Resection of metastatic liver cancer in a patient with a left-sided gallbladder and intrahepatic portal vein and bile duct anomalies: A case report

INTRODUCTIONThe presence of left-sided gallbladder is closely associated with multiple combined anomalies of the portal vein, hepatic vein, hepatic artery, and bile duct. This requires special attention for preoperative evaluation for the purpose of preventing postoperative complications.PRESENTATION OF CASEA 70-year-old woman with metastatic liver cancer and intrahepatic portal vein, biliary system and hepatic artery anomalies with left-sided gallbladder is reported. On computed tomography (CT), a solitary low density mass occupied from the right anterior to the posterior segment of the liver. The gallbladder bed was on the left of the hepatic fissure. On drip-infusion-cholangiography (DIC) CT three-dimensional (3D) reconstruction, the left medial bile duct arose from the right umbilical portion after arising from the left lateral bile duct. Following a right hepatectomy and lymph node dissection of the hepatoduodenal ligament, hepaticojejunostomy was conducted separately to the left medial and left lateral bile duct.DISCUSSIONThe left-sided gallbladder accompanies with several anomalies of hepatic vascular and bile duct anomalies in a frequent manner. A safe hepatectomy needs accurate operative plans to ascertain the range of hepatectomy, because it often has the diversity of a combined anomaly.CONCLUSIONPreoperative DIC-CT 3D reconstruction was extremely useful because it provided an important information that could not be obtained with 2D-DIC-CT. 3D imaging has the ability to demonstrate complex anatomical relationships, this devise is a effective new tool for making appropriate preoperative strategy.     

Rehabilitation Exercises to Induce Balanced Scapular Muscle Activity in an Anti-gravity Posture

[Purpose] The purpose of this study was to compare the intramuscular balance ratios of the upper trapezius muscle (UT) and the lower trapezius muscle (LT), and the intermuscular balance ratios of the UT and the serratus anterior muscle (SA) among prone extension (ProExt), prone horizontal abduction with external rotation (ProHAbd), forward flexion in the side-lying position (SideFlex), side-lying external rotation (SideEr), shoulder flexion with glenohumeral horizontal abduction load (FlexBand), and shoulder flexion with glenohumeral horizontal adduction load (FlexBall) in the standing posture. [Methods] The electromyographic (EMG) activities of the UT, LT and SA were measured during the tasks. The percentage of maximum voluntary isometric contraction (%MVIC) was calculated for each muscle, and the UT/LT ratios and the UT/SA ratios were compared among the tasks. [Results] The UT/LT ratio with the FlexBand was not significantly different from those of the four exercises in the side-lying and prone postures. The UT/SA ratio with the FlexBall demonstrated appropriate balanced activity. [Conclusion] In an anti-gravity posture, we recommend the FlexBand and the FlexBall for inducing balanced UT/LT and UT/SA ratios, respectively.Key words: Scapular muscle exercise, Balanced scapular muscle activity, Electromyography     

Novel compound heterozygous mutations of the growth hormone-releasing hormone receptor gene in a case of isolated growth hormone deficiency

ObjectiveTo elucidate the pathogenesis of isolated growth hormone (GH) deficiency in a Japanese girl without consanguinity.DesignA 2-year-old girl of height 77.2 cm (? 3.0 SD for Japanese girls) was found to have an insulin-like growth factor (IGF)-1 level of 7 ng/mL and IGF binding protein-3 (IGFBP-3) level of 0.41 μg/mL. GH responded modestly to a series of pharmacological stimulants, increasing to 2.81 ng/mL with insulin-induced hypoglycemia, 3.78 ng/mL with arginine, and 3.93 with GH-releasing hormone (GHRH). Following direct sequencing of the GHRH receptor (GHRHR) gene, evaluation by the luciferase reporter assay, immunofluorescence study, and in vitro splicing assay with minigene constructs was conducted.ResultsNovel compound heterozygous GHRHR gene mutations were identified in the patient. A p.G136V substitution elicited no luciferase activity increment in response to GHRH stimulation, with normal membranous expression. Splicing assay demonstrated that the IVS2 + 3a > g mutation would lead to aberrant splicing.ConclusionsA case of isolated GH deficiency due to novel GHRHR gene mutations was identified.     

The interaction of cephalosporin antibiotics with renal cortex of rats: Accumulation to cortical slices and binding to purified plasma membranes

The interaction of cephalosporin antibiotics with renal cortex of rats has been examined in vitro by means of cortical slice uptake and binding assay to plasma membranes and other subcellular fractions, including the comparative study with p-aminohippurate. The uptakes of cephalexin and cephaloridine by cortical slices were concentrative, and were strongly inhibited in the presence of 2, 4-dinitrophenol, ouabain, nitrogen gas and probenecid. In the case of cefazolin, the degree of concentrative uptake and influence of inhibitors were low. Cephalexin, cephaloridine and p-aminohippurate specifically bound to the basolateral membranes, compared to brush border membranes and other subcellular fractions. Cefazolin binding to basolateral membranes was relatively small. These results suggest that the specificity of cephalexin and cephaloridine bindings to the basolateral membranes could be related to the interaction with the organic acid transport system at the antiluminal side. Thus, an examination of cephalosporin interaction with plasma membranes from renal cortex could offer an appropriate in vitro model system to study the renal transport of these antibiotics.     

