Effects of intravenous fat emulsion on respiratory failure

The effects of intravenous fat emulsion on ventilated normal, diseased or distressed lungs were studied. Forty-eight patients with different types of respiratory failure were divided into four groups. Group A was composed of the patients with a normal lung condition; group B, patients with infectious pulmonary condition and respiratory failure; group C, patients with COPD and respiratory failure; and, group D was composed of the patients with ARDS due to various causes. Five hundred milliliters of 10 percent fat emulsion was infused within 4 h as partial parenteral nutritional support. We concluded that intravenous fat infusion decreased PaO2/FIO2 and increased P(A-a)O2 and intrapulmonary shunt in the patients with ARDS, while it had little effect on the patients with infectious pulmonary disease or COPD. The infusion of fat emulsion had positive effects on the patients with normal lung condition with increased PaO2/FIO2 and decreased P(A-a)O2 and shunt.

Effect of DL-buthionine-S,R-sulfoximine on 1,2-dimethyl-hydrazine-induced colonic tumors in rats

The effect of DL-buthionine-S,R-sulfoximine (BSO), a specific inhibitor of glutathione biosynthesis, on colon tumor development was studied in rats. Weanling male Sprague-Dawley rats were randomly assigned to one of three groups following a week of adaptation. Group 1 rats received BSO (4.5 mM) daily in the drinking water one week before 1,2-dimethylhydrazine (DMH) injections and continued to receive BSO daily until sacrificed; group 2 rats received BSO (4.5 mM) after the last DMH injection, and continued to receive BSO daily until sacrificed; group 3 rats did not receive BSO. All experimental rats received 20 weekly subcutaneous injections of DMH (20 mg/kg body wt.) for colon tumor induction. The tumor incidence was lower in group 1 (54%) than in group 2 (97%) or group 3 (96%). The median tumor size is significantly smaller in group 1 (11 mm2) than group 3 (46 mm2). The group 2 had the largest median tumor size (65 mm2).

The pharmacological and pathological studies on Taiwan folk medicine (III): The effects of bupleurum kaoi and cultivated bupleurum falcatum var. komarowi

The protective effects of water extract from roots of Bupleurum kaoi Liu, Chao et Chuang and Bupleurum flacatum L. var. Komarowi Koso-Polj on CCl4-induced hepatoxicity have been investigated. Both B. kaoi (p less than 0.05) and B. falcatum var. komarowi (p less than 0.01) possessed more marked anti-hepatotoxic pharmacological effects than Bupleurum chinense DC., the typical strain widely used in Taiwan. The pathological improvement from treatment by means of the three drugs to alleviate CCl4-induced hepatic toxicity was estimated using morphological changes of hepatocytes, reduction of inflammatory cells infiltration and liver function tests.

Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma

During the 10-year period from 1978 to 1987, hepatic resections were performed on 20 patients with peripheral cholangiocarcinoma (PCC). Nine of these patients were men and 11 were women (mean age, 48.5 years). Among them, 80% had intrahepatic stones with recurrent cholangitis. The 20 patients were subdivided into the following three groups: Group I (12 patients with surgery for PCC); Group II (4 patients with surgery for chronic cholangitis [but the final pathologic diagnosis confirmed PCC]); and Group III (4 patients with surgery for space-occupying liver lesions). No early postoperative mortality was noticed. The few complications that occurred were related to surgery for hepatolithiasis. Postoperative wound infection was the most common complication. The overall mean survival time was 20.5 months. Four patients survived for more than 3 years; one was even alive for more than 5 years after surgery.

Intraoperative fiberoptic choledochoscopy for malignant biliary tract obstruction

A prospective study to determine the safety and effectiveness of intraoperative fiberoptic choledochoscopy in the management of malignant obstruction of the biliary tree was conducted in 44 patients. There were 12 patients with cancer of the pancreatic head, 9 with adenocarcinoma of the distal common bile duct, 4 with adenocarcinoma of the ampulla of Vater, 8 with cholangiocarcinoma of the common hepatic duct, 9 with intrahepatic bile duct carcinoma, and 2 with hepatocellular carcinoma. Five patients with intrahepatic bile duct carcinoma and two with hepatocellular carcinoma were found during a search for intrahepatic duct stones in patients with recurrent cholangitis. In nine patients with bile duct carcinoma (seven extrahepatic and two intrahepatic), histopathological diagnosis was made at operative endoscopy. Treatment strategy was altered in seven patients based on findings at operative choledochoscopy. Complications were few with no mortality. Intraoperative fiberoptic choledochoscopy was safe and useful in the management of malignant obstruction of the biliary tree.

