Effect of induced hypotension on arterial blood ketone body ratio (AKBR)

Arterial blood ketone body ratio (AKBR; acetoacetate/beta-hydroxybutyrate) is known as a parameter to indicate the function of the liver cells. We evaluated the effects of induced hypotension with prostaglandin E1 (PGE1) or trimetaphan (TMP) on AKBR in patients without liver disease undergoing mastectomy. Almost no change was observed in AKBR before, during and after hypotension with PGE1, but slight diminution was observed during hypotension with TMP. No hepatic dysfunction, however, developed in these patients postoperatively. These findings suggest that usual hypotension with TMP may provoke no postoperative hepatic dysfunction in patients without liver disease. For the patient who required either hypotension of long duration or hypotension with other factors affecting function of liver (surgical procedures, drugs and others), we prefer PGE1 to TMP as a hypotensive drug. We should also adopt PGE1 when cardiovascular control with hypotensive drug is necessary in patients with liver disease.     

Research review: DNA polymerases as molecular markers of the regenerating capacity of hepatocytes

Hepatocyte regeneration has been widely investigated, with the mitotic index and the incorporation of [³H]thymidine being used as regeneration markers. We focused on the induction of DNA replication enzymes, particularly DNA polymerases (pol) α, δ, and ε. Using rat models, we have shown that the activity of pol α in crude liver extract well represents the regenerating capacity of hepatocytes. Using pol α as an indicator, we analyzed liver regeneration in rat models under various conditions: obstructive jaundice, external or internal biliary drainage, and the obstruction of portal vein branches. It has been revealed that the ligation of the common bile duct alone induces a certain amount of hepatocyte proliferation. It was striking that external biliary drainage suppressed regeneration capacity in cholestatic rat liver after partial hepatectomy. The strong regeneration in nonligated lobes induced by portal branch ligation was similar to the liver regeneration seen after partial hepatectomy with respect to the induction of DNA polymerases. Taken together, the aspects of DNA replication, particularly the induction of DNA polymerases, may contribute to shedding new light on the regeneration of human liver. This work was supported in part by a Grant-in-Aid for General Scientific Research and for Cancer Research from the Ministry of Education, Science and Culture, Japan, and by grants from the Uehara Memorial Foundation     

Modifications of temporal lobectomy according to the extent of epileptic foci and speech-related areas

The authors applied combined depth and subdural electrodes in patients with intractable complex partial seizures to detect the precise extent of epileptic foci and functionally map speech-related areas. The medial temporal structures were explored with depth electrodes and the lateral temporal cortex with subdural electrodes. On the speech-dominant side, electrical stimulation was given to demarcate the speech-related areas in the lateral temporal cortex. Based on these data, the extent of surgical resections was tailored to include as much of the epileptogenic areas as possible while preserving the functionally essential zones of the lateral cortex. According to the range of resection, three different approaches were employed for en bloc ablation of the lateral cortex and opening of the inferior ventricle. The results thus acquired have been satisfactory in terms of seizure control and the preservation of speech function.     

A case of renal pelvic carcinoma in situ]

A 72-year-old female visited our hospital with the complaint of macroscopic hematuria on Jan. 29, 1990. Cystoscopic examination revealed hematuria flowing out from the left ureteral orifice. A 1 cm mass was found in the left upper calyx by retrograde pyelography (RP). Urine cytology obtained by RP was class IIIb. Later, the mass was found in the left middle calyx by CT. Repeated RP revealed no mass and the wall of the left upper calyx was irregular. Washing cytology from the left renal pelvis was class V. Left total nephroureterectomy was performed on Feb. 2, 1990. Macroscopically, no tumor mass was apparent. Microscopically, transitional cell carcinoma in situ was widely spread from the left renal pelvis to the middle ureter. The preoperative upper calyceal mass was thought to have been a blood clot. At twelve months after the operation, there has been no evidence of tumor recurrence.     

