breast cancer.

Effects of NSAID on collagen and proteoglycan synthesis of cultured chondrocytes

Three major NSAID (tiaprofenic acid, indomethacin and acetylsalicylic acid) were studied with regard to their effects on the biosynthesis and gene expression of collagen and proteoglycan of chondrocytes. We found that the biosynthesis of type 11 collagen was suppressed in 60-70% of the controls by either indomethacin or acetylsalicylic acid; tiaprofenic acid did not suppress collagen synthesis. Although the biosynthesis of proteoglycan was suppressed to 80-90% of the control by indomethacin or acetylsalicylic acid, tiaprofenic acid did not suppress proteoglycan synthesis. In order to investigate the gene expression of type 11 collagen and proteoglycan, dot blot hybridization was performed using type 11 collagen and proteoglycan cDNA. The effects of NSAID on the amount of type 11 collagen and proteoglycan mRNA were consistent with those on collagen and proteoglycan biosynthesis. Thus, we concluded that tiaprofenic acid has less effect on cultured chondrocytes.

[Influence of endocrine therapy on the proliferation of estrogen (ER) positive cells and ER negative cells of human breast cancer (MCF-7)]

The influence of endocrine therapy on the proliferation of estrogen receptor (ER) positive cells and ER negative cells of human breast cancer (MCF-7) serially transplanted into nude mice was analyzed by tumor growth, dextran-coated charcoal (DCC) method, ER-immunocytochemical assay (ER-ICA) and ER-immunocytochemically stained 3H-thymidine autoradiography. In the tamoxifen (TAM) group and the medroxyprogesterone acetate (MPA) group, tumor growth was inhibited, but it was promoted in the 17 beta-estradiol dipropionate (E2) group. The ER level by the DCC method significantly decreased in the TMA, the MPA and the E2 groups. The ER-ICA showed that the ER positive cells rate in the TAM and the MPA group decreased, but it increased in E2 group. However, the ER-immunocytochemically stained 3H-thymidine autoradiography showed that not only the labelling index of ER-positive cells but also that of ER negative cells significantly decreased in the TAM and the MPA groups, but significantly increased in the E2 groups. Therefore it was concluded that endocrine therapy affected the proliferation of both ER positive cells and ER negative cells of ER positive breast cancer.

Effects of nonsteroidal antiinflammatory drugs on collagen biosynthesis of cultured chondrocytes

In conclusion, the data obtained from the present study show that TA has less effect than indomethacin or ASA on cultured chondrocytes in gene expression and synthesis of collagen. These findings cannot be directly interpolated to clinical application, but attention to pharmacologic activities of NSAIDs on chondrocytes may have future applications. Two major NSAIDs, TA, indomethacin, and ASA, were examined for their effects on the biosynthesis and gene expression of articular cartilage collagen. The biosynthesis of type II collagen was suppressed to 70% to 80% of the control by indomethacin and ASA. TA did not suppress collagen synthesis. To know the gene expression of type II collagen, dot blot hybridization was performed using type II collagen cDNA. The effects of NSAIDs on the amount of type II collagen mRNA were consistent with those on collagen biosynthesis. Thus, TA had the least effect on cultured chondrocytes.

The significance of regional lymph node dissection in the surgical management of breast cancer

The results of an analysis done on the regional lymph node metastases of 300 patients with operable breast cancer, who were treated in the Department of Surgery (II), Kanazawa University Hospital from 1973 to early 1988 are reported herein. It was found that the metastases of the axillary and internal mammary lymph nodes were closely related to the survival of patients, but they were hardly diagnosed before the operation. Only the dissection of these lymph nodes proved useful for providing the prognostic information. Moreover, in a retrospective study comparing the en bloc extended radical mastectomy versus the other types of mastectomy, the extended radical mastectomy was seen to greatly improve the survival of patients with 3 or less than 3 metastatic axillary lymph nodes. Thus, the extended radical mastectomy provides the maximum diagnostic and prognostic information, and gives the best chance of loco-regional control of the disease. The anterior chest deformity created by the extended radical mastectomy, however, should be avoided in those patients without internal mammary involvement. We therefore propose the modified extended mastectomy as a staging operation.

