Clinical significance of measuring urinary sulfated bile acids in adult patients with hepatobiliary diseases.

BACKGROUND/AIMS: Measurement of urinary sulfated bile acid (USBA) level is a simple urine test that reflects the degree of cholestasis in newborns. The aim of this study was to clarify the clinical significances of this test for liver diseases in adults. METHODOLOGY: We examined the relationship between USBA level in a urine sample by enzymatic assay and clinical parameters and postoperative complications in 27 patients with hepatobiliary diseases who underwent surgical procedures between 2002 and 2007. RESULTS: Mean USBA in all patients before surgery was 39.8 +/- 64.0 micromol/L (median value was 6.6). USBA level was increased in patients with cholestasis. USBA level was significantly correlated with serum total bile acid, total bilirubin level and serum hyaluronic acid level (r = 0.850, 0.602 and 0.504, respectively) (p < 0.05) and, furthermore, tended to be correlated with liver-uptake ratio (LHL15) by technetium-99m galactosyl human serum albumin (99SmTc-GSA) scintigraphy and alanine aminotransferase level (r = -0.469 and 0.436, respectively but not significant). USBA level tended to be associated with postoperative uncontrolled ascites (p = 0.050, not significant). Postoperative USBA level by day 7 was not changed; however, USBA level in patients with cholestatic diseases was decreased. CONCLUSIONS: USBA is a simple and sensitive noninvasive test for cholestasis and also useful to predict postoperative uncontrolled ascites after hepatic resections.

Beneficial effects of plasmapheresis before thymectomy on the outcome in myasthenia gravis.

OBJECTIVE: Since 1980, we have performed plasmapheresis before thymectomy for patients with generalized symptoms in order to protect against myasthenic crisis and to improve patient outcomes after thymectomy. The aim of this study was to evaluate an immediate and a long-term results of plasmapheresis before thymectomy for myasthenia gravis, retrospectively. METHODS: Between January 1980 and December 1997, 51 patients with Osserman class IIA or IIB symptoms were treated with transsternal thymectomy. Nineteen patients (group 1) were treated with plasmapheresis before thymectomy and 32 patients (group 2) were treated with thymectomy alone. RESULTS: In group 1, the time of plasmapheresis prior to thymectomy was 3.2 +/- 1.5. Nine (28.1%) patients in group 2 had crisis within 1 year after thymectomy as compared with only one (5.3%) patient in group 1 had crisis (p = 0.049). There was no evidence of crisis within 30 days after thymectomy in group 1 and 5 (15.6%) patients in group 2 (p = 0.0724). There was no postoperative death among patients in group 1. Responses to thymectomy in group 1 improved significantly, the improvement and pharmacologic remission rate had increased up to 100% and 79% at 5-7 years after operation, while the improvement and pharmacologic remission rate of group 2 had increased to 81.3% (p = 0.0466 vs. group 1) and 50.0% at that time (p = 0.0427 vs. group 1). CONCLUSIONS: The present study demonstrated that preoperative plasmapheresis may facilitate improved outcomes of patients with myasthenia gravis after thymectomy.

Congenital intrathoracic kidney with right Bochdalek defect.

Intrathoracic kidney is a rare congenital anomaly. Since most reported cases are asymptomatic, it is extremely rare for this ectopia to be diagnosed in the neonatal period. We report a male infant with right intrathoracic kidney associated with Bochdalek defect. Chest X-ray demonstrated a right posterior mediastinal mass and intestinal gas in the right lung field. Contrast-enhanced CT and intravenous urography led to a diagnosis of intrathoracic kidney. Due to the presence of Bochdalek defect, the intrathoracic kidney was reduced into the abdominal cavity at the time of diaphragmatic repair. The intrathoracic kidney with attached adrenal gland was located at the level of the carina and was covered with protruded retroperitoneum. The kidney was thought to have been pushed this high by the small intestine and left lobe of the liver, which had also herniated through the defect. Postoperative hemodynamics and renal function were normal.

Pulmonary tractotomy for a patient with traumatic penetrating lung injury: report of a case.

We report a case of traumatic hemopneumothorax caused by penetrating lung injury in a 26-year-old man. The patient underwent emergency thoractomy, which revealed hemorrhage in the lingular segment of the left lung. We found the bleeding point and controlled the hemorrhage using pulmonary tractotomy by inserting a linear stapler into the stab wound in the pulmonary parenchyma. The original technique of pulmonary tractotomy was performed for complete through-and-through injury by dividing the bridge of lung tissue between the aortic clamps. We were able to apply this procedure safely to stop bleeding from a stab wound that did not go through the lung. Thus, pulmonary tractotomy is an effective damage-control operation for the lung with obvious advantages over major lung resection.