Histochemical and immunohistochemical studies on development of biliary carcinoma in forty-seven patients with choledochal cyst--special reference to intestinal metaplasia in the biliary duct

Histochemical and immunohistochemical studies on 47 consecutive specimens excised for choledochal cyst were performed to clarify possible metaplastic changes of the biliary duct in relation to carcinogenesis. An anomalous arrangement of the pancreaticobiliary ductal system was observed in all 39 cases examined. Among the 47 patients, 5 (10.6 per cent) had biliary carcinoma. 27.3 per cent mucous gland, 13.0 per cent goblet cell and 9.5 per cent argyrophil cell in 23 children. On the other hand, 81.8 per cent exhibited mucous gland, 41.7 per cent goblet cell and 27.3 per cent argyrophil cell in 24 adults. These metaplastic changes seemed to be an intestinal metaplasia and increased with age. Immunoreactive-gastrin or -somatostatin were evident immunohistochemically in 4 adults. These findings confirmed that intestinal metaplasia may develop in the biliary duct in cases of choledochal cyst. Although direct evidence between intestinal metaplasia and the development of biliary carcinoma was not found, reflux and stasis of pancreatic enzymes in the biliary duct may relate to the development of intestinal metaplasia and be an important factor related to the carcinogenesis of choledochal cyst.     

Immunohistochemical localization of neurotensin and β-endorphin in the rat anterior pituitary gland

Nakane's enzyme-labeled antibody technique revealed that cells containing neurotensin-like immunoreactivity were widely distributed in the anterior lobe of the pituitary body. Immunohistochemical studies on serial sections showed that a part of neurotensin positive anterior lobe cells contained β-endorphin-like peptide simultaneously. The results show that β-endorphin and neurotensin occur together in certain pituitary cells and this is an evidence of coexistence of more than one peptide within one anterior pituitary cell.     

Autoradiographic studies on benzodiazepine receptor subtypes in the rat brain

The technique of in vitro autoradiography which was developed by Kuhar and others was applied to the rat brain with use of 3H-flunitrazepam (flu) as a radioactive ligand. The cerebral cortex, hippocampus, substantia nigra and cerebellar cortex were rich in 3H-flu binding sites. To differentiate the benzodiazepine receptor (BZR) subtype, the authors used a type 1 specific ligand, either triazolopiridazine (CI 218872) or methyl-beta-carboline-carboxylate (beta-CCM), as an unlabeled displacer. The preparations were exposed on a 3H-sensitive film and then the film was developed. Computer-analysis of thus obtained autoradiographic pictures revealed that type 2 binding sites were distributed evenly within the rat brain, but with slight predominance in the hippocampus. After adding beta-CCM, no silver grains were noticed in the cerebellum and substantia nigra. These data meant that these two structures contained essentially type 1 BZR, while the hippocampus contained both type 1 and type 2 receptors. Autoradiographically, characteristic distribution of BZR represented by 3H-flu binding was considerably lost by adding a type 1 specific ligand, and this treatment caused the silver grains to be evenly distributed. These data suggest that the BZR which is directly associated with characteristic pharmacological actions such as anxiolytic and hypnotic effects is type 1, and type 2 binding sites have a less characteristic distribution pattern and might be pharmacologically less specific.     

Intrahepatic Arteriovenous Shunting Due to Hepatocellular Carcinoma and Cirrhosis, and Its Change by Transcatheter Arterial Emholization

Objectives : To investigate intrahepatic arteriovenous shunt rate due to cirrhosis and hepatoceliular carcinoma (HCC), complicated by cirrhosis, and its change after transcatheter arterial embolization. Methods : The shunt rate was measured hy hepatic artery infusion of labeled macroaggregated albumin. Counts were taken over the liver and both lungs for calculation of the shunt rate: cpm in lungs ÷ (cpm in liver and lungs) × 100%. Results : The intrahepatic arteriovenous shunt rate of cirrhosis ranged from 6.8% to 16.6% (12.6%± 3.4%, mean + SD). In HCC, it ranged from 7.2% to 27.1% (16.0%± 4.9%, mean ± SD). The difference between the groups was statistically significant (p < 0.05). When the liver was more than 20% replaced by tumor, the intrahepatic arteriovenous shunt rate was higher than when less than 20% occupied (n = 6, 20.1%± 4.8% vs. n = 15, 14.4%± 4.0%; p < 0.05). Although the former was significantly different from liver cirrbo-sis, the latter was not significantly different from the shunt rate ohserved in liver cirrhosis without HCC. After transcatheter arterial embolization. excluding one patient who developed a visible bepatofugal arteriopor-tal shunt, the mean change in shunt rate between the effective treatment group (n = 9, −2.1%± 2.8%, mean ± SD) and the ineffective treatment group (n = 5, 3.0%± 3.3%, mean ± SD) was statistically significant (p < 0.05). Conclusions: We found that intrabepatic arteri-ovenous shunt rate more sensitively detects intrabepatic arteriovenous shunting due to HCC than does angiog-raphy alone. Measuring intrahepatic arteriovenous stunt rate may provide useful information regarding response to treatment.     

