Effect of naloxone on detrusor-sphincter dyssynergia in the chronic spinal cat

Naloxone, an opioid peptide antagonist, has been reported to facilitate voiding in neurologic bladder disorders, but its effects on the neural micturition reflex arc are poorly understood. We studied the effect of naloxone in 34 male adult cats, spinalized at C5-C6 level 7 to 119 days previously. Each cat served as its own control. The following tests were performed: Urethral pressure profiles, cystosphincterograms with the urethro-vesical junction opened and closed and mechanograms of the detrusor, and the circular and longitudinal urethral muscles. The study included (1) the effects of anesthesia of the bladder and pelvic nerve, as well as that of the urethral and pudendal nerves; (2) the action of naloxone; and (3) the action of oxymorphone. Our results demonstrated that naloxone (1) increased somatic (osteotendinous and nociceptive) reflexes and aggravated spasticity; (2) increased vegetative micturitional and sexual reflexes, in particular the urethra-urethral contraction reflex, aggravating the spasmodic contractions of the external sphincter; and (3) increased the frequency and intensity of the mass reflex. In consequence, we suggest that naloxone is contraindicated in cases of spinal cord lesions with detrusor-sphincter dyssynergia syndrome.     

ENDOSCOPIC OBSERVATION OF MUCOSAL SPREAD LESION OF CHOLANGIOCARCINOMA USING PERORAL CHOLANGIOSCOPY WITH NARROW BAND IMAGING

A 69‐year‐old man was admitted to Toho University Omori Medical Center complaining of icterus. Abdominal computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were suspicious of cholangioma of inferior bile duct. Peroral cholangioscopy using narrow band imaging (NBI) was performed and it was possible to diagnose the mucosal spread lesions of cholangioma. Histological findings reflected the endoscopic findings. Mucosal spread lesions of cholangiocarcinoma were successfully diagnosed using the CHF‐B260 for NBI.     

肝硬化门脉高压性胃粘膜损害52例临床分析

本文对５２例肝硬化门脉高压性胃粘膜损害患者临床分析表明，肝功能损害与胃粘膜病变有显著相关性，而与胃底食道静脉曲张没有显著相关性。同一组病人中ＰＨＧ与ＧＥＶ的发生率虽有差异，但认为这种差异的临床意义不大。结合文献对ＰＨＧ的发生机理和诊断治疗进行了讨论     

门脉高压性胃病患者的胃壁血气变化

作者观测了４３例门脉高压症患者股动脉血ＰＯ２、胃网膜有动静脉胃壁支血ＰＯ２、胃壁支静脉及肘静脉血ｐＨ、ＨＣＯ３－和胃网膜右静脉压力，其中２３例并有非出血期门脉高压性胃病。结果表明：①门脉高压症患者的股动脉血ＰＯ２低于对照组；②门脉高压症患者胃网膜右动静脉胃壁支血氧分压差低于对照组，胃网膜右静脉压力高于对照组，胃壁支静脉血ｐＨ和ＨＣＯ３－低于对照组和同组肘静脉血。并有门脉高压性胃病者这些变化更为显著。提示门脉高压性胃病的发病机制在于门脉系压力增高、胃粘膜下动静脉短路开放、胃粘膜缺血缺氧和胃壁局部酸中毒。     

胎盘型谷胱甘肽S转移酶mRNA在大鼠肝癌癌前病变组织中的原位表达

应用原位杂交技术，观察了二乙基亚硝胺（ＤＥＮ）诱发大鼠肝癌前病变组织中胎盘型谷胱甘肽Ｓ转移酶（ＧＳＴ－Ｐ）ｍＲＮＡ的表达。结果显示，ＧＳＴ－ＰｍＲＮＡ主要在癌前病变肝组织中的变异灶及灶外卵圆形细胞内表达，且在变异灶间或和同一灶内阳性细胞间表达程度不尽一致，而正常肝、再生肝组织中未见其表达。提示在分子水平上变异灶细胞及卵圆型细胞可能成为实验性肝癌的癌前期细胞     

胃幽门弯曲菌感染对胃癌发生影响的探讨

应用Warthin-starry镀银技术检查胃幽门弯曲菌,对中国胃癌高发区及美国胃癌高发区新奥尔良检查了300例具有胃症状的胃粘膜标本。结果发现幽门弯曲菌阳性率为60～62%,并且看到这种细菌的感染与慢性胃炎病变的程度有明显的关系。本文探讨了幽门弯曲菌的感染与胃癌癌前病变的关系。     

