Endoscopic nasobiliary drainage (ENBD) is a well established mode of biliary decompression. Although ENBD is certainly an uncomfortable procedure with the potential risk of spontaneous dislocation or removal of the drainage catheter by disoriented patients, it has several advantages over endoscopic biliary drainage (EBD) using an indwelling stent. The current indications for ENBD are: (i) temporary drainage to treat obstructive jaundice and cholangitis caused by malignant or benign biliary stricture; (ii) urgent drainage to treat suppurative cholangitis primarily caused by common bile duct stones; (iii) temporary drainage after stone removal in patients with suspected incomplete clearance and/or with cholangitis; and (iv) biliary leaks that occur primarily after surgery, as well as other indications. Different types of nasobiliary catheters are currently available that have been designed with various diameters, shapes, and materials. However, the current catheters are not considered by most endoscopists to be sufficient. Further improvements are needed to achieve better drainage and better maneuverability. 相似文献
One of the pyrimidine compounds, 2-piperadino-6-methyl-5-oxo-5,6-dihydro(7H)pyrrolo[3,4-d]pyrimidine (MS-818), has neurotropic effects in vitro. Therefore, we studied the effect of MS-818 on the regeneration of the peroneal nerve in C57BL/6J mice after a crush injury. Two test groups, which received a daily intraperitoneal injection of 5 mg/kg or 10 mg/kg MS-818, respectively, were compared with controls, which received daily intraperitoneal injections of physiological saline, over a 14-day period. The maximum foot-width ratio (crushed side/uncrushed side) was obtained on days 1, 8 and 14 after the crush injury, and the various morphometric parameters were evaluated at both 5 and 10 mm distal to the proximal portion of the crush site. The significant effects of MS-818 included a larger maximum foot width (P<0.04) and a greater number of unmyelinated axons per nerve at both levels (P<0.003) in both test groups than in controls. MS-818 had no significant effects on body weight, the increase of total transverse fascicular area after the crush injury, the total number of myelinated fibers with their size distributions, or the number of nuclei of Schwann cells and macrophages. Therefore, we conclude that MS-818 promotes axonal sprouting and elongation after a crush injury in mice. 相似文献
We investigated the presence of anti-human T-lymphotropic virus type I (HTLV-I) IgM in sera and cerebrospinal fluid from patients with HTLV-I-associated myelopathy (HAM) by Western blot analysis. Analyses of 36 serum samples revealed that most patients (31/36; 86.1%) had anti-HTLV-I IgM, whereas only four of 23 (17.4%) HTLV-I carriers had it. In studies of cerebrospinal fluid, anti-HTLV-I IgM was detected in 24 of 36 (66.7%) HAM patients, whereas none was detected in nine HTLV-I carriers. The differences were statistically significant (p less than 0.01). These results suggest that persistent active replication of HTLV-I occurs in the central nervous system as well as in the peripheral blood of HAM patients, and may contribute to the development of HAM. 相似文献
We report a 3-year-old girl with hereditary motor and sensory neuropathy type III with a decrease in unmyelinated fibers. There have been few reports of such cases. The present findings suggest the possibility that the primary lesion in this disease is in the axons. We consider that more attention should be paid to the changes in unmyelinated fibers and axons in further studies on this disease. 相似文献
Congenital absence of the portal vein (CAPV) is a rare malformation of the splanchnic venous system. Although CAPV is usually detected in the pediatric age group, our patient was a 35-year-old woman. She had been diagnosed with CAPV in 1996 when she was 27 years old. In 1998, she was placed on hemodialysis due to chronic renal failure. After several episodes of encephalopathy in 2002, liver transplantation (LT) was recommended to her and her family. Since there was no suitable living donor candidate, she was put on the waiting list for a deceased donor liver transplant in Japan. In 2004, her ammonia level increased to around 300 microg/dl, and she went into a coma lasting for three days. After recovering from this event, she underwent a living domino transplantation using a whole liver donated by a familial amyloid polyneuropathy (FAP) patient. Her portal vein, which had drained directly into the inferior vena cava (IVC), was transected together with a cuff of the IVC wall and anastomosed to the graft liver portal vein in an end-to-end fashion. In conclusion, liver transplantation proved to be a safe and effective way to save this patient and improve her quality of life. 相似文献
We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman
with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series
that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung.
Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory
change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that
identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by
squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically
compatible with congenital fistulae. 相似文献
Background: Previous studies documented that near-infrared spectroscopy values were affected by factors related to optical path length, such as hemoglobin concentration, the differential path length factor, skull thickness (t-skull), and the area of the cerebrospinal fluid layer (a-CSFL). Lately, the NIRO-100 (Hamamatsu Photonics, Hamamatsu, Japan) has provided a tissue oxygen index (TOI) that theoretically is not supposed to be affected by optical path length. Therefore, the authors hypothesized that TOI is not influenced by the above-described individual factors.
Methods: Cardiac surgical or neurosurgical 103 patients (65 men and 39 women; aged 63 +/- 14 yr) were studied. TOI and regional cerebral oxygen saturation (rSO2) (INVOS 4100; Somanetics, Troy, MI) were measured sequentially on patients in a resting state. The t-skull and a-CSFL were calculated using computed tomographic image slices of the head corresponding with the position of near-infrared spectroscopy sensors. The effects of these two factors, hemoglobin concentration and mean arterial pressure, on TOI and rSO2 values were evaluated by linear regression analysis.
Results: Simple linear regression analysis showed that mean arterial pressure (r = 0.27, P = 0.008), t-skull (r = 0.22, P = 0.034), a-CSFL (0.26, P = 0.012), and hemoglobin concentration (r = 0.42, P < 0.0001) were significant determinants of rSO2. Multiple linear regression analysis showed that hemoglobin concentration (r = 0.34, P < 0.001), a-CSFL (r = -0.252, P = 0.012), and t-skull (r = 0.22, P = 0.037) were significant determinants of rSO2. On the other hand, simple and multiple linear regression analysis showed that there was no significant determinant of TOI. 相似文献