Kidney displacement simulator for retroperitoneal laparoscopic nephrectomy

PURPOSE: We evaluated the efficacy of a renal displacement simulator originally developed at our department for retroperitoneal laparoscopic nephrectomy. MATERIALS AND METHODS: A total of 12 patients with a malignant localized renal (7) or ureteral (5) neoplasm underwent multidetector row computerized tomography. Imaging data were sent to a dedicated work station to create volume rendering and virtual laparoscopic images of the kidney, which was displaced ventral using a retroperitoneal balloon. These findings were compared with video images obtained during laparoscopy surgery. RESULTS: The kidney displacement simulator depicted all renal arteries (100% sensitivity) and 13 of 14 renal veins (93% sensitivity). Hilar anatomy, including the tumor, as well as major vessels and their relationships were visualized by the simulator in the laparoscopic views. The major vessel portions completely corresponded to those seen during surgery, and the left adrenal and gonadal veins were also synchronized quite well. CONCLUSIONS: Our kidney displacement simulator was able to visualize the major vessel portions and branched small vessels, such as the adrenal and gonadal veins, prior to surgery. It is considered useful for providing guidance to surgeons and decreasing operative risks and possible complications.     

Spontaneous rupture of renal angiomyolipoma: a case report

A 55-year-old woman presented with sudden right lower abdominal pain. Computed tomography demonstrated retroperitoneal hematoma associated with minus-density area, diagnosed as spontaneous rupture of angiomyolipoma. Super-selective transarterial embolization was performed, but anemia and right abdominal pain became worse in spite of conservative therapy including transfusion, indicating re-rupture of the renal tumor. Although partial nephrectomy was planned, right nephrectomy was finally performed because of massive intraoperative bleeding. Accurate diagnosis and prompt treatment are required when life-threatening rupture of renal tumor is suspected.     

Prefrontal cortical cells projecting to the supplementary eye field and presupplementary motor area in the monkey

We examined the location and spatial distribution of prefrontal cortical (PF) cells projecting to the supplementary eye field (SEF) and presupplementary motor area (pre-SMA) using a double retrograde-labeling technique in monkeys (Macaca fuscata). The SEF and pre-SMA were physiologically identified based on the findings of intracortical microstimulation and single cell recordings. Two fluorescent tracers, diamidino yellow and fast blue, were injected into the SEF and pre-SMA of each monkey. Retrogradely labeled cells in the PF were plotted with an automated plotting system. The cells projecting to the SEF and pre-SMA were mainly distributed in the upper and lower banks of the principal sulcus (area 46), with little overlap. Cells projecting to the SEF, but not to the pre-SMA, were observed in areas 8a, 8b, 9, 12, and 45. These findings suggest that the SEF and pre-SMA receive different sets of information from the PF cells.     

Characterization of multidrug-resistance phenotypes and genotypes of Escherichia coli strains isolated from swine from an abattoir in Osaka, Japan

A total of 455 highly tetracycline-resistant Escherichia coli strains were isolated from 84 healthy swine from abattoirs and it was found that 56.9, 43.1, 22.2, 15.4, 2.6 and 1.5% of strains were resistant to chloramphenicol, ampicillin, kanamycin, trimethoprim-sulphamethoxazole, ofloxacin and gentamicin respectively. Interestingly, E. coli strains isolated from certain finisher hog groups exhibited resistance against 2-7 antimicrobials, but strains isolated from multiparous sow groups in each herd were resistant to only 2-4 antimicrobial agents. When randomly selected 108 tetracycline-resistant isolates were tested for the presence of resistance genes, the following genes tet(A) (n = 6), tet(B) (n = 95), tet(D) (n = 1) or both tet(A) and tet(B) (n = 6) were found to be distributed among them. Furthermore, 52 isolates carried the integrase 1 gene and 24 strains gave five different PCR amplicon profiles using primers from the variable region of integron. Extensive nucleotide sequence analyses of these amplicons revealed the presence of dhfrI, dhfrXII, dfr17, aadA, aadA2, aadA5, aadA21, aacA4 and catB3 genes which code for different antibacterial resistance proteins.     

Intracorporeal electrohydraulic lithotripsy for intrahepatic bile duct stone formation after choledochal cyst excision

An 18-year-old girl who had undergone excision of a choledochal cyst and Roux-en-Y hepatico-jejunostomy at another hospital when 23 months old was referred to our department because of recurrent cholangitis. Radiological investigations showed stones lying in minimally dilated, right posterior intrahepatic bile ducts (IHBD). At laparotomy, the hepatico-jejunostomy site was incised, and a flexible endoscope inserted into the IHBD. Multiple stones packed in the IHBD were easily fragmented using an electro-hydraulic lithotripsy (EHL) device inserted through the endoscope, and removed. There were no EHL-related complications, and her postoperative progress was uneventful. She is currently well with no episodes of cholangitis after a follow-up period of 3 years. EHL is a simple, effective alternative method for removing IHBD stones after choledochal cyst excision. To the best of our knowledge, this is the first report of EHL being used to remove stones that developed in the IHBD after choledochal cyst excision.     

