Unilateral optical nerve hypoplasia in a Beagle dog.

Unilateral (left eye) optic nerve hypoplasia was detected in a six-month-old male Beagle dog. Vision testing indicated that the left eye had poor vision and testing the pupillary light reflex showed the left eye to have an absence of the afferent pathway of the reflex but it had a normal efferent pathway. Ophthalmoscopy revealed a small-sized optic disc, winding retinal artery and dilated retinal vasculature in the left globe. Electroretinography showed no abnormal findings even in the left globe. Histopathologically, the left optic nerve was markedly hypoplastic and was composed of sparse neural elements and a moderate amount of connective and glial tissues. In the retina of the left globe, the nerve fibre layer and the ganglion cell layer were reduced in thickness, although a small number of ganglion cells were still present. There were no abnormal findings detected in the right globe and the right optic nerve. The brain appeared normal macroscopically.

Endoscopy and intraductal ultrasonography.

Because the prognosis in pancreatic carcinoma is so poor, a reliable method for early detection of tumors is needed. Endoscopic ultrasonography (EUS) is a useful method for precise diagnosis of pancreatic tumors. Recently, peroral pancreatoscopy (POPS) and intraductal ultrasonography (IDUS) have been introduced to make a more detailed diagnosis of pancreatic tumors. These three techniques were performed in 48 patients with pancreatic carcinoma. The ultrasonographic and endoscopic findings of pancreatic carcinoma were studied. EUS, IDUS, and POPS are very useful for differentiating between benign and malignant pancreatic tumors.

[Diagnosis of the wall-thickened lesions of the gallbladder with dynamic MRI].

We studied 32 patients with the thickened lesions of the wall of the gallbladder by using dynamic MRI. We tried the differential diagnosis of gallbladder lesions according to the time intensity curve (TIC) and enhanced pattern. TIC of carcinoma was elevated more seeply from plain to arterial phase than the inflammatory diseases. The Inflammatory diseases were keeping three-layer structures of the wall of the gallbladder, but gallbladder carcinoma destroys the wall-structure. We could diagnose as direct liver invasion of the carcinoma clearly. We could exactly diagnose adenomyomatosis in dynamic MRI by small low intensity spots within the wall of the gallbladder. In the patients with gall stones, the wall of the gallbladder were more clearly observed in dynamic MRI compared with US and EUS.

Mucin-producing tumor of the pancreas--intraluminal ultrasonography.

BACKGROUND/AIMS: Many patients with mucin-producing pancreatic tumor, characterized by dilatation of the pancreatic duct, are diagnosed by conventional ultrasonography in a mass ultrasonographic survey in Japan. It is a necessary and reliable method for making a precise diagnosis and for deciding on the treatment approach. Endoscopic ultrasonography (EUS) is appreciated as a useful method for precise diagnosis of pancreatic tumors. Intraductal ultrasonography (IDUS) is expected to be a new modality for the more detailed diagnosis of pancreatic tumors. METHODOLOGY: Endoscopic ultrasonography and intraductal ultrasonography were performed in 23 patients with mucin-producing pancreatic tumor. The differences in ultrasonographic findings between benign and malignant tumors were studied. RESULTS: Ultrasonographic findings of mucin-producing pancreatic tumor revealed by EUS and IDUS were: cystic lesion, mural nodule in the cystic lesion, wall thickness of the cyst, mucus echoes, and solid tumor with a mixed echo pattern. Seven out of 11 patients with mural nodule were diagnosed as carcinomas and another 4 patients had adenoma. Seven of 8 patients with mucus echoes were diagnosed as carcinoma. Three of 4 patients with solid tumor were diagnosed as invasive carcinoma. The ultrasonographic findings suggesting malignancy were: mural nodule, irregular wall thickness, mucus echoes, and solid tumor with a mixed pattern. Solid tumor indicated invasive carcinoma exclusively. CONCLUSIONS: Intraluminal ultrasonography, EUS and IDUS are very useful in making a differential diagnosis between benign and malignant tumors in mucin-producing pancreatic tumors.

Ras gene point mutations in gallbladder lesions associated with anomalous connection of pancreatobiliary ducts.

