A Histopathological Study on Ventral and Dorsal Pancreas Tissues in Patients with Pancreas Divisum

Abstract: Five cases of pancreas divisum, clinically diagnosed by endoscopic retrograde choledochopancreatography (ERCP), were studied histopathologically. They consisted of four biopsied cases and one patient who underwent pancreatoduodenectomy under the diagnosis of a suspected pancreatic carcinoma. Fibrosis was found in three out of the five cases, two cases with fibrosis in the dorsal pancreas and one in the ventral pancreas. In the two dorsal fibrosis pancreas cases, fibrosis was distributed in the intra- and interlobular areas and was accompanied by atrophy or disappearance of the acinar cells. These findings were compatible with chronic obstructive pancreatitis, distal to a stricture of the pancreatic duct. In the one ventral fibrosis pancreas case, i. e., the pancreatoduodenectomized case, fibrosis was distributed mainly in the interlobular area associated with hemosiderin deposition. Hemosiderin deposition was also observed in inflammatory foci at the posterior aspect of the ventral pancreas. Hence, such interlobular fibrosis developed in relation to the inflammatory foci, and was not caused by pancreas divisum. Therefore, in pancreas divisum, abnormal findings were observed in the dorsal pancreas tissue, and they were compatible with chronic obstructive pancreatitis. (Dig Endosc 1994; 6 : 74–79)     

Dose--response effects of malachite green on free radical formation, lipid peroxidation and DNA damage in Syrian embryo cells and their modulation by antioxidants

Malachite green (MG), consisting of green crystals with a metalliclustre, is very soluble in water and is highly cytotoxic tomammalian cells and also acts as a liver tumour promoter. Inview of its industrial importance and possible exposure to humanbeings, MG poses a potential environmental health hazard. Wehave earlier reported the possible involvement of reactive freeradicals in morpho logical transformation of Syrian hamsterembryo (SHE) cells by MG. In this study we have studied thedose–response effects of MG on free radical formation,lipid peroxidation and DNA damage in SHE cells. Electron spinresonance analysis with 5,5-dimethyl-1-pyrrollne-N-oxlde asa spin-trapping agent was used to study the production of freeradicals from MG. Exposure of SHE cells to MG demonstrated adose-dependent increase in the generation of free radicals,lipid peroxidation and DNA damage. Treatment of SHE cells withantioxidant enzymes such as catalase (CAT) and glutathione peroxidase(GPx) prior to MG exposure decreased lipid peroxidation andDNA damage, with CAT being more effective than GPx. Since metabolismof MG leads to the generation of free radicals, and CAT andGPx decreased MG-induced lipid peroxida don and DNA damage,the present study conlirins the possible relationship betweenthe genotoxicity of SHE cells by MG and the involvement of reactivefree radical formation.     

Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein

Since the tumor thrombus in the main portal vein appears in the terminal stage of hepatocellular carcinoma (HCC), any attempt to remove it surgically is thought to be impractical as the malignancy itself cannot be entirely removed. During the past 5 years, we have performed tumor thrombectomy combined with hepatectomy in 29 of 298 patients with HCC. This combined therapy was initially decided upon as an emergency measure to prevent impending rupture of esophageal varices, rather than to improve patient survival. Since portal flow was obtained after removal of thrombi, this condition enabled transcatheter arterial embolization (TAE) and/or percutaneous ethanol injection therapy (PEIT). Although improved patient survival was not the primary goal of the emergency operation and there was an operative mortality of 11%, half of the other patients in the present series had unexpectedly high survival rates of 1 year (52.2%), 2 years (23.2%), and 3 years (11.6%), which were significantly higher than in patients not undergoing operation (n=22).

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Resumen Puesto que el trombo tumoral en la vena porta principal aparece en el estado terminal del carcinoma hepatocelular (CHC), cualquier esfuerzo destinado a removerlo por medios quirúrgicos se considera poco práctico teniendo en cuenta que la neoplasia no puede ser totalmente resecada. En el curso de los últimos 5 años hemos realizado la trombectomía tumoral combinada con hepatectomía en 29 de 298 casos de CHC. Esta modalidad de terapia combinada fue adoptada inicialmente como una medida de emergencia destinada a prevenir la ruptura de várices esofágicas, y no con miras a incrementar la sobrevida del paciente. El hecho de lograr flujo portal después de la remoción del trombo hace posible la embolización arterial por catéter y/o la inyección percutánea de etanol. Aunque el logro de una mayor tasa de sobrevida no constituyó el objetivo primario de la operación de emergencia y aunque se observó una mortalidad de 11%, la otra mitad de los pacientes en esta serie tuvo una inesperada mayor tasa de sobrevida a 1 año (52.2%), 2 años (23.2%) y 3 años (11.6%), cifras significativamente superiores a las del grupo de pacientes que no fueron operados (n=22).