Identification of V-ATPase as a major component in the raft fraction prepared from the synaptic plasma membrane and the synaptic vesicle of rat brain

Cholesterol is important in the maintenance and remodeling of the synapse. Since membrane cholesterol participates in the formation of the membrane microdomain (raft), the characterization of raft components within membrane structures in the synaptic region could be a good approach to understand the role of cholesterol in the synaptic function. In this study, protein complexes in the raft prepared from synaptic plasma membrane and the synaptic vesicle were analyzed with blue-native polyacrylamide gel electrophoresis and vacuolar H(+)-pump (V-ATPase) was identified as a major raft component using mass spectrometry. The ATPase activity was reduced through cholesterol deprivation with methyl-beta-cyclodextrin. Since the H(+) -gradient is used to transport synaptic transmitters or their precursors into the vesicle, this result suggests the essential role of cholesterol and raft in the synaptic function.     

Long-term hospitalization during pregnancy is a risk factor for vitamin D deficiency in neonates

 In order to examine the effects of long-term hospitalization during pregnancy on vitamin D metabolism in pregnant women and neonates, we measured the serum 25-hydroxyvitamin D (25OHD) levels in pregnant women, as well as measuring 25OHD levels in cord blood and breast milk. In pregnant women hospitalized for longer than 1 month, the serum 25OHD levels were decreased at delivery compared with those in control subjects (10.9 ± 2.6 ng/l vs 19.5 ± 4.9 ng/l; P < 0.01). Although the levels of 25OHD in the cord blood were not significantly different between the long-term hospitalized and control pregnant women in this study (9.36 ± 1.7 ng/l vs 11.1 ± 3.0 ng/l), the 25OHD concentrations in the cord blood were significantly lower than the maternal levels in both groups; the ratios of the levels in cord blood to sera in the long-term hospitalized women and control subjects were 82.1% and 60.3%, respectively. Long maternal hospitalization does not always cause neonatal vitamin D deficiency, but could be one of its major risk factors. Therefore, sufficient sunlight exposure and intake of sufficient vitamin D are considered to be important to prevent vitamin D deficiency in long-term hospitalized pregrant women as well as their babies. Received: July 10, 2002 / Accepted: October 23, 2002 Acknowledgments. This work was supported in part by a Grant-in Aid from the Ministry of Education, Science, Sports, and Culture of Japan, and a Grant-in Aid from the Research for Metabolic Bone Diseases in Japan. Offprint requests to: S. Nakajima     

Increased c-Met tyrosine kinase expression in segmental renal dysplasia

Renal dysplasia (RD) is a disorganized development of renal parenchyma that results in a deficit of functional renal tissue. It has been suggested in the animal model that increased expression of HGF receptor, c-Met tyrosine kinase in the epithelial cells during kidney development may induce a growth of dysplastic epithelia and result in RD. The aim of this study was to investigate the immunoreactivity of c-Met tyrosine kinase in the dysplastic kidney in order to further understand the pathogenesis of RD. Specimens of dysplastic upper pole kidney were obtained from 19 patients during upper pole partial nephrectomy for non-functioning upper moiety of duplex kidney. In the dysplastic kidney, there was strong c-Met immunoreactivity in the epithelium of primitive tubules. In contrast, c-Met immunoreactivity was barely detectable in the normal kidney. Markedly increased expression of HGF receptor, c-Met tyrosine kinase in renal dysplasia suggests that HGF may be involved in the development of renal dysplasia.     

Aggressive surgery for liver metastases from gastrointestinal stromal tumors

Background/Purpose. The utility of hepatectomy for patients with metastatic liver tumors from gastrointestinal stromal tumors (GISTs) was evaluated in the present study. Methods. Between 1989 and 2001, ten patients with liver metastases from GIST (four men and six women; age, 34–77 years) underwent hepatectomy at our hospital. All patients underwent complete resection of the primary tumor and hepatectomy with or without microwave coagulation therapy (MCT) for all detectable hepatic tumors. Results. The median survival time after hepatectomy was 39 months (range, 1 to 96 months). There was one postoperative death. One patient is still alive with relapse of hepatic tumors, and the remaining eight patients died of disease (liver in six, peritoneum in one, and bone in one). Relapse of hepatic tumors occurred in seven patients. The disease-free rate after hepatectomy was 22% at 2 years and 11% at 5 years. The survival times of the four patients who received hepatic arterial chemoembolization for recurrent hepatic metastases were 7 months (still alive), 17, 23, and 28 months (average, 19 months). Conclusions. Our data suggest that aggressive surgery (hepatectomy and MCT) for all detectable hepatic tumors and hepatic arterial chemoembolization for recurrent hepatic metastases improve survival. Received: March 31, 2002 / Accepted: September 24, 2002 RID="*" ID="*" Offprint requests to: Y. Shima