[The treatment of esophagojejunal anastomotic stricture after total gastrectomy]

From December 1983 through December 1988, 200 cases of total gastrectomy were performed in Chang Gung Memorial Hospital. The esophagojejunostomy was performed with EEA staplers in 196 cases, and with hand suture in 4 cases. Twelve cases developed anastomotic stricture after the operation. All of these 12 anastomoses were done with EEA 28 mm staplers. Four of the 12 patients received no further treatment either because the symptoms were mild or because of development of carcinomatosis. Six patients received endoscopic YAG laser treatment, only 2 had good results. Four Patients received balloon dilatation, 2 of them had good results, 4 patients received surgical intervention after failure of the balloon dilatation or YAG laser treatment. Of the 4 patients who underwent surgery, the thoracoabdominal approach was used in 3, and a thoracotomy in 1. Three patients received side to side esophagojejunostomy to bypass the stricture site. In the remaining patient, stricture was excised and a new end to end anastomosis was done with hand sutures. All of these 4 patients had good results after the operation. There are many possible mechanisms of the development of anastomotic stricture. Anastomotic leakage, technical error, lack of mucosa-to-mucosa apposition, size of the EEA stapler and tissue ischemia all have been regarded as the possible causes of anastomotic stricture. Once the esophagojejunal anastomosis stricture occurs, treatment should be done to relieve dysphagia. From the results of our patients, endoscopic YAG laser is not a satisfactory treatment for anastomotic stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic resection in 120 patients with hepatocellular carcinoma

During the 11-year period from 1977 through 1987, hepatic resections were carried out in 120 patients with hepatocellular carcinoma (HCC). Twenty-five had HCCs smaller than 5 cm in diameter. There were 97 male and 23 female patients, with an average age of 51.5 years. Among them, 45.8% had liver cirrhosis and 80.8% were positive for hepatitis B surface antigen. Fourteen with ruptured HCCs underwent hepatic resection to control the intra-abdominal hemorrhage. Operative mortality within one month after surgery was 4.1%. The postoperative course was complicated by pleural effusion in 5.8%, subphrenic abscess in 2.5%, postoperative bleeding in 1.6%, hepatic failure in 1.6%, and bile leakage in 0.8% of the patients. The overall five-year survival rate in this series was 25.9%, while survival for the last five years was better (42.3% vs 11.9% for patients treated between 1977 and 1982). The cumulative survival rate had no relation to tumor rupture or liver cirrhosis. The group of patients with smaller tumors (diameter, less than 5 cm) or without vascular invasion by tumor had better survival.

Pharmacokinetic and pharmacodynamic comparison of conventional and controlled release formulations of metoprolol [correction of motoprolol] in healthy Chinese subjects

A double-blind, crossover comparison of the pharmacokinetics and pharmacodynamics of controlled-release metoprolol (CR) 100 mg and 200 mg, metoprolol plain tablet 100 mg, metoprolol Durules 200 mg, and placebo was carried out in 10 healthy Chinese subjects. Standardized treadmill exercise tests according to the Bruce protocol were performed at a steady state of medication, before and 2, 6, 12, and 24 hours after the dose, and multiple blood samples were collected for determination of the metoprolol concentration. The plasma metoprolol levels over 24 hours were more uniform after metoprolol CR than Durules and the plain tablet. The mean peak concentrations for CR 100 mg, 200 mg, Durules, and the plain tablets were 231, 426, 790, and 1105 nmol/l, respectively. The corresponding fluctuation incides were 1.1, 1.5, 2.2, and 5.0. The effects on exercise heart rate (EHR) were investigated at steady state. Metoprolol CR produced more even reduction in EHR over 24 hours than Durules and plain tablets. All four treatments gave similar maximal reduction in EHR of about 20% at 2 hours after the dose. In conclusion, once daily metoprolol CR showed almost even blood levels and provided relatively constant levels of beta1 blockade over 24 hours in healthy Chinese subjects.

