Carcinoma of the main hepatic duct junction: indications, operative morbidity and mortality, and long-term survival

Carcinoma of the main hepatic duct junction tends to spread extensively along the hepatic ducts into the liver parenchyma. Therefore extensive resection of the bile ducts combined with hepatic resection is the procedure of choice. Between January 1973 and April 1989, 25 of 50 patients with this type of carcinoma underwent resection, a resectability rate of 50%. One patient died of staphylococcal sepsis on the postoperative day 42 after right trisegmentectomy and resection of the bile ducts, a hospital death rate of 4%. Twenty-four patients were discharged from the hospital. The 5-year actuarial survival rate calculated by the Kaplan-Meier method was 19%. Four patients lived longer than 5 years after surgery; the longest survival was 9 years after right trisegmentectomy and resection of the bile ducts. These four patients had clear margins at the resected bile ducts. This article was designed to clarify the point at issue by presenting our results in terms of indications, operative morbidity and mortality, and long-term survival.     

Hypoosmotic swelling test of sperm

For the diagnosis and evaluation of the therapy for male infertility and for predicting the outcome of AIH and IVF-ET, technically simple, replicable tests that can be performed virtually anywhere and that have definite reliability are required. The results of the HOS test correlate well with the functions of the sperm cell membrane, indicating such aspects as motility, and it is thought to be a particularly effective test of human sperm fertility. Because the HOS test reflects the functions and integrity of the sperm cell membrane, it should be possible to use it to predict the potential for fertilization of frozen sperm.     

Acquired cystic disease of the kidney and renal carcinoma in haemodialysis patients: ultrasonographic evaluation.

Ultrasonography was performed in 661 dialysis patients and acquired cystic disease of the kidney was found in 156 (125 men and 31 women). A higher incidence of cystic disease was found in males. There was no significant difference between the patients with and those without acquired cystic disease in terms of average age, but the duration of haemodialysis in those with acquired cystic disease was significantly longer. There was an increased incidence of cystic disease in patients with glomerulonephritis and the duration of haemodialysis in these patients was significantly longer. This suggests that the increased incidence of acquired cystic disease of the kidneys in the patients with glomerulonephritis is simply related to the longer duration of treatment. Twelve patients with renal carcinoma were found in this study. The average age at diagnosis of renal carcinoma was not significantly different between the patients with and those without acquired cystic disease, but the duration of dialysis was significantly longer in renal carcinoma patients with acquired cystic disease. The incidence of renal carcinoma in dialysis patients with acquired cystic disease was 3.85% and in those without it was 1.19%. These rates are considerably higher than those found in the general population and indicate that the risk of renal carcinoma is higher in dialysis patients both with and without acquired cystic disease.     

Effects of heparin on the vasodilator action of protamine in the rabbit mesenteric artery.

1. The effects of protamine on the rabbit isolated small mesenteric artery were investigated both in the presence and in the absence of heparin, by the isometric tension-recording method. 2. The dissociation constant for the binding of heparin to protamine has never been previously reported, so in order to minimize the effects of protamine, known to have a vasodilator action, and to examine only the effects of a heparin-protamine complex, the experiments with heparin were performed in the presence of high concentrations of heparin (21-700 u ml-1), concentrations at which heparin itself does not affect the vascular tone. 3. Protamine (15-500 micrograms ml-1), in the absence of heparin, was found to inhibit (P < 0.05) noradrenaline (1 microM)-induced contractions both in endothelium-intact and in endothelium-denuded tissues. 4. Such vasodilator action of protamine in either endothelium-intact or -denuded tissues continued, even in the presence of excess heparin at a heparin/protamine (H/P) ratio of 1.4 u micrograms -1, but was almost completely blocked in the presence of a much greater excess of heparin (H/P ratio > or = 4.7 u micrograms -1): heparin was present both before and during the application of protamine. 5. The vasodilator action of protamine in the absence of heparin was prolonged both in the endothelium-intact and -denuded tissues after protamine had been washed out from the bath with Krebs solution.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of mediastinal neurinoma originating from right intrathoracic vagal nerve

A 34-year-old woman was admitted with an abnormal shadow on a chest X-ray film. Under a preoperative diagnosis of benign bronchogenic cyst, operation was carried out and the tumor was found to be originating from the right main vagal nerve in the mid-superior mediastinum. The vagal nerve was transected to remove the tumor. Pathological diagnosis was a neurinoma. Postoperative complication was chylothorax which was successfully treated with thoracic drainage and intravenous hyperalimentation.     

A case of aneurysm of the inferior left ventricular wall

Aneurysms of the inferior left ventricular wall represent only a small fraction of all aneurysms that have been reported in surgical series. And in comparison to anterior left ventricular aneurysms, a comparatively higher percentage of reported inferior wall aneurysms was classified as false. A 73-year-old male was admitted for acute inferior myocardial infarction. Three weeks after admission, cardiac catheterization was carried out. Coronary arteriography revealed triple vessel disease and left ventriculography showed an aneurysm of the inferior left ventricular wall, whose feature near the mitral annulus was multiple fenestrations. Left ventricular aneurysmectomy and aortocoronary bypass grafting to the left anterior descending artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The pathological feature was a true aneurysm. The postoperative course was uneventful.     

Direct determination of benzalkonium chloride in ophthalmic systems by reversed-phase high-performance liquid chromatography

High-performance liquid chromatography has been used to quantitate benzalkonium chloride (alkylbenzyldimethylammonium chloride) in complex ophthalmic formulations at or below concentration levels of 50 ppm. The method involves a one-step dilution for sample preparation and direct injection; therefore, recovery and/or conversion problems are nonexistent. The assay is quick, specific, reproducible, and simple. This new approach makes routine determinations far simpler than previous methods and is especially useful for product stability studies and quality control procedures.