Prophylaxis of Postoperative Biliary Stasis: A Retrospective and Prospective Study

Postoperative biliary stasis is a common state before the onset of postoperative acute cholecystitis. In order to study its characteristics and methods of prophylaxis, we examined the frequency of biliary stasis and postoperative recovery of gallbladder contractility ultrasonographically from the 2nd to the 28th postoperative day in 43 esophagectomy cases. A retrospective study in 17 patients revealed a high incidence of biliary stasis during the early postoperative period and improvement by the initiation of enteral nutrition. Furthermore, the contractility of the gallbladder recovered remarkably soon after the operation. This first randomized prospective study concerning prophylaxis of biliary stasis in 26 patients showed that postoperative biliary stasis was prevented by early initiation of enteral nutrition.     

Poor Prognoses Following left Hepatic Trisegmentectomies for Cancer

Five patients with hepatocellular carcinoma, and one with agallbladder cancer with liver metastases, underwent left hepatictrisegmentectomy with, in four cases, resection of the leftcaudate lobe. A bleeding peptic ulcer and an anaphylactic shockdue to a drug allergy caused two hospital deaths. A third majorcomplication was a prolonged bile leakage which healed spontaneously.One patient who died in hospital had not undergone a radicalresection, and all four patients surviving the procedure eventuallydied with recurrent local (and sometimes also distant) tumorsbetween 3.5 and 11 months after resection. The results appearto give relatively few indications for left trisegmentectomyin the treatment of these tumors.     

Major limb,hand, and digital replantation

Successful replantation of an amputated extremity depends mainly upon the accurate repair of blood vessels, but the final goal must be complete restoration of function. Before a decision to replant is made, the extent of tissue damage, the patient's age and general condition, sex, occupation, and the patient's wishes regarding replantation are evaluated. All tissues that influence survival of the replanted part and its ultimate function must be repaired primarily. An operating microscope should always be used for the vascular and nerve repairs, especially in digital replantation. Good postoperative management is the final key for successful replantation, and includes prevention of thrombosis and adequate rehabilitation. Systemic heparinization is used in digital replantation, but is not used in major limb replantation. Rehabilitation is begun on the first post-operative day, but several reconstructive operations may be necessary on the replanted part to achieve improved function. Between May, 1959 and December, 1977, replantation operations were performed in 218 extremities of 159 patients. Thirteen of 16 major limb replantations and 181 of 204 digital replantations have survived, an overall success rate of 88%. Functional recovery has varied in each individual for several reasons, but most patients are satisfied with the function of their replanted part.

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Résumé Dans les réimplantations de membres ou segments de membres amputés, le succès dépend principalement de la revascularisation, mais le but final doit être la récupération fonctionnelle complète. Avant de décider d'une réimplantation, il faut prendre en considération l'étendue des lésions tissulaires, l'âge du malade, son sexe et son état général, ses occupations et ses souhaits concernant la réimplantation. Tous les tissus qui vont influencer la survie du segment amputé et sa fonction doivent être immédiatement réparés et suturés. Pour les anastomoses vasculaires et nerveuses, il faut toujours travailler sous microscope opératoire, en particulier pour les réimplantations de doigts. Une surveillance et un traitement post-opératoires adéquats sont essentiels: il faut, entre autre, prévenir les thromboses et assurer une excellente rééducation. L'héparinisation est utilisée pour les réimplantations de doigts, mais pas pour les ré implantations de membres. La rééducation doit commencer dès le premier jour postopératoire; mais plusieurs opérations reconstructives peuvent être nécessaires pour atteindre un résultat fonctionnel satisfaisant.Entre Mai, 1959 et Décembre, 1977, nous avons réalisé 218 réimplantations chez 159 patients. Sur 16 réimplantations de membres, 13 ont réussi et sur 204 réimplantations de doigts, 181 sont restées viables, soit au total 88% de succès. Le degré de la récupération fonctionnelle a été variable d'un malade à l'autre, pour des raisons diverses, mais la majorité des opérés sont satisfaits des résultats.

     

HYPOPHOSPHATASIA

An autopsy case of bypophosphatasia in lethal form in a fetus was reported. The female fetus of 40 gestational weeks was prenatally diagnosed as the specific type of congenital disease, because of no detection of calcification of whole bones by X-ray examination. Autopsy showed decrease of the anterioposterior diameter of the chest and marked short extremities. Laboratory data revealed an extreme low value of alkaline phosphatase in the serum. Microscopical examinations showed marked retardation of calcification in the trabecule of whole bones. Family pedigree in second generations suggested that this disease was an autosomal recessive disorder and the parents were heterozygous carriers.     

Behavioral state cycles, background EEGs and prognosis of newborns with perinatal hypoxia

The classification of the background EEG was performed in 132 fullterm neonates who had suffered perinatal hypoxia by visual inspection of whole polygraphic records of 2--3 h duration, i.e., maximally depressed, markedly depressed, moderately depressed, mildly depressed, minimally depressed, normal and other, according to the distribution of 7 EEG patterns. The quantitative analysis of the polygraphic record was made in 33 of the above and 10 control infants to investigate the effect of perinatal hypoxia on the background EEG and behavioral state cycle and to confirm the validity of the above classification. The calssification of the background EEG was well correlated with the disturbance of sleep cycle, which was also related to the interval after the hypoxic insult. The relation between sleep states and EEG patterns also had a close correlation with the classification and became progressively disrupted with increasing severity of the background EEG. Each grade of the background EEG abnormality had a different prognostic significance accordsing to the time of the recording. The one in the first week offered the best prognostic value.     