Therapeutic effects for hypersensitivity pneumonitis induced by Japanese mushroom (Bunashimeji)

BACKGROUND: Bunashimeji-related hypersensitivity pneumonitis is found among workers who cultivate the mushroom in indoor facilities. An evaluation of protective measures was initiated using the outcomes of clinical, immunological, and radiological findings. METHODS: Twenty-two patients presented with symptoms of HP; all were employed cultivating Bunashimeji mushrooms in indoor facilities. After hospitalization, 6 of 22 patients quit their job to avoid exposure to spores (Avoidance group). Sixteen patients continued to work used a mask for 3 months, and were then divided into two subgroups: Mask alone (seven patients) and mask plus oral prednisolone (Mask + PSL) (nine patients). The erythrocyte sedimentation rate (ESR), serum Krebs von der Lungen-6 (KL-6), surfactant protein-D (SP-D), lymphocyte stimulation test (LST), ground-glass scores in chest high-resolution computed tomography (HRCT), and bronchoalveolar lavage (BAL) were assessed before and after treatment. RESULTS: Complete avoidance resulted in a significant decrease in LST. There was a significant decrease after PSL treatment in serum KL-6, SP-D, and total cell counts in the BAL fluid in the Mask + PSL group. In the Mask alone group, serum KL-6, SP-D, ground-glass scores in chest HRCT and total cell counts in BAL fluid showed high levels compared with the other two groups. CONCLUSIONS: Complete cessation was the best treatment for hypersensitivity pneumonitis. The use of a mask was ineffective for patients with a high serum KL-6 and SP-D concentration and severe ground-glass opacity on chest HRCT. Initial treatment with PSL is recommended for these patients with high levels of total cell counts in BAL fluid.     

Changes in nitric oxide and inducible nitric oxide synthase following stretch-induced injury to the tibialis anterior muscle of rabbit

This study investigated the changes in nitric oxide (NO) together with inducible nitric oxide synthase (iNOS) content and enzyme activity at 0, 4, 12, 24, and 48 h following acute muscle stretch injury. A single stretch injury was induced to the tibialis anterior muscle of 30 male New Zealand white rabbits (n = 6 at each time point). Injured and uninjured contralateral sham-operated muscles were harvested and analyzed for NO levels, iNOS content, and iNOS activity at each time point. Furthermore, three animals were used to estimate baseline NO levels and iNOS activity. There was a progressive reduction in NO content in the injured and the sham-operated muscles up to 24 h postoperation and stretch injury (p < 0.05). At 48 h postinjury, however, NO levels were 146% higher in injured muscles than in sham-operated muscles (p < 0.05). iNOS protein content was higher at 4 h and 48 h in injured versus shamoperated muscles (p < 0.05). Similarly, iNOS activity was higher at 4 h (p < 0.05) and at 48 h (p < 0.01) in injured versus sham-operated muscles. These results suggest that NO may play an active role during the postinjury recovery of skeletal muscle modulated by iNOS expression.     

Anaphylactic hepatic venoconstriction is attenuated by nitric oxide released via shear stress-dependent and -independent mechanisms in Guinea pig

1. The role of shear stress in nitric oxide (NO)-mediated attenuation of anaphylactic venoconstriction was studied using an isolated ovalbumin-sensitized guinea pig liver. 2. Guinea pigs were actively sensitized by a subcutaneous injection of 1 mg ovalbumin. Two weeks after sensitization, the livers were perfused with diluted blood under constant flow or constant perfusion pressure. The constant flow could result in increased shear stress during constriction, while the constant perfusion pressure could prevent changes in shear stress. Using the double occlusion technique to estimate the hepatic sinusoidal pressure, pre- and postsinusoidal constriction was evaluated. Hepatic anaphylaxis was induced by an injection of ovalbumin (4 microg) into the perfusate, the volume of which was 40 mL. 3. Under either constant flow or pressure, anaphylaxis caused venoconstriction of predominantly presinusoids over postsinusoids, although anaphylactic venoconstriction under constant pressure was significantly greater than that under constant flow. When shear stress was held constant by maintaining constant perfusion pressure, a NO synthase inhibitor, Nomega-nitro-L-arginine methyl ester (L-NAME, 100 micromol/L), potentiated similarly both pre- and postsinusoidal constriction induced by anaphylaxis. This suggests that hepatic anaphylaxis shear stress-independently generates NO, resulting in dilatation of both pre- and postsinusoidal vessels in a similar magnitude. In contrast, when shear stress was allowed to rise under constant flow, anaphylactic presinusoidal constriction was preferentially potentiated by L-NAME. 4. Hepatic anaphylaxis can increase NO production in a shear stress-independent manner and dilates similarly both pre- and postsinusoids, while NO produced in a shear stress-dependent manner attenuates predominantly venoconstriction of the presinusoids where shear stress is preferentially increased.     

Effect of aminated gelatin on the nasal absorption of insulin in rats

Absorption enhancers, which increase the permeability of drugs through epithelial membranes without damaging them, are especially useful for intranasal administration of peptide drugs. In this study, aminated gelatins, candidate enhancers, having different numbers of amino groups were prepared from gelatin (H-gelatin, isoelectric point = 9.0, MW 100 kDa) and a partial gelatin hydrolysate (L-gelatin, isoelectric point = 8.0, MW 5 kDa), and the enhancing effects on the nasal absorption of insulin, used as a model peptide drug, and 5(6)-carboxyfluorescein (CF), a paracellular marker, were examined in rats. The enhancing effect on insulin and CF depends on the MW and number of amino groups. A high correlation between the enhancing effects on insulin and CF was observed and this suggests that an increase in the paracellular permeability is the mechanism governing the nasal absorption-enhancement of aminated gelatins, at least as far as insulin and CF are concerned. The enhancing mechanism might be shared with other cationic polymers having absorption-enhancing effects.