Efficacy of hypothermic perfusion using University of Wisconsin solution in extended hepatectomy with hepatic inflow occlusion in a canine model

This study was designed to elucidate the efficacy of University of Wisconsin (UW) solution for preventing liver injury, when used as a hypothermic perfusate infused into the systemic circulation during extended hepatectomy with hepatic inflow occlusion. Adult mongrel dogs (9.5–17.5 kg, n= 14) were subjected to 75% hepatectomy under 60 min hepatic inflow occlusion. The animals were divided into two groups. The UW group (n= 7) underwent hypothermic perfusion using 4°C UW solution (core temperature of the liver: 12.3±0.2°C). The control group designated as the Ringer's lactate (LR) group (n= 7) underwent hypothermic perfusion using 4°C LR solution. The perfusate was introduced into the systemic circulation via the hepatic vein. Blood from the hepatic vein was sampled, and alanine amino-transferase, purine nucleoside phosphorylase activities and the ammonia concentration were measured. The 7 day survival rate was higher in the UW group than in the LR group. The parameters of liver function were less significantly altered in the UW group than in the LR group. The plasma ammonia concentration was significantly (P<0.05) lower 6h after reperfusion in the UW group than in the LR group. A small volume of hypothermic perfusion of the liver using UW solution was safe if it returned to systemic circulation. Hypothermic perfusion of the liver using UW solution may be effective for preventing hepatic tissue injury during extended hepatectomy with hepatic vascular occlusion.     

PORTAL HAEMODYNAMICS AND HEPATIC BLOOD FLOW

Abstract Obstructive jaundice was produced in adult mongrel dogs by cholecystectomy and ligation of the common bile duct. Two weeks later 40% hepatectomy was performed during 10 min occlusion of hepatic inflow (group I). Liver tissue lipid peroxide levels increased significantly and superoxide dismutase activity decreased. The portal endotoxin (Et) concentration increased markedly after reperfusion and peripheral blood Et and serum β- N-acetyl hexosaminidase levels increased markedly, beginning 3 h after reperfusion. The phagocytic index increased transiently after reperfusion, but decreased markedly thereafter. Hepatocyte degeneration and necrosis became severe, intestinal villi were damaged and the 1 week survival rate was 23.1%; deaths were due to liver failure. These changes were prevented by construction of a portosystemic bypass and a 1 week survival rate of 70% (group II) was achieved. When the ischaemic time was prolonged to 20 min with the portosystemic bypass (group III), the pathological changes resembled those seen in group I, although no changes were observed in portal or peripheral blood Et levels. These findings suggest that major hepatectomy in the presence of severe jaundice should be carefully performed so that the ischaemic time is minimized during portosystemic bypass in an attempt not only to prevent production of Et in portal venous blood due to intestinal congestion, but also to reduce ischaemia-reperfusion injury.     

Interaction of Trichloroethane Isomers with Cytochrome P-450 in the Perfused Rat Liver

Interaction of Trichloroethane Isomers with Cytochrome P-450in the Perfused Rat Liver. TAKANO, T., MIYAZAKI, Y., and MOTOHASHI,Y. (1985). Fundam. Appl. Toxicol. 5, 353–360. The real-timeinteractions of 1,1,1-trichloroethane (TCE) and 1,1,2-TCE withcytochrome P-450 were observed using in vivo optical methodsto measure the spectral changes of cytochrome P-450 and thereduction-oxidation transition of pyridine nucleotides in theperfused liver of rats treated with phenobarbital. Changes inoxygen consumption and TCE uptake were also measured. The spectralchanges of cytochrome P-450 indicated that both TCE isomersbound to low spin (substrate free) ferric cytochrome P-450 andformed a high spin (substrate complexed) form. However, 1,1,1-TCEbound more tightly to cytochrome P450 and seemed to be onlyslowly metabolized compared to 1,1,2-TCE. The stoichiometryof the change in oxygen consumption rate to the change in 1,1,1-TCEuptake rate ranged between 5/1, and 9/1, whereas that of 1,1,2-TCEwas 1.4 to 2.0. Decreases in reduced pyridine nucleotides associatedwith TCE administration were significantly larger with 1,1,1-TCEthan with 1,1,2-TCE. The inhibitory effect of 1,1,1-TCE on hexobarbitalmetabolism in the perfused liver was greater than that of 1,1,2-TCE.Considering our previous data indicating that TCE did not stimulatemitochondrial respiration, it is postulated that the far higheramount of oxygen consumption associated with the binding of1,1,1-TCE to cytochrome P450 than the amount which was necessaryto mixed-function oxidation of this compound was due to an uncouplingeffect of 1,1,1 -TCE on the mixed-function oxidase system.     

PURIFICATION AND CHARACTERIZATION OF HUMAN NEPHRITOGENIC ANTIGEN THAT INDUCES ANTI-GBM NEPHRITIS IN RATS

Human nephritogenic antigen induces anti-glomerular basement membrane antibody glomerulonephritis in rats. This antigen was purified from collagenase-solubilized renal basement membrane by means of gel filtration and affinity chromatography using a rabbit antibody. Western blots of the purified nephritogenic antigen using epitope-defined monoclonal antibodies showed that it contains the NC1 domains of the α1 to α6 chains of type IV collagen. Nephritogenicity was thought to be a feature of the NC1 domains of the α3 to α5 chains, because the α6 chain is not located in the glomerular basement membrane, and because an NC1 fraction consisting of the NC1 domains of the α1 and α2 chains was poorly nephritogenic. Autoantibodies in the sera of patients with Goodpasture's syndrome were detected by ELISA using the purified nephritogenic antigen. These results indicate that the nephritogenic antigen contains the Goodpasture antigen, defined as the antigen reactive with sera from patients with Goodpasture's syndrome. © 1997 John Wiley & Sons, Ltd.     