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Résumé Lorsqu'il existe un thrombus dans la veine porte au cours d'un carcinome hépatocellulaire (CHC), l'exérèse est généralement déconseillée car le plus souvent la tumeur n'est pas enlevable chirurgicalement. Au cours de ces 5 dernières années, nous avons effectué une thrombectomie associée à une hépatectomie dans 29 des 298 cas de CHC. Cette attitude thérapeutique était, à l'origine, destinée à prévenir la rupture imminente des varices oesophagiennes plutôt qu'à améliorer la survie. Une fois la circulation portale a été ré-établie, l'embolisation par cathéter artériel et/ou par injection percutanée d'éthanol a été possible. Alors que l'amélioration de survie n'était pas le but initial de ce geste thérapeutique, et que la mortalité périopératoire a été de 11%, près de la moitié des patients ayant survecu la période périopératoire ont eu une survie significativement plus longue que les patients non opérés (n=22): 52.2% à un an, 23.2% à deux ans et 11.6% à trois ans.

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Presented at the Société Internationale de Chirurgie in Stockholm, Sweden, August, 1991.     

Gross dissection and radiological studies of abnormal pancreatico-choledocho-ductal junction

The reliability of radiological diagnosis of abnormal pancreatico-choledocho-ductal junction (APCDJ) in comparison with findings of gross dissection of the pancreatic choledocho-ductal junction was studied in 8 patients, based on comparison between radiologic and macroscopic findings of the junction in 99 patients who had received pancreatoduodenectomy. APCDJ, that is the joining of the common bile duct and the pancreatic duct in the pancreatic parenchyma extraduodenally, was identified in 5 patients both radiologically and macroscopically. Macroscopically, the length of their common channel ranged from 20 to 32 mm. with a mean of 29 mm. In the other three patients, APCDJ was misdiagnosed radiologically, for the following reasons. In a patient with pancreatic carcinoma, a rather long common channel, 15 mm in length, while ran in the submucosal layer of the duodenum, was though to be APCDJ on radiologic examinations. In a patient with bile duct carcinoma, an abnormal closing between the common bile duct and the pancreatic duct due to carcinomatous infiltration of the pancreas led to a radiologication misinterpretation for APCDJ. In the last patient, APCDJ was identified only macroscopically, not radiologically, because of a relatively short common channel and the location of common bile duct carcinoma. Thus, APCDJ was clearly identified in patients with a long common channel, whereas it was difficult to identify in patients with a short common channel.     

Effects of Stimulated Free Latissimus Dorsi Muscle Graft on LVEDV and LVSW: A New Dynamic Cardiomyoplasty Technique

