A comparison of treatment and outcomes of perihilar cholangiocarcinoma between Eastern and Western centers

Background

Perihilar cholangiocarcinoma (PHC) often requires extensive surgery which is associated with substantial morbidity and mortality. This study aimed to compare an Eastern and Western PHC cohort in terms of patient characteristics, treatment strategies and outcomes including a propensity score matched analysis.

Assessment of hepatic microvascular flow and density in patients undergoing preoperative portal vein embolization

Background

The microvascular effects occurring after unilateral preoperative portal vein embolization (PVE) are poorly understood. The aim of this study was to assess the microvascular changes in the embolized and the non-embolized lobes after right PVE.

Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies

BackgroundOver the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome.MethodsAll consecutive PDs performed between 1992–2017 in a single pancreatic center were identified from a prospectively maintained database and analyzed according to three time periods.ResultsIn total, 1434 patients underwent PD. Over time, more elderly patients underwent PD (P < 0.001) with increased use of vascular resection (10.4 to 16.0%, P < 0.001). In patients with cancer (n = 1049, 74.8%), the proportion pT3/T4 tumors increased from 54.3% to 70.6% over time (P < 0.001). The postoperative pancreatic fistula (16.0%), postpancreatectomy hemorrhage (8.0%) and delayed gastric emptying (31.0%) rate did not reduce over time, whereas median length of stay decreased from 16 to 12 days (P < 0.001). The overall failure-to-rescue rate (6.9%) and in-hospital mortality (2.2%) remained stable (P = 0.89 and P = 0.45). In 523 patients with pancreatic cancer (36.5%), the use of both adjuvant and neoadjuvant chemotherapy increased over time (both p<0.001), and the five-year overall survival improved from 11.0% to 17.4% (P < 0.001).ConclusionsIn a period where indications for PD expanded, with more elderly patients, more advanced cancers and increased use of vascular resections, surgical outcome remained favorable and five-year survival for pancreatic cancer improved.     

The pathology of the heart following long-term anticoagulant therapy in elderly patients after myocardial infarction. The Dutch sixty-plus reinfarction study

A pathomorphologic study of 30 hearts of elderly patients, who died during a double-blind trial to assess the long-term effects of oral anticoagulants following myocardial infarction, showed that all patients had suffered of severe and extensive obstructive coronary atherosclerotic disease. Eight hearts were obtained from patients who had received anticoagulants, while 22 hearts were obtained from patients of the placebo group. Complicated coronary arterial lesions, such as cracked plaques and coronary thrombosis, occurred more frequently in hearts of patients of the placebo group. A recurrent recent infarction was found at autopsy in 13 of the 22 patients receiving a placebo, in contrast to 3 of the 8 hearts from the group of patients receiving anticoagulants. The findings point in the same direction as the clinical trial, which showed a statistically significant reduced risk of recurrent myocardial infarction and, hence, cardiac death, but in the autopsy study do not reach statistical significance. The occurrence of grossly recognizable intraventricular thrombosis in 5 of the 22 hearts from the placebo group contrasted to none in the 8 hearts of the anticoagulant group. Although none of these differences is statistically significant they all point in one and the same direction, viz. prevention of complicating thrombotic lesions following the long-term application of anticoagulants.     

The incidence of bacterial meningitis in the Netherlands—A comparison of three registration systems, 1977–1982

Data on the incidence of bacterial meningitis (BM) in the Netherlands are important for a cost-benefit analysis of new effective vaccines. During the period 1977-1982 we compared the notifications of meningococcal meningitis, diagnoses on discharge from hospital of all causes of BM (Stichting Medische Registratie, Medical Registration Foundation; SMR) and bacteriological data (Netherlands Reference Laboratory for Bacterial Meningitis; RBM). Notifications of meningococcal meningitis were 42% lower than SMR-data. RBM-registration of meningococcal, haemophilus and pneumococcal meningitis was 20% lower than SMR. Reviewing patient-records we found that these diseases had not been reported in 16% (RBM) and 11% (SMR) of cases. We estimate the incidence of BM during an endemic period at 8.0 per 100 000 population per year, to which the meningococcus contributes 20-25%. In children under 5 years of age the age-specific incidence of haemophilus meningitis is 22/100 000.     

