An experimental study on cell dynamic alteration in digestive organs following total parenteral nutrition in dogs

To investigate the effects of total parenteral nutrition (TPN) on the alimentary tract, liver and pancreas, dogs were kept under TPN for 3 weeks, and changes in the cell dynamics of those organs and gastrointestinal hormones were evaluated. DNA synthesis activity in the mucosa of the stomach, jejunum and ileum decreased after TPN, and these changes recovered after oral refeeding. However, in the non-mucosal structures of the gastrointestinal wall, liver and pancreas, no corresponding changes were observed. Serum gastrin concentration was lowered after TPN, and it recovered after oral refeeding. A positive correlation was observed between serum gastrin level and DNA synthesis activity in the mucosa of the stomach, jejunum and ileum at all periods. However, enteroglucagon and pancreatic glucagon in the blood did not show any changes after TPN. In conclusion, TPN-induced changes in cell dynamics in the mucosa of the alimentary tract are reversible after resumption of oral feeding, and the serum gastrin release may be a regulating factor in these changes. A part of this study was presented at the 25th Annual Meeting of the Japanese Society of Surgical Metabolism and Nutrition (at Tokyo, Japan in July, 1988) and at the 75th General Meeting of the Japanese Society of Gastroenterology (at Yokohama, Japan in March, 1989).     

Fluorescein fundus angiography of optic nerve head in primary open angle glaucoma and low tension glaucoma]

Fluorescein fundus angiography was performed at angle of 20 degrees in the 58 low tension glaucoma (LTG) eyes (30 cases) and 77 primary open angle glaucoma (POAG) eyes (41 cases) and the relation of the optic nerve head fluorescein changes to visual field disturbances (stage classification of Kosaki) was compared between POAG and LTG groups. The filling defect of fluorescein in the deep area and the decrease in number of superficial capillaries were observed in the optic nerve head. The filling defect area of fluorescein in the optic nerve head corresponding to Bjerrum scotoma was recognized even in the mild visual field disturbance cases of both LTG and POAG. The following findings were noted in both LTG and POAG cases; expansion of the filling defect area and the decrease in number of superficial capillaries in the same area with progression of visual field disturbances. Filling defect area of fluorescein of the optic nerve head accorded with visual field disturbance area in 19 LTG eyes (32.8%) and 61 POAG eyes (79.2%). On the contrary, the filling defect area of the optic nerve head was wider than the visual disturbance area in 37 LTG eyes (63.8%) and 16 POAG eyes (20.8%). These findings suggest that blood circulatory disorders of the optic nerve head occurred earlier in LTG than in POAG and that the development of LTG might be closely associated with the blood circulatory disorders.     

Evaluation of the degree of severity in liver cirrhosis by computed tomography

As CT findings useful for the evaluation of the degree of severity in liver cirrhosis, the following items were chosen for statistical analysis: atrophy of the right lobe, enlargement of the left lobe, irregularity of the liver surface, ascites, varices or collaterals, and dilatation of the SMV. According to the frequency with which these six items were found, the CT findings were expressed in the form of a score, and the resulting scores agreed well with ICG values, portal-venous flow (Qp) ratios obtained from radionuclide angiography, and the scores on the Child-Turcotte criteria. A score of 5 or 6 meant severe cirrhosis. A score of 4 meant liver cirrhosis, however, the degree of severity could not be determined, because there was overlap among the cirrhotic groups. A score of 3 meant liver cirrhosis with a probability of about 90%. A score of 1 or 2 was nonspecific for evaluation. When a score of 0 was noted with splenomegaly, there was a probability of more than 90% that it was chronic hepatitis. In conclusion, this approach was considered to be useful for evaluating the degree of severity in liver cirrhosis and differentiating between liver cirrhosis and chronic hepatitis to some degree in Japanese.     

Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy

Background The use of intraoperative cholangiography (IOC), routinely rather than selectively, during laparoscopic cholecystectomy (LC) is controversial. Recent findings have shown laparoscopic ultrasound (LUS) to be safe, quick, and effective not only for screening of the bile duct for stones, but also for evaluating the biliary anatomy. This study aimed to evaluate, on the basis of the LC outcome and the cost of LUS and IOC, whether and how much the routine use of LUS would be able to reduce the need for IOC. Methods During LC, LUS was used routinely to screen the bile duct for stones and to evaluate the biliary anatomy, whereas IOC was used selectively only when LUS was unsatisfactory or unsuccessful. Results For 193 (96.5%) of 200 patients, LUS was completed successfully, whereas IOC was needed for 7 patients (3.5%). Bile duct stones were identified in 20 patients (10%). For the detection of bile duct stones, LUS yielded 19 true-positive, 175 true-negative, 0 false-positive, and 1 false-negative results. It had a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 99.4%. The postoperative complications included bile leaks from the liver bed in two patients and a retained bile duct stone in one patient. If IOC had been used selectively in a traditional manner on the basis of preoperative risk factors, IOC would have been needed for 77 patients (38.5%). The total cost of LUS plus IOC for the current 200 patients was $26,256. The total estimated cost of selective IOC, if it had been performed for the 77 patients, would have been $31,416. Conclusions Routine LUS accurately diagnosed bile duct stones and significantly reduced the need for selective IOC from a potential 38.5% to an actual 3.5% without adversely affecting the outcome of the LC or increasing the overall cost. The routine use of LUS during LC is accurate and cost effective.     

