Complications of percutaneous transhepatic catheterization of the portal venous system in patients with portal hypertension

We report here complications of percutaneous transhepatic catheterization of the portal venous system in 170 Japanese patients with portal hypertension. All patients underwent percutaneous transhepatic portography and percutaneous transhepatic obliteration of oesophagogastric varices was also performed in 29 patients. After retraction of the catheter, the puncture canal was plugged with gelatin sponge in 150 subjects and with one steel coil in 20 others. The overall complication rate was 16.5%. Intraperitoneal bleeding occurred in 10.6% of patients and 2.9% required blood transfusion. In these patients with intraperitoneal bleeding, the gelatin sponge was used for plugging after retraction of the catheter, while in the 20 patients with a steel coil plug, haemoperitoneum never occurred. Right pleural effusion was recognized in 3.5% of patients, intraperitoneal bile leakage in 1.8% and deterioration of liver function due to arteriovenous fistula in 0.6%. By univariate and multivariate analyses, female gender was the only risk factor for intraperitoneal bleeding among 150 patients investigated by percutaneous transhepatic catheterization of the portal venous system with gelatin sponge plugging. Intraperitoneal bleeding is the most important complication in patients with portal hypertension; it is difficult to predict intraperitoneal bleeding before retraction of the catheter in patients for whom gelatin sponge is used. Thus, for patients undergoing percutaneous transhepatic catheterization of the portal venous system, close follow up is recommended.     

内皮素-1受体拮抗剂对肺气肿大鼠肺组织的保护作用及机制

目的 探讨内皮素-1受体拮抗剂对肺气肿大鼠肺组织的保护作用及机制.方法 将24只SD大鼠随机分为健康对照组、肺气肿模型组、BQ123干预组、Bosentan干预组,每组6只.测4组大鼠平均内衬间隔(MLI)和肺泡破坏指数(DI).用缺口末端标记法(TUNEL)测肺泡间隔细胞凋亡;用免疫组化法、Western blot测caspase-3表达;用明胶酶谱法测基质金属蛋白酶(MMP)-2、MMP-9活性;用ELISA测TNFα、IL-1β浓度.结果 (1)肺气肿模型组大鼠出现典型肺气肿变化,MLI[(108.7±6.8)μm]和DI[(62.2±7.0)%]较健康对照组显著增高[(69.8±6.6)μm;(13.9±2.7)%;P<0.01];BQ123干预组[MLI(89.0±7.4)μm,DI(41.5±4.5)%]、Bosentan干预组[MLI(81.9±6.1)μm,DI(44.0±8.5)%]均较肺气肿模型组显著降低,但2组间差异无统计学意义.(2)4组大鼠肺内均可见凋亡细胞,肺气肿模型组凋亡指数(AI)较健康对照组明显增高,BQ123干预组、Bnsentan干预组AJ较肺气肿模型组明显减低,但仍高于健康对照组(P<0.01).(3)肺气肿模型组大鼠肺组织caspnse-3表达明显增高,BQ123干预组、Bosentan干预组caspase-3表达较肺气肿模型组明显降低.(4)肺气肿模型组大鼠肺内MMP-2、MMP-9活性较健康对照组明显增高,BQ123干预组、Bosentan干预组MMP-2、MMP-9活性降低,但差异无统计学意义.(5)肺气肿模型组大鼠肺组织匀浆上清中TNFα、IL-1β水平较健康对照组明显增高,BQ123干预组、Bosentan干预组TNFα、IL-1β水平较肺气肿模型组明显减低.结论 内皮素受体拮抗剂可通过抑制肺气肿大鼠凋亡基因表达,降低MMPs活性和减少炎性因子释放而起到部分保护作用.     

Increased urinary endothelin excretion in patients with liver cirrhosis

The urinary endothelin level in patients with chronic liver disease was determined in order to explore its possible involvement in renal function. The plasma endothelin level was significantly higher in patients with liver cirrhosis (LC) than in those with chronic hepatitis (CH) or in control patients (C). Similarly, urinary endothelin excretion in LC was significantly increased, compared with CH and C. Urinary endothelin demonstrated a significant positive correlation with creatinine clearance. The ratio of endothelin clearance/creatinine clearance did not differ statistically among the three groups. Urinary sodium excretion in LC was positively correlated with plasma endothelin, but not with urinary endothelin. Urinary endothelin excretion demonstrated a significant negative correlation with urinary kallikrein in LC. The present data suggest that increased urinary endothelin excretion in cirrhotic patients primarily depends upon elevated plasma levels of endothelin, but not renal production. Also, a possible link between endothelin and the kallikrein-kinin system in liver cirrhosis is indicated.     