BACKGROUND/AIMS: The present study was undertaken to investigate possible changes in the K-ras oncogene in patients with gallbladder lesions (carcinoma, adenoma or hyperplasia) in relation to the presence or absence of an anomalous connection of pancreatobiliary ducts (ACPBD). METHODOLOGY: Gallbladder specimens were obtained from 44 patients with lesions that were either with or without ACPBD, and DNA samples were analyzed using PCR-SSCP. Point mutations in codons 12, 13 and 61 were analyzed by direct sequencing methods with oligonucleotide primers. RESULTS: The K-ras codon 12 was detected in 83.3% (5/6) of carcinomas the one adenoma tested and in 35.7% (5/14) of hyperplastic lesions with ACPBD, as opposed to only 36.4% (4/11) of carcinomas without ACPBD. The one case of gallbladder adenoma and 11 cases of normal gallbladder without ACPBD studied demonstrated no point mutations in the K-ras oncogene. CONCLUSIONS: Alteration of the K-ras oncogene appears to be involved in the early stages of gallbladder carcinogenesis when in association with ACPBD. The results further suggest that hyperplasia in cases with ACPBD may be a significant pre-cancerous lesion.

[The studies of extracorporeal shock wave lithotripsy (ESWL) for pancreatic ductal stones].

30 patients with main pancreatic duct stones were treated by ESWL. In 18 of 22 patients who had not previously undergone endoscopic pancreatic sphincterotomy (EPST) or endoscopic sphincterotomy (EST), the stone fragments disappeared after ESWL. The fragments were removed endoscopically in the remaining 4 cases. Complete clearance was achieved in 8 cases with endoscopically unextractable stones by ESWL. After the ESWL procedure, absolute relief from pain was reported by in 19 of 22 patients with abdominal complaints. Serum amylase levels decreased significantly, and dilatation of the main pancreatic duct (MPD) was reduced. In the medium-term follow-up period, pancreatic exocrine function and endocrine function had a possibility to be preserved. One case of pancreatic cancer and one case of an intraductal papillary tumor of the pancreas were found, indicating that careful observation is necessary even after complete removal of pancreatic stones. In cases of Santorini duct dominant, multiple stones, or stricture of the MPD, ESWL should be combined with EPST and endoscopic stenting for preventing recurrence of acute pancreatitis and pancreatic stones. In conclusion, ESWL is the first choice of treatment for pancreatolithiasis and useful procedure and the limited complications.

Three-dimensional intraductal ultrasonography: preliminary results of a new technique for the diagnosis of diseases of the pancreatobiliary system.

BACKGROUND AND STUDY AIMS: Intraductal ultrasonography (IDUS) is a useful method for the diagnosis of pancreatobiliary diseases, but the images obtained using the presently available ultrasonic probes are limited by their two-dimensional nature and are sometimes difficult to interpret. The possible application of three-dimensional intraductal ultrasonography (3 D-IDUS) to facilitate the diagnosis of pancreatobiliary disease was therefore studied using a newly developed system. PATIENTS AND METHODS: 3 D-IDUS of the biliary system was performed on 26 patients with benign (n = 100) or malignant pancreatobiliary diseases (n = 16), via percutaneous transhepatic or peroral approaches. Three-dimensional diagnoses were made using both radial and linear images generated on the monitor of this system along with a comparison with conventional IDUS (2 D-IDUS) findings. RESULTS: The courses of vessels surrounding the bile duct could be easily imaged in all cases, and accurate assessment of tumor extension and the relationship with surrounding organs could be achieved for all the malignancies. In four of six cases of bile duct cancers the whole outline of the tumor could be visualized so that the tumor volumes could be measured. CONCLUSIONS: These preliminary results of 3 D-IDUS in the pancreatobiliary system, the first to be reported in the English literature, indicate that this new system has clear advantages over the 2 D-IDUS approach for diagnostic purposes. Further technical improvements can be expected which will ensure a clinical role for 3 D-IDUS.

Prospective study of the detection of anomalous connections of pancreatobiliary ducts during routine medical examinations.

