Jaundice and Renal Failure Following Radical Surgery for Cancer: An Analysis of Five Autopsied Cases

An analysis of postoperative jaundice and renal failure in fiveautopsied cases is presented. Two patients had total resectionof esophageal cancer, one had a subtotal gastrectomy, and theother two had radical operations for urinary bladder carcinoma.Halothane was used for anesthesia for three patients, and allfive required blood transfusions. Postoperatively, jaundiceand azotemia developed between the 1st and 7th days, with deathsix to 10 days after surgery. Total bilirubin ranged from 1.5to 13.4mg/dl despite the normal or modest rise in hepatic enzymes.BUN varied from 46 to 288 mg/dl. Pre- and postoperative ECGrevealed a prolongation of QTc in all cases. At autopsy, theliver, kidneys and heart showed a definite increase in weight.The salient hepatic pathology included diffusely dilated spaceof Disse, centrilobular bile stasis and steatosis. This, alongwith acute tubular necrosis confirmed at autopsy, was thoughtto be due to ischemia. Although the significance of prolongedQTc remains uncertain, it is worthy of attention as one of thepreoperative checks.     

An association study between the Cys311 variant of dopamine D2 receptor gene and schizophrenia in the Okinawan population

Abstract  Neuroleptic drugs have a high affinity for the dopamine D₂ receptor (DRD2); therefore DRD2 is thought to be a candidate gene for schizophrenia. Arinami et al . have reported a positive association between schizophrenia and the Cys311 variant of the DRD2 gene. We determined the allele frequency of this polymorphism in 78 Okinawan schizophrenic patients and 112 control subjects. The patients and controls did not differ significantly in allele frequencies of Cys311.     

Relationship between Blood Pressure and Nocturia in Hypertensive Patients

Objective: We investigated the relationship between the pattern of hypertension and nocturia. Methods: Seventy‐seven patients who were being treated for hypertension completed a questionnaire regarding the number of times they urinated during the day and at night, and measured their blood pressure at home immediately after rising in the morning and just before going to sleep at night. The patients' blood pressure was also measured at the clinic. The patients were divided into groups according to their blood pressure patterns. The relationship between blood pressure pattern and number of urinations during the day and at night was investigated. Results: When the patients were divided into white coat hypertension, masked hypertension, sustained hypertension, and normotension groups, the number of daytime urinations was significantly lower in the sustained hypertension group compared with the normotension and white coat hypertension groups. When the subjects were divided into morning blood pressure surge and non‐morning surge groups or into morning hypertension and non‐morning hypertension groups, the numbers of nighttime urinations was significantly higher in the morning surge group or the morning hypertension group compared with the non‐morning surge group or non‐morning hypertension group, respectively. Conclusion: Sustained hypertension and elevation of blood pressure in the early morning influence the frequency of daytime and nighttime urination, respectively. It is important to control both the blood pressure and nocturia of hypertensive patients to improve their prognosis.     

Surgical Treatment of Pacemaker Induced Left Innominate Vein Occlusion Using a Spiral Vein Graft

Superior vena cava syndrome due to transvenous pacing leads is an uncommon but potentially life-threatening complication. This case involves a 54-year-old man who developed left innominate vein occlusion due to a pacemaker lead. This complication induced a progressive swelling on the left side of his face, neck, arm, and upper chest. The left innominate vein occlusion was surgically treated using a composite spiral saphenous vein graft. Postoperatively, the patient has received anticoagulation therapy with warfarin to prevent thrombosis and, thereby, the long-term patency of the graft. He has undergone follow-up on a regular outpatient basis without showing any recurrence of clinical symptoms.     

