Fate of Equine Pericardial Roll Conduit for Rastelli Operation during Long‐term Follow‐up

Background. Right ventricular outflow tract obstruction is a frequent condition after Rastelli operation. Although several modifications have been reported elsewhere, ideal conduit has not been developed yet during long‐term follow‐up. We reviewed our experiences over 15‐year long‐term follow‐up with patients who underwent Rastelli operation using house‐made equine pericardial roll graft. Methods. Since June 1981, 16 patients underwent Rastelli operation with the pericardial roll graft. Median follow‐up time was 15.6 years (7.3–26.8 years). Results. Twelve out of 16 patients using pericardial roll graft with (n = 6) or without (n = 6) cusps underwent 13 reoperations during the follow‐up period. Median time from first Rastelli to re‐do operation was 8.4 years with median time to reoperation of 8 years. Major indication for reoperation was conduit obstruction (n = 10), but not conduit regurgitation. Conduit problem includes kinking and compression of the graft. Reoperation procedures include 7 Danielson procedures, 2 patch augmentations, 1 homograft replacement, 1 pericardial roll graft, 1 expanded polytetrafluoroethylene tube graft replacement, and 1 patch closure for pulmonary artery aneurysm. Balloon angioplasty was not effective for pericardial roll conduit stenosis. Conclusion. We conclude that house‐made equine pericardial roll graft was durable for certain time period, but conduit change may be inevitable. Because of excellent handling and wide application, further modification may be warranted.     

Fibrillary glomerulonephritis in a patient with familial sensorneural deafness

Summary: A 47-year-old woman was admitted to the hospital for evaluation of proteinuria. Bilateral sensorineural deafness had been diagnosed previously at age 35. She had a positive family history of deafness going back three generations. A renal biopsy showed the presence of highly organized fibrillary deposits in the subendothelial mesangial areas. the microfibrils had a diameter of 11-16 nm, larger than the diameter of amyloid fibrils, and did not have a microtubular appearance. the renal specimen was negative for Congored staining. There was no clinical or serologic evidence of paraproteinaemia, cryoglobulinaemia, light-chain disease, or systemic lupus erythematosus. the diagnosis was fibrillary glomerulonephritis. This is the first known case of fibrillary glomerulonephritis in a patient with familial sensorineural deafness.     

Ubiquitin-positive intraneuronal inclusions in the extramotor cortices of presenile dementia patients with motor neuron disease

Summary Ubiquitin-positive intraneuronal inclusions were found in the extramotor cortices of ten presenile dementia patients with motor neuron disease. There were inclusions in the hippocampal granular cells and in the small neurons of the superficial layers of the temporal and frontal cortices. Bunina bodies were present in the anterior horn cells in all cases. These results suggest that ubiquitin-related cytoskeletal abnormalities are common in cerebral non-motor small neurons in these patients.     

The effect of different routes of administration on the metabolism of morphine: The disposition of morphine and its metabolites after topical application

The disposition of morphine (MOR) and its metabolites in the rabbit was measured after topical administration of its hydrochloride salt (MOR · HCl), and their time course was compared with those after intravenous and oral administration. The area under the plasma concentration—time curve (AUC) ratio of metabolites/MOR after the topical application of MOR · HCl was similar to that after intravenous injection, but differed from that after oral administration. Pharmacokinetic parameters of the disposition of MOR and its metabolites were obtained by a general curve fitting of the time course of plasma concentrations of these compounds after intravenous injection of MOR · HCl and its metabolites, respectively. On the other hand, the time courses of plasma concentrations of the metabolites after intravenous, oral, and topical administration of MOR · HCl were simulated using a simple compartment model without consideration of enterohepatic circulation and the pharmacokinetic parameters obtained as above. The resulting curves of the metabolites agreed well with the observed values except for those after oral administration. These results suggest that no first-pass metabolism of MOR · HCl occurs after percutaneous administration, and that topical administration of this salt is more advantageous than oral administration in terms of bioavailability.     