Analysis of early phase [11C]BF-227 PET,and its application for anatomical standardization of late-phase images for 3D-SSP analysis

Purpose

To examine the usefulness of the early phase [¹¹C]BF-227 positron emission tomography (PET) for (1) conferring additional diagnostic value by providing perfusion-like information and (2) obtaining the appropriate anatomical standardization (AS) using three-dimensional stereotactic surface projection (3D-SSP) method.

Methods

This study included 20 mild cognitive impairment (MCI), 19 Alzheimer’s disease (AD), and 17 normal cognitive (NC) subjects. Early- and late-phase BF-227 PET images were obtained 0–10 and 40–60 min after the injection, respectively. AS for late-phase BF-227 images were performed by 2 methods: (1) method A, for AS of late-phase BF-227 images using ⁸F-fluorodeoxyglucose (FDG) images of the same subject and (2) method B, for AS of late-phase BF-227 images using early phase BF-227 images.

Results

Method B was successfully used for AS in all cases. The Z score maps of 3D-SSP analyses of FDG PET and early phase BF-227 PET for AD and MCI groups showed a typical AD-like pattern. Regional analyses revealed that the early phase BF-227 PET showed significant differences between AD and NC, and MCI and NC.

Conclusion

The early phase BF-227 PET images showed significant abnormal findings for the AD and MCI groups. AS of late-phase BF-227 images using early phase BF-227 images were successful, and enabled appropriate 3D-SSP analyses.     

Ultrasound-guided radiofrequency thermal ablation of liver tumors: Percutaneous, laparoscopic, and open surgical approaches

Only 10% to 20% of patients with primary and colorectal metastatic liver tumors are candidates for curative surgical resection. Even after curative treatment, tumors recur commonly in the liver. As a less invasive therapy, radiofrequency thermal ablation (RFA) of primary, metastatic, and recurrent liver tumors was performed under percutaneous, laparoscopic, or open intraoperative ultrasound guidance. The safety and local control efficacy of RFA were investigated. RFA was performed mostly in patients with unresectable hepatomas or metastatic liver tumors. Patients with large tumors, major vessel or bile duct invasion, limited extrahepatic metastases, or liver dysfunction were not excluded. An RFA system with a 15-gauge electrode-cannula with four-pronged retractable needles was used. All patients were followed for more than 8 months to assess morbidity and mortality, and to determine tumor recurrence. Sixty RFA operations were performed in 46 patients: 11 patients underwent repeat RFA once or twice. A total of 204 tumors were treated: 70 hepatomas and 134 metastatic tumors. Tumor size ranged from 5 mm to 180 mm (mean 36 mm). RFA was performed in 29 operations for 81 tumors percutaneously, in seven operations for 14 tumors laparoscopically, and in 24 operations for 109 tumors by open surgery. Combined colorectal resection was carried out in five operations and combined hepatic resection was carried out in three operations. There was one death (1.7%) from liver failure, and there were three major complications (5%): one case of bile leakage and two biliary strictures due to thermal injury. There were no intra-abdominal infectious or bleeding complications. The length of hospital stay ranged from 0 to 2, 1 to 3, and 4 to 7 days for percutaneous, laparoscopic, and open surgical RFA, respectively. During a mean follow-up period of 20.5 months, local tumor recurrence at the RFA site was diagnosed in 18 (8.8%) of 204 tumors. The risk factors for local recurrence included large tumor size and major vessel invasion: recurrence rates for tumors less than 4 cm, 4 to 10 cm, and greater than 10 cm, and for those with vessel invasion were 3.3%, 14.7%) 50%) and 47.8%) respectively. Ten of 18 tumors recurring locally were retreated by RFA, and eight of them showed no further recurrence. Ultrasound-guided RFA is a relatively safe, well-tolerated, and versatile treatment option that offers excellent local control of primary and metastatic liver tumors. The appropriate use of percutaneous, laparoscopic, and open surgical RFA is beneficial in the management of patients with liver tumors in a variety of situations.