Modifying Effects of Various Chemicals on Preneoplastic and Neoplastic Lesion Development in a Wide-spectrum Organ Carcinogenesis Model Using F344 Rats

Modifying potentials of various chemicals on tumor development were investigated in a wide-spectrum organ carcinogenesis model using male F344/DuCrj rats. The animals were treated with N-nitroso-diethylamine (100 mg/kg body weight, ip, single injection at the commencement of the study), N-methyl-N-nitrosourea (20 mg/kg body weight, ip, 4 times during weeks 1 and 2) and N-bis(2-hydroxypropyl)nitrosamine (0.1% in drinking water, during weeks 3 and 4) for multi-organ initiation and then were given one of 14 test chemicals including 6 hepatocarcinogens, 7 non-hepatocarcinogens and 1 non-carcinogen, or basal diet for 16 weeks. All rats were killed at the end of week 20, and the major organs were carefully examined for preneoplastic and neoplastic lesions. Immunohistochemical demonstration of glutathione S -transferase-positivc foci was also used for quantitative assessment of liver preneoplastic lesion development. Modifying effects were shown for 11 out of 14 test agents in the liver, forestomach, glandular stomach, lung, urinary bladder or thyroid, 7 of them targeting more than two organs. This was the first demonstration to our knowledge that cloflbrate possesses enhancing potential for urinary bladder carcinogenesis and an inhibiting effect on thyroid carcinogenesis. Caprolactam showed no effect in any organ, in agreement with its established inactivity. The results indicated that the system could be reliably applied as a medium-term multiple organ bioassay for assessment of the modification potential of test agents in unknown target sites.     

Tumor-Like Meniscal Cyst

A 50-year-old woman presented with a 5-year history of mild pain in her right knee, which had increased over the last 2 years. A palpable mass over the anterolateral aspect of the knee was obvious and the last 3 months she was experiencing locking episodes with consequent knee effusion. The differential diagnosis was driven between meniscal cyst, pigmented villonodular synovitis, synovial sarcoma, synovial chondromatosis, and aneurysm. After a diagnostic arthroscopy, the lesion was excised by a limited lateral arthrotomy. The pathologic findings revealed a synovial cyst. Intra-articular synovial cysts are uncommon, nonsymptomatic, and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. This lateral meniscus synovial cyst (2.5 × 2.5 cm) was enlarged within the intracondylar notch and produced disabling knee symptoms. The peculiarity of this lesion was the tumor-like appearance: its large size, the progress of symptoms, and the multilobulated, nonhomogenous signal on the MRI scan. One year postoperatively, the patient is asymptomatic and the MRI obtained at 6 months revealed no remnant of the fully excised cyst.     

Arthroscopic Shoulder Stabilization: Is There Ever a Need to Open?

Recent studies show comparable results of arthroscopic shoulder stabilization techniques compared with the gold standard open Bankart reconstruction. Great technical advances and ever-increasing surgeon experience have rendered pathology once deemed an indication for open surgery as treatable by arthroscopic means. With this movement toward a more universal application of all-arthroscopic techniques, we might consider the following question: Is there ever a need to open? To answer this question, we must first consider normal anatomy and then appreciate the contribution of deranged pathoanatomy to recurrent instability in each individual case. The surgeon must then determine whether this is best addressed via an arthroscopic or open technique. Arthroscopy, as compared with open stabilization procedures, holds the potential benefits of decreased morbidity rates, early functional rehabilitation, and improved range of motion. Despite potential advantages, arthroscopic stabilization is clearly contraindicated when a significant pathologic lesion contributing to recurrent instability cannot be adequately addressed as a result of the limitations of current techniques or instrumentation. On the basis of this principle, we believe that sizable glenohumeral bone defects remain the only absolute contraindication to an all-arthroscopic approach. Many complicating issues, such as attenuated capsule, humeral avulsion of the glenohumeral ligament lesions, cases of revision surgery, and collision or contact athletes, exist and warrant close attention. We prefer to think of these situations as “challenges” for which both arthroscopic and open surgery should be considered, rather than as true contraindications to arthroscopic shoulder stabilization. We are, by no means, advocating arthroscopic treatment in all cases of shoulder instability, because this would represent a gross oversimplification of the issues at hand. However, we do acknowledge that the steadfast contraindications to arthroscopic shoulder stabilization are decreasing every day.