Seven-year follow-up study after the replacement of the esophagus with an artificial esophagus in the dog.

An artificial esophagus was made of silicone rubber (Phycon) tube covered with a Dacron mesh. A segment of thoracic esophagus of 16 dogs was replaced with this graft using three different types of anastomosis--overlayer end-to-end anastomosis with flanged tube, two-layer end-to-end anastomosis with flanged tube, and monolayer end-to-end anastomosis with no flange tube. Seven of 16 dogs (44%) survived more than 12 months without complications, four of them surviving more than 6 years. In six of seven of the prolonged survivors, extrusion of the graft was recognized in the 3 to 6 months after operation. Esophageal stricture increased slightly up to 6 months after extrusion of the graft, but it did not further advance until sacrifice. In these dogs, mucosal regeneration of the neoesophagus was complete with muscle layers and mucous glands in the submucosa recognized microscopically. Proximal esophagus from the replaced portion was apparently dilatated more than that of the distal portion. There was no definite difference between the anastomotic techniques with regard to complication or prognosis. These results suggest that this artificial esophagus should be considered as a possibility for clinical trials in the future.

Neuropeptide release from the isolated, perfused, lower esophageal sphincter region of the rabbit and the effect of vasoactive intestinal peptide on the sphincter.

BACKGROUND: The aim was to evaluate the isolated, vascularly perfused, lower esophageal sphincter (LES) as a model for investigating the functional role of neuropeptides such as vasoactive intestinal peptide (VIP). METHODS: At laparotomy the LES was removed along with the distal esophagus, stomach, and left gastric artery and vein. The LES area, isolated from the body of the stomach by a custom-made clamp, was perfused with oxygenated Krebs-Ringer bicarbonate solution (pH 7.4, 38 degrees C) via the left gastric artery. The LES pressure was monitored continuously with a custom-made Dent sleeve catheter. LES pressure and release of neuropeptides were investigated after carbachol and VIP were administered alone or in combination. VIP, calcitonin gene-related peptide (CGRP), and somatostatin were measured in the venous perfusate collected from the left gastric vein. RESULTS: LES tone and contraction frequency were similarly increased by 10 and 100 nmol/L carbachol (increment, 4.0 +/- 0.26 mm Hg with 10 nmol/L carbachol; p less than 0.0003). Perfusion with 10 nmol/L VIP decreased basal tone and completely abolished the contraction induced by 100 nmol/L carbachol. VIP, CGRP, and somatostatin were released from the LES in response to 10 nmol/L carbachol (VIP rose from 55 +/- 13 to 179 +/- 24 pmol/L, CGRP, from 114 +/- 30 to 239 +/- 33 pmol/L, and somatostatin from 15 +/- 2 to 27 +/- 4 pmol/L; all p less than 0.001). CONCLUSIONS: These findings support a role for VIP in the inhibitory reflex of the LES but suggest that other neuropeptides may also be involved. The isolated, perfused LES provides a new tool for investigating neuropeptide interactions.

A prostacyclin analogue reduces free radical generation in heart-lung transplantation.

The mechanism by which prostacyclin acts to prevent in vivo reperfusion injury is still uncertain. This study was therefore undertaken to assess the effect of a stable prostacyclin analogue (OP 41483-alpha-CD [OP]) on oxygen-derived free radicals after heart-lung transplantation. OP was administered to the heart-lung graft through the pulmonary artery for 25 minutes encompassing the reperfusion process. Free radicals were directly measured by electron spin resonance spectroscopy. The radical intensities of pulmonary venous blood were significantly lower in the OP group than in the control group, suggesting that fewer free radicals were generated in the lungs of the OP group. The cardiac and respiratory function were better in the OP group than in the control group. The lung is the primary source of oxygen free radical attack, and the beneficial action of OP on free radical generation is almost exclusively restricted to the lung and does not apply to the heart. This result suggested that OP probably is effective in inhibiting free radical generation from the endothelium.

