Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

Portal venous blood flow (PVF), hepatic arterial blood flow (HAF) and systemic arterial pressure (SAP) were examined after dopamine (DA) injection into the jugular vein under carbon dioxide pneumoperitoneum in pigs. When intraabdominal pressure (IAP) was increased by 12 mmHg, PVF and HAF were reduced, but SAP was unchanged. When IAP was kept at 12 mmHg, the injection of DA at 10 micrograms/kg/min for 2 min produced an increase in PVF without causing any change in HAF or SAP. The response in PVF was dose-dependent. When IAP was increased to 16 mmHg, PVF response was diminished, and no change in HAF or SAP was seen at the same dose of DA. These observations suggest that DA is effective in increasing PVF under enhanced IAP conditions, but such circulatory improvement due to the agent would be prominent when IAP is below 12 mmHg.

Argatroban has selective antithrombin activity and widely used for treatment of ASO. In this study we investigated vasodilating activity of Argatroban besides antithrombin activity in ASO patients. Three patients who have undergone F-P bypasses previously which were all occluded received 10 mg or 20 mg of Argatroban per day intravenously for 4 weeks. Skin temperature were measured before and after administration of Argatroban at the point of 1, 2, 4 weeks which increased 2.3-6.0 degrees C after administration of Argatroban. Subjective symptoms were also improved and these patients became to be able to walk 1.5-3.3 km. These patients were also given PGE, intravenously, however, temperature increase was less than 1.1 degrees C. These results showed that Argatroban has not only antithrombin activity but also significant vasodilating activity resulting in increase of skeletal muscle blood flow.

We present a case of ruptured aneurysm in which extravasation of contrast medium was suspected during cerebral angiography and confirmed by computed tomography. In cases of ruptured aneurysm, post-angiographic computed tomography before operation (measurement of the Hounsfield unit numbers and grading by them) is necessary for establishing the diagnosis of extravasation of contrast medium and for grasping its degree and extent.

To know the role of HSP70 in chondrocytes, HSP70 expressions under heat stress or in a non-stress condition were examined by using electrophoresis, immunohistochemistry, and in situ hybridization. As a result, HSP70 was observed in proliferating chondrocytes in the micro-mass cultures without heat stress. In this culture, chondrocytes maintained the terminal differentiation potency. On the other hand, HSP70 did not appear in the chondrocytes in the logarithmic growth phase of the monolayer culture. In growth plates in vivo, HSP70 expressions in the chondrocytes located in the resting and hypertrophic zones were observed with immunohistochemistry. Appearance of HSP70 mRNA was also confirmed by in situ hybridization in the proliferating zone of growth plate. HSP70 can be expressed not only in chondrocytes under heat stress but also in the cells without stress, and the expression would be related to the terminal differentiation of chondrocytes. HSP70 is surmised to promote hypertrophy and calcification by stopping protein synthesis in chondrocytes which possess terminal differentiation potency.

A 48-year-old woman underwent total gastrectomy, splenectomy, and distal pancreatectomy with en bloc regional lymph node dissection for gastric carcinoma. Dull pain in the right upper quadrant and the back developed postoperatively. Contrast-enhanced computed tomography and ultrasonography disclosed portal vein thrombosis (PVT). Heparin and urokinase were given in conjunction with antibiotics. This treatment resulted in clinical improvement, but failed to achieve complete thrombolysis. Cavernous transformation of the portal system was confirmed. Although PVT after splenectomy has been reported mainly in patients with hematological disorders, our case suggests that splenectomy for en bloc node dissection in gastric carcinoma is a possible cause of PVT.

Whether melanoma develops as a primary tumor in the small bowel remains controversial. A 57-year-old male Japanese presented signs of intestinal obstruction. Ultrasonography and computed tomography disclosed an abdominal mass with multiple concentric rings, characteristic of intussusception. At surgery, a spherical tumor, 3.8 cm in diameter, with scattered pigmentation was found to lead the intussusception. Segmental intestinal resection with regional lymph node dissection was performed. Pathological examination revealed diffuse infiltration of malignant melanoma cells. Nodal metastasis was seen only in the mesenteric node draining from the tumor-bearing intestinal segment. Twelve months after surgery, melanoma recurred in the liver and para-aortic lymph nodes, where a malignancy of the digestive organs frequently metastasizes; however, no extraperitoneal melanoma was found after repeated examinations. Thus, this case suggests that primary malignant melanoma can originate in the small intestine and be a cause of intussusception in the adults.

The clinical effect of fructose-1,6-bisphosphate (FBP) administered to posthepatectomy patients was examined. FBP at 0.25 mmol/kg was administered continuously into the hepatic artery for 60 minutes on the 1st postoperative day in 11 cases. Hepatic arterial infusion of 0.25 mmol/kg glucose was performed in 7 cases. Furthermore, in 10 cases in which a catheter was not inserted in to the hepatic artery, 0.25 mmol/kg FBP was administered intravenously over a 60-minute period. Arterial ketone body ratio (AKBR) and serum levels of cyclic adenosine monophosphate, immunoreactive insulin, inorganic phosphorus, glucose, fructose, pyruvate, lactate and pyruvate kinase (PK) in the arterial blood were measured before and after administration. AKBR hardly changed after hepatic arterial infusion of glucose. It rose until 3 hours after intravenous or intrahepatic arterial administration of FBP. Especially, after hepatic arterial infusion of FBP, the AKBR was significantly higher up to 2 hours after administration than that before administration (P < 0.01). With hepatic arterial infusion of FBP, serum pyruvate transiently increased immediately after infusion (P < 0.01). PK activity was significantly elevated after administration of FBP (P < 0.05). Serum lactate levels decreased significantly after hepatic arterial infusion of FBP (P < 0.05). There was no difference in the recovery of protein synthetic ability and the postoperative changes in serum liver function test values among the three groups. Hepatic arterial infusion of FBP was suggested to promote adenosine triphosphate production by acceleration of the glycolytic pathway and lactate uptake in the hepatic cell.

Three surgical cases of subacute subdural hematomas are reported considering the pathophysiology. All patients had head traumas and complained the worsenings of the headaches 7-14 days after the head traumas. Serial computed tomography scan (CT) revealed the expansions of the subdural hematomas with the change of the density from high to mixed. The surgical findings of the hematomas showed blood clots and liquid covered with thin membranes. Morinaga et al. suggested the etiology of the subacute subdural hematoma that the influx of cerebrospinal fluid (CSF) to the hematoma cavity through the teared arachnoid. Our macroscopic findings of the hematomas which had the CSFlike liquid supported this estimation. We suggest that subacute subdural hematoma should be differed from chronic subdural hematoma because it may have the proper mechanisms of the development. Mild acute subdural hematomas should be observed carefully because they may develop to be subacute subdural hematomas between 1 and 3 weeks after the onset.