Sustained spatial disturbance of bile canalicular networks during regeneration of the steatotic rat liver

BACKGROUND: Although it is generally considered that livers with moderate steatosis can be safely used in the setting of living-donor liver transplantation, the effect of the regenerative process of such a graft on postoperative liver function is incompletely understood. We assessed the morphologic and functional alterations during the regeneration of fatty liver, with special reference to the biliary system. METHODS: Wistar rats with normal or fatty livers induced by a choline-deficient diet were subjected to 70% partial hepatectomy (PH). The regenerated liver weight and serum parameters were compared. Furthermore, to assess the spatial alterations of bile canalicular networks, the distribution of AGp110, a fibronectin receptor that localizes on the apical (bile canalicular) membrane of the hepatocytes, was analyzed immunohistochemically. RESULTS: The serum albumin levels of the fatty-liver rats decreased significantly after 24 hours, and this continued until day 7. The increase in the total bile acid levels of the fatty-liver group was higher and more prolonged compared with that of the normal-liver group. At 24 hours after PH, discontinuity of the AGp110-positive canalicular network was evident in both groups. At 7 days after PH, the typical AGp110-positive canalicular network was almost restored in the normal-liver group. In contrast, the fatty-liver group showed sustained discontinuity of canalicular networks at the same time point. CONCLUSIONS: The livers with moderate steatosis are associated with prolonged cholestasis after 70% PH, and this was caused, in part, by sustained spatial disturbance of bile canalicular networks during the regenerative process.     

Localised vulva Langerhans cell histiocytosis

A cutaneous lesion as sole manifestation of adult Langerhans cell histiocytosis is rare. We report a 65-year old female who presented with vulvar ulcers. Histological examination of the ulcer showed diffuse proliferation of histiocytic cells with large bright cytoplasm that were positively stained for anti-S-100 protein and anti-CD1a antibodies by immunohistochemistry. Electron microscopy demonstrated Birbeck granules in the cytoplasm of the cells. Since there was no other organ involvement, the patient was treated by complete surgical excision without recurrence or other-organ involvement in the 1-year follow-up period.     

Postoperative results of non-penetrating trabeculectomy for primary open-angle glaucoma

PURPOSE: To estimate the postoperative results of non-penetrating trabeculectomy(NPT), the success rate of postoperative intraocular pressure(IOP) and the clinical factors affecting postoperative IOP were evaluated. SUBJECTS AND METHODS: 32 eyes of 32 primary open-angle glaucoma(POAG) patients who underwent NPT as the first filtering surgery were enrolled in the study. We evaluated postoperative IOP using the Kaplan-Meier method, a proportional hazard model, and multiple logistic analysis. RESULTS: 53.2% of all patients had an IOP of less than 16 mmHg without antiglaucoma medication, and 63.8% had an IOP of less than 16 mmHg with antiglaucoma medication 36 months postoperatively. The performance of Nd:YAG trabeculopuncture(YLT) was indicated as a significant factor affecting postoperative IOP by the proportional hazard model(p = 0.037). 72.2% of patients who did not undergo YLT had an IOP of less than 16 mmHg without antiglaucoma medication, and 36.5% who underwent YLT had a postoperative IOP of less than 16 mmHg. There was significant difference between the both groups(log rank test, p = 0.045). Preoperative IOP with antiglaucoma medication was indicated as a significant factor affecting performance of YLT by multiple logistic analysis. CONCLUSION: These results suggest that NPT may be useful to reduce the use of antiglaucoma medication in patients with POAG whose preoperative IOP is controllable with antiglaucoma medication.     

Phase II study of nedaplatin and irinotecan for elderly patients with advanced non-small cell lung cancer

We conducted a phase II study of combination chemotherapy with nedaplatin (NP) with irinotecan (CPT) to determine the effects against unresectable non-small cell lung cancer (NSCLC) and to determine the qualitative and quantitative toxicities of this combination chemotherapy in 70 years or older patients. Thirty-eight patients received 100 mg/m2 NP on day 1 and 60 mg/m2 CPT on days 1 and 8 every four weeks. Twenty-five patients achieved PR, nine SD and three PD, and the overall response rate was 65.8%. Nineteen patients (50%) experienced grade 4 neutropenia. Neutropenic fever occurred in 11 patients (29%) and one of them died. Of other grade 3 non-hematologic toxicities, two patients experienced diarrhea; one interstitial pneumonitis; one liver injury; and one rash. The median survival time was 418 days and the one-year survival rate was 55.3%. In conclusion, NP combined with CPT is an active treatment for elderly patients with NSCLC.     

Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum. Case report

A 58-year-old woman harboring a partially thrombosed giant aneurysm of the vertebral artery (VA) presented with lower cranial nerve palsies and cerebellar ataxia. The authors initially attempted to reduce the mass effect by obliterating the lumen of the aneurysm as well as by trapping of the parent artery with coils. Although there was no angiographically demonstrated evidence of filling, the aneurysm continued to enlarge. Magnetic resonance imaging revealed a marked enhancement around the packed coils close to the neck of the aneurysm. Aneurysmectomy and removal of the coils were performed and resulted in an almost complete cure of the patient's symptoms. Interestingly, at the time of resection, a marked development of vasa vasorum on the occluded VA and the neck of the aneurysm was noted. When the occluded VA was cut, there was blood oozing through the coils packed within its lumen on the side where the aneurysm lay. Histological examination showed the presence of inflammatory cells and neovascularization of a partially organized thrombus around the packed coils in both the aneurysm and occluded VA. The proliferation of vasa vasorum was also recognized histologically. This unique case provides insight into the growth mechanisms of a partially thrombosed giant aneurysm after an apparently complete occlusion by endovascular treatment, especially the role of vaso vasorum on the occluded parent artery in the dynamic process of neovascularization in the incomplete organization of thrombus around the packed coils.     

Hepatocyte growth factor and transforming growth factor β1 contribute to regeneration of small-for-size liver graft immediately after transplantation

Although the ability of the liver to regenerate to a predetermined size after resection made adult-to-adult living donor liver transplantation (LDLT) possible, there is little information regarding the growth regulatory mechanism for a small-for-size graft. Forty-one cases of LDLT were divided into two groups by graft volume to standard liver volume ratio (GV/SLV); small graft group (Group S, GV/SLV<40%, n=16) and non-small graft group (Group NS, GV/SLV>40%, n=25). The regeneration rate (GV at 1 week/harvested GV) and serum levels of hepatocyte growth factor (HGF), transforming growth factor- (TGF-) and transforming growth factor-1 (TGF-1) were compared between two groups. The regeneration rates in Group S were significantly higher than that of Group NS (217±12% and 178±10%, respectively, P<0.01). The serum HGF levels of Group S were significantly higher than those of Group NS on POD 1. The TGF-1 levels of Group S were significantly higher than those of Group NS on POD 3 and 5. The TGF- levels were not different at any time points studied. These results indicate that a small-for-size graft retains the capacity to regenerate faster by modulation of expression pattern of HGF and TGF-1 immediately after LDLT. After the acceleration of the regenerative response by HGF, subsequent elevation of TGF-1 synergistically controls graft size, regulating uncontrolled proliferation of hepatocytes.     

Effect of human cationic antimicrobial protein 18 Peptide on endotoxin-induced uveitis in rats

PURPOSE. Human cationic antimicrobial protein 18 (hCAP18, 18 kDa) was originally identified in leukocytes on the basis of its antimicrobial activity. The peptide composed of the 27 C-terminal amino acids of hCAP18 (hCAP18(109-135)) binds lipopolysaccharide (LPS). The purpose of the present study was to investigate the effects of hCAP18 peptide on endotoxin-induced uveitis (EIU) in rats. METHODS. EIU was induced by footpad injection of LPS. Each rat was injected intravenously with 1, 10, or 100 micro g hCAP18 peptide in 0.1 mL of PBS immediately after LPS injection in male Lewis rats. At 24 hours after LPS injection, enzyme-linked immunosorbent assay was performed to evaluate concentrations of protein, nitric oxide (NO), tumor necrosis factor (TNF)-alpha, prostaglandin (PG)-E2, interleukin (IL)-6, monocyte chemoattractant protein (MCP)-1 and macrophage inflammatory protein (MIP)-2 in aqueous humor. Also, EIU was evaluated by counting inflammatory cells in aqueous humor. RESULTS. hCAP18 peptide at 10 and 100 micro g significantly suppressed an LPS-induced increase in the number of inflammatory cells and the levels of protein, NO, TNF-alpha, PGE2, MCP-1, and MIP-2. The anti-inflammatory effect of 10 micro g hCAP18 peptide was as strong as that of 100 micro g hCAP18 peptide. Treatment with 1 micro g hCAP18 peptide did not suppress EIU, compared with the LPS group. CONCLUSIONS. The present results indicate that hCAP18 peptide suppresses development of EIU. A possible mechanism for the ocular anti-inflammatory effect of hCAP18 peptide is that it suppresses onset of LPS-triggered inflammatory reactions by binding directly to LPS.     

Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues.

Primary retroperitoneal neoplasms are a rare but diverse group of benign and malignant tumors that arise within the retroperitoneal space but outside the major organs in this space. Although computed tomography and magnetic resonance imaging can demonstrate important characteristics of these tumors, diagnosis is often challenging for radiologists. Diagnostic challenges include precise localization of the lesion, determination of the extent of invasion, and characterization of the specific pathologic type. The first step is to determine whether the tumor is located within the retroperitoneal space. Displacement of normal anatomic structures of the retroperitoneum is helpful in this regard. For tumors that are located within the retroperitoneum, the next step is to identify the organ of origin. Specific signs, including the "beak sign," the "embedded organ sign," and the "phantom (invisible) organ sign," are useful for this purpose. When there is no definite sign that suggests the organ of origin, the diagnosis of a primary retroperitoneal tumor becomes likely. Awareness of specific patterns of spread, specific tumor components, and tumor vascularity help in further narrowing the differential diagnosis. Attention to these diagnostic clues is essential in making an accurate radiologic diagnosis of primary retroperitoneal tumors and in obtaining clinically significant information. Copyright RSNA, 2003.