Laparoscopy-assisted distal pancreatectomy with mobilization of the distal pancreas and the spleen outside the abdominal cavity

Laparoscopic ligation of the peripancreatic vessels or duct requires a particularly skillful technique. If the pancreatic tail and the spleen can be mobilized outside of the abdominal cavity, surgeons can perform these procedures as easily as ordinary open surgery. We developed a novel approach to laparoscopy-assisted distal pancreatectomy without hand-assist. In brief, the pancreatic tail and the spleen were mobilized laparoscopically from the retroperitoneum until the celiac axis was exposed, then the pancreatic tail and the spleen were laparoscopically mobilized outside the peritoneal cavity from a small incision at the upper abdomen. After mobilization, the distal pancreatectomy was performed as usual open method. This approach offers better results in coping with organs, which seem to be difficult to resect through laparoscopic surgery alone.     

X-Ray microanalytical studies of lead-implanted rat brains

Summary Various cytoplasmic and intranuclear inclusions found in macrophages and astrocytes of lead-implanted rat brains were studied with an energy dispersive x-ray microanalytical technique. Cytoplasmic inclusions contained large quantities of lead, calcium and phosphorus. The proportions of these elements were different within each inclusion. Intranuclear inclusions also contained small amounts of lead and, occasionally, calcium.     

An epithelial cyst of the spinal cord. An electron microscopic study

Summary The fine structure of an intradural and extramedullary cyst compressing the spinal cord was examined. The cyst was lined by a single epithelial layer of both ciliated and non-ciliated cells. The non-ciliated cells differ from the former by the presence of secretory granules and a surface coating as well as other characteristics. The epithelial layer was bordered by a basement membrane and prominent interdigitation was found along the lateral borders. The origin of these cells is unknown but the similarity between them and the epithelium of the respiratory tract is noted.This study was aided by the Sandy Schneider Memorial Fund and the USPHS General Research Support Grant No. RR. 5499.     

The fine structure of phosphotungstic acid stained neuropathologic tissue

Summary The ethanolic phosphotungstic acid technique of Bloom and Aghajanian has been applied to formalin-fixed neuropathological specimens. The staining reactions of various normal organelles were studied as well as a number of pathological alterations including Alzheimer neurofibrillary tangles, eosinophilic rod-like structures, corpora amylacea, lamellar bodies and honeycomb-like structures in the axoplasm.     

Novel method of the double-loop slip-knot: preknotting on the laparoscopic forceps enables easy and secure intracorporeal ligation

Background  

Laparoscopic ligation is a difficult and advanced technique because of the limited movement of forceps under two-dimensional videoscopic view. Currently, single-port surgery is widely used and a simple method for intracorporeal ligation is required. We describe an intracorporeal slip-knot with a double-loop strand that can be used to provide security and present the experimental results obtained.     

Parity and risk of type 2 diabetes: the Atherosclerosis Risk in Communities Study

OBJECTIVE: While high parity is hypothesized to be associated with insulin resistance and type 2 diabetes, few studies have examined this association in diverse racial samples or geographical areas. Our objectives were to estimate the magnitude of association between parity and diabetes and to determine if higher parity is predictive of future risk of diabetes. RESEARCH DESIGN AND METHODS: This was a population-based, prospective cohort study of 7,024 Caucasian and African-American women from the Atherosclerosis Risk in Communities study, a prospective epidemiological study of men and women aged 45-64 years, with 9 years of follow-up. Incident diabetes was defined by the 1997 American Diabetes Association diagnostic criteria. Parity was defined as the number of live births (no live births [nulliparity], one to two live births, three to four live births, and five or more live births [grandmultiparity]). Parity and risk of diabetes was estimated for 754 incident cases of diabetes with Cox proportional hazard regression models, adjusting for sociodemographic, clinical, and lifestyle factors and inflammatory markers. RESULTS: Incidence rates were highest among women with five or more live births (23/1,000 person-years [95% CI 20.3-26.7]) and lowest among women with one to two live births (11/1,000 person-years [9.6-12.5]). Adjustment indicated that much of the risk was due to sociodemographic factors and higher obesity, but after adjustment for all covariates, grandmultiparity (five or more) was still associated with a 27% increased risk for diabetes (hazard ratio 1.27 [95% CI 1.02-1.57]). CONCLUSIONS: Grandmultiparity is predictive of future risk of diabetes after adjustment for confounders.     

Refractoriness to platelet transfusion in acute myeloid leukemia correlated with the optical density of anti-platelet factor 4/heparin antibodies

A small number of reports have described cases of heparin-induced thrombocytopenia complicating hematological disorders with impaired platelet production. We describe the case of a 66-year-old woman with acute myeloid leukemia who exhibited unexplained refractoriness to platelet transfusion, while receiving heparin flushes, and was found to have anti-platelet factor 4 (PF4)/heparin antibodies with high optical density (OD) values (>2 units) detected by an enzyme-linked immunosorbent assay. After cessation of heparin flushes, her refractoriness to platelet transfusion resolved. We retrospectively confirmed that the OD values for anti-PF4/heparin antibodies declined gradually; refractoriness to platelet transfusion resolved when the OD values fell below 1.0 units. Given the absence of any other evident explanation for this phenomenon, and the correlation between the OD values for anti-PF4/heparin antibodies and the efficacy of platelet transfusions, we conclude that the patient’s refractoriness to platelet transfusion was most likely caused by anti-PF4/heparin antibodies that had platelet-activating properties.     

Drug Screening for ALS Using Patient-Specific Induced Pluripotent Stem Cells

Amyotrophic lateral sclerosis (ALS) is a late-onset, fatal disorder in which the motor neurons degenerate. The discovery of new drugs for treating ALS has been hampered by a lack of access to motor neurons from ALS patients and appropriate disease models. We generate motor neurons from induced pluripotent stem cells (iPSCs) from familial ALS patients, who carry mutations in Tar DNA binding protein-43 (TDP-43). ALS patient-specific iPSC-derived motor neurons formed cytosolic aggregates similar to those seen in postmortem tissue from ALS patients and exhibited shorter neurites as seen in a zebrafish model of ALS. The ALS motor neurons were characterized by increased mutant TDP-43 protein in a detergent-insoluble form bound to a spliceosomal factor SNRPB2. Expression array analyses detected small increases in the expression of genes involved in RNA metabolism and decreases in the expression of genes encoding cytoskeletal proteins. We examined four chemical compounds and found that a histone acetyltransferase inhibitor called anacardic acid rescued the abnormal ALS motor neuron phenotype. These findings suggest that motor neurons generated from ALS patient-derived iPSCs may provide a useful tool for elucidating ALS disease pathogenesis and for screening drug candidates.