Changing Policies on Vaginal Birth after Cesarean: Impact on Access

ABSTRACT: Background: The issue of vaginal birth after cesarean (VBAC) has become highly visible and contentious. In 1999, the American College of Obstetricians and Gynecologists advocated a policy that surgical capability be “immediately available” for women in labor attempting VBAC. Methods: Every hospital in Colorado, Montana, Oregon, and Wisconsin was contacted by telephone at least once during the period 2003 to 2005. Using a semistructured interview, respondent hospitals were asked whether and when their policies for VBAC had changed and what was the availability of VBAC services before and after the 1999 policy was issued. Results: Of 314 hospitals contacted, 312 responded to the survey (response rate 99.4%). Babies were delivered at 230 (74%) respondent hospitals. Almost one‐third, 68 of 222 (30.6%), of responding delivery hospitals that previously offered VBAC services had stopped doing so; seven hospitals had never allowed VBAC. Of the hospitals that still allowed VBAC, 68 percent had changed their VBAC policies since 1999, with the most frequent changes requiring the in‐house presence of surgery (53%) and anesthesia (44%) personnel when women desiring VBAC presented in labor. Compared with hospitals that stopped allowing VBAC, those that currently permit VBAC were larger (156.6 vs 58.1 beds, t = 7.02, p < 0.001), closer to other delivery hospitals (20.9 vs 39.2 miles, t = 4.33, p < 0.001), annually delivered more babies (1009.9 vs 458.3, t = 4.41, p < 0.001), and annually had more cesarean deliveries (226.7 vs 105.7, t = 3.91, p < 0.001). Conclusions: In the years following advocacy of the 1999 policy, the availability of VBAC services significantly decreased, especially among smaller or more isolated hospitals. (BIRTH 34:4 December 2007)     

Rib fracture after postoperative tangential irradiation in breast cancer

Incidence of rib fracture was analyzed for 118 postoperated breast cancer patients who were tangentially irradiated at the Department of Radiology, Kyushu University, from 1961 to 1976 and followed more than 5 years. Rib fracture was observed in 5% and 50% of cases treated with total radiation doses of 32.5 Gy and 52.5 Gy respectively.     

Induction of preleukemic stage of adult T cell leukemia-like disease in rabbits

Two HTLV-I-carrying T cell lines were prepared from peripheral lymphocytes of a virus-infected (B/J X Chbb:HM) F1 rabbit, and these cells were inoculated intraperitoneally into 5 newborn F1 rabbits. These animals were killed 3-5 weeks later. Their leukocyte counts were higher than those in normal control animals, with abnormal lymphocytes amounting to 3-5% of total leukocytes. Histological examination showed leukemic infiltration in liver, spleen, lung and kidneys of all these animals. The peripheral lymphocytes at first lacked HTLV-I antigens, but became antigen-positive after in vitro culture. Southern blot analysis of these cells revealed HTLV-I integration patterns different from those of the inoculated cells.     

Rapidly absorbed solid oral formulations of ibuprofen using water-soluble gelatin

Rapidly absorbed oral dosage forms of ibuprofen using water-soluble gelatin (hydrolysate of common gelatin: mean mol. wt: 6000) have been studied and compared with tablets prepared with common gelatin (mean mol. wt: 100,000) and commercial tablets. Spray-dried and speed-kneaded powders, two types of granules and tablets were prepared with water-soluble gelatin. The in-vitro dissolution rates of water-soluble gelatin preparations were significantly faster than those of commercial tablets, whereas the tablets prepared using common gelatin had slower dissolution rates than commercial tablets. Water-soluble gelatin enhanced the dissolution rate of ibuprofen by improving the wettability of the drug particle surface by water, without any interaction in solution and the solid state. The absorption behaviour of various preparations was evaluated in four beagle dogs. The peak concentration time (tmax) of the water-soluble gelatin preparations was significantly shorter than that of tablets prepared with common gelatin and commercial tablets. The maximum concentration (cmax) and the area under the serum concentration-time curve (AUCo-10 h) were similar in all cases. The serum concentration profiles of water-soluble gelatin solid preparations were almost the same as those of the solutions. On the other hand, the profiles of the common gelatin tablets were similar to those of the commercial tablets. The mean absorption time (MAT) from water-soluble gelatin preparations was about 0.7 h, while the MAT from commercial tablets and common gelatin tablets was about 1.2 h. The differences in the MAT of water-soluble gelatin preparations and commercial tablets or common gelatin tablets were the same as the differences in mean dissolution time (MDT) in gastrointestinal fluid.(ABSTRACT TRUNCATED AT 250 WORDS)