Transthoracic cardiectomy with infraesophago-supragastric devascularization for bleeding esophageal varices.

Based on the thoughts that transthoracic approaches give less load to liver than transabdominal ones, and that effectiveness for bleeding esophageal varices is secured by cardiectomy with complete devascularization of lower esophagus and upper stomach, a new operative procedure for esophageal varices is described which is more safely applicable to the risky patients. Twenty cases with portal hypertension were operated, including eight cirrhotic patients with severe hepatic dysfunction, six cases of emergency bleeding and six reoperated cases. No operative death was encountered, but three cirrhotic patients died during the late follow up period. The remaining 17 patients had uneventful postoperative courses without recurrence esophageal bleeding during 20 months follow up period. Thus this operation may eliminate the shortcoming of previous operative methods for portal hypertension.     

The selective shunt for variceal bleeding: a personal perspective

It has been proved that selective decompression of esophageal varices can occur by way of the left gastric venous route or the transsplenic route. The left gastric venacaval shunt functions well over a long postoperative period, if the shunt is technically satisfactory; however, the distal splenorenal shunt (DSRS) can be problematic. Unless the proximal and distal portions of the splenic vein are both entirely isolated from the pancreas, blood flow will be diverted from the portal vein to the distal splenic vein, where the pressure has been lowered by the shunt. This portal malcirculation may lead to portal thrombosis or stenosis on occasion. To prevent this adverse effect, complete isolation of the splenic vein (splenopancreatic disconnection) is necessary. Extensive gastric disconnection is irrelevant in this regard. Although the conventional DSRS has been viewed with disfavor, we must realize that splenopancreatic disconnection makes the DSRS a satisfactory technique. The clinical evidence and theoretic basis of the selective shunt for esophageal varices are described herein.     

Establishment of a near-triploid human B-cell lymphoma cell line with t(14;18) and a p53 gene point mutation

We report a rare large B-cell non-Hodgkin's lymphoma having a characteristic near-triploid cell population with add(17)(p22) and t(14;18)(q32;q21) translocation. We also established and characterized a new cell line (TK cell) derived from the present lymphoma. A codon 180 mutation (GAG --> GAT) in the p53 gene was detected. t(14;18)(q32;q21) was revealed juxtaposition of the bcl-2 and JH genes. Immunoprecipitation analyses of p53 and bcl-2 revealed that abnormality of the p53 protein and aberrant bcl-2 expression, which may protect cells from apoptosis, may be critical to the development of leukaemogenesis exhibiting near-triploid chromosomes.     

Flame retardance-donated lignocellulose nanofibers (LCNFs) by the Mannich reaction with (amino-1,3,5-triazinyl)phosphoramidates and their properties

Nitrogen/phosphorus-containing melamines (NPCM), a durable flame-retardant, were prepared by the successive treatment of ArOH (Ar = Br_nC₆H_5−n, n = 0, 1, 2, and 3) with POCl₃ and melamine monomer. The prepared flame-retardants were grafted through the CH₂ unit to lignocellulose nanofibers (LCNFs) by the Mannich reaction. The resulting three-component products were characterized using FT-IR (ATR) and EA. The thermal behavior of the NPCM-treated LCNF fabric samples was determined using TGA and DSC analyses, and their flammability resistances were evaluated by measuring their Limited Oxygen Index (LOI) and the UL-94V test. A multitude of flame retardant elements in the fabric samples increased the LOI values as much as 45 from 20 of the untreated LCNFs. Moreover, the morphology of both the NPCM-treated LCNFs and their burnt fabrics was studied with a scanning electron microscope (SEM). The heat release lowering effect of the LCNF fabric against the water-based paint was observed with a cone calorimeter. Furthermore, the mechanical properties represented as the tensile strength of the NPCM-treated LCNF fabrics revealed that the increase of the NPCM content in the PP-composites led to an increased bending strength with enhancing the flame-retardance.

LCNFs were grafted with nitrogen/phosphorus-containing melamines to achieve potent flame-retardance and converted to PP-composites of improved mechanical properties.     

The Effect of Lateral Shift of Cricoid Cartilage on Pharyngeal Swallowing

Head rotation is widely used as one of the postural techniques for dysphagic patients. However, it cannot be used for patients with severe limitations to the range of motion of the neck. The purpose of this study was to determine the effect of applying pressure to the cricoid while swallowing and to explore the possibility of this maneuver as an alternative to head rotation. The swallowing function of 12 volunteers was examined with videofluorography under nine conditions: neutral, head rotated to the right, head rotated to the left, applying pressure to the cricoid on the right side at 5, 10, and 15 N, and applying pressure to the cricoid on the left side at 5, 10, and 15 N. To examine the effect of this maneuver on pharyngeal swallowing, the laterality of bolus flow was evaluated using 3 ml barium thin liquid from the posterior-anterior (P-A) view. The “pressing-cricoid” maneuver significantly altered the laterality of the bolus flow; the bolus flow was shifted to the side opposite to which the pressure was applied. The results of these changes were similar to those achieved with head rotation. These results demonstrated that the “pressing-cricoid” maneuver changes the bolus flow. This maneuver may have therapeutic value for the treatment of dysphagic patients as an alternative to head rotation.     

Technical Note: Method for estimating volume of subretinal fluid in cases of localized retinal detachment by OCT ophthalmoscopy

The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments.     

The quality of life is sustained after operation for carcinoma of the esophagus

An interview was conducted to determine the quality of life, both objectively and subjectively, in 64 patients without a recurrence of the disease more than one year after esophageal resection and reconstruction with a gastric tube for carcinoma of the thoracic esophagus. Despite the decrease in body weight, the patients appeared to be well adjusted and had a most optimistic attitude toward their illness. The laboratory data showed normal values, postoperatively. As there was no evidence of a diminished quality of life in these patients, we consider that physicians should recommend surgical therapy for patients with carcinoma of the esophagus.     

Olfactory evoked potentials in the rat

Routine clinical assessment of the integrity of the olfactory pathway using olfactory evoked potentials remains an elusive goal. One important difficulty arises from the uncertainty of the exact origin of the potentials: are they produced by olfactory or trigeminal elements? To resolve this problem, an animal model using the rat was developed. Amylacetate was used as an odorant stimulus, and potentials were measured and computer averaged after elimination of trigeminal and vomeronasal activity. A positive-negative wave was recorded from the olfactory bulb surface, and a negative wave often followed by a positive wave was recorded from the surface of the cerebral cortex. Measurements from the scalp surface gave comparable results. Lesioning experiments of the olfactory pathway indicate that the evoked potentials recorded at the vertex originate in the ventral forebrain, specifically in the prepyriform cortex, olfactory tubercle, and anterior olfactory nucleus.