Repeated Percutaneous Aspiration Therapy Prior to Surgery for a Pancreatic Pseudocyst: Report of a Case

(Received for publication on Oct. 7, 1996; accepted on July 8, 1997)     

Mass Screening for Neuroblastoma in Japan

The present status of NB mass screening in Japan, which is the first national trial in the world, is presented. This program was conducted in cooperation with infants' mothers, local health centers, screening centers and hospitals. Three hundred and thirty-seven cases detected by the program, from the start in Kyoto in 1974 to the end of 1989, are analyzed. As many cases were detected at early stages, 97% of them were expected to be cured. Several clinical, technical and programmatic problems are also discussed.     

Pituitary abscess in a patient with painless thyroiditis.

The preoperative diagnosis of pituitary abscess is difficult. The case of a 56-year-old man with a pituitary abscess and painless thyroiditis is presented. There has been no previous such report. The differential diagnosis includes pituitary abscess, lymphocytic adenohypophysitis or infundibuloneurohypophysitis, share clinical symptoms of panhypopituitarism and diabetes insipidus, and is of critical importance as the treatment of these conditions differ. The association with painless thyroiditis suggests a diagnosis of lymphocytic adenohypophysitis or infundibuloneurohypophysitis. However, the coincidence of pituitary abscess and painless thyroiditis was observed in our patient, and thus though rare, should be considered. Surgical exploration and histopathological examination are essential for the differential diagnosis of these diseases.     

Genomic Organization of the Human WT1 Gene

We have analyzed the genomic structure of the human WT1 gene, one of the recessive oncogenes for Wilms'tumor at chromosome lip 13. By analyses of three cosmids covering the WT1 gene as well as products generated by polymerase chain reaction, cleavage sites for 10 restriction enzymes were mapped in a region of about 80 kb, and the positions of 10 exons were defined. We also mapped two polymorphic sites for TaqI. Our genomic map will be useful to analyze DNA abnormalities sometimes found in the tumors, as well as loss of heterozygosity.     

Living related liver transplantation

Liver transplantation from a brain death donor has not yet been accepted in Japan. The only alternative method at present is transplantation from a living donor. After the first successful living related liver transplantation was performed by Strong in Brisbane, Australia, Japanese hepatic and transplant surgeons also began to perform such operations. As of February 1991, 16 living related liver transplantations had already been performed in Japan, mainly for children with biliary atresia. Five of these patients subsequently died, however, our patient has survived more than 1 year, and she is presently leading a normal school life. The most important issue regarding living related liver transplantation is to ensure the donor's safety. For this purpose, we conducted a preoperative banking of the donor's own blood and plasma. In addition, a selective vascular occlusion was carried out to reduce blood loss during the resection of the liver. Intraoperative color Doppler ultrasonography was introduced for evaluating the circulation of the graft. By using this modality, the following three points were able to be accurately estimated in order to obtain optimal graft perfusion: 1) The most suitable position for the graft to be fixed to the abdominal wall, 2) whether or not the abdominal wall could be closed and 3) the indication for a ligation of the collateral veins to form a porto-systemic shunt. Thanks to these procedures, living related liver transplantations have now become an acceptable transplant method, however, a transplantation from a cadaver that is brain dead but still has a beating heart is still absolutely necessary for adult recipients. Therefore, in the future, both methods should be performed.This report is the gist of a paper read at the 91st Annual Meeting of the Japanese Surgical Society, Kyoto, Japan, 1991     

Vibration Assessment for Thrombus Formation in the Centrifugal Pump

Abstract: To clarify the correlation of vibration and thrombus formation inside a rotary blood pump, 40 preliminary vibration studies were performed on pivot bearing centrifugal pumps. No such studies were found in the literature. The primary data acquisition equipment included an accelerometer (Isotron PE accelerometer, ENDEVCO, San Juan Capistrano, CA, U.S.A.), digitizing oscilloscope (TDS 420, Tektronix Inc., Pittsfield, MA, U.S.A.), and pivot bearing centrifugal pumps. The pump impeller was coupled magnetically to the driver magnet. The accelerometer was mounted on the top of the pump casing to sense radial and axial accelerations. To simulate the 3 common areas of thrombus formation, a piece of silicone rubber was attached to each of the following 3 locations as described: a circular shape on the center bottom of the impeller (CI), an eccentric shape on the bottom of the impeller (EI), and a circular shape on the center bottom casing (CC). A fast Fourier transform (FFT) method at 5 L/min against 100 mm Hg, with a pump rotating speed of 1,600 rpm was used. The frequency response of the vibration sensors used spans of 40 Hz to 2 kHz. The frequency domain was already integrated into the oscilloscope, allowing for comparison of the vibration results. The area of frequency domain at a radial direction was 206 ± 12.7 mVHz in CI, 239.5 ± 12.1 mVHz in EI, 365 ± 12.9 mVHz in CC, and 163 ± 7.9 mVHz in the control (control vs. CI p = 0.07, control vs. EI p < 0.001, control vs. CC p < 0.001, EI vs. CC p < 0.001, CI vs. CC p < 0.001). Three types of imitation thrombus formations were roughly distinguishable. These results suggested the possibility of detecting thrombus formation using vibration signals, and these studies revealed the usefulness of vibration monitoring to detect thrombus formation in a centrifugal pump.     

Application of a Remodeled Stiegmann-ligator to Esophageal Varix

Abstract: The Stiegmann-ligator has been recently proved to be useful for the treatment of esophageal varices. With those ligators, however, we found difficulty in performing ligation when the pathological change was on the tangent line or relatively large, such as F₃, or associated with concentrated RC signs. To overcome these problems, we modified the Stiegmann O-ring ligator by diagonally cutting the tip of the inner sleeve. Using this ligator, we conducted some animal-model experiments and clinical trials. In all cases, the remodeled ligator covered a wider range of lesions. We no longer encountered difficulties in performing ligation with the remodeled ligator when pathological changes were on the tangent line. The procedure did not cause any complications apart from temporary chest discomfort after surgery.     

30-kDa Trypsin-like Proteases in the Plantar Stratum Corneum

The casein digestible proteases in human plantar stratum corneum were determined to be about 75-kDa, 30-kDa and 25-kDa in molecular weight by zymography. The enzymatic activity of the 75-kDa and 25-kDa proteases was specifically inhibited by chymostatin, which is an inhibitor of chymotrypsin-like serine proteases, and the proteases around 30-kDa were inhibited by leupeptin, a trypsin-like serine protease inhibitor. The enzymatic activity of all these proteases was inhibited by aprotinin. The 30-kDa trypsin-like proteases were heat-stable; their enzymatic activity still remained even after heating at 100°C for 60 minutes. Their optimal pH was around 9, and the activity was higher in the outer part of the stratum corneum than in the inner part.