An Improved Endoscopic Variceal Ligator for Esophagogastric Varix

Abstract: We recently reported a 16.0 mm in length new type of instrument with an inner cylinder of 10.3 mm for endoscopic variceal ligation (EVL). This device is capable of shooting three elastic O bands consecutively in rapid succession without removing the endoscope. The aspirated volume of variceal tissue with the new instrument is larger than that obtained with the Stiegmann ligator. We performed EVL in 16 cases with esophageal varices and seven with solitary gastric varices. EVL was performed for prophylaxis in all cases. The esophageal varices disappeared in all 16 cases after ulcer formation. The procedure was performed once in 14 cases and twice in the remaining two. Three patients died of hepatic failure during the follow-up period which ranged from four to 16 months. Six and 12 month cumulative recurrence rates were 30% and 48%, respectively. All gastric varices disappeared after a single EVL session. There was one variceal recurrence during the follow-up period. Computed tomography and/ or arterioportography performed previously had shown patent gastro-renal shunt in five cases. No changes in the shunts were observed after treatment. No serious complications attributable to EVL were encountered in this series. Therefore, this method is potentially useful for the treatment of not only esophageal varices but also gastric varices.     

Effect of Application Volume and Area on the Absorption of Phenol Red,as a Model Drug,from the Liver Surface in Rats

To determine the influence of the method of administration of a pharmaceutical formulation we have examined the importance of application volume and area in the absorption of phenol red, as a model drug, from the rat-liver surface. When 1 mg phenol red was applied to the rat-liver surface, in-vivo, in three volumes (0.1, 0.2 or 0.334 mL) using a cylindrical glass cell (i.d. 9 mm), the shape of the plasma concentration profile differed greatly, particularly the maximum concentration. These patterns were well fitted by a two-compartment model with first-order absorption, and the absorption-rate constant K_a obtained was inversely proportional to the application volume. The absorption ratio and biliary recovery of phenol red after 6 h increased with glass cell area (i.d. 6, 9 or 14 mm; area 0.28, 0.64 or 1.54 cm²). Furthermore, the permeability coefficient P_app derived from K_a did not depend on application area, indicating no difference in the absorption characteristics of the liver surface. This also implies transport of the drug by passive diffusion from the liver surface. After intraperitoneal administration to the rat-liver surface for clinical application, increasing the application volume resulted in the delayed disappearance of phenol red from the plasma. However, the difference was not as marked as that obtained by use of the glass cell. The assumption that the effective area relating to the absorption changed with the application volume enabled us to estimate P_app. Consequently, we speculate that absorbability can be estimated precisely by consideration of application volume and area.     

Diffuse xanthogranulomatous pyelonephritis in a patient with myotonic dystrophy and cerebral palsy

Xanthogranulomatous pyelonephritis (XGP), a morphological and clinical variant of chronic pyelonephritis, is an uncommon disease in children. It is characterized by the destruction of the renal parenchyma and replacement by granulomatous tissue containing foamy lipid-laden macrophages and is classified into diffuse and focal XGP. We present a case of diffuse XGP in a child with myotonic dystrophy complicated by cerebral palsy and discuss the importance of correct diagnosis and preoperative management to reduce inflammation and improve malnutrition associated with the disease.     

Relationship between behavioral disturbances and characteristics of patients in special units for dementia

Abstract The aim of the present study was to examine the relationships between behavioral disturbances and patient characteristics of inpatients with dementia nationwide. The five patient characteristics used were age, gender, years of education, cognitive status, and walking ability. The subjects consisted of 730 inpatients selected by systematic sampling from 180 units that have specialized psychiatric beds for acute/long‐term care of dementia. Clinical staff members assessed the 730 patients with the Mini‐Mental State Examination (MMSE), and filled out a questionnaire for long‐term care insurance, including 19 items relating to behavioral disturbances and walking scale. Five meaningful factors were identified out of the 19 behavioral disturbances by factor analysis. Linear regression analysis revealed that the factor ‘psychotic/neurotic’ was not related to any patient characteristics; ‘aggression/negativistic’ was related to male gender and a lower MMSE score; and ‘dirty/destructive’ and ‘disorientation/fire management’ were related to a lower MMSE score and higher walking score. The factor ‘sexual behavior’ included only one behavior at a very low frequency. These findings suggest that different behavioral disturbance factors have different correlations with patient characteristics, while cognitive dysfunction has a relatively important role in behavioral disturbances of inpatients with dementia.     

Collagenous and basement membrane proteins of chordoma: immunohistochemical analysis

Tissue localization of collagenous and basement membrane proteins in the extracellular matrix of five sacro-coccygeal chordomas and human fetal notochords was examined immunohistochemically to assess the implications for the histogenesis and histological diagnosis of chordoma. Human fetal notochords and conventional chordomas both exhibited basement membrane proteins (such as type IV collagen and laminin) and type VI collagen on the surfaces of cellular cords. Type II collagen, a main structural protein of cartilage, was also present in both tissues. In the chordomas, however, type II collagen was not so widespread as it was in the notochords, and the predominant collagenous protein was type I. In contrast, an altered deposition of these proteins was noticed in a recurrent tumour which, histologically, showed considerable atypia and eventually metastasized to the liver. The characteristic cartilage-type and basement membrane proteins disappeared and unusual collagen types, such as types III and V, appeared in the stroma. The results further support the notochordal origin of chordoma and suggest that the immunohistochemistry of collagenous and basement membrane proteins may be a helpful criterion for the histological diagnosis and prediction of the biological aggressiveness of chordomas.