Intrahepatic stones associated with cholangiocarcinoma

Twenty cases of cholangiocarcinoma associated with hepatolithiasis were treated surgically. The incidence of cholangiocarcinoma associated with hepatolithiasis was 2.4%. Surgical procedures included common bile duct exploration after intraoperative choledochofiberoscopy in 20, with hepatic resection in nine. Overall survival was 8 months, with a range of 3-40 months. The hepatectomy group seemed to have a better prognosis. Accurate preoperative diagnosis of intrahepatic bile duct carcinoma associated with intrahepatic stones is difficult. All 20 patients in this series had surgery for recurrent cholangitis due to intrahepatic stones. From a retrospective review, it became apparent that early diagnosis can be obtained from the following: 1) detection of a hyperechoic mass in the liver parenchyma during abdominal ultrasonography, 2) a scintigraphic defect near the hilum, 3) filling defects or obliteration of intrahepatic ducts in ERCP or PTC, 4) gross appearance of the liver during surgery revealed a nodular tumor mass or an atrophic, fibrotic liver, and 5) intraoperative choledochoscopic findings which showed an intraluminal tumor or infiltrative lesion.

Relationship between coronary artery size and ventricular hypertrophy

The relationship between coronary blood flow and ventricular hypertrophy has been studied in animal models. But, this relationship in the human body is scarcely evaluated. In this study we measured coronary arterial sizes by coronary arteriograms and correlated them with ventricular hypertrophy. Patients who underwent cardiac catheterization and coronary arteriography and showed no significant coronary arterial lesions were included in this study. There were 131 patients, 75 men and 56 women, with a mean age of 53 +/- 10 years (S.D.). After evaluation with electrocardiograms, echocardiograms and left ventriculograms these patients were divided into 4 groups: (1) the non-hypertrophy (NVH) group, 50 cases; (2) the left ventricular hypertrophy (LVH) group, 38 cases; (3) the right ventricular hypertrophy (RVH) group, 23 cases; and (4) the biventricular hypertrophy (BVH) group, 20 cases. The proximal portion of the 3 major coronary arteries and the left main stem were measured from coronary arteriograms with the catheter tip as a size reference. The results showed that the left main stem was larger than the 3 major coronary arteries in the NVH, LVH and BVH groups. But in the RVH group, the left main stem was not significantly larger than the right coronary artery. In all 4 groups the left circumflex coronary artery was the smallest while the left anterior descending coronary artery and the right coronary artery were similar in size. Patients with LVH showed dilatation of all 3 left coronary measurements (left main stem, left anterior descending coronary artery and left circumflex coronary artery) as compared with the NVH patients and the RVH patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment for spontaneous rupture of hepatocellular carcinoma

Twenty-seven patients with spontaneous rupture of hepatocellular carcinoma (HCC) underwent surgical treatment during the past ten years. The indications for emergent laparotomy were hemoperitoneum in 14 and unspecified peritonitis in 13. Twelve were found to have noncirrhotic HCC. The incidence of associated cirrhosis was 55.56 per cent. Surgical procedures included hepatic resection in 14, hepatic arterial ligation in six and packing, suture and electrocauterization in seven. Seven died within one month postoperatively, a surgical mortality rate of 28 per cent. Recently, palliative resection has been used more frequently. The group of patients who underwent resection have a better prognosis.

Effect of endotoxin on the rat colon glutathione level

The effect of endotoxin on the colon glutathione level was studied in male rats. Endotoxin (Escherichia coli) from 25 ug to 100 ug/100g body weight was administered intravenously. The Glutathione level was measured 16 hours after endotoxin was given. Results showed that endotoxin significantly enhanced the colon glutathione concentration as measured by 5,5'-dithiobis (2-nitrobenzoic acid). The increase which ranged from 11% to 50% was dose dependent. At an endotoxin dose of 1000 ug/100g body weight, colon glutathione level was found to be enhanced from 2 hours up to 48 hours. In contrast, the duodenum and jejunum glutathione levels were found to be significantly reduced. The increase in the colon glutathione level may have a protective effect against oxidative damage to the colon.

Percutaneous transhepatic cholangioscopy

Since 1983, percutaneous transhepatic cholangioscopy has been performed in 50 patients for both therapeutic and diagnostic purposes. Percutaneous transhepatic cholangioscopy was used to evaluate the nature of obstructive jaundice in 15 patients and bile duct stones were removed in 35 patients, 27 of whom also had intrahepatic duct stones. The overall success rate for stone removal was 80 per cent. Complications were few with no mortality. Emergency surgery was necessary in two patients, one for subphrenic haematoma, the other for a bile leak. Percutaneous transhepatic cholangioscopy is an effective and safe method for management of biliary stones and is a useful procedure for establishing the diagnosis of obstructive jaundice.