Clinical studies on morphological changes in the prostate in patients with benign prostatic hypertrophy after antiandrogen therapy--by means of transrectal ultrasonotomography]

Transrectal ultrasonotomography is useful in following patients with benign prostatic hypertrophy, because prostatic shape and weight are precisely assumed. We studied the effect of chlormadinone acetate (CMA) on benign prostatic hypertrophy. CMA (50 mg/day) was administered to 30 patients with benign prostatic hypertrophy. Weight reduction over 10% of the gland was noticed in 24 cases (80%). Mictional conditions were improved in 70% subjectively and in 71.4% objectively. However, the number of nocturia decreased in only 18.9%. Reduction rate of the weight was unrelated with the weight of prostate before administration of CMA. Duration of administration of CMA and the reduction rate were estimated. There was no definite difference in reduction rate for the first 15 months, but there was a slightly high reduction rate after administration of CMA for more than 24 months. In 3 cases, the shape and weight of prostate were studied after discontinuation of CMA. The size of prostate showed a tendency to increase gradually.     

A case of double cancer: renal cell carcinoma and transitional cell carcinoma of urinary bladder

This is a case report on a patient with double cancer of kidney and urinary bladder. The patient was a 65-year-old female, and she was admitted with the chief complaint of gross hematuria and right flank pain. After careful examinations, she was diagnosed with right nonfunctioning kidney caused by invasive bladder cancer. Computerized tomography incidentally revealed a mass in the upper pole of the left kidney. Selective left renal arteriography showed stretched arteries and irregularity and tortuosity of the smaller vessels. She was diagnosed with double cancer of bladder and left kidney. Owing to the damage of the right renal function, left partial nephrectomy, total cystectomy, right nephroureterectomy and left ureterocutaneostomy were performed. According to DMSA scintigraphy measured 15 days later, the uptake value of the left kidney was 13.25%, compared to the preoperative value of 25.62%. To date, this case is 36th reported case in Japan.     

Biocompatibility of zirconia dispersed hydroxyapatite ceramics

Because of the lack of adequate strength and toughness, hydroxyapatite (HA) ceramic can not be used for a substitute for a bone and joint despite its excellent affinity for the bone. The present authors have succeeded in producing a new type of HA ceramic containing zirconia. This new ceramic material is superior to ordinary HA ceramic in quality and exceeds compact bone in bending strength and fracture toughness. The Young's modulus was about 3-4 times greater than that of compact bone. The new ceramic material contained either 1.6 or 50% of zirconia by volume and was produced using a special technique to disperse the metal dioxide. In order to assess their affinity for the bone, the new ceramic materials were implanted into rabbit femurs. Sections of the bones removed at different times after operation were prepared without decalcification and subjected to optical microscopy, scanning electronmicroscopy (SEM), and electron-probe X-ray microanalyser (EPMA). The formation of direct chemical bonds with the bone was seen without intervening membrane. Thus, the new ceramic material was shown to have an excellent affinity for the bone, comparable to that of ordinary HA ceramic.     

Two cases of subcortical hemorrhage with asymptomatic occlusion of the main trunk of cerebral artery

We report two cases of asymptomatic occlusion of the main trunk of the cerebral artery associated with subcortical hemorrhage in the area fed by collateral circulation. The first patient, a 51-year-old female who had suffered from untreated hypertension for 20 years, was hospitalized in a state of coma. Computed tomography (CT) revealed a subcortical hemorrhage in the right parietal lobe as well as subdural and subarachnoid hemorrhages. Cerebral angiography disclosed occlusion of the right internal carotid artery at its origin. The region normally supplied by the right anterior (ACA) and middle cerebral (MCA) arteries was supplied instead by the posterior cerebral artery via leptomeningeal anastomosis. The hematoma was removed and the patient was discharged 1 month later. The second patient was a 54-year-old female who had suffered from uncontrollable hypertension for 27 years and was hospitalized after sudden development of stupor, right hemiparesis and motor aphasia. CT demonstrated a subcortical hemorrhage in the left parietal lobe. Cerebral angiography disclosed occlusion of the left MCA at its origin. The area normally fed by the left MCA was supplied instead by the ACA by way of leptomeningeal anastomosis. One month after operation the patient was transferred to another hospital for rehabilitation of right hemiparesis. Both of these middle-aged women had long-standing hypertension. The hemorrhages were thought to result from rupture of the leptomeningeal anastomosis, which had developed as collateral vessels. It is probable that the relatively weak leptomeningeal anastomosis could no longer withstand the increased blood flow brought on by the hypertension.