Hepatic artery reconstruction following ablative surgery for hepatobiliary and pancreatic malignancies.

OBJECTIVE: Hepatic artery (HA) reconstruction is an important part of resective surgery for advanced hepatobiliary and pancreatic malignancies, but few reports have been published. To identify indications for HA reconstruction, we retrospectively analyzed our surgical procedures and outcomes. METHODS: En-bloc resection of advanced hepatobiliary and pancreatic malignancies followed by HA reconstruction was performed in 35 patients. Patients ranged in age from 27 to 81 years and included 18 men and 17 women. The primary site of cancer included the bile duct in 22 patients, the pancreas in 7, and others in 6. Reconstruction of the HA was necessitated by HA resection due to direct cancer invasion in 29 patients and by accidental arterial injury during surgical procedure in 6 patients. RESULTS: The HA was reconstructed with end-to-end anastomosis between hepatic arteries in 17 patients. Transposition of an intra-abdominal artery, such as the gastroepiploic artery, was required in 14 patients, and arterial grafting was required in 4 patients. Although the HA patency was achieved in 30 patients, 4 cases of arterial thrombosis and 1 case of arterial rupture developed postoperatively. The overall RFS time was analyzed in all patients, and mean and median RFS times were 18 and 9 months, respectively. CONCLUSION: Although oncologic outcomes remain poor, HA resection and reconstruction can be performed in selected patients. We believe that the method of first choice for HA reconstruction is end-to-end anastomosis between HAs. A vascular autograft should be used only in selected cases.

Antifogging effects of a socket-type device with the superhydrophilic, titanium dioxide-coated glass for the laparoscope.

BACKGROUND: Lens fogging during laparoscopic surgery extensively deteriorates operative field visibility and may provoke serious complications. METHODS: A simulation model study was conducted using a conventional laparoscope, a conventional laparoscope plus heating (100 degrees C, 10 s), a conventional laparoscope plus surfactant, and a conventional laparoscope plus both a titanium dioxide (TiO2)-coated glass (with > or = 15 h of preoperative ultraviolet irradiation) and a water supply. For each, the time from laparoscope insertion into the peritoneal cavity to fogging-induced interruption of surgery was measured. RESULTS: The TiO2-coated glass had unique verified properties of exerting antifogging effects on the oil film after 15 or more hours of previous ultraviolet irradiation, and of inversely accelerating fogging after less than 15 h of previous ultraviolet irradiation. The clinical study showed later fogging with the TiO2-coated glass model, which successfully completed surgery without retraction of the laparoscope from the peritoneal cavity, as compared with the other models. CONCLUSION: An antifogging device using superhydrophilic TiO2-coated glass was very effective in preventing fogging during laparoscopic surgery.

Identification, quantitative determination, and antioxidative activities of chlorogenic acid isomers in prune (Prunus domestica L. ).

Neochlorogenic acid (3-CQA) and cryptochlorogenic acid (4-CQA), isolated from prune (Prunus domestica L.), were identified by NMR and MS analyses. In addition, the quantity of chlorogenic acid isomers in prune were measured by HPLC. These isomers, 3-CQA, 4-CQA, and chlorogenic acid (5-CQA), were contained in the ratio 78.7:18. 4:3.9, respectively. 4-CQA was identified and quantified in prune for the first time, and relatively high amounts of this isomer were characteristic. Antioxidative activities of the chlorogenic acid isomers, such as scavenging activity on superoxide anion radicals and inhibitory effect against oxidation of methyl linoleate, were also evaluated. Each isomer showed antioxidative activities which were almost the same.

Migration of pollutants in groundwater. VI. Flushing of DNAPL droplets/ganglia.

Models for describing the flushing of DNAPL from contaminated aquifers are developed, and the dependence of the calculated cleanup times on the model parameters is explored. Diffusion transport from isolated DNAPL droplets, from low-permeability porous spherical domains containing distributed DNAPL droplets, and from low-permeability porous planar lamellae containing distributed DNAPL is analyzed, and the resulting expressions then coupled with the equations for advective transport of dissolved VOC by means of natural uniform flow and a system of injection and recovery wells generating a two-dimensional flow field. The models are readily run on currently available microcomputers. The results of computations with the models are consistent with the severe tailing and slow rates of remediation which are generally observed when DNAPLs are removed by flushing.