Percutaneous transhepatic biliary drainage for acute cholangitis

Percutaneous Transhepatic Biliary Drainage (PTHBD) was performed in 56 consecutive patients with severe acute cholangitis, during a period of one year. An immediate decompression effect with a "good" response was achieved in 46 (82.2%), who usually became afebrile within 18 to 24 hours, and "poor" response in 10 (17.8%). Five died (8.93%) in a subsequent operation. No mortality was associated with the use of PTHBD. Complications related to the procedure occurred in 12 of the 56 patients (21.4%). Hemobilia was the major complication. The other complications were intraabdominal hemorrhage, bleeding from the puncture site, transient hypotension, catheter occlusion and/or dislodgement, bile leak, pneumothorax and hemothorax. Two with hemobilia, one with intraabdominal hemorrhage and the other with bile leak required an emergency operation. PTHBD procedures can be lifesaving in biliary sepsis. Once infection and hyperbilirubinemia are controlled, rational subsequent therapy can be formulated for the underlying disease.

Resection of hepatocellular carcinoma after transcatheter arterial embolization. Reevaluation of the advantages and disadvantages of preoperative embolization

Hepatocellular carcinomas (HCCs) were resected in eight patients who had preoperative transcatheter arterial embolization (TAE) and in 25 patients without preoperative TAE. Three patients in the former group had ruptured HCCs before operation. Two of the former group and three of the latter group were found to have recurrences after a follow-up of 1 1/2 years. Although preoperative TAE resulted in significantly increased tumor necrosis, it increased the risk of gangrenous change of the gallbladder, induced adhesion of the hepatoduodenal ligament, and was not effective in reducing operative blood loss or operative time if the vessel selected for TAE was inadequate. Pathologic examination revealed tumor emboli still existing in the intrahepatic veins. Daughter nodules and capsular invasion by tumor cells were not affected by TAE. Transcatheter arterial embolization seems to be effective in controlling bleeding from ruptured HCC prior to staged resection of the tumor.

Nonthoracotomy esophagectomy for corrosive esophagitis with gastric perforation

Surgical treatment of corrosive esophagitis with gastric perforation is a high risk operation. Nonthoracotomy esophagectomy plus total gastrectomy was performed upon seven patients and compared with cervical esophagostomy plus total gastrectomy performed upon five patients. Two patients in the first group and all of the patients in the second group died. Transpleural esophagectomy for these critically ill patients is usually dangerous with high morbidity rates, while nonthoracotomy esophagectomy is a procedure which has lower risks and more advantages for removing the damaged esophagus of the patient with corrosive esophagitis.

Human fetal lung changes associated with maternal smoking during pregnancy

Pulmonary impairment in the offspring of smoking mothers is well documented by epidemiologic studies. The morphologic bases for the functional impairment are largely unexplored. We studied 17 infant lungs obtained at autopsy, ten from smoking (group 1) and seven from nonsmoking (group 2) mothers, by light (LM), transmission (TEM), and scanning electron microscopy (SEM). By LM, the alveolar mean linear intercept was similar in both groups; the total lung volume and alveolar surface area increased with the increase in gestational age in all lungs studied. By SEM, the sizes of the neuroepithelial bodies (NEB) were larger in group 1 than in group 2. By SEM and TEM, ciliated cells were increased, but the amount of dense core granules was decreased, in the NEB of the smoking group. Maternal smoking during pregnancy appears to alter the size and cellular composition of fetal NEB. The detailed mechanisms of the alteration in NEB and their implications are unclear from this study and needed further clarification.

Radiometric studies of Mycobacterium tuberculosis

An in vitro assay system that included automated radiometric quantification of 14CO2 released as a result of oxidation of 14C- substrates was applied for studying the metabolic activity of M. tuberculosis under various experimental conditions. These experiments included the study of a) mtabolic pathways, b) detection times for various inoculum sizes, c) effect of filtration on reproducibility of results, d) influence of stress environment e) minimal inhibitory concentrations for isoniazid, streptomycin, ethambutol and rifampin, and f) generation times of M. tuberculosis and M. bovis. These organisms were found to metabolize 14C-for-mate, (U-14C) acetate, (U-14C) glycerol, (1-14C) palmitic acid, 1-14C) lauric acid, (U-14C) L-malic acid, (U-14C) D-glucose, and (U-14C) D-glucose, but not (1-14C) L-glucose, (U-14C) glycine, or (U-14C) pyruvate to 14CO2. By using either 14C-for-mate, (1-14C) palmitic acid, or (1-14C) lauric acid, 10(7) organisms/vial could be detected within 24 48 hours and as few as 10 organisms/vial within 16-20 days. Reproducible results could be obtained without filtering the bacterial suspension, provided that the organisms were grown in liquid 7H9 medium with 0.05% polysorbate 80 and homogenized prior to the study. Drugs that block protein synthesis were found to have lower minimal inhibitory concentrations with the radiometric method when compared to the conventional agar dilution method. The mean generation time obtained for M. bovis and different strains of M. tuberculosis with various substrates was 9 ± 1 hours.

