Morphologic Analysis of Gastroesophageal Reflux Diseases in Patients after Distal Gastrectomy

The precise mechanisms that cause gastroesophageal reflux after distal gastrectomy remain unclear. We analyzed the endoscopic findings of the cardia and the position of the remnant stomach, which are related to gastroesophageal reflux. We retrospectively examined the records of 45 patients with Billroth I (B-I) and 39 patients with Roux-en-Y (R-Y) procedure for gastric cancer. Esophagitis was evaluated by the Los Angeles (LA) classification. The endoscopic findings of hiatus hernia were classified according to the criteria of the Keio Cancer Detection Center form (K-form). The valvular appearance of the cardia was classified according to V-grades. The height of the remnant stomach was measured on computed tomography scans. The postoperative findings of esophagitis in the B-I group were significantly worse than the preoperative findings, but no significant change was observed in the R-Y group. The postoperative V-grades and K-forrn findings in the B-I group were worse than their preoperative findings. In the R-Y group, however, there was no significant change in the V-grades or K-form findings. In addition, the height of the remnant stomach was significantly higher in the B-I group than in the R-Y group. This study suggested that an aggravated cardia is associated with the B-I procedure and that the position of the remnant stomach may therefore play an important role in the occurrence of postoperative reflux esophagitis. In contrast, the R-Y operation was shown to preserve the cardia and the position of the remnant stomach better. As a result, R-Y might help prevent not only duodenogastric reflux but also gastroesophageal reflux.     

Traumatic cervical internal carotid artery occlusion in an infant. Case report

A 10-month-old boy presented with traumatic internal carotid artery (ICA) occlusion caused by blunt injury after falling from a baby carrier attached to a standing bicycle. Physical examination found bruises on the scalp in the right temporal region and the right shoulder, but no wound in the neck. Chest radiography showed a right clavicular fracture. He developed left hemiparesis at 19 hours after the injury. Computed tomography revealed cerebral infarct and angiography showed cervical ICA occlusion. Conservative therapy with hemodilution was given under a diagnosis of cervical ICA occlusion caused by extension and rotational head injury. Traumatic cervical ICA occlusion due to blunt injury is not uncommon in adults, but extremely rare in infants. We would like to emphasize the dangers of leaving a baby unattended in a carrier attached to a standing bicycle.     

Duration of cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage for prevention of symptomatic vasospasm and late hydrocephalus

The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p = 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p = 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.     

Multiple spontaneous dissecting aneurysms of the anterior cerebral and vertebral arteries

A 50-year-old woman presented with rare multiple dissecting aneurysms that appeared first in the anterior cerebral artery (ACA) and shortly afterwards in the vertebral artery (VA). She initially suffered sudden motor weakness in the left lower limb due to acute brain infarction. Angiography revealed diffuse string sign in the right ACA. Conservative treatment resulted in resolution of the deficits. Follow-up angiography performed 1 year later revealed recovery of the ACA stenosis. Fourteen days later, she complained of sudden headache and became comatose. Computed tomography showed diffuse subarachnoid hemorrhage. Angiography revealed a new right VA dissecting aneurysm involving the posterior inferior cerebellar artery (PICA). The orifice of the dissection was not apparent in the operative field and the dissection extended to the median. The patient underwent extracranial right VA ligation, clipping of the proximal PICA, and revascularization between the right occipital artery and distal PICA. Her postoperative course was uneventful and she was discharged without neurological deficits. VA dissecting aneurysms involving the PICA without evident orifice or extending over the median can be treated by extracranial ligation with clipping of the PICA, followed by revascularization.     

Antibody- and complement-independent phagocytotic and cytolytic activities of human macrophages toward porcine cells

BACKGROUND: It has been speculated that host macrophages contribute to rapid clearance of transplanted xenogeneic cells. To address such a possibility, phagocytotic and cytolytic activities of human macrophages toward xenogeneic porcine cells were evaluated in vitro in the absence of antibodies and complement factors. METHODS: Human peripheral monocyte-derived macrophages (P-macrophages) and reticulo-endothelial macrophages (RE-macrophages) were obtained from volunteers' peripheral blood and from the perfusion effluents of liver allografts for transplantation, respectively. 5-(and 6-) carboxyfluorescein diacetate succinimidyl ester (CFSE)-labeled human autologous red blood cells (auto-RBCs), ABO-incompatible RBCs (incom-RBCs) and xenogeneic porcine RBCs (xeno-RBCs) were incubated with the human macrophages; subsequently, the macrophages that had phagocytosed the RBCs could be identified as CFSE positive cells by FCM analyses and confocal microscopy. Cytolytic activity was quantified by calculating levels of lactate dehydrogenase in each culture supernatant. RESULTS: Human RE-macrophages spontaneously phagocytosed and had a remarkable cytolytic activity toward xeno-RBCs, but not toward auto-RBCs or incom-RBCs. Elimination of alpha-galactosyl xenoantigen (alpha-Gal) epitopes on xeno-RBCs did not prevent phagocytotic or cytolytic activity of RE-macrophages. CONCLUSIONS: These findings indicate phagocytotic and cytolitic activities of human macrophages toward porcine cells are initiated by a factor other than alpha-Gal in a mechanism independent of antibody/complement opsonization.     

Urinary excretion of liver fatty acid-binding protein in health-check participants

Background Messenger RNA of liver fatty acid-binding protein (L-FABP) is expressed in proximal tubules of the kidney, and a certain amount is excreted into urine. We analyzed factors relating to the urinary L-FABP excretion in health-check participants.Methods We measured L-FABP in the first morning urine by ELISA in 715 men and 193 women 30–79 years of age who entered a 2-day hospitalized health checkup program. In addition to the routine physical examination and laboratory tests, plasma high-sensitivity C-reactive protein (HSCRP) was assayed.Results In 150 healthy subjects, urinary L-FABP averaged 3.6 ± 0.2µg/g creatinine, whereas the values were significantly increased in patients with hypertension (5.2 ± 0.4, P = 0.010), diabetes mellitus (5.5 ± 0.5, P < 0.001), and chronic hepatitis (5.8 ± 1.0, P = 0.022). Urinary L-FABP excretion was significantly greater in women than in men when the value was related to creatinine. In regression analysis in men, urinary L-FABP was positively correlated with fasting plasma glucose (r = 0.103, P = 0.033) and plasma HSCRP (r = 0.135, P = 0.006).Conclusions It is suggested that renal production and urinary excretion of L-FABP are increased in situations in which arteriosclerosis is promoted, such as hypertension, diabetes mellitus, and cardiovascular inflammation.