Long-Term Outcome of Adult-to-Adult Living Donor Liver Transplantation for Post-Kasai Biliary Atresia

Our objective was to analyze problems in the perioperative management and long-term outcome of living donor liver transplantation (LDLT) for biliary atresia (BA). Many reports have described the effectiveness of liver transplantation (LT) for BA, particularly in pediatric cases, but little information is available regarding LT in adults (> or =16 years old). Between June 1990 and December 2004, 464 patients with BA underwent LDLT at Kyoto University Hospital, of whom 47 (10.1%) were older than 16 years. In this study, we compared the outcomes between adult (> or =16 years old) and pediatric (<16 years old) patients. The incidence of post-transplant intestinal perforation, intra-abdominal bleeding necessitating repeat laparotomy and biliary leakage was significantly higher (p < 0.0001, <0.001 and <0.001, respectively) in adults. Overall cumulative 1-, 5- and 10-year survival rates in pediatric patients were significantly higher (p < 0.005) than in adults. Two independent prognostic determinants of survival were identified: a MELD score over 20 and post-transplant complications requiring repeat laparotomy. Outcome of LDLT in adult BA patients was poorer than in pediatric patients. It seems likely that LT will be the radical treatment of choice for BA and that LDLT should be considered proactively at the earliest possible stage.     

Potentiating effects of extraluminal oxyhemoglobin to intraluminal 5-hydroxytryptamine in isolated canine internal carotid arteries

The interaction between oxyhemoglobin (oxyHb) and 5-hydroxytryptamine (5-HT) was investigated in an experimental model of isolated canine internal and common carotid arteries with insertion of stainless steel cannulae. Extraluminal application of 10(-5) M oxyHb induced marked and long-lasting vasoconstriction in the internal carotid but not in the common carotid arteries. The 5-HT-induced vasoconstriction was potentiated significantly in both the internal and common carotid arteries. These potentiations were not influenced by the presence or absence of endothelium, a finding which was confirmed by vascular responses to intraluminal acetylcholine. It is concluded that the interaction between extraluminal oxyHb and intraluminal 5-HT may be one of the possible etiological factors behind the chronic phase of vascular spasm following subarachnoid hemorrhage.     

Malignant Rhabdoid Tumor of the Breast: A Case Report

A 66-year-old woman time of 10 days. One month after radicalmastectomy, there was local recurrence, followed by multiplepulmonary metastases, and the patient died of respiratory failure5 months after surgery. The gray-white-colored tumor measured13x12x;10 cm, and its border was well defined. The tumor wascomposed of diffusely growing round or polygonal cells withvesicular nuclei, prominent nucleoli, and ample cytoplasm containingeosinophilic inclusions. Lymph node involvement was widespread.Both vimentin and keratin were clearly demonstrated by immunohistochemicalstaining. Ultrastructural studies revealed that the MRT cellscontained cytoplasmic whorls of intermediate filaments.     

A case report of paraplegia following an operation for thoracic aortic aneurysm--with special reference to pathological findings of the spinal cord

A 60-year-old man suffered from paraplegia after the operation for thoracic aortic aneurysm and died 10 months after the operation. Detailed examination on the distribution of spinal cord lesions and of the locations of anterior radicular arteries revealed that the spinal cord ischemia occurred at the mid-thoracic segments between T-6 and T-10; the artery of Adamkiewicz entered at T-12; another radicular artery entered at T-4. We concluded that the spinal cord ischemia was caused by the interruption of the radicular artery at T-4 and that the segments nourished by the blood flow of the artery of Adamkiewicz were intact. We suggest that in some patients important radicular arteries other than the artery of Adamkiewicz are essential to preserve blood flow to the upper or middle thoracic spinal segments.