Effect of duodenal components of the refluxate on development of esophageal neoplasia in rats.

When duodenal content is allowed to reflux into the esophagus of nitrosamine-treated rats, esophageal cancer is induced more rapidly and at higher frequency than after carcinogen treatment alone. The purpose of the present study was to identify the components of the duodenal content that are responsible for enhancing esophageal carcinogenesis. Eight-week-old Sprague-Dawley rats underwent one of four operations as follows: diversion of bile alone, pancreatic juice alone, both bile and pancreatic juice into the esophagus, or a control operation with no induced reflux. Two weeks after surgery, rats were treated with the esophageal carcinogen 2, 6-dimethylnitrosomorpholine (48 mg/kg [0.1 of LD50] intraperitoneally weekly for 20 weeks). The rats were killed at age 30 weeks. The esophagus was removed and full-length strips were examined under a microscope; separate segments were taken for flow cytometric evaluation. The prevalence of DNA aneuploidy and histologic esophageal papillomas or squamous cancer was increased in carcinogen-treated rats with pancreatic juice reflux (P <0.05 vs. control) and the combination of pancreatic and bile reflux (P <0.05 vs. control) but not in rats with bile reflux alone. We conclude that pancreatic juice is the most potent component of the duodenal refluxate in the promotion of esophageal carcinogenesis in rats.

Surgical treatment of mesenteric infarction, thoracoabdominal aortic aneurysm, and proper hepatic aneurysm in a middle-aged woman with Takayasu's arteritis.

Although Takayasu's arteritis may present a wide variety of signs and symptoms depending on the vessel affected, it is rarely associated with acute abdomen requiring emergency laparotomy. We report a case of Takayasu's arteritis that required several surgical interventions for mesenteric infarction, thoracoabdominal aneurysm, and proper hepatic artery aneurysm, all of which were noted in succession within a 1-year period. This is also the first report, to our knowledge, of a hepatic artery aneurysm caused by Takayasu's arteritis.

Simple and low-cost tele-nuclear medicine conference system with the e-mail protocol.

PURPOSE: Because of the recent innovative growth in computer technology, digital imaging, and the Internet, we can take advantage of these facilities for education and clinical work in nuclear medicine. We developed a tele-nuclear medicine conference system with electronic mail (e-mail) on the Internet. METHODS: Twenty-one physicians (20 radiologists, 1 neurologist), 6 technologists and 2 medical students in six university hospitals (Japan 5, Canada 1), 5 local hospitals in Japan participated in this project. We used digital still cameras (330 k pixels) equipped with a floppy disk drive and 10 x optical zoom to digitize images with JPEG compression (640 x 480 matrix). The images were attached to e-mail messages (containing a brief description of each case). The mail was sent simultaneously to all members on the mailing list. Scintigram and SPECT images as well as other radiological images were sent by e-mail. Reply mails about each case were sent to all members via the mailing list. RESULTS: During a period of 6 months, 18 cases (tumor/infection: 7, bone: 6, cardiovascular: 1, neurology; 3, endocrine: 1) with 144 e-mails (average 5.6/case) were submitted to the conference. The average period of discussion was 15.6 days. The number of attached images was 1 to 9 (average, 4.2/e-mails). JPEG compression rate was 1/10 to 1/20. The quality of the images was good enough for discussion. Some cases required additional images for further discussion. CONCLUSION: Our tele-nuclear medicine conference with an electronic mailing list and digital camera was simple and low-cost. The conference system was useful for education and clinical work.

Prevalence of Coxiella burnetii infection in dairy cattle with reproductive disorders.