Downward displacement of aortic anulus leading to aortic and mitral regurgitation

A rare case of combined aortic and mitral regurgitation resulting from downward displacement of the aortic anulus is reported. The patient was treated successfully with an aortic valve replacement with a Björk-Shiley valve prosthesis, which was anchored at the normal site of the aortic anulus. No procedures were performed on the mitral valve, but mitral regurgitation was not evident postoperatively.

Transcatheter hepatic arterial embolization followed by hepatic resection for the spontaneous rupture of hepatocellular carcinoma

In three cases of the spontaneous rupture of hepatocellular carcinoma, emergent transcatheter hepatic arterial embolization was performed for controlling the intraperitoneal hemorrhage. No more transfusions were required after embolization. Operation was carried out on the 10th, 5th, and 5th day, respectively, after liver function studies returned to the pre-embolization level. Hepatic resection of left hemi-hepatectomy was performed in Case 1, and segmentectomy in Case 2 and Case 3 each. Transcatheter hepatic arterial embolization followed by hepatic resection is a rational treatment in the management of the spontaneous rupture of hepatocellular carcinoma.

Increased bone marrow blood flow in rabbits with acute hemolytic anemia

The bone marrow blood flow in the femur of the rabbit with acute hemolytic anemia was measured by the radioactive microsphere method. Acute hemolytic anemia was induced by a single intraperitoneal injection of phenylhydrazine. An increase in the bone marrow blood flow was detected three days after the induction of anemia and continued for about one week. The bone marrow blood flow of the anemic rabbit (66 ml/min/100 g marrow) was about three times that of the control (20 ml/min/100 g marrow). The increased blood flow to the bone marrow appeared to be correlated to the increased erythropoietic activity.

Nicotine-induced neuroepithelial cell changes in young rabbits: a preliminary communication

Nicotine, 1 mg/kg body weight/day, was injected subcutaneously in 3 female rabbits during gestational and lactating periods, and the lungs of the offspring were studied by scanning and transmission electron microscopy (SEM and TEM) on days 5, 10, and 25 postpartum. Three other female rabbits served as controls. The size and number of neuroepithelial bodies (NEB) as estimated by SEM were larger in the experimental group than in the control group, especially on days 5 and 25. Moreover, the NEB in the nicotine-exposed groups showed loss of normal boundaries and derangement of cells and granules by TEM. Neural components also became prominent. These findings suggest that chronic maternal exposure to nicotine may directly, or, through the neural route, indirectly induce hyperplasia and dysplasia of the NEB in the offspring of rabbits. Because NEB are suspected to regulate regional bronchial and vascular smooth muscle cells, such alterations may be similar to respiratory functional impairments found in infants of mothers who smoke.

Thyroid function in epileptic mothers and their infants at birth

It has been suggested that patients receiving anticonvulsant therapy have depressed thyroid function. Thyroid function was studied in 16 pregnant epileptic women who were receiving various anticonvulsants; 20 nonepileptic pregnant women served as controls. Maternal and umbilical cord blood was collected at delivery and serum thyrotropin, total thyroxine, triiodothyronine, triiodothyronine resin uptake, and free thyroxine levels were measured. The free thyroxine index was calculated from the thyroxine and triiodothyronine resin uptake data. There were no significant differences in any of the maternal parameters. In cord serum, the thyroxine level was significantly lower (p less than 0.001) in the infants of the epileptic mothers. The triiodothyronine resin uptake was slightly increased in the epileptic group (p less than 0.05) so that the free thyroxine index largely compensated for this. The thyrotropin, free thyroxine, and triiodothyronine levels did not differ between the two groups. Thus the low thyroxine values in cord blood of infants of epileptic mothers receiving anticonvulsants probably reflect an alteration in protein binding rather than a true alteration in thyroid function.