Significance of mitochondrial enhancement in restoring hepatic energy charge after revascularization of isolated ischemic liver.

The critical point of reversibility in hepatic ischemia was investigated. Immediately after the liver was isolated, the hepatic energy charge decreased rapidly from the control level of 0.85 to 0.28 and remained at a constant value during 30-, 60-, and 90-min ischemic periods. After revascularization of the liver, the rapidity toward the normalization of the energy charge and the mitochondrial phosphorylative activity were different according to the ischemic time. The livers after 30- and 60-min exclusion showed a normalization of the energy charge and the enhancement of mitochondrial phosphorylative activity, while the livers after 90-min exclusion showed only a slight increase of energy charge, which remained far from the normal value, and the enhancement of mitochondrial phosphorylative activity was not observed. From these results, it is suggestive that a rapid enhancement in phosphorylative activity of the liver mitochondria after revascularization plays a decisive role on the restoration of the viability of isolated ischemic liver.

Short-term changes in blood ketone body ratio in the phase immediately after liver transplantation.

Arterial blood ketone body ratio was measured after orthotopic liver transplantation in piglets. Ketone body ratio immediately decreased at the beginning of the anhepatic phase and was rapidly restored to the normal levels within 30 min after the revascularization of the allograft. Serum lactate and pyruvate levels increased in anhepatic phase and gradually decreased after revascularization. Changes in the lactate and pyruvate levels were always preceded by changes in ketone body ratio. In the case of transplantation after 12-hr-preservation of the allograft, ketone body ratio failed to maintain normal levels after transplantation, resulting in a high mortality. It is suggested that the elevation of decreased ketone body ratio is prerequisite for the normalization of the deranged metabolic state after liver transplantation, and that ketone body ratio provides an accurate means to assess the initial metabolic function of the allograft.

Changes in blood ketone body ratio: their significance after major hepatic resection.

Changes in the ratio of acetoacetate to 3-hydroxybutyrate (the ketone body ratio) in arterial blood were investigated after massive liver resection in patients and rabbits. In a patient who had had a successful hepatectomy, the blood ketone body ratio decreased rