Staged cranial reconstruction after epidural abscess associated with dural substitute exposure

Cadaveric dura mater was widely used for a long time but has recently been associated with the transmission of Creutzfelt-Jakob disease. Expanded polytetrafluoethylene sheet has been suggested as a suitable alternative in Japan. Recently epidural abscesses associated with exposure to Expanded polytetrafluoethylene have been on the increase in Japan.We experienced one case of staged cranial reconstruction for chronic ulcer of the head associated with MRSA epidural abscess.Surgical Technique: the exposed expanded polytetrafluoethylene must be completely removed along with the skin. Reconstruction of dura mater should be made watertight with the application of autologous free fascia lata collected from the paralyzed thigh. Autologous free fascia lata is reconstructed with the rectus abdominis muscle so that there is no dead space remaining. Calvarial bone should be reconstructed in a separate operation as at a second stage.     

Tumor thrombi in the portal vein system originating from gastrointestinal tract cancer

Received: October 4, 2000 / Accepted: January 26, 2001     

Preoperative assessment of hepatic function: Utility of a new convenient two-compartment model analysis using galactosyl human serum albumin scintigraphy

BACKGROUND AND AIM: Preoperative hepatic function was evaluated using technetium-99 m-diethylenetriaminepenta-acetic acid-galactosyl-human serum albumin (Tc-GSA) and a scintillation camera to detect hepatic Tc-GSA uptake by the asialoglycoprotein receptor. METHODS: Sixty-two preoperative patients with liver cancer, including hepatocellular and cholangiocellular carcinomas, were studied, using two-parameter two-compartment model analysis. This model is simpler than either the three- or five-compartment model, both of which are accurate but which require complicated analysis and enormous calculation. The parameters k1 and k2 represented the transfer rate constant from the blood to the liver and from the liver to the blood, respectively. We calculated k1, k2, and k1/k2 from time-radioactivity curves of the heart and liver as well as VLmg, which represented the maximal amount of Tc-GSA in the liver. RESULTS: The results were compared to those of conventional liver function analysis using Tc-GSA (the index of blood clearance (HH15) and the receptor index (LHL15)) or indocyanine green (ICGR15). Both HH15 and LHL15 were significantly correlated with k1, k1/k2, and VLmg. In addition, they closely correlated with the results of ICGR15 and some serum hepatic function tests (aspartate aminotransferase, choline esterase, albumin, platelet). The pathological grading for liver cirrhosis also correlated with k1, k1/k2, and VLmg. From a clinical point of view, VLmg had a significant correlation with the Child-Pugh score. CONCLUSIONS: These results suggest that this new compartment analysis will be useful in evaluating liver function, as it is accurate, simple and convenient.     

Letter to the Editor: Mean Hepatic Recovery Ratio in Capacity-Limited First-Pass Effect by Three-Point Sampling Method

Recently,a three-point sampling method (portal and hepatic veins, and systemic artery) was developed to evaluate a capacity-limited first-pass effect through the liver (1). In this paper, the hepatic recovery ratio, F_H, increased to unity with an increase in the concentration of 5-fluorouracil in the blood entering the liver. Under steady-state conditions, the hepatic clearance, CL_H, of pravastatin decreased with an increase in the concentration in the arterial blood (2). The capacity in hepatic metabolism can be saturated or the hepatic local disposition can be nonlinear. Therefore, an index is needed to characterize nonlinear local hepatic disposition in the whole body (in loci).     

Whole-body PET with FDG is useful for following up an ovarian cancer patient with only rising CA-125 levels within the normal range

In April 2000, a 54-year-old woman underwent surgery for ovarian serous cell carcinoma (stage IIb). After initial treatment, the patient underwent a physical examination, ultrasound examination and measurement of serum CA-125 levels every month. Although neither diagnostic imaging (ultrasound and computed tomography) nor physical examination showed any evidence of recurrence, the CA-125 level rose slowly and continuously within the normal range. In March 2001, an increased accumulation of 18F-fluorodeoxyglucose (FDG) in the pelvic cavity was seen on a positron emission tomography (PET) scan obtained 2 weeks before a relapse of a malignant lesion was diagnosed by gadolinium-enhanced MRI (Gd-MRI). It is reasonable to suppose that FDG-PET is clinically useful for detecting an early, small region of relapsed ovarian cancer. Moreover, FDG-PET may be helpful for determining whether a patient who has a continuous rising CA-125 level within the normal range should be treated in the absence of relapse regions detected by conventional methods.     