The prevalence of Coxiella burnetii infection in 207 cattle with reproductive disorders was studied by using an indirect immunofluorescence (IF) test, nested polymerase chain reaction (PCR) and isolation. IF antibodies to phase I and phase II antigens of C. burnetii were found in 122 (58.9%) and 125 (60.4%) of the sera, respectively, and PCR-positives were found in 8 (3.9%) of the sera and in 51 (24.6%) of the milk samples. In addition, C. burnetii was isolated from 51 (24.6%) of the milk samples by inoculating laboratory mice. The results indicate that the IF test plus PCR are useful in the diagnosis of bovine coxiellosis. It is difficult to deny that dairy cattle with reproductive disorders would be one of the important reservoirs of C. burnetii responsible for infection in both animal and human populations in Japan.

[Effect of recombinant human erythropoietin on autologous blood pre-donation in open heart surgery].

We have used recombinant human erythropoietin (EPO) with an autologous blood predonation in open heart surgery looking forward to preventing patient's blood level of hemoglobin and quick recovery in post-operative period. In our results, patient's value of hemoglobin (Hb) and hematocrit (Ht) decreased due to autologous blood predonation. In group A (autologous blood predonation with EPO administration), however, predonated blood volume were larger than in group B (without EPO administration), decreased value of Hb and Ht were smaller than in group B. The counts of reticulocyte were higher in group A at the operative day. Among six cases phlebotomized with EPO administration, five cases required no homologous blood transfusion for their hospital course. Postoperative recovery of patient's Ht value were earlier in preoperative blood donation group. In particular, patients who administered EPO intravenously have showed fair recovery from anemia. EPO is very effective drug to prevent patients from the developing anemia as a complication of autologous blood predonation. We conclude that autologous blood predonation with EPO administration is beneficial method to reduce homologous blood requirement in open heart surgery.

[A case of mediastinal goiter with hyperthyroidisms].

A 65-years-old woman admitted to the hospital in order to treat of the mediastinal tumor, but she suffered from palpitation, slight fever, sweating, uneasiness, sleeplessness and weightloss. On the physical examination, she was experiencing tachycardia, fevering (37.2 approximately 37.6 degrees C). Skin was moist but had no exophtalmos or neck tumor. Chest X-ray showed an abnormal shadow in the upper mediastinum. On chest CT, a tumor mass (9 x 5 x 4 cm) with cystic regions and scattered calcifications occupied from anterior to posterior mediastinum. The tumor compressed trachea to the left and right brachiocephalic vein and SVC to the right. Lower portion of the tumor intruded into behind of the trachea. Lymph node swelling of mediastinum was also detected. Results of general laboratory examination were within normal limits. Thyroid function test revealed hyperthyroidism; T3U 58%, free T3 24.4 pg/ml, free T4 6.0 ng/dl and thyroglobulin 967 mg/dl, but TSH was < 0.01 microIU/ml. After daily administration of methimazole (300 mg/day) for 4 weeks, thyroid function became to normal level and symptoms of hyperthyroidism was disappeared. The tumor was completely extirpated with right hemithyroidectomy and lymph node dissection under neck colla incision and median sternotomy. Pathological finding of the tumor showed follicular-fetal adenoma of thyroid with hyaloid degeneration and cystic change. There was no finding suspected of Graves' disease. She is well without any complications for 8 months after operation. Some discussion of the literature was mentioned.

[A new design of annulus sizer].

Reconstruction of the right ventricular outflow tract at the time of total correction of tetralogy of Fallot, the pulmonary valve annulus has been sized with fingers and Hegar dilators at our institute. But it has not always been sized correctly. To preclude such a problem, we designed new annulus sizers which have two cylindrical parts and a flexible handle (100 mm). The cylindrical parts are 40 mm in length, 8 to 30 mm in diameter, and have three lines marked every 10 mm from the end. Adjustment of the line to the valve annulus allows for correct measurement of the size. Moreover, we consider these sizers to be beneficial for annuloplasty of the atrioventricular valve, measurement of the mitral valve area after commissurotomy and the inner diameter of arteries.

[Clinical analysis on side effects of long-term oral administration of futraful to out-patients].

