Direct observation of the portal vein interior by intra-operative angioscopy in the dog and man

The purpose of this study was to develop the technique of intra-operative portal angioscopy using a portal angioscope, and to demonstrate its potential use in the therapy for patients with hepatocellular carcinoma (HCC) bearing a portal thrombus. Portal angioscopes, Olympus BF3C10 and CHFP10 of a diameter of 3.5 mm and 4.8 mm, respectively, were used during operation in five dogs, two patients with hepatic metastasis from colon cancer and three patients with HCC having a portal tumour thrombus. The portal vein and hepatic artery were ligated simultaneously, and the angioscope was immediately introduced under direct vision through a small portal venotomy. Blood in the portal vein was almost fully diverted by infusion of heparinized saline through a channel of the angioscope at a rate of 3 mL/min in dogs and 5 mL/min in patients with hepatic metastasis. Rates of 6 mL/min and 10 mL/min in dogs and patients, respectively, were adequate to clear completely the portal vein of blood. In patients with HCC, portal tumour thrombectomy was performed with a Fogarty balloon catheter by suctioning thrombi through a channel of the fibrescope after visual study of the portal thrombus. Observation and treatment of portal thrombus by angioscopy may become an important part of surgical treatment of HCC with portal invasion, but further technical improvement is desirable before this technique becomes a routine procedure.     

THE CONTUSION INDEX: A REAPPRAISAL IN HUMAN AND EXPERIMENTAL NON-MISSILE HEAD INJURY

A previously described method of quantifying cerebral contusions in man (the contusion index) caused by non-missile head injury has been modified and applied to a larger series of cases, and used to assess contusions in experimental head injuries. The initial findings in man have been confirmed, viz. that contusions are most severe in the frontal and temporal lobes; that contusions may be entirely absent in a patient dying as a result of a head injury; that there is no correlation between the severity of contusions and the nature of the injury; that the concept of contrecoup must continue to be questioned; that contusions are more severe in patients who have a fracture of the skull in comparison to those who do not; that contusions are more severe in patients who do not experience a lucid interval than in those who do; and that contusions are less severe in patients with diffuse axonal injury than in those who do not have diffuse axonal injury. The distribution of contusions in subhuman primates is similar to that seen in man, and they occur more frequently with short duration than with long duration acceleration.     

Time course of saliva and serum melatonin levels after ingestion of melatonin

Abstract Salival and serum melatonin levels after melatonin ingestion were measured by gas chromatography-mass spectrometry. Ingestion of 3 mg melatonin caused a marked increase in serum melatonin (3561 ± 1201 pg/mL) within 20 min, followed by a gradual decrease, but the level still remained higher than the basal level at 240 min after the ingestion. The saliva melatonin 60 min after the ingestion showed the highest level (1177 ± 403 pg/mL) which was one-third of the plasma level. The saliva melatonin level was highly correlated with the serum level throughout the experimental period ( r = 0.82, P = 0.0001). These data indicate that the measurement of saliva melatonin level may be a suitable indicator for the melatonin secretion into general circulation.     

Impact of Intraoperative 3-Tesla MRI on Endonasal Endoscopic Pituitary Adenoma Resection and a Proposed New Scoring System for Predicting the Utility of Intraoperative MRI

The aim of this study was to evaluate the impact of 3-Tesla intraoperative high-field magnetic resonance imaging (3T-iMRI) for pituitary adenoma resection, and to propose a new scoring system for predicting the utility of 3T-iMRI. This retrospective study evaluated 82 patients with pituitary adenoma who underwent purely endoscopic endonasal resection with 3T-iMRI between 2015 and 2019. 3T-iMRI revealed unexpected residual tumor in 39 cases (47.6%), which led to further resection and contributed to upgrading of the resection level in 28 cases (34.1%), which led to gross total resection rates (GTRs) of 67.1% and near total resection of 15.9%. To construct a new scoring system, patients were divided into a discovery cohort (56 patients) and a validation cohort (26 patients). Three variables for the scoring system were selected according to a univariate analysis of the discovery cohort: the size of the tumor (>20 mm: 1 point), the presence of suprasellar tumor lobulation (1 point) and the history of previous operations (1 point). The risk of additional resection after iMRI was well stratified by this scoring system (range 0–3; p = 0.0037 for trend). Robustness of the system was confirmed in the validation cohort (0 points, 0%; 1 point, 30.8%; 2 points, 70.0%; 3 points, 100%; p = 0.0116 for trend). These results indicate that 3T-iMRI optimized the extent of resection, even with the use of an endoscope, and that the proposed scoring system is useful for predicting whether 3T-iMRI is likely to be of value for a particular patient.     

A pilot study to evaluate a new combination therapy for gastric ulcer: Helicobacter pylori eradication therapy followed by gastroprotective treatment with rebamipide

Background and Aim: Controversies remain over the need for antiulcer treatment following 1‐week eradication triple therapy for Helicobacter pylori‐positive peptic ulcers. The usefulness of combination therapy for gastric ulcers in Japanese patients, which consists of H. pylori eradication followed by gastroprotective therapy with rebamipide, was therefore evaluated. Methods: The study was conducted in 52 H. pylori‐positive patients with an endoscopically‐proven open gastric ulcer. All patients received 1‐week triple therapy (lansoprazole, amoxicillin and clarithromycin) followed by 7‐week rebamipide therapy. After completion of the combination therapy, all patients underwent evaluation of ulcer healing by endoscopy, gastric ulcer symptoms and H. pylori eradication by rapid urease test and ¹³C‐urea breath test. Results: The ulcer healing rates were 85.7% (36/42) at 8 weeks, 83.3% (30/36) in eradicated patients and 100% (6/6) in non‐eradicated patients. The overall gastrointestinal symptom‐free rate improved from 19.0% at baseline to 88.1% at 8 weeks. H. pylori was effectively eradicated in 85.7% (36/42) of patients. Conclusions: The results suggested that the combination therapy for open gastric ulcer was safe, well‐tolerated and effective. However, data from a double‐blind placebo‐controlled study is necessary to confirm these findings.     

Japan''s share of research output in urology and nephrology

BACKGROUND: Recent studies have documented Japan's share of articles in different biomedical fields. However, Japan's contribution to urology and nephrology is not known. METHODS: Seven journals in this field with the highest impact factors were selected to obtain relevant data. In June 2002, we searched the Medline database to obtain country affiliation details of articles published in the selected journals during 1991-2000. The proportion of articles with a higher grade of evidence (randomized controlled trials or clinical trials, cohort studies and case-control studies) were also generated and compared to the average values for all articles published in these journals. RESULTS: Of the total number of articles (22 232), Japan's share of research output for the selected journals in urology and nephrology was 6% (1335 articles) and it ranked second in the world following the USA (56.5%). The recent increase in the share was statistically significant for Japan, Austria, France, Germany, Spain and Turkey. The proportion of articles with a high grade of evidence was lower for articles originated in Japan than for the total number of articles. CONCLUSION: Japan's contribution to urology and nephrology research is within the range of its contribution to other biomedical fields. However, the number of high quality clinical research conducted in Japan in this field was small.