Changes in work performances in obstructive sleep apnea patients after dental appliance therapy

Abstract The effects of dental appliances on work performances of obstructive sleep apnea syndrome (OSAS) is not well examined. This study evaluated the polysomnographic and psychological findings before and after therapy. Nine patients were diagnosed OSAS by nocturnal polysomnography. The psychological battery was performed from 13:00 to 14:00, which consisted of Uchida-Kraepelin psychodiagnostic test (U-K's test) and Bourdon's cancellation test (Bourdon's test). Approximately 3 months after the treatment, the examinations were performed. Apnea and desaturation index decreased significantly after the therapy. In addition, sleep architecture improved after the therapy compared with that before the therapy. Dysfunction of task performances, such as mean level of work amounts in U-K's test, mean error, mean performance time and mean deviation in Bourdon's test improved after therapy. We conclude that dental appliances therapy is effective not only to apnea but also to work performance in OSAS.     

Therapeutic results of endoscopic variceal ligation for acute bleeding of oesophageal and gastric varices

Endoscopic variceal ligation (EVL) using 'O' rings is widely accepted as a treatment of oesophageal varices that is at least as effective as endoscopic injection sclerotherapy but which produces fewer complications. Endoscopic variceal ligation using detachable snares has attracted attention as a safe and easy method of endoscopic treatment for gastric varices. Nineteen patients with acute bleeding from oesophageal or gastric varices were treated in the present study. Of these, 14 patients were treated with EVL using 'O' rings and five patients were treated with EVL using detachable snares and the treatment results were evaluated. Haemostasis was achieved in all patients. No serious complications of the procedures were observed. However, recurrences and rebleeding were observed in some patients during the maximum follow-up period of 24 months. Endoscopic variceal ligation using 'O' rings and detachable snares is useful for achieving haemostasis in cases of acute bleeding from oesophageal or gastric varices. However, additional endoscopic sclerotherapy may be needed to eliminate the variceal feeding vessels to further improve the long-term prognosis of these patients.     

Rotation of the head might not be recommended for internal jugular puncture in infants and children

Background:  Traditionally, we have been puncturing the internal jugular vein (IJV) with the head rotated. However, in adults it has been suggested that rotation of the head increases the magnitude of an overlapping of the IJV to the carotid artery (CA). Therefore, in infants and children, we have examined anatomic relationship between the IJV and the CA under the head in midline and head in rotated position.
Method:  Eleven infants and 51 children were included. Under general anesthesia, the patient was positioned in the Trendelenburg position with a shoulder roll to allow extension of the neck. At first, the head was placed in the midline position. The ultrasound probe was placed perpendicular to the skin, and images of the right IJV and CA were collected at the level of the cricoid cartilage. Then, the head was rotated to the left at 45°. The images were collected in the same way. The position of the right IJV relative to the CA was defined as anterior (A), anterolateral (AL), or lateral (L).
Results:  Rotation of the head increased the magnitude of an overlapping because of more changes from L → AL, L → A, or AL → A ( P  < 0.05, Wilcoxon t -test).
Conclusion:  We conclude that the rotation of the head increases the magnitude of an overlapping of the IJV to the CA in infants and children.     

Results for 79 patients with neuroblastoma detected through mass screening at 6 months of age in a single institute

BACKGROUND: In Japan, mass screening for neuroblastoma has been performed at 6 months of age to improve the prognosis of this condition for more than 20 years. In recent years, most neuroblastomas detected by mass screening were considered to have favorable biological features and sometimes tend to regress spontaneously. METHODS: The authors established non-treated observation criteria in 1997 and criteria for observation of residual tumor after first-line chemotherapy in 1999, and have made an effort to reduce the intensity of medical treatment for neuroblastoma. The authors examined outcomes of 79 patients who were found in the Shizuoka neuroblastoma mass screening at 6 months of age and who received medical treatment or underwent observation in Shizuoka Children's Hospital, Shizuoka, Japan, between December 1981 and December 2004. RESULTS: A total of 77 patients survived but the remaining two patients died from complications of medical treatment. None of the patients died due to progression of neuroblastoma. In the cases, non-treated observation was performed in 17. Of those, 12 patients are now under non-treated observation. Of their tumors, two have disappeared, nine have become smaller and another one has not change in size. Observation of residual tumor after first-line chemotherapy was performed in 15 cases, and three disappeared and the other 12 cases became smaller. Medical treatment-related complications were observed in 20 of 67 patients who received medical treatment, and 18 of the 20 patients were seen before establishing non-treated observation criteria. CONCLUSION: Non-treated observation and observation of residual tumor after first-line chemotherapy were useful to reduce medical treatment-related complications.     

Overcoming Electromagnetic Interference by LVADs on ICD Function by Shielding the ICD Programmer Wand and Extension Cable

Patients with end-stage cardiomyopathy and congestive heart failure are increasingly undergoing implantation with left ventricular assist devices (LVADs). In addition, implantable cardioverter-defibrillator (ICD) therapy has been proven to be an important part of the treatment for cardiomyopathy/congestive heart failure. Previous reports have noted a potential and dramatic electromagnetic interference from LVADs on ICDs that cause impaired telemetry communication between the ICD and ICD programmer. Such interference has necessitated explantation and generator replacement in order to resume communication between the ICD and programmer. We report two patients with advanced congestive heart failure and ICD programming impairment caused by a HeartMate II LVAD (Thoratec Corporation, Pleasanton, CA, USA) that was overcome by placing aluminum shielding around the ICD programmer wand and steel shielding around the extension cable during ICD interrogation.