Double-outlet right ventricle with intact ventricular septum

An infant with double-outlet right ventricle (DORV) with intact ventricular septum (VS) is described. Hypoplastic left ventricle and mitral valve atresia were also associated. To the authors' knowledge, this appears to be the first case in which this rare form has been demonstrated with magnetic resonance imaging (MRI). The patient required balloon atrial septostomy (BAS) three times until 4 months of age because of progressive cyanosis. In such a form of DORV, surgical atrial septectomy should be performed instead of repeating BAS because the tendency to functional closure of the restrictive secundum arterial septal defect caused by incompetent foramen ovale seems to be prominent.     

Differences of LAK-activity and IL-2 responsiveness between α/β and γ/δ T cells which developed after thymus transplantation

A patient with severe combined immunodeficiency was transplanted with T cell depleted haploidentical bone marrow from his father and was later given a thymic graft from an unrelated donor, α/β and γ/δ T cells of bone marrow donor origin appeared only after the thymus transplantation procedure. Among the peripheral blood lymphocytes (PBL), γ/δ T cells comprised 10–20% and most of them were δTCS1⁺. The α/β T cells were single positive cells, either CD4⁺ or CD8⁺. Expression of CD5, CD7 and CD8α,β molecules on α/β T cells was reduced. Functional studies showed that γ/δ T cells proliferated slightly in response to anti-CD3 stimulation, and proliferated well with exogenous IL-2 stimulation, while α/β T cells did not proliferate following mitogenic stimulation even in the presence of IL-2. γ/δ T cells but not α/β T cells exhibited some LAK activity after culturing with IL-2. Since α/β T cells expressed IL-2R α and β chains after mitogenic stimulation and bound IL-2, the deficit(s) in these cells was considered to occur after IL-2 binding to the IL-2R. These results indicate thymic dependency of both types of T cells and that two types of T cells differed in the acquisition of IL-2 responsiveness during development.     

Double Adenocarcinoma in Barrett's Esophagus: A Case Report

At the National Cancer Center Hospital in Tokyo, a patient withBarrett's esophagus developed double adenocarcinoma of the esophagus.One carcinoma was located in the midesophagus and the otherjust above the anatomic cardia. Esophagoscopic examination withbiopsy revealed two carcinomas surrounded with columnar epitheliumand ectopic islets of gastric mucosa situated in the postcricoidregion. There was no ulcer or stricture in the esophagus. Thepatient received subtotal esophagectomy and survived the operation.Microscopically, depth of invasion of the proximal cancer wasto the proper muscle, and that of the distal one was to thesubmucosal layer. There was metastasis to two lymph nodes. Therewas no sign of inflammation or ulcer in the esophagus.     

Comparison of Arrhythmogenicity of Atrial Pacing at Several Right Atrial Pacing Sites: Evaluation of Canine Atrial Electrograms During Atrial Pacing and Arrhythmogenicity for Atrial Fibrillation

The changes in the duration of atrial electrograms and the appearance of AF during atrial pacing were compared among five atrial pacing sites in dogs to clarify the arrhythmogenicity of atrial pacing at different atrial pacing sites. In seven mongrel dogs (15–20 kg), the right atrial surface was exposed by right thoracotomy. Atrial electrograms were recorded via bipolar electrodes with an interelectrode distance of 1.2 mm at four right atrial sites: (1) the high right atrium (HRA), (2) the mid-right atrium (MRA), (3) the low right atrium (LRA), and (4) the center of the pectinate muscle (PM). The duration of the atrial electrograms at these four recording sites were measured during atrial pacing with fixed cycle lengths of 200, 150, and 120 ms delivered at five atrial sites: (1) the HRA, (2) the inferior vena cava (IVC), (3) the right atrial appendage (RAA), (4) Bachman's bundle (BB), and (5) the atrial septum (AS). In each dog, the atrial pacing with the 120-ms cycle length was performed five times at each pacing site to evaluate the in-ducibility of AF. When AF was induced, the atrial recording site which first showed a fragmented atrial electrogram was considered the initiation site of the AF. AF was induced during 9 of 35 episodes of atrial pacing at the HRA site, 11 of 35 at the IVC site, 5 of 35 at the RAA site. 3 of 35 at the BB site, and none at the AS site. The initiation site of AF was in the HRA site in 11 of 28 episodes of induced AF, in the MRA site in 9 of 28, and in the LRA site in 8 of 28. At each recording site, the shorter the paced cycle length, the longer the duration of the atrial electrogram regardless of the pacing site. During the atrial pacing with the 200-ms cycle length, the HRA pacing resulted in the shortest duration of the atrial electrogram at each recording site in comparison with the other pacing sites. However, during atrial pacing at the two shorter paced cycle lengths, the duration of the atrial electrogram was shorter during the pacing at the BB or AS sites in comparison with the other three pacing sites, i.e., the HRA, IVC, and RAA sites. These results were the same for all atrial recording sites, but the prolongation of the atrial electrogram was most prominent at the HRA and MRA recording sites, which are most likely initiation sites of the induced AF. In the canine atria, (1) the initiation sites of AF were likely to be the HRA, MRA, or LRA sites in comparison with the PM site; and (2) the atrial pacing at the BB or AS sites was considered less arrhythmogenic for AF than the pacing at the HRA, LRA, or RAA sites.     