Ganglio-N-tetraosylceramide (Asialo GM1), an antigen common to the brain and immune system: its localization in myelin

Anti-brain antisera are known to contain several interesting antibodies showing immunological cross-reactions between the nervous and hematopoietic systems, suggesting the existence of antigens common to the two systems (common antigens). One of these is the glycosphingolipid asialo GM1 (ganglio-N-tetraosylceramide, GgOse4Cer), but its location in the nervous system is unknown. Therefore, the location of the brain antigen that reacts with anti-asialo GM1 antibody was examined. On immunohistochemical treatment of sections of mouse brain with purified anti-asialo GM1 IgG, the white matter was stained specifically. Because myelin is a major component of the white matter, neutral glycosphingolipids were prepared from the myelin fraction. On thin-layer chromatography, myelin glycosphingolipids gave a band with the same mobility as asialo GM1. This band was also stained immunochemically by the peroxidase anti-peroxidase procedure using anti-asialo GM1 IgG. The glycosphingolipid of this band gave the molar ratio of sugars expected for asialo GM1. From these results it was concluded that the glycosphingolipid asialo GM1 exists in myelin.     

Whole-body Autoradiography of Tumor-bearing Hamsters with a New Tumor Imaging Agent, Indium-111-labeled Porphyrin

We have synthesized a new tumor imaging agent, ¹¹¹In-labeled porphyrin (¹¹¹In-ATN-2). In order to image transplantable pancreatic carcinoma in Syrian golden hamsters, we investigated the biodistribution of ¹¹¹In-ATN-2 72 hr after injecting the agent by means of whole-body autoradiography. The efficacy of the agent was compared with that of ⁶⁷Ga citrate. The images with ¹¹¹In-ATN-2 were found to be clearer than those with ⁶⁷Ga citrate. Tumor-to-tissue radiodistribution ratios of the former were higher than those of the latter. Thus, ¹¹¹In-ATN-2 seems to be more useful for tumor diagnosis.     

Experimental and clinical studies of sulbactam/cefoperazone in pediatric field

Clinical trials were carried out with sulbactam/cefoperazone (SBT/CPZ) (combination ratio of 1:1) in pediatric infections. Results were as follows. The mean half-lives of SBT and CPZ in the serum following intravenous injection of SBT/CPZ were about 0.7 and 1.2 hours, respectively. Urinary excretions of SBT and CPZ within 6 hours after intravenous injection of SBT/CPZ were 81.9% and 28.1%, respectively. SBT/CPZ was administered to 33 pediatric patients with various infection; 18 respiratory tract infections, 12 urinary tract infections and 3 Salmonella enterocolitis. The overall efficacy rate was 87.9%. In particular, 7 of 8 urinary tract infections caused by beta-lactamase producing organisms were improved after administration of SBT/CPZ. Diarrhea in 8 and soft stool in 3 of 33 patients occurred, and slight elevation of GOT/GPT was observed in 2 patients.     

Surface Area Effects on Efficiency and Biocompatibility in Experimental Membrane Plasmapheresis

The effect of different surface areas on cellular, humoral, and hemodynamic changes and on plasma separation performance were investigated. Membrane plasmapheresis, consisting of plasma separation and on-line reinfusion, was carried out on dogs for 3 h with 0.6 and 0.3-m2 polyethylene (PE) and polyvinyl alcohol (PVA) modules. The plasma separation and sieving performance was comparable in both the 0.6 and 0.3-m2 modules. The initial white blood count (WBC) reductions were independent of the surface area difference, but the rebound was greater in the smaller modules. The platelet (PLT) reductions were less with the 0.3-m2 PE module in comparison to those with the larger PE module, but no differences existed between both of the PVA modules. The smaller PVA module showed less complement activation compared to the 0.6-m2 module, whereas both of the PE modules showed comparable changes. Hemodynamic responses, especially the changes in pulmonary vascular resistance, were less with the smaller modules compared to the 0.6-m2 modules. The PE modules themselves showed less blood cellular, humoral, and hemodynamic changes compared to the PVA modules. The smaller modules showed greater rebound of WBC counts, however, PLT reductions, complement activation, and changes in hemodynamic parameters were less in the smaller modules.     

5-HT3 receptor antagonists inhibit the response of kappa opioid receptors in the morphine-induced Straub tail [corrected

We used the morphine-induced Straub tail to examine the actions of a 5-HT₃ receptor antagonist and κ opioid receptor agonist. The κ opioid receptor agonist, U-50,488H (4–16 mg/kg i.p.), produced a dose-related inhibition of the tail elevation induced by morphine (10 mg/kg s.c.) in ICR male mice. ICS-205-930 (3 and 10 mg/kg i.p.) and zacopride (0.3 and 1 mg/kg i.p.), 5-HT₃ receptor antagonists, attenuated the inhibitory effect of U-50,488H in a dose-dependent manner. ICS-205-930 and zacopride did not inhibit the morphine-induced Straub tail. These observations suggest that the actions of κ opioid receptors may be modulated by 5-HT³ receptors in the morphine-induced Straub tail.