Cytokine response to human liver ischemia-reperfusion injury during hepatectomy: marker of injury or surgical stress?

BACKGROUND/AIMS: The aim of this study was to evaluate the inflammatory or antiinflammatory cytokine response to ischemia-reperfusion during hepatectomy and to find a useful marker of injury or surgical stress during hepatic ischemia-reperfusion. METHODOLOGY: In 9 patients with liver disease who underwent hepatectomy using the Pringle maneuver, serum cytokines, including alanine transaminase, aspartate transaminase, and hyaluronic acid, were measured just prior to vascular occlusion; 5, 10 and 15 min after initial clamping; and 3 min after initial declamping. RESULTS: The mean concentrations of aspartate transaminase and alanine transaminase did not significantly differ before and after ischemia-reperfusion during hepatectomy. However, mean concentrations of hyaluronic acid after ischemia-reperfusion were significantly (P < 0.03) higher than before clamping. Although there were no significant differences in the mean concentrations of IL-1 beta, IL-6, IL-8, IL-10 and TNF-alpha among, before and after ischemia-reperfusion, the mean concentrations of granulocyte colony-stimulating factor after ischemia-reperfusion and macrophage colony-stimulating factor after reperfusion were significantly (P < 0.05) higher than before clamping. CONCLUSIONS: Although hepatic parenchymal cell function was maintained after ischemia-reperfusion during hepatectomy, sinusoidal endothelial cell dysfunction was found. Release of granulocyte colony-stimulating factor and macrophage colony-stimulating factor after ischemia-reperfusion were also found. These cytokines and hyaluronic acid may be useful indicators in the early phase of human ischemia-reperfusion injury during hepatectomy.     

Gas-forming liver abscess after transcatheter arterial embolization for hepatocellular carcinoma: Report of a case

A case of a gas-forming liver abscess developing after transcatheter arterial embolization for recurrent hepatocellular carcinoma (HCC) in a 65-year-old man is presented herein. He was admitted to hospital with fever and jaundice, following which ultrasonography (US) and computed tomography revealed a gas-containing abscess in the posterior segment of the hepatic lobe with multiple HCC. Percutaneous transhepatic drainage was performed using US. Antibiotics which were sensitive to theEscherichia coli bacteria detected in the abscess were administered both intravenously and through the drainage tube into the abscess. Four months later, the abscess had diminished and the patient was discharged after receiving percutaneous ultrasonographically guided ethanol injection therapy for the recurrent HCC.     

A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer

A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of the ascending colon cancer is reported. A 47-year-old woman complained of colic on right costa-vertebral angle. Excretory urograms showed right peripelvic extravasation and CT-scan showed urinoma formation around right kidney. Subsequent examination of right retrograde pyelo-ureterograms showed ureteral stenosis at sacro-iliac region. Operative findings revealed ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer, which was regarded as inoperable. There are a few reports of spontaneous peripelvic extravasation caused by a malignant tumor in Japanese literature. Twenty of them are reviewed.     

Expression of neurite outgrowth factor and gicerin during inner ear development and hair cell regeneration in the chick

Several cell adhesion molecules are expressed in the developing inner ear. The present study focused on gicerin, a novel member of the immunoglobulin superfamily, in an attempt to improve our understanding of the development and regeneration of chick inner ear. Gicerin is known to homophilically interact with itself and to bind to neurite outgrowth factor (NOF). The data collected herein show that gicerin is highly expressed in auditory epithelium and acoustic ganglion during early embryogenesis. The immunoreactivity of gicerin in the auditory epithelium decreases more rapidly than that in the acoustic ganglion as the mature hair cells become distinguishable. At the post-hatch stage, the expression of gicerin is not observed. In contrast, NOF was expressed on the basement membranes around the auditory epithelium, and in the acoustic ganglion during development and after birth, but not in the auditory epithelium. Following noise damage, gicerin is transiently re-expressed on the damage receptor epithelium when active cell proliferation is observed in the epithelium. This positive reaction immediately disappears as immature short hair cells appear. These results suggest that gicerin may be associated with cell proliferation in the auditory epithelium, and play a role in neurite extension of the acoustic ganglion cells in conjunction with NOF.     

Effect of cefaclor in urinary tract infections (the first report)

A part of our continuous investigation on the clinical effect of cefaclor against urinary tract infections was reported herein. Cefaclor, a daily dose of 0.75 g t.i.d., has been applied for the treatment of (I) 26 cases with the simple UTI and (II) 41 cases with the complicated. Rates of effectiveness were obtained 100% in (I) and 80% in (II). Side effects were noted in 8 cases (8.4%) out of total 95 cases.     

External skeletal fixation using methylmethacrylate. Current technique, clinical results, and indications

External skeletal fixation using self-curing acrylic resin was applied by inserting A-O cortical screws into the diaphyseal region and A-O cancellous screws into the epiphyseal and/or metaphyseal regions. The position of the screws was designed to secure three-dimensional fixation. Points of insertion are selected that avoid infected bone, open wounds, thick muscles, and skin that is relatively mobile during joint motion. After reduction the acrylic resin rather than conventional metal linking devices is used for fixation of the screws. Once the fixation is completed, it is adjustable and so rigid that exercises for joint function are possible. The apparatus is light in weight and sufficiently compact to fit under clothing. In the 204 patients treated by this method, open tibial fractures occurred in 123; nonunion or delayed union in 28; metaphyseal and epiphyseal fractures in 30; femoral fractures in ten children; and miscellaneous fractures and other conditions in 13. Nearly all of the operations were successful. Three patients had refractures after removal of the fixation device.