BACKGROUND/AIMS: It is important to achieve detection of of anomalous connections of the pancreatobiliary ducts (ACPBD), because this condition often leads to pancreatobiliary disease. The present prospective investigation focused on revealing the incidence of ACPBD in asymptomatic individuals undergoing medical checkups. MATERIAL AND METHODS: Extracorporeal ultrasonography (US) was performed on all asymptomatic individuals undergoing medical checkups. Identification by abdominal ultrasonography of 3 mm or more gallbladder wall thickening, or 10 mm or more dilatation of the bile duct were considered indicative of ACPBD and endoscopic ultrasonography (EUS) was carried out in selected cases. Endoscopic retrograde cholangiopancreatography (ERCP) was then performed to confirm the existence of ACPBD. RESULTS: The overall incidence of ACPBD was 0.03% (9/27,076 subjects). ACPBD was found in 23% of cases with bile duct dilatation, and in 2.9% with gallbladder wall thickening. CONCLUSION: ACPBD was not as rare a disease as expected. For early detection of ACPBD, identification by abdominal ultrasonography of gallbladder wall thickening or dilatation of the bile duct are indicative. Patients who are suspected of having this abnormality should then undergo EUS. The final diagnosis should then be made by ERCP.

Effects of growth hormone injection to embryos on growth and myosin heavy chain isoforms in growing turkeys (Meleagris gallopavo).

Effects of embryonic imprinting with growth hormone (GH) on growth and myosin heavy chain (MyHC) isoforms in pectoralis muscle were determined by injecting turkey embryos with ovine growth hormone (oGH) at a dose of 10 micrograms three times a day. Injections were made on days 20 and 26 (Treatment 1), days 14 and 20 (Treatment 2) or days 14 and 26 (Treatment 3) of incubation. In Treatment 1 poults, plasma GH concentrations were elevated at 3 days posthatch and in Treatment 3 poults, plasma GH concentrations were elevated at 15 days posthatch, as compared to control poults. At 4 weeks of age, in males, body weights, shank length and weights of pectoralis, gastrocnemius and sartorius muscles were increased in Treatment 3, and in females, body weights, shank length and weights of gastrocnemius muscle of female turkeys were increased in Treatment 1. The growth rate of female turkeys from 4 weeks through 16 weeks was increased by Treatment 1. Treatment 1 resulted in a delay in the transition from the embryonic MyHC isoform to the neonatal MyHC isoform and to the adult MyHC isoform. Treatment 3 induced an earlier appearance of the adult MyHC isoform. No effects on body and muscle growth and MyHC isoforms were observed by Treatment 2.

[A study of the relationship between nocturnal intragastric pH and sleep stages of peptic ulcer].

We studied the correlation of the gastric acid secretion and the depth of sleep at night with no medication in 32 cases (19 gastric ulcer, 6 duodenal ulcer patients and 7 healthy controls). Using Memory PH: Monitor intragastric pH values were consecutively measured without antiulcer drugs. The depth of sleep were monitored continuously by recording without any sleeping drugs. In healthy controls, the pH values of awake phase was significantly lower than that of sleep stage 1, 4 and rapid eye movement (REM) phases. The pH values of REM phases were significantly high rather than that of sleep stage 1 and 2 phases. In patients with gastric ulcer, the pH values of awake phases were significantly lower than that of sleep stage 1 and REM phases. The pH values of REM phases were significantly high rather than that of the other sleep stages. On the other hand, in patients with duodenal ulcer, the obvious changes of the pH values were not seen with sleep stages. The pH values of healthy controls and gastric patients were changed with sleep stages. But the pH of duodenal ulcer patients were not changed obviously. Therefore, it is suggested that the dysfunction of autonomous nervous system was influenced the nocturnal intragastric pH in the patients with duodenal ulcer and played one of the important role in the occurrence of duodenal ulcer.

Endoscopic MRI: preliminary results of a new technique for visualization and staging of gastrointestinal tumors.