A case of giant perirenal malignant lymphoma: a case report

We report a case of malignant lymphoma arising as a giant perirenal mass in a 62-year-old woman who presented with an enlarging abdominal mass. Computed tomography (CT) revealed a large homogeneous mass with a diameter of 20 cm arising in the retroperitoneum. It surrounded the left kidney without renal infiltration and accompanied with para-aortic lymph node enlargement. Compared with the renal cortex, the tumor showed a homogeneous isodense mass by plain CT and only slight enhancement by the contrast-enhanced CT. On the basis of these imaging studies, the tumor was diagnosed as lymphoma. Then, a US guided percutaneous biopsy was performed and the tumor was diagnosed as malignant B-cell lymphoma by the histopathological analysis. This patient was treated by systemic chemotherapy since tumor cells were also disseminated in the bone marrow. The tumor responded well to the chemotherapy and about 70% of regression was achieved after six courses of chemotherapy.     

Kupffer cell targeting by intraportal injection of the HVJ cationic liposome

The aim of this study was to target Kupffer cells (KCs) selectively and efficiently by the intraportal injection of fusigenic cationic liposomes with hemagglutinating virus of Japan components (HVJ cationic liposomes). Phosphorothioate FITC-oligodeoxynucleotides (FITC-ODNs) encapsulated in either HVJ cationic liposomes, HVJ anionic liposomes or conventional cationic liposomes without HVJ were transferred to the rat. FITC-ODNs in HVJ cationic liposomes administered via portal vein were selectively transfected to KCs for up to 24 h with no apparent cytotoxicity at higher transfection efficiency than FITC-ODNs in conventional cationic liposomes without HVJ administered via portal vein or tail vein. On the other hand, FITC-ODNs in HVJ anionic liposomes were observed mainly in hepatocytes, not KCs. This new method will be useful for the modulation of KCs activity in both basic research and clinical applications.     

Effects of vasopressors on contractile and phosphatidylinositol responses of rat trachea

Purpose. Vasopressors, such as dopamine (DA), norepinephrine (NE), and phenylephrine (Phe), are commonly used during anesthesia to increase blood pressure through α₁-adrenoceptors. The present study was designed to examine the effects of DA, NE, and Phe on the contractile and phosphatidylinositol (PI) responses of the rat trachea induced by a muscarinic agonist, carbachol (CCh). Methods. A rat tracheal ring was suspended between two stainless-steel hooks in Krebs-Henseleit (K-H) solution. Contraction was induced with 0.55 μM CCh, and 30 min later DA, NE, or Phe was added. The tracheal slices were incubated in K-H solution containing LiCl, ³[H]myo-inositol, and CCh in the presence or absence of DA, NE, or Phe. The ³[H]inositol monophosphate (IP₁) formed was measured. Results. CCh caused tracheal ring contraction. NE attenuated CCh-induced contraction at a dose of 1 μM or greater and had a maximal effect at 3 μM. DA and Phe did not affect CCh-induced contraction. CCh-induced IP₁ accumulation was potentiated significantly by NE and Phe, but not by DA. Conclusion. Although NE and Phe potentiated CCh-induced IP₁ accumulation, they could not potentiate CCh-induced contraction, suggesting that in clinical settings, vasopressors such as NE, DA, and Phe might be safely used in patients with asthma. Received: February 25, 2002 / Accepted: July 2, 2002 Acknowledgments. This study was supported in part by a Grant-in-Aid for Scientific Research C (no. 10671421), from the Ministry of Education, Science, and Culture, Japan. Address correspondence to: O. Shibata