Primary IgA Glomerulonephritis and Schonlein-Henoch Purpura Nephritis: Clinicopathological and Immunohistological Characteristics

A comparative analysis on clinicopathological and immunohistologicalcharacteristics was performed of 205 cases with primary IgAnephritis and 35 with Schönlein-Henoch purpura nephritis(purpura nephritis). Diagnostic criteria for primary IgA nephritiswere set out so that IgA was either the most prominent immunoglobulinor, at least, equal to IgG and/or IgM, if present, irrespectiveof mesangial or peripheral localization. In primary IgA nephritis,one half of the cases were discovered by asymptomatic proteinuria,and one-third presented recurrent upper respiratory tract infectionand gross hematuria, one-fourth abdominal pain and a few casesjoint pain, while purpura nephritis was associated with a significantlyhigher incidence of such systemic symptoms as abdominal andjoint pains, in addition to purpura. Both diseases shared atendency toward conspicuous hematuria in contrast to the modestproteinuria, with normal renal function in three-fourths totwo-thirds. Moreover, four of 35 with purpura nephritis showedpreceding proteinuria and had been regarded as primary IgA nephritisuntil purpura appeared. The glomerular pathology had a commonfeature in that there was frequent occurrence of mesangial proliferativeand focal and segmental lesions. The immunohistology in thetwo diseases was indistinguishable with regard to the glomerularimmunoglobulins and mediators, whether purpura was present orabsent. Thus, we propose a unifying concept that, by analogywith SLE, primary IgA nephritis may be regarded as ‘sinelupo,’ lying on one side of the nosological spectrum withless systemic symptoms, whereas purpura nephritis may occupythe other side with more systemic aspects. Furthermore, we confirmedthe epimembranous granular deposition of IgA in both diseasesas the most characteristic morphological expression of circulatingimmune complexes.     

Branch Fusion Between the Ventral and Dorsal Pancreatic Duct

Abstract : Fusion of the dorsal and ventral pancreatic ducts exhibits various forms and one of them is branching fusion. Branch fusion was divided into 3 types according to ERP findings. Fusion of the upper branches of the ventral pancreatic duct with the dorsal pancreatic ducts was designated as being type 1. Fusion of the lower branch of the dorsal pancreatic duct with the ventral pancreatic duct in roundabout way was designated as being type 2. Fusion of the lower branch of the dorsal pancreatic duct with the ventral pancreatic duct in short way was designated as being type 3. We demonstrated the presence of branch fusion involving the branch of the dorsal pancreatic duct by histopathological examination and immunohistochemical examination using pancreatic polypeptide cells as an indicator in one patient with type 1 branch fusion and one with type 3 branch fusion who underwent a pancreatoduodenectomy. ERP showed chronic pancreatitis in 3 of 4 patients with type 1, 3 of 8 patients with type 2, and 7 of 18 patients with type 3 branch fusion, of whom 1, 2, and 4, respectively had non-alcoholic pancreatitis. The high incidence of pancreatitis suggested that branch fusion is the cause of pancreatitis. In addition, evaluation of ERP images revealed Santorini's duct originating from the ventral pancreatic duct in 5 patients with type 1 branch fusion, suggesting the presence of the ansa pancreatica proposed by Dawson. This finding may also be closely associated with the development of pancreatitis. (Dig Endosc 1994; 6 : 87–93)     

Effect of Plaunotol on Gastric Injury Induced by Ischaemia-Reperfusion in Rats

Plaunatol, an anti-ulcer drug, increases prostaglandin content in gastric tissue but its effect on radical-mediated gastric damage or activity against reactive oxygen species is unknown. We examined the effects of oral administration of plaunotol (Kelnac) on the acute gastric mucosal lesion and its progression to ulcer lesion induced by ischaemia-reperfusion in rats. Plaunotol (30 and 100 mg kg^?, 15 min before ischaemia) significantly reduced the total erosion area observed immediately after ischaemia-reperfusion. When plaunotol (30 and 100 mg kg^?, once a day) was administrated orally 60 min after reperfusion, it prevented the progression from erosion to ulcer. At 72 h after ischaemia-reperfusion, the total area of ulcers lesions was significantly reduced compared with that without plaunotol administration. Furthermore, treatment with plaunotol (100 mg kg^?) significantly increased prostaglandin E₂ content in gastric tissues of both acute gastric mucosal lesion and gastric ulcer lesion. In in-vitro experiments, plaunotol (1–3 mg mL^?) reduced the superoxide radicals generated by leucocytes, but not by xanthine oxidase. These results indicate that plaunotol has protective effects on both the onset of acute gastric mucosal injury and its progression to ulcer lesion induced by ischaemia-reperfusion. Both effects of plaunotol on increase in prostaglandin content in gastric tissues and inhibition of superoxide radical from leucocytes may play important roles on the protection against gastric mucosal injury.