Portal imaging by intravneous three-dimensional computed tomography after pancreaticoduodenectomy: A report of four cases

By employing three-dimensional computed tomography (CT) for portography, we analyzed the portal vein changes during the initial stage after a pancreaticoduodenectomy (PD), which seemed to affect postoperative complications. Four patients underwent PD without portal vein reconstruction with a standard radical lymph node dissection for cancer of the pancreaticoduodenal area. A total of 140 ml of contrast medium was intravenously injected at 2.5 ml/s, and imaging was started after 65 s with a Hitachi W-2000 CT scanner. Three-dimensional portal vein images were then reconstructed by the Voxel Transmission method. Three-dimensional CT showed portal stenosis in our all patients from the first to the third week after PD. In three of the patients, stenosis disappeared by week 7,8, or 15, respectively, without the formation of a bypass. In three patients, portal vein stenosis was severe while in one patient, it was mild. Severe complications such as gastrointestinal hemorrhaging and hepatic abscess occurred in two patients with severe portal stenosis. The onset of portal stenosis might therefore affect postoperative complications after PD.     

Pharmacokinetics of triamterene and its metabolite in man

The pharmacokinetic profiles of triamterene and hydroxytriamterene sulfuric acid ester, the major metabolite of triamterene, were studied in six normal male volunteers using a newly developed specific HPLC analytical method. Following a 100 mg oral dose of triamterene, the plasma concentration time course of the sulfate conjugate parallels that of triamterene in all subjects, but concentrations of the metabolite were more than 10 times higher than unchanged triamterene concentrations at identical sampling times. Interestingly, the renal clearance of the sulfate conjugate was less than that of triamterene. These characteristic features of triamterene disposition were fitted to a compartment model incorporating a first-pass metabolic process. Unbound fractions of triamterene and metabolite in plasma were 0.39 and 0.10 (mean of 6 subjects), respectively. The low unbound fraction of the metabolite in plasma most probably accounts for the low renal clearance of the sulfate conjugate as compared with triamterene.Supported in part by NIH Grant AM20884 and funds from Mylan Pharmaceuticals.     

ELEVATED LEVELS OF CHEMOTAXIS INHIBITORY ACTIVITY IN SERA OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

An inhibitory activity against neutrophil chemotactic factors was found in normal human serum. Elevated levels of this chemotaxis inhibitory activity were demonstrated in sera of patients with systemic lupus erythematosus (SLE). The physico-chemical characteristics of this chemotaxis inhibitory substance(s) in SLE serum were almost identical to those of the inhibitory substance(s) in normal human serum; both the inhibitory substances were heat labile, soluble in 45% saturated ammonium sulphate, worked directly on chemotactic factor and affected various chemotactic factors. A study using Sephadex G- 100 chromatography showed that the molecular sizes of both inhibitory substances were almost identical. No correlation was found between the levels of the chemotaxis inhibitory activity in SLE sera and other clinical parameters including erythrocyte sedimentation rate, and serum concentration of either the third component of complement (C3) or the fourth component of complement (C4). Specimens from patients with the following diseases failed to demonstrate elevated levels of chemotaxis inhibitory activities; rheumatoid arthritis, urticaria, psoriasis vulgaris, atopic dermatitis and discoid lupus erythematosus (DLE).     

Considerations of some serologic reactions for autoantibodies against the liver

The existence of autoantibodies to liver and kidney was determined at autopsy from 34 patients with various diseases. Tissue and heart blood were collected, and the reaction between the two was evaluated by Outchterlony's method, complement-fixation tests, and Boyden's method. Positive reactions from one or more tests were seen in seven serums with the homogenate of autologous liver. The diseases were systemic lupus erythematosus (1 patient), thrombotic thrombocytopenic purpura (1 patient), cirrhosis (1 patient), and malignant tumors (4 patients).The authors wish to thank Professor Hans Popper, Mount Sinai School of Medicine, for his valuable criticism and kind advice. We are grateful to Dr. Masahiko Okudaira, Tokyo Medical Examiner's Office, for providing us with the control materials for this study.