Hepatic and extrahepatic splanchnic glucose metabolism in the postabsorptive and glucose fed dog

In awake dogs we measured the glucose balance across the liver and extrahepatic splanchnic tissues in the postabsorptive state and during two hours of IV infusion of glucose or for three hours following ingestion of oral glucose and during four hours of sequential intraportal followed by oral glucose. The IV glucose infusion rate was adjusted to maintain a steady state glucose concentration of either euglycemic levels (insulin clamp, group 1, N = 4), 125 mg/100 mL above the postabsorptive glucose concentration (+125 mg glucose clamp, group 2, N = 3) or 200 mg/100 mL above basal glucose levels (+200 mg glucose clamp, group 3, N = 7). Oral glucose was given at a dose of either 1.5 g/kg (group 4, N = 7) or 2.5 g/kg (group 5, N = 12). In dogs that received IV glucose, basal gut glucose uptake (0.5 +/- 0.1 mg/min X kg) was stimulated by hyperglycemia (1.5 +/- 0.5 and 1.4 +/- 0.1 mg/min X kg for group 2 and 3, respectively, P less than 0.05). In these same animals basal hepatic glucose output (-2.7 +/- 0.3 mg/min X kg) was promptly suppressed and net hepatic glucose uptake occurred (2.8 +/- 0.2 and 2.4 +/- 0.5 mg/min X kg in group 2 and 3 respectively). Euglycemic hyperinsulinemia (group 1) suppressed postabsorptive hepatic glucose release but did not enhance glucose removal by either the liver or gut tissues. After oral glucose gut tissues released absorbed glucose into portal blood. Over three hours following the glucose meal 74% and 59% of the ingested glucose was absorbed in group 4 and 5, respectively. As with IV glucose, postabsorptive hepatic glucose production was suppressed and over the first two hours after feeding the liver took up glucose (3.4 +/- 1.0 and 3.1 +/- 0.7 mg/min X kg groups 4 and 5, respectively) at a rate similar to that seen with IV glucose. To further examine the effect of the route of glucose administration on liver glucose handling, hepatic glucose balance was measured serially over four hours in three dogs that received IV glucose into a mesenteric vein to produce portal hyperglycemia (+125 mg/dL portal glucose clamp N = 3). Oral glucose (2.5 mg/kg) was given at two hours, and the rate of the mesenteric glucose infusion adjusted to maintain portal glycemia constant. The hepatic glucose balance averaged 5.5 mg/min X kg over the 0 to 2 hour period and 4.2 +/- 1.0 mg/min X kg over the 2 to 4 hour time.(ABSTRACT TRUNCATED AT 400 WORDS)     

A study of 280 cases of neonatal meningitis in The Netherlands

Within the framework of a more extensive study of the epidemiology of bacterial meningitis in The Netherlands (1976-1982), 280 cases of neonatal meningitis were investigated retrospectively. Escherichia coli (132 cases, 47%), Streptococcus agalactiae (68 cases, 24%), Listeria monocytogenes (12 cases, 4%) were the organisms most commonly isolated. The mortality rate for these 280 cases was 27%. The male-female ratio was 1.33:1. The minimum incidence for The Netherlands was calculated to be 23 per 100 000 live births.     

A quantitative method for the localization of the ventricular pre-excitation area in the Wolff-Parkinson-White syndrome using singular value decomposition of body surface potentials

In order to localize quantitatively the site of ventricular pre-excitation, singular value decomposition (SVD) was applied to the body surface potential distributions of patients with the Wolff-Parkinson-White syndrome. The body surface potentials of sixty-two patients were recorded during sinus rhythm and pre-excitation by means of thirty electrodes placed on the anterior thoracic wall. The sites of the anomalous bundles had been determined beforehand by multicatheter electrophysiologic study. Considerable data reduction was obtained by using the SVD technique and displaying the potential distribution during the delta wave on two isofunction maps of the first two positional vectors and their corresponding two singular values (SV). A distinction was made between two types of isofunction maps. A type-S (single extreme) and a type-D (double extremes). A quantitative analysis was performed with the orientation of the zero line on the isofunction map being represented by the angle alpha or beta, and the singular values quotient (SVQ) of the two first singular values. The angle beta belonging to type D was used to subdivide this group of pre-excitation areas. The parameters SVQ and alpha belonging to type-S were illustrated in a graph on which a distinction between the various locations of the pre-excitation areas can be seen.     

The influence of the thyroid state on energy turnover during tetanic stimulation in the fast-twitch (mixed type) muscle of rats

The effects of thyroid hormones on energy metabolism and force development during tetanic stimulation of fast-twitch skeletal muscle (mixed type) were studied. Hypothyroid, euthyroid, and hyperthyroid (ten days of daily administration of 15 micrograms T3/100 gm body weight) rats showed the same tension-time integral (force x time) under tetanic stimulation. The ATP turnover rate was significantly lower in the hypothyroid group than in the euthyroid and hyperthyroid animals. The ratio difference in the energy/force ratio in the Tx group cannot be ascribed to differences in internal work. Lactate production was diminished in the hypothyroid group; this was probably not the result of a block in glycogenolysis but rather was a reflection of more economic energy expenditure during contraction. After tetanic stimulation, the phosphorylation potential ([ATP]/[ADP]f[Pi]) was decreased most strongly in the hyperthyroid group, mainly because of the higher accumulation of Pi compared with the other groups, which suggests that during the recovery phase the stimulation of oxidative phosphorylation is greater in this group.     