Inverse Relation of Body-Surface Activation-Recovery Interval and Recovery Time to Activation Time in Normal Subjects: Stronger Correlation and More Heterogeneous Distribution in Activation-Recovery Interval Than in Recovery Time

The activation-recovery interval (ARI), measured directly from the myocardium, has shown a good correlation with the action potential duration (APD) in experiments. APD has been reported to be inversely related to the activation time (AT). However, no studies have examined the correlation between the body-surface ARI and AT in normal subjects. Fifty normal subjects (25 men and 25 women) were studied to elucidate the relationship between the body-surface ARI and AT. The body-surface AT was defined as the duration between the QRS onset and the minimum dV/dt of the QRS wave, and ARI as the interval between the minimum dV/dt of the QRS wave and the maximum dV/dt of the T wave in each lead of an 87 unipolar lead system. We also measured the recovery time (RT) defined as the duration between the QRS onset and the maximum dV/dt of the T wave. ARI was inversely correlated with AT (r = -0.73). RT was also inversely correlated with AT (r = -0.61), however, RT had a less heterogeneous distribution than ARI (148 ms vs 159 ms). There were no differences between male and female subjects in the relation between ARI and RT or in the body-surface distribution of ARI and RT. These findings suggest that the body-surface ARI may reflect recovery properties over the cardiac surface and that APD may distribute inhomogsneously over the human cardiac surface with a longer RT over an area with a shorter AT. ARI calculated from body-surface ECG may be a useful noninvasive and repeatedly measurable estimate of APD.     

Cellular immunity in IgA nephropathy

Summary: A comprehensive study on the role of various cytokines in the regulation of IgA synthesis and progression of glomerular damage in IgA nephropathy was attempted. Semi-quantitative PCR for IL-I, IL-2, IL-4, IL-6, IL-10, IL-12, interferon (IFN)-γ, transforming growth factor (TGF)-β, tumour necrosis factor (TNF)-α, platelet derived growth factor (PDGF) and monocyte chemoattractant protein-1 (MCP-1) was performed. In parallel studies, protein production of some cytokines was also determined. It was demonstrated that IL-4, IFN-γ and presumably IL-12 expressed predominantly in peripheral blood mononuclear cells in patients with IgA nephropathy. Some positive correlations between the mRNA expression of these cytokines and the degree of tissue damage were observed. It was concluded that these cytokines may play some role in the alteration of cellular immunity in this disease.     

Inverse correlation of microvessel density with metastasis and prognosis in renal cell carcinoma

BACKGROUND: Although a correlation between microvessel density (MVD) and tumor aggressiveness has been established for several malignancies, the data for renal cell carcinoma (RCC) is conflicting. In order to clarify the significance of MVD, we investigated the relationships between MVD and tumor stage, grade, size, occurrence of metastasis and patient survival. METHODS: Tumor specimens from 70 patients with primary renal cell carcinoma were examined by immunohistochemical staining for CD34. RESULTS: There was a tendency for MVD to decrease from G1 to G3 tumors or from stage T1 to T3 tumors, although this was not statistically significant. However, the MVD for 56 non-metastatic and 14 metastatic tumors were significantly different (P = 0.005) at 109 +/- 67 and 58 +/- 35 per x400 field (mean +/- SD), respectively. Microvessel density for 36 large and 34 small tumors was also significantly different (P < 0.0001) at 48 +/- 22 and 142 +/- 54 per x400 field, respectively. The survival rate of patients with small, low grade and hypervascular tumors was significantly higher than that of patients with large (P = 0.0015), high grade (P = 0.05) or low MVD (P = 0.039) tumors. Cox proportional hazards regression analysis showed that tumor grade and size emerged as independent prognostic factors. CONCLUSION: High MVD in RCC was inversely associated with tumor aggressiveness, but MVD was not the independent prognostic factor.