Ninety-six cases of cancer patients were treated with long-term oral administration of Futraful ranging more than one to five years. Group A consisted of 57 cases receiving the drug for 1-2 years and Group B of 39 cases receiving the drug for 3-5 years. In Group A abnormality of TTT was observed in 49% and also abnormality of LHD in 32% of the patients, abnormalities of hemoglobin, leucocyte count, lymphocyte per cent, GOT, GPT, ALP, Bilirubin and ZST were respectively reported in 10-20%. On the other hand, in Group B abnormalities of TTT (64%), hemoglobin (26%), LDH (21%) were observed as well as abnormalities 10-20% of leucocyte count, lymphocyte, GOT, and ALP in each approximately 10-20% of the patients. But all of the disorders were not severe and clinically not serious. These results suggested and safety of long-term oral administration of Futraful to out-patients.

[Preoperative treatment of esophageal cancer with oral peplomycin jelly].

Pepleo-jelly, peplomycin (PEP) compounded with sodium polyacrylate (PANa), was used as a local preoperative chemotherapy for esophageal cancer. Thirty milligrams of PEP emulsified in 10 ml of jelly was orally administered for 17 patients on consecutive bed time, and the average total dose was 470 mg. Concentrations of PEP in blood and tissue were measured with a bioassay. PEP was not detected in the blood but was detected in esophageal tissue and regional lymphnodes. A significant difference (p less than 0.05) of tissue concentrations between normal esophageal mucosa (0.11 microgram/g) and malignant region (0.34 microgram/g) was noted. Furthermore, PEP was detected in many regional lymphnodes. Histological antitumor effect (Ef2) was noted in three of the eight metastatic lymphnodes. A side effect of this treatment was not recognized. It is believed that this treatment is safe and useful in combination with other adjuvant cancer therapy.

[Nutritional management of anastomotic leakage after gastrointestinal surgery--with special reference to the serious cases].

Effects of intravenous hyperalimentation (IVH) were studied in 38 patients with anastomotic leakage following gastrointestinal surgery. Spontaneous closure of the leakage were found in 23 patients (60%), and surgical closure were needed in 9 patients (24%). The duration required for spontaneous closure was 5 weeks on the average; and closure occurred readily in cases of tubular fistula. Death occurred in 6 patients (16%); among these, 5 were MOF cases. The following three points are emphasized concerning measures to increase IVH efficacy in serious cases such as MOF. GFX-solution is efficacious for reduced glucose tolerance. Administration of canrenoate potassium(Soldactone), linoleic acid and BCAA enriched amino-acid mixture is effective for accelerated albumin synthesis. Concomitant treatment by IVH and ED(elemental diet) is efficacious in cases of high caloric administration.

[Report of a case of bilateral adrenal teratoma with CA19-9 production].

Reports of adrenal teratomas in adults are rare, and all of adrenal teratomas which were reported in the literature were found in unilateral adrenal gland. This is the first reported case of CA19-9 producing huge teratomas found in bilateral adrenal gland. Twenty-two year-old woman was hospitalized for an episode of abdominal growing mass and an abnormality of high CA19-9 serum level. Operatively, bilateral adrenal tumors were removed, and the weights of right one and left one were 3976g and 618g, respectively. Histological diagnosis of both tumors was mature teratoma. Immunohistochemical findings revealed CA19-9 was produced from intestinal epithelium in teratoma.

[An adult case of secundum atrial septal defect with severe postoperative pulmonary hypertensive crisis].

We reported an adult case of secundum atrial septal defect with severe postoperative pulmonary hypertensive crisis. A 52 year-old female with secundum atrial septal defect and pulmonary hypertension underwent ASD patch closure. After the operation she experienced severe postoperative pulmonary hypertensive crisis. Only administration of PGE1 through the pulmonary artery was effective of hemodynamic improvement and reduction of pulmonary hypertension. Histological diagnosis of lung biopsy showed thromboembolism of small pulmonary artery. Pulmonary hypertension has not been evident during the 3 months since the cardiac catheterization was performed.