Renal concentrating ability in obesity. Effect of modified fasting and the supplementation of T3, sodium chloride and carbohydrate

The renal concentrating ability (RCA) was studied in 30 obese subjects before and after modified fasting (MF) and T3 supplementation, and during hypocaloric-carbohydrate refeeding. We also studied the effect of sodium supplementation on the RCA during MF. Modified fasting induced a low T3-high rT3 state ("sick euthyroid"). During T3-supplementation plasma T3 levels increased but were in the normal range for normal weight controls. Plasma sodium, potassium, and calcium remained within the normal range during all study periods. After MF (14 days) the mean maximal urinary osmolality was significantly lower compared to prefast values both after dehydration alone (706 +/- 12 mosm/kg H2O v 975 +/- 14, P less than 0.001) and after dehydration plus sc vasopressin administration (676 +/- 19 v 899 +/- 17, P less than 0.001). After 14 days MF followed by 14 days MF + T3-supplementation plasma urea, urinary urea excretion, and the creatinine clearance were significantly greater than after MF alone as was the RCA (764 +/- 15 v 652 +/- 25, P less than 0.002). Sodium chloride supplementation increased RCA (P less than 0.02) but no additive effect of T3 and sodium chloride supplementation was observed. Severe dietary salt restriction induced a significant decline in RCA (P less than 0.005). Refeeding with carbohydrate increased plasma T3 from 79.9 +/- 7.7 to 97 +/- 7.5 ng/100 mL (NS) and decreased plasma rT3 from 0.33 +/- 0.02 to 0.27 +/- 0.02 ng/mL, (P less than 0.02); no significant change in RCA was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of parathyroid hormone and calcitonin on tissue zinc homeostasis in the rat

Tissue zinc accumulation kinetics and compartmental analysis models were evaluated in thyroparathyroidectomized (TPTX) rats treated with parathyroid extract or calcitonin. The animals were injected with ⁶⁵Zn and studied at multiple time intervals. SAAM-25 was utilized to generate models from the plasma specific activity decay curves. Calcitonin had a marked effect to decrease the fractional influx and efflux transfer coefficients in the model and inhibit tissue zinc accumulation in several, but not all, tissues. Parathyroid extract increased accumulation in all tissuesstudied, but had minimal effects on the model. It is concluded that parathyroid hormone acts nonspecifically and that calcitonin appears to have specific influences on zinc homeostasis.     

Magnesium balance and distribution during total parenteral nutrition: effect of calcium additives

Homeostatic alterations and derangements in magnesium (and phosphate) metabolism may occur during total parenteral nutrition (TPN) and may be influenced by the amounts of calcium supplied daily. We tested these possibilities in previously fasted or nonfasted animals receiving TPN with variable amounts of calcium. Large calcium additives (90 mg/d) produced hypomagnesemia in nonfasted animals and increased the degree of hypomagnesemia observed in some of the fasted groups. Bone and muscle magnesium were occasionally altered, by high-calcium additives. Urine magnesium was increased, metabolism may have been dependent upon the amount of calcium added and magnesium supplied in TPN. Some of the derangements may have been dependent upon the state of fasting (and resultant phosphate-depletion syndrome).     

Coupled diminished energy turnover and phosphorylase a formation in contracting hypothyroid rat muscle

Hypothyroidism leads to a diminished phosphorylase a formation and a reduction in both glycogen breakdown and lactate production during tetanic stimulation of fast-twitch skeletal muscle (mixed type). Phosphorylase kinase activity is almost 50% lower in the hypothyroid (Tx) group, and the possibility that this might explain the reduction in phosphorylase a formation is discussed. In both the Tx group and the euthyroid (C) group the reconversion of phosphorylase a to b correlates well with a decrease in the energy cost for contraction.     

Reduced norepinephrine turnover in mice with monosodium glutamate-induced obesity

The disappearance of norepinephrine from the heart, interscapular brown adipose tissue (BAT), and pancreas has been examined in mice with monosodium glutamate (MSG)-induced obesity and in untreated controls. MSG-treated mice became obese in the absence of increased food intake and their core temperature was significantly lower compared to control mice. The rate of norepinephrine turnover following blockade of norepinephrine synthesis with alpha-methyl-para-tyrosine was significantly slower in heart and interscapular BAT of these mice than in untreated controls, but MSG had no effect on the pancreas. It is suggested that reduced norepinephrine turnover may be a major factor in the development of obesity after neonatal administration of MSG.     

Triglyceride turnover in severe chronic non-nephrotic renal failure

In 12 patients with chronic non-nephrotic renal failure (creatinine clearance 3.5–11 ml/min) and 8 control subjects, plasma triglyceride turnover was studied. The patients showed significantly increased fasting triglyceride concentrations and absolute plasma triglyceride turnover rates, while the fractional turnover rate was significantly decreased. The finding of an elevated triglyceride turnover rate with a near normal fractional removal rate in the patients with the highest creatinine clearance suggests the involvement of an increased triglyceride synthesis rate in these patients. However, most patients showed an impaired removal mechanism as the major cause of the hypertriglyceridemia.