BACKGROUND AND STUDY AIMS: The principle of endoscopic ultrasonography--introducing the transducer of an external imaging method, such as ultrasonography, in combination with an endoscope into the gastrointestinal tract for higher-resolution imaging--has also been applied to magnetic resonance imaging (MRI). We report here on our preliminary experience with a new method of endoscopic MRI in the upper gastrointestinal tract. PATIENTS AND METHODS: Endoscopic MRI was performed in 32 patients with esophageal (n = 8) or gastric diseases (n = 24), mostly tumors (n = 26). Most cancers were at an advanced stage (T3/T4). A prototype MRI endoscope connected to a 1.5 tesla MRI scanner was used. The accuracy of endoscopic MRI in visualizing and staging gastrointestinal lesions was assessed. RESULTS: The normal gastrointestinal wall consisted of three layers, and tumors were visualized as having a low signal intensity on both T1- and T2-weighted sequences. Destruction of the wall layers was found to be characteristic of malignancy. Sufficient images were obtained in seven of eight esophageal cases (88%), but in only 14 of 24 gastric cases (58%). In patients in whom adequate visualization was achieved, the endoscopic MRI results of local and regional staging were consistent with surgical, histopathological, CT and/or EUS results in all six esophageal cancer cases and in 89% (T stage) and 56% (N stage) of the nine patients with gastric cancer. CONCLUSIONS: These preliminary results of endoscopic MRI are the first to be reported in the English literature. They show the potential of the method for local and regional staging, three-dimensional visualization of lesions being a potential advantage. Further technical improvements are expected.

[Diagnostic strategy for malignancy and parenchymal invasion of so-called mucin-producing tumor of the pancreas].

This study investigated diagnostic indications of malignancy and parenchymal invasion of so-called mucin-producing tumor of the pancreas (MPT). We reviewed 40 patients with this type tumor. In diagnosis of malignancy, jaundice, mural nodule (EUS), displacement or compression of the portal vein (angiography), compression of the common bile duct (cholangiography) and Group IV-V in biopsy, Class III-V in brushing cytology were important. In diagnosis of parenchymal invasion, solid mass (US, EUS, CT), arterial encasement (angiography), defect in the common bile duct (cholangiography), stenosis or obstruction of the MPD (pancreatography) and elevation of serum CA19-9, CEA levels were important. By these findings, MPT diagnosed as benign can be observed without surgical treatment. On the other hand, MPT diagnosed as malignant must be treated by surgical resection, and operative procedure must be chosen according to whether the MPT was accompanied by parenchymal invasion or not.

[A study of the influence of gastric acid on the extension of regenerative epithelium of gastric ulcer].

To study the influence of gastric acid on the extension of the regenerative epithelium, 26 patients (28 ulcers) of gastric ulcer were examined by the stereo video-endoscope being able to measure the length and 24-hours intragastric pH monitoring. Extending speeds of the regenerative epithelium were measured from the time the regenerative epithelium of the ulcer was observed till the last examination, but which was limited 8 weeks after the first observation of the regenerative epithelium. The relationship was not observed between the extending speeds and the stages (A2-H1, H1-H2, H2-S1) of the ulcer. For 21 ulcers followed up by the stereo video-endoscope from active stage, the extending speed of the regenerative epithelium and the pH 3 holding time in a day were significantly correlated (r = 0.51, p = 0.014), and the same relationship (r = 0.56, p = 0.008) were observed in the nighttime. It was confirmed that the gastric acid regulated strongly the extending speed of regenerative epithelium of gastric ulcer. The intragastric circumstance of the low acid secretion induced by the antacid-drugs was considered to accelerate the extension of regenerative gastric epithelium.

[The effects of synthetic protease inhibitor on motility of the human duodenal papilla].

We studied the effects of synthetic protease inhibitors on the motility of the human duodenal papilla. Before and after the intravenous administration of gabexate mesilate (GM) or nafamostat mesilate (NM), the duodenal papillary pressure was measured with a catheter tip pressure transducer under duodenoscopy. GM was administered to fourteen subjects at 1 and 3 mg/kg/h. The peak pressure and the basal pressure were dose-dependently reduced by GM, but the frequency did not change. The blood CCK concentration was not changed after GM administration. NM was administered to twelve subjects at 0.3 mg/kg/h. Both the papillary pressure and the frequency were not changed by NM. GM inhibited the papillary motility, but NM had no consistent effect on the papillary motility.