Abstract: The effectiveness of dynamic cardiomyoplasty (DCMP) remains controversial. We hypothesized that effectiveness of DCMP using the latissimus dorsi muscle graft (LDMG) depends on the wrapping method. We analyzed pressure-volume relations (PVR), the left ventricular stroke work (LVSW), and the left ventricular end diastolic volume (LVEDV) changes during nonstimulation and stimulation of the LDMG to evaluate the effect of a new wrapping method of DCMP on the LVSW and the LVEDV changes. The new wrapping technique was evaluated in an acute animal experimental model. In 12 mongrel dogs, we performed continuous measurement of the dimensional and pressure dates of the left ventricle (LV) after the DCMP. The measurement was performed 15 min after wrapping during 5 periods. The duration of one measurement period was 15 s. The animals were divided into 2 groups according to the wrapping method. The heart was wrapped with the LDMG using 2 different methods. For Method 1, Carpentier's method, the heart was wrapped primarily with the distal part of the LDMG, the lateral segment. The vasculoneural pedicle of the latissimus dorsi muscle (LDM) was preserved. For Method 2, the LDM was separated, and the vasculoneural pedicle was cut. The medial sternotomy was performed. The thoracodorsal artery of LDMG was anastomosed to the right internal mammary artery, and the thoracodorsal vein was anastomosed to the right atrial appendage. The heart was wrapped primarily with the proximal part of the “free LDMG,” the transverse segment. Based on the PVR loops, the changes of the LVSW and the LVEDV in both experimental groups were analyzed. The paired t-test was used for statistical analysis. Using Method 1, the LVSW and the LVEDV showed no significant changes during stimulation (stim) of the LDMG, compared with non-stimulation (nonstim) (LVSW: nonstim, 970 ± 168 erg × 10³; stim, 1,181 ± 203 erg ± 10³; p = 0.126 and LVEDV: nonstim, 36.6 ± 6.7 ml; stim, 37.2 ± 6.8 ml; p = 0.36). Using Method 2, the LVSW was increased, and the LVEDV was decreased during stimulation of the free LDMG, compared with nonstimulation (LVSW: nonstim, 694 ±117 erg ± 10³; stim, 846 ± 104 erg ± 10³; p < 0.001 and LVEDV: nonstim, 47.7 ± 2.8 ml; stim, 46.8 ± 2.7 ml; p < 0.001). The stimulated free LDMG wrapping of the heart seems to be a more effective wrapping method for DCMP, and it results in an increase of the LVSW and a decrease of the LVEDV, compared with the original Carpentier's rnethod.     

An Autopsied Case of Acute Lymphocytic Meningoencephalitis with a Long Clinical Course: Special Reference to CT, MR, SPECT and Neuropathological Findings

Abstract: This report describes the clinico-pathological features of acute lymphocytic meningoencephalitis (ALME) of a patient with a long clinical course of 24 months. The patient rapidly developed a confusional state, occasionally with stupor, various involuntary movements and generalized convulsions followed by fever and headache at the age of 29. Clinical symptoms, except fever and convulsions, had not distinctly improved throughout the clinical course, and cortical atrophy on CT and MR gradually progressed. SPECT revealed a low blood perfusion in the cerebral cortices. Neuropathologically, inflammatory findings were very mild, but nerve cells degenerated prominently. From these clinicopathological findings, it is suggested that chronic degenerative changes followed an acute inflammatory phase.     

The fluorescent simultaneous azo dye technique for demonstration of tartrate-resistant acid phosphatase (TRAP) activity in osteoclast-like multinucleate cells

The purpose of our research was to show that the fluorescent simultaneous azo dye technique for tartrate-resistant acid phosphatase (TRAP) activity is useful for demonstration of osteoclasts under a fluorescent microscope and a confocal laser scanning microscope. Osteoclast-like multi-nucleate cells (MNC) were obtained from cultured mouse calvariae. The fluorescent simultaneous azo dye technique for TRAP activity was applied for cultured MNC. For the observation of specimens, both a conventional fluorescent microscope and a confocal laser scanning microscope for three-dimensional localization of TRAP-positive sites were used. Double staining with the azo dye technique was also adapted for mitochondria and tubrin staining. We found that the fluorescent simultaneous azo dye technique for TRAP activity could be used as a method of demonstrating MNC with a fluorescent microscope. We were also able to obtain the serial localization of three-dimensional sectioning images of TRAP-positive sites in MNC with a confocal laser scanning microscope. Moreover, with double staining of MNC as a modified version of the azo dye technique, we were able to observe both cell localization of TRAP-positive sites and other staining with epifluorescent illumination using the blue excitation method. Therefore, by using the fluorescent azo dye technique for TRAP activity, we can simultaneously observe not only the presence of osteoclasts, but also their characteristic construction and function.     

Changes in Personality and Emotion following Bilateral Infarction of the Posterior Cerebral Arteries

Abstract: Remarkable changes in personality, emotion and behavior were observed in a 66-year-old female with bilateral infarction of the medial Inferior portion at the temporo-occipital region. Aggressiveness, emotional lability and indifference were noted in the patient as psychiatric manifestation. No dehite delirium, however, was observed. A neuroradiological examination revealed the lesions located at the territory of the posterior cerebral artery, which involved the hippocampus, the parahippocampal gyri, the fusiform gyri and the lingual gyri. Therefore, the psychiatric disturbances and the neuropsychological symptoms presented here are attributed to these lesions with the multiple infarctions in the brain. The present case is noteworthy for its unique changes in personality and emotion which in the literature have not reported to be caused following the vascular accident of the bilateral posterior cerebral artery.