Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

The effect of nutritional status on livers preserved either by simple cold storage or by hypothermic perfusion was studied using isolated rat liver perfusion model. Livers either form fed or fasted rats were preserved for 18 hours by simple cold storage procedure with UW solution, or continuously perfused for 12 hours at 5 or 20 degrees C. Each liver was assessed by one hour normothermic reperfusion following preservation period. Fasted livers in each preservation procedure demonstrated deterioration of hepatocytes more than fed livers assessed by AST, ALT and LDH liberation into perfusate. PNP in the perfusion procedures showed no difference between fasted and fed livers. Slight sinusoidal lining cells changes and vacuolization in hepatocytes were preferential in all groups. Patchy areas of hepatocytic discoloration were often seen in fasted group in each preservation procedure. The nutritional status of hepatic graft is important in both simple storage and continuous perfusion preservation method.

Result of developments of Er-YAG laser and its delivery system were reported. Er-YAG laser's wavelength is 2.94 microns, the beam absorption rate by water is higher than other laser beam. Er-YAG laser has repeated pulse oscillation, pulse width is 400 mu, sec, the repeat frequency is between 5 to 10 pulse per second. The mean power is 4 W maximum, 10 pps. The fibers of laser are made of zirconium-F-glass. We carried out a study on the possible application of the Er-YAG laser on the rabbit arteries and myocardium and human arteries were examined in vitro. Very clear cuts were observed on the histological examination. There were no evidence of thermal damage, no carbonization on the sharp cutting surface. Experimental result showed that Er-YAG lasers had good potential for angioplastic laser.

The usefulness of ligature and excision method with diathermy (group D) for haemorrhoidectomy was evaluated in comparison with conventional ligature and excision method with scalpel and scissors (group S) from several parameters. Intraoperative bloodloss and hospitalization days in group D were significantly smaller than those in group S. Moreover, post-operative woundal bleeding and edema in group D were significantly smaller than those in group S. As regards post-operative pain, although there were no significant differences between the two groups, the values in group D were slightly improved as compared with group S. These results indicate the usefulness of diathermic method for haemorrhoidectomy because of its better cost-efficacy as compared with conventional method with scalpel and scissors.

It is necessary for a neurosurgeon to know the course of repair of vascular injury caused by the procedure of an operation. And further more, it is very important to understand how existence of hypercholesteremia would affect it. Injuries of operations were caused to carotid arteries of Watanabe heritable hyperlipidemic (WHHL) rabbit and a morphological study of the course of repair was made. Japanese white rabbit (JWR) were treated exactly same as WHHL, and their course of repair was compared and examined as control. One week after operation, both WHHL rabbit and JWR showed edematous thickening of a intima, increase in grade of thickening which was continued until two of three months after operation was observed, however gradually decrease thereafter. In case of WHHL rabbit, thickened intima at suture portion was formed by smooth muscle cells migrated from media. Foamy cells were not observed here. The grade of thickening of WHHL rabbits was lower than that of JWR, and that WHHL rabbits tended to show slower change of elastofibrosis in thickened intima rather than JWR. It was considered that the smooth muscle cells of WHHL rabbit has a poor activity naturally.

Serum cathepsin B levels and urinary excretion of cathepsin B in the patients with gastric cancer were significantly higher than those in the control non-cancer patients. Moreover, cancer tissue cathepsin B content was significantly higher than that in the normal tissue. After radical curative operations for gastric cancers, both serum cathepsin B levels and urinary excretion of cathepsin B were restored to the control values. These results suggest a possible role of lysosomal enzyme, cathepsin B in the pathogenesis of tumor growth, and also suggest that these parameters might be possible indicators for tumor malignancy.

MRI angiography and x-ray conventional angiography was performed in 10 patients with ischemic cerebral diseases. In 3 patients, MRI angiography showed narrowing or occlusion of main intracranial arterial trunks, but x-ray angiography confirmed these findings only in one patient. In two other patients, narrowing or occlusion was not observed. Also, no narrowing or occlusion was observed on x-ray angiography, when MRI angiography showed normal findings. It was concluded that MRI angiography was sensitive investigation, when intracerebral occlusive disease was suspected.

Need of oxygen by the liver during hypothermic perfusion was evaluated using isolated perfusion model. Livers were perfused by a continuous perfusion system with oxygen saturated perfusate or nitrogen saturated perfusate, or simply stored for 12 hours at 5 degrees C. Quality of individual liver was assessed at one hour after normothermic reperfusion. Tissue edema was significant in all experimental groups, but the extent of which was much higher in nitrogen and simple cold storage groups. AST, ALT, LDH and PNP in the perfusate at the end of normothermic reperfusion were significantly higher in nitrogen and simple storage groups and those of oxygen group were similar to the control. Tissue adenine nucleotide and purine catabolite concentration in oxygen group was almost identical to the control at the end of hypothermic preservation, while ATP and energy charge in nitrogen and simple cold storage groups were significantly low. Conjugated dienes before and after reperfusion showed no difference in any groups, indicating no involvement of free radical injury on reperfusion in this asanguineous perfusion model. These results suggest that continuous supply of oxygen is necessary for liver preservation even though the temperature is lowered to inhibit cellular metabolism.

A case of 79-year-old man with pancreatic cancer associated with the sign of Leser-Trélat was presented. Abdominal CT scanning was performed and a pancreatic tail tumor involving the spleen and the greater omentum as well as ascitic retention were detected. Ba-enema study showed the stenosis of the sigmoid colon, suggesting the peritoneal disseminations. Absolute non-curative operation of side-to-side transverso-sigmoidostomy was performed for colonic stenosis, and biopsy of the disseminated omental tumor was performed, which was histologically diagnosed as well differentiated papillary adenocarcinoma compatible with pancreatic cancer. The postoperative course was uneventful and at present the patient was followed at outpatient clinic. To our knowledge, this case is the first report with pancreatic cancer associated with the sign of Leser-Trélat in Japan.