Congenital pelvic arteriovenous fistula in a male. A case report]

A congenital arteriovenous fistula (AV fistula) in the true pelvis is extremely rare, especially in males. We present a case of this disease with pollakiuria and intrarectal discomfort. Diagnosis was made by computed tomography and magnetic resonance imaging and confirmed by cine angiography. Because the AV fistula involved the bladder, prostate and rectum, ligation of the main feeding arteries was performed. He also had benign prostatic hypertrophy and was treated by conservative therapy because of a high risk of massive bleeding in surgical treatment.     

The significance of portal vein chemotherapy for liver micrometastases: An experimental study of a rat model

To clarify the significance of prophylactic portal vein chemotherapy for hepatic metastases, the correlation between the timing of the portal infusion and the growth of liver micrometastases was examined in a rat model. Male Donryu rats weighing 160-180g were first inoculated intraportally with 5 X 106 ascites hepatoma AH60C cells, following which an intraportal infusion of 5-fluorouracil (5-FU) 20 mg/kg/day with heparin 100 U/kg/day was given over 5 days, commencing on day 0, 3, and 6, in groups A, B, and C, respectively. Compared with a control group of rats which received no treatment, a significant inhibition of tumor growth and prolongation of survival time were observed in groups A (P < 0.01) and B (P < 0.05); however, group C, in which the mean diameter of the micrometastases was 0.52 ±0.10 mm at the commencement of the portal infusion, showed no therapeutic response. These results suggest that prophylactic portal vein chemotherapy should be given to prevent the lodgement of tumor cells in the portal system and inhibit their initial proliferation, rather than to destroy established micrometastases.     

The Usefulness of Endoscopic Color Doppler Ultrasonography (ECDUS) for Endoscopic Injection Sclerotherapy (EIS)

Abstract: We studied 12 patients using endoscopic injection sclerotherapy (EIS) guided by endoscopic color Doppler ultrasonography (ECDUS). The ECDUS was performed with a PENTAX FG-32UA (7.5MH2, convex type) and a HlTACHl EUB 565 as a display machine. The EIS needle, as well as changes in intramural blood flow before and after EIS were clearly observed with the ECDUS. When the sclerosant was injected properly into the esophageal varices, the blood flow in the esophageal varices could not be detected with color Doppler flow imaging nor with fast-Fourier transform (FFT) analysis. Therefore EIS was safely performed with an adequate volume of sclerosant having been accurately injected into the varices. Of the disadvantages of this technique, the forceps channel was found to be a bit narrow, and the anterior view was somewhat oblique. Even so, EIS guided by ECDUS is surely a promising method for the treatment of esophageal varices, especially once the technical difficulties are overcome. (Dig Endosc 1994; 6 : 39–44)     

Adsorption of Hepatitis C Virus Particles Onto the Dialyzer Membrane

Abstract: It was recently found that the blood level of hepatitis C virus (HCV) RNA is significantly reduced after each dialysis procedure in patients on chronic hemodialysis. This study was designed to elucidate the mechanism for this phenomenon. In two patients with high serum levels of HCV RNA, the filtrate through the dialyzer (TF-α, Teijin Co., Tokyo, Japan) was analyzed for viral RNA using the polymerase chain reaction. At the end of dialysis, the filter was washed with saline, and during the saline washing, aliquots were taken for quantification of RNA by the branched DNA method. The HCV core antigen was quantified as a measure of viral particles, and hemoglobin was also measured for correcting for blood contamination. After the clearance of the blood, the filter was washed with guanidinium isothiocyanate, and the recovery of RNA was measured. The filtrate did not contain detectable RNA.
The saline washing of the filter after dialysis contained a significant amount of RNA. Washing with guanidinium isothiocyanate of the thoroughly saline washed filter also recovered a significant amount of RNA. During saline dashing, the recovery of RNA in the washing was much delayed behind that of hemoglobin, suggesting the adsorption of the former onto the filter membrane. There was a discordant recovery of RNA and HCV core antigen in the washing, the recovery of the former being delayed behind that of the latter. These results indicate that viral particles are adsorbed onto the inner surface of the filter membrane during dialysis. Some of these adsorbed viral particles are perhaps destroyed by hydraulic pressure applied to blood for dialysis.