The sinusoidal barrier in rats with portacaval anastomosis: A morphometric study

Summary Shunting of portal blood in the rat leads to liver atrophy and to an increase in arterial blood flow with microcirculatory disturbances. The aim of this study was to investigate the effects of these disturbances on the liver sinusoidal barrier (endothelial and perisinusoidal cells) using morphometric techniques. Rats with portacaval anastomosis (PCA) and sham operated pair-fed controls were studied 3 months after the shunt. Sinusoidal volume density in PCA increased but not significantly and the volume density (V_v) of total endothelial (EC) and perisinusoidal cells (PSC) increased by 104.54% compared to sham operated pair-fed rats. The increase of EC V_v was not associated with an increase in surface density (S_v) suggesting a fall in the number of small fenestrations and an increase in cell thickness. This interpretation supports the morphological observations. The increase of PSC V_v was mainly related to the increase in their subendothelial processes V_v and not to that of the cell body V_v. Lipids V_v and RER S_v expressed per sinusoidal cells remained unchanged suggesting that the balance between the 2 hypothetical functions of the PSC, namely fibrogenesis and storage of vitamin A, was maintained.In conclusion, changes of EC and PSC after PCA result mainly in thickening of the sinusoidal barrier. This increase may impair exchanges between the sinusoidal lumen and Disse space and contribute to functional abnormalities.This work was supported by a grant from INSERM CRL n^o 807003     

Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution real-time sonography.

Although contrast cholangiography has a greater accuracy than sonography in determining the precise nature of extrahepatic biliary obstruction, it is not without risk. High-resolution real-time sonography is frequently adequate to evaluate the extrahepatic biliary system in multiple planes without known risk to the patient. In a one-year period the authors prospectively observed eight instances of distal biliary obstruction with abrupt termination of the common bile duct, and all were associated with malignant obstruction. There was no instance of abrupt ductal termination secondary to benign disease in this series. Malignancy should be suspected when careful sonograms along the longitudinal axis of an obstructed distal common bile duct reveal an abrupt termination.     

Sexually transmissible diseases and female sterility

Regarding personal studies and a review of the literature, the authors are discussing the consequences of STD on fertility. Thus, through salpingitis, STD represent the main cause of tubal sterility, distal and proximal, and ectopic pregnancies. It seems desirable to look for them in the latter and treat them with a suitable antibiotherapy. The chlamydia serology seems a good screening examination. The best prevention of STD will certainly permit to decrease the frequency of tubal sterility and ectopic pregnancies, in the years to come, limiting therefore the major public health expenses they involve.     

Determination of left-ventricular volume from first-pass kinetics of labeled red cells

A mathematical model is presented for the dynamics of a bolus of technetium-99m-labeled red blood cells through the left ventricle. It is used to correct for attenuation the count rate observed over the left ventricle during a conventional gated blood-pool study. The left-ventricular volumes are calculated from the corrected count rates and expressed as a percentage of total blood volume, or in absolute terms if a blood sample is obtained. The procedure is applied to a number of patients with nonvalvular cardiac disease. Cardiac volumes determined by the method are found to correlate well (r = 0.98) with those determined by contrast left ventriculography. The method is simple, requires no special equipment, and can be applied with existing computer software.     

Griffithsin has antiviral activity against hepatitis C virus

Hepatitis C virus (HCV)-infected patients undergoing liver transplantation universally experience rapid reinfection of their new liver graft. Current treatment protocols do not prevent graft reinfection and, in addition, an accelerated disease progression is observed. In the present study, we have evaluated a novel strategy to prevent HCV infection using a lectin, griffithsin (GRFT) that specifically binds N-linked high-mannose oligosaccharides that are present on the viral envelope. The antiviral effect of GRFT was evaluated in vitro using the HCV pseudoparticle (HCVpp) and HCV cell culture (HCVcc) systems. We show here that preincubation of HCVpp and HCVcc with GRFT prevents infection of Huh-7 hepatoma cells. Furthermore, GRFT interferes with direct cell-to-cell transmission of HCV. GRFT acts at an early phase of the viral life cycle by interfering in a genotype-independent fashion with the interaction between the viral envelope proteins and the viral receptor CD81. The capacity of GRFT to prevent infection in vivo was evaluated using uPA(+/+)-SCID mice (uPA stands for urokinase-type plasminogen activator) that harbor human primary hepatocytes in their liver (chimeric mice). In this proof-of-concept trial, we demonstrated that GRFT can mitigate HCV infection of chimeric mice. Treated animals that did become infected demonstrated a considerable delay in the kinetics of the viral infection. Our data demonstrate that GRFT can prevent HCV infection in vitro and mitigate HCV infection in vivo. GRFT treatment of chronically infected HCV patients undergoing liver transplantation may be a suitable strategy to prevent infection of the liver allograft.     

Gastrointestinal injuries during gynaecological laparoscopy

A retrospective case review study was carried out on gastrointestinal injuries which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complications (32.2%) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the use of monopolar coagulation. Diagnosis of these gastrointestinal injuries was made during surgery in only 20 patients (35.7%). The mean time before diagnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systematic use of bowel preparation for patients presenting a risk of bowel complications, systematic supervision of the route taken by the trocars, meticulous inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the rectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypochondrium can be the judicious option.