Indications for bilateral neck dissection in well-differentiated carcinoma of the thyroid

This paper analyses the results of sixty-eight patients with thyroid carcinoma in whom bilateral modified radical neck dissection was performed, and discusses the indications for bilateral modified radical neck dissection. High frequencies of bilateral jugular lymph node metastases were found in eleven patients with obviously widespread involvement of both thyroid lobes, 13 with cancer mainly located in the isthmus, 2 with clinically detectable bilateral or contralateral jugular chain lymph node metastases, and 10 with recurrent thyroid cancer. Bilateral modified radical neck dissection, therefore appears to be indicated for those conditions. On the other hand, lymph node metastases in the contralateral neck were histologically confirmed in 6 out of 27 patients (22 per cent), in whom papillary carcinoma was clinically confined to one lobe, and where there were no obviously enlarged lymph nodes in the contralateral neck. In those patients, the histological confirmation of the contralateral thyroid lobe involvements, and of the contralateral paratracheal lymph node metastasis, appears to be a valid indication for elective contralateral modified radical neck dissection.

Stewart-Treves syndrome. A report of two cases with a review of Japanese literature

Two cases of postmastectomy lymphangiosarcoma seen at our department are reported. One case, treated by amputation, died 1 year 4 months later and the other case, treated by local excision followed by amputation, died 7 months later. Twenty cases from the Japanese literature, including our 2 cases, are reviewed herein. The initial treatment for the other 18 cases was as follows: amputation in 8 cases, local excision in 2, radiotherapy in 4 and chemotherapy in 4. Fifteen of 16 cases eligible for follow up were dead within 20 months after treatment. Although the knowledge available as to the results of the treatment of postmastectomy lymphangiosarcoma is still insufficient to indicate the optimal therapeutic approach, early recognition of the lesion and prompt radical ablative surgery seem to offer the best chance for survival.

Regional lymph node metastases in well-differentiated thyroid carcinoma

The status of regional lymph node metastases was assessed in 171 patients with thyroid cancer who underwent a variety of thyroidectomy procedures with regional lymph node dissection at Kanazawa University, from January 1979 to March 1986. The rates of regional lymph node metastasis in minimal and ordinary thyroid cancer were 57% and 84% respectively. Since the rates of lymph node metastasis were high not only in the central cervical compartment but also in the lateral jugular compartment, modified radical neck dissection in the ipsilateral neck is at least recommended in patients with these thyroid cancers. Furthermore, high frequencies of bilateral regional lymph node metastases were found in patients with obviously widespread involvement of the bilateral lobes, with cancer located in the isthmus, with clinically detectable bilateral or contralateral jugular lymph node metastases and with histological involvement in the contralateral paratracheal lymph nodes. Bilateral modified radical neck dissection is recommended in these patients.

[A case report of hyperlipemia with giant fatty liver during adjuvant endocrine therapy by tamoxifen]

A 36-year-old woman was treated with tamoxifen for lung metastasis of breast cancer and had marked hyperlipoproteinemia with giant fatty liver, high plasma triglyceride levels (3673 mg/dl), and increased levels of very low density lipoprotein (VLDL) and intermediate density lipoprotein (UDL). A low level of activity of both plasma lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) was also noted. Our observations support the concept that, in some patients, the weak estrogen-like activity of tamoxifen is amplified and, in severe lipemia, reduction of the activities of LPL and HTGL might impede the conversion of VLDL to LDL, thus causing the amplification of the effect.

Five year results of radical mastectomy for breast cancer, by a sternal splitting, intrapleural en bloc resection of the internal mammary lymph nodes

A new operative method of extended radical mastectomy enables complete resection of the axillary and internal mammary lymph nodes. In this paper, we present the histological analysis of the internal mammary involvement, and the estimated 5 year survival rate, of 100 patients with breast cancer of Stage I, II or III, who underwent this operation. The incidences of axillary and internal mammary involvements were 41 per cent and 17 per cent, respectively. The metastases in the internal mammary lymph node chain were located from just below the supraclavicular vein to the third intercostal space along the internal mammary vessels. The types of lymphatic invasion observed in the internal mammary chain were lymph node metastases in 88 per cent, metastatic lesion in the lymphoid tissue in 29 per cent and cancer cell emboli in the lymphatic channel in 71 per cent. The overall estimated 5 year survival rate was 90.5 per cent. Where there was internal mammary involvement, the estimated 5 year survival rates for those with no axillary lymph node metastasis, those with fewer than 3 metastatic axillary lymph nodes, and those with more than 4 metastatic axillary lymph nodes were 100 per cent, 80 per cent and 31.2 per cent, respectively. Although the assumption that more aggressive surgical removal of the primary lesion and the regional lymphatic spread gives a higher cure rate has not been proved, this extended radical mastectomy with adjuvant chemoendocrine therapy seems to give a higher 5 year survival rate for patients with internal mammary involvement.