Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

Our experiences concerning the end colostomy using the stapling method are reported. The anvil which has been inserted to the proximal end of the colon and purse string suture with the skin is engaged the anvil shaft, and then, is fired. This operative procedure is simple, safe and convenient, and we can expect a uniform and satisfactory outcome. We applied this technique on 6 cases and have had no postoperative complications.

To examine the possible secretion of lysosomal enzymes into the pancreatic juice in rats stimulated with pancreatic secretagogues under both physiological and pathological conditions, we investigated the changes in the secretion of cathepsin B, as a lysosomal enzyme, into pancreatic juice with stimulation of 5 different doses (0.1, 0.2, 0.5, 1.0, and 1.5 micrograms/kg.hr) of caerulein. Control rats had only pancreatic duct cannulation. In other rats, the pancreatic duct was obstructed for 3 hours and secretin was infused (0.2 CU/kg.hr). Caerulein stimulated the secretion of cathepsin B into the pancreatic juice in a dose-dependent manner, as in amylase secretion, and caerulein in higher doses (1.0 and 1.5 microgram/kg.hr) inhibited cathepsin B output as it did amylase output. There was a significantly high positive correlation between cathepsin B output and amylase output after stimulation with caerulein. The secretion of several other lysosomal enzymes was also stimulated by caerulein. Blockage of the pancreatic duct for 3 hours caused a significant but moderate rise in serum amylase levels. Redistribution of cathepsin B activity in the pancreatic subcellular fractions was noted with an increase in the amount of cathepsin B recovered from zymogen-rich pellets after 15 min of centrifugation at 1300 x g. These changes after temporary pancreatic duct obstruction are very similar to those previously noted during the early stage of diet-and caerulein-induced experimental pancreatitis and suggest colocalization of lysosomal enzymes and digestive enzymes. In addition, in duct obstructed rats, the secretion of cathepsin B and other lysosomal enzymes stimulated by caerulein was significantly greater than in animals with free-flowing pancreatic juice. These results indicate that lysosomal enzymes are secreted into pancreatic juice after stimulation by gut hormones in the same manner as classical pancreatic digestive enzymes such as amylase. Moreover, lysosomal enzymes which colocalize with zymogen granules in rats with short-term pancreatic duct obstruction are also secreted into pancreatic juice together with digestive enzymes after stimulation with gut hormones. These findings suggest that lysosomal enzymes are present in zymogen granules under normal conditions and that they may play pathophysiological roles in pancreatic juice. They also contribute to an understanding of the pathogenesis of pancreatitis, since cathepsin B can activate trypsinogen.

The intrabiliary rupture of hydatid cyst of the liver is a severe and relatively frequent complication. In this study six similar cases are presented. 4 of the cases had hydatid cyst surgery before the admission. The obstructive jaundice, cholangitis and unclosed bile fistula are the most frequent clinical findings. Ultrasound is very useful for the diagnosis. In the cases of space occupying lesions of the liver with wide choledochus (1.1 cm >) the intrabiliary rupture of hydatid cyst can be suspected by ultrasonographic examinations. Surgical therapy as the capitonnage combined with the resection of the projecting dome of the cyst and T tube application remains a method which gives good results and has low mortality and morbidity.

Four-hour intravenous ethanol infusion at two doses of 0.5 and 1.0 g/kg.hr caused mild, but significant, rises in serum amylase and pancreatic water content as well as pancreatic histological changes such as interstitial edema in rats. These doses of ethanol also caused an impaired pancreatic adenylate energy charge levels and increased pancreatic mitochondrial fragility. The dose of 0.2 g/kg.hr caused only marginal changes in these parameters. Moreover, gabexate mesilate (FOY) at the dose of 20 mg/kg.hr inhibited almost completely all these pancreatic injuries induced by ethanol, exerting significant protective effects. These results suggest that impaired pancreatic energy metabolism and increased mitochondrial fragility seem to play an important role in the pathogenesis of ethanol-induced pancreatic injuries, and that some unknown protease activity, which can be inhibited by FOY, also seems to play an important role. Finally, FOY seems to be useful in protecting the exocrine pancreas in the alcoholic patients. Excessive intake of ethanol often precedes the development of both acute and chronic pancreatitis, and pancreatitis occurs more commonly in alcoholics than in the general population. Thus, alcohol has been reported to be one etiological factor in the pathogenesis of human pancreatitis. However, little is known about the mechanism whereby alcohol induces pancreatic acinar cell injuries. Moreover, there have been few reports regarding the effect of ethanol on pancreatic adenylate energy metabolism. Recently, we have reported the important role of subcellular organellar fragility in the triggering of pancreatic injuries in other models of pancreatitis such as secretagogue-induced and pancreatic duct obstruction. In this study, we evaluated the effect of ethanol administration at various doses on the exocrine pancreas from several parameters including pancreatic adenylate energy charge levels and subcellular organellar fragility as well as the protective effect of a synthetic protease inhibitor, gabexate mesilate (FOY) [ethyl-4-(6-guanidino hexanyloxy benzoate) methanesulfonate; M.W. 417 daltons].

We studied the effect of high dose nicardipine in patients with ruptured cerebral aneurysm. Seventeen patients were treated with intravenous infusion of nicardipine, 23.0-124.4 mg/day, for 15 days, which was started within 72 hours after onset of subarachnoid hemorrhage (SAH). Aneurysmal neck was clipped within 96 hours after SAH. Five patients were excluded because of discontinuation of treatment due to hypotension and intra- or postoperative complication. Among the 12 patients, symptomatic vasospasm was observed in 6, and one of them had a permanent deficit. Severe angiographic vasospasm was observed in 3 patients, but two of them did not show symptomatic vasospasm. From this study we can't draw any conclusion about effect of nicardipine on prevention of symptomatic and angiographic vasospasm after SAH, because of small number of cases.

From January 1986 through December 1992, 9 cases of diverticular disease of the colon have been surgically operated in our department. In 56% of the cases, diverticula were located in the left side, in 33% in the right side, and in 11% in the both sides. 67% cases had a complication of hypertension, 33% cases had hypoproteinemia, and 78% cases had anemia. Moreover, 67% cases had hyperlipidemia. Only one case had a minor leakage in the anastomosis after colectomy, which was cured by intravenous hyperalimentation. These results suggest that such a complication should be taken into consideration in the surgical treatment of diverticular disease of the colon, although the disease is in itself a benign disease.

A new approach to the problem of recurrent infection of an aortic valve prosthesis in a patient with an inaccessible coronary arterial system is presented. The coronary arteries were reconstructed by anastomosing a looped ringed-PTFE graft to the left and right coronary ostia within the aorta, and the graft was withdrawn from the aorta just above the ostia. Then the top of the looped graft was anastomosed to the aorta above a translocated aortic prosthesis. This procedure is most likely to be useful in the treatment of recurrent aortic prosthetic valve endocarditis which has dense pericardial adhesion secondary to multiple cardiac operations. Aortic prosthetic valve endocarditis frequently is associated with a paravalvular ring abscess which may destroy the normal annulus. In these cases, translocating the aortic valve to the ascending aorta, and placing saphenous vein bypass grafts to the right and the left anterior descending coronary artery may be required. However, the coronary arteries may not be accessible following multiple operations. The following case illustrates a new solution to the problem how to translocated the aortic valve and reconstruct the coronary arteries in a patient with an infected aortic root and inaccessible coronary arteries.