Nitric oxide sensitive depolarization‐induced hyperpolarization: a possible role for gap junctions during development

Electrical coupling is a widespread feature of developing neuronal circuits and it contributes to the generation of patterned activity. In the developing rat hippocampus, release of GABA by coactive hilar interneurones generates widespread synchronized activity. Here it is shown that hilar interneurones strongly rectify in the outward direction when depolarized. This depolarization-induced hyperpolarization, abolished by gap junction uncouplers, is modulated by nitric oxide. This phenomenon might represent a current-shunting mechanism of the excess current by providing functional inhibition at a developmental stage when GABA is excitatory. Spatial buffering of the current might represent an osmotic mechanism for growth and differentiation.     

Rupture of the hepatic artery after left hemihepatectomy for hilar bile duct carcinoma

Hilar bile duct carcinoma has a poor prognosis, but this has been improved in recent years by an aggressive surgical approach. We treated a 73-year-old woman who had obstructive jaundice due to bile duct carcinoma at the hepatic hilum. The jaundice decreased after percutaneous transhepatic biliary drainage. The tumor was resected with the left and caudate lobe of the liver and a part of portal vein. The right hepatic artery was located behind the common hepatic duct, and was suspected to be invaded by the tumor. We dissected the tumor from the arterial wall without carrying out combined resection of the hepatic artery. On the 6th postoperative day, the hepatic artery ruptured and the patient suffered hypovolemic shock. Resection of the hepatic artery and reconstruction were done, but the patient died 2 days later. Histological examination of the resected artery showed that the tumor had been curatively removed by dissection and that no tumor remained at the arterial wall. The rupture of the right hepatic artery was thought to have been caused by damage to the wall during the dissection procedure.     

Hilar bile duct resection for bile duct carcinoma at the hilus of the liver

Hilar bile duct resection, by which only the bile duct is resected, was carried out in 31 patients with bile duct carcinoma at the hepatic hilus. However, curative resection was possible in only 4 patients (12.9%). The postoperative 1-, 3-, and 5-year survival rates were 58.1%, 19.4%, and 7.7%, respectively. These results indicate that treatment of this hilar bile duct carcinoma by hilar bile duct resection is of limited value. We believe that this operative procedure should be used only for papillary or nodular carcinoma at the hepatic confluence at relatively early stages of Bismuth's type I or II.     

Cholangiocarcinoma arising in a choledochal cyst: Diagnostic value of computed tomography and ultrasonography

A case of cholangiocarcinoma arising in a choledochal cyst (type II or biliary cyst in Alonso-Ley classification) in a 53-year-old woman is presented. Ultrasonography and computed tomography provided the correct preoperative diagnosis. The value of these modalities in presurgical planning is illustrated.     

Role of radiology in the treatment of malignant hilar biliary strictures 1: Review of the literature

Malignant strictures of the biliary tree are an uncommon cause of obstructive jaundice. There are a number of pathological subtypes, but tumours in this region tend to have similar clinical and diagnostic features and therapeutic and prognostic implications. We review the published literature on this topic discussing diagnostic modalities and treatment options with a focus on radiological intervention. Diagnosis currently is best achieved using a range of procedures. Direct cholangiography remains the gold standard in delineating anatomy, but the invasiveness of this procedure limits its use as a purely diagnostic tool. Magnetic resonance technology, in particular magnetic resonance cholangiopancreatography, has an increasing role as accessibility is improved. Treatment of these tumours is difficult. Surgical resection and palliative biliary enteric bypass are the most common methods used with endoscopic and percutaneous therapies reserved for palliating patients not fit for surgery. There is little firm evidence to suggest that any one palliative modality is superior. Interventional radiology is particularly suitable for palliative management of difficult and expansive lesions as the anatomy can preclude easy access by surgical or endoscopic techniques. Good palliative results with minimal mortality and morbidity can be achieved with percutaneous stenting .     

维吾尔族及哈萨克族青年正常X线胸片的测量

作者测量了145名维吾尔族、110名哈萨克族健康青年胸片的25项参数,测量的项目包括右肺门角、肺门高度比值、肺门宽度比值、左肺动脉弓高等。并推导出身长与肺门宽、胸宽与肺门宽等回归方程式,它们均呈明显的正相关。     

右肺动脉叶间干的应用解剖学

在30例成尸标本上对右肺门角顶点的位置和右肺动脉叶间干进行了观测。右肺门角顶点位于右中叶动脉起始部者占67%,位于起始部以上者占23%,位于右肺动脉叶间干末端者占10%。右肺动脉叶间干长约21.3mm,上、中1/3段交界处:中、下1/3段交界处及末端的外径分别是11.7mm、11.1mm 和8.9mm。     

Long-term follow-up of patients of intrahepatic malignancies treated with iodine-125 brachytherapy

PURPOSE: We investigated the role of intraoperative iodine-125 (125I) brachytherapy as a treatment option for unresectable primary and metastatic liver tumors. METHODS AND MATERIALS: Between 1989 and 2002, 64 patients with unresectable or residual disease after surgical resection for intrahepatic malignancies underwent 160-Gy permanent 125I brachytherapy. RESULTS: The median length of follow-up was 13.2 years. The overall 1-year, 3-year, and 5-year actuarial intrahepatic local control rates were 44%, 22%, and 22%, respectively, with a median time to liver recurrence of 9 months (95% CI, 6-12 months). The 5-year actuarial intrahepatic control was higher for patients with solitary metastasis (38%) than for those with multiple metastases (6%, p = 0.04). The 1-year, 3-year, and 5-year actuarial overall survival rates were 73%, 23%, and 5%, respectively (median, 20 months; 95% CI, 16-24; longest survival, 7.5 years). Overall survival was higher for patients with smaller-volume implants (p = 0.003) and for patients without prior liver resection (p = 0.002). No mortality occurred. Radiation-related complications were minimal. CONCLUSIONS: For select patients with unresectable primary and metastatic liver tumors for whom curative surgical resection is not an option, 125I brachytherapy is a safe and effective alternative to other locally ablative techniques and can provide long-term local control and increased survival.     

Prospective comparison of computed tomography and magnetic resonance imaging for liver cancer delineation using deformable image registration

PURPOSE: The aim of this study was to compare magnetic resonance imaging (MRI) with computed tomography (CT) for liver cancer tumor definition for high-precision radiotherapy planning. METHODS AND MATERIALS: Diagnostic quality MRI scans and triphasic CT scans, with the liver immobilized in exhale, were obtained at the time of radiation planning for 26 patients with unresectable liver metastases (n = 8), hepatocellular carcinoma (n = 10), and cholangiocarcinoma (n = 8). On the CT and MRI series best demonstrating the tumor, the liver and gross tumor volumes (GTVs) were contoured, and intrahepatic anatomic reference points were identified. Deformable registration was used to register the liver from the CT with that from the MRI. RESULTS: A difference in the number of tumor foci was seen on CT vs. MRI in 5 patients with hepatocellular carcinoma: MRI showed more foci in 3 patients, CT in 2. After deformable registration of the livers, the population median of the average distance between the CT tumor surface and MRI tumor surface was 3.7 mm (2.2-21.3 mm). The median percentage of tumor surface area that differed by > or = 5 mm was 26% (1-86%). Median percentage concordance volumes were 81% (77-86%) in metastases, 77% (60-88%) in hepatocellular carcinoma and 64% (25-85%) in cholangiocarcinoma. CONCLUSION: Differences between MRI-defined liver cancer GTVs and CT-defined GTVs can be substantial and are more common in primary liver cancer.     

Isolated biliary cryptococcosis manifesting as obstructive jaundice in an immunocompetent adult

Cryptococcosis is a symptomatic fungal infection caused by Cryptococcus, which frequently occurs in patients who are immunologically compromised or chronically ill. Localized involvement of the hepatobiliary system in an immunocompetent adult is extremely rare. We report a unique case of isolated biliary cryptococcosis manifesting as obstructive jaundice and mimicking hilar cholangiocarcinoma in an immunocompetent woman. By integrating surgical and antifungal drug therapy, the disease was effectively controlled. Despite an increasing incidence of biliary malignancies, hepatobiliary surgeons and gastroenterologists must maintain a high index of suspicion for other rare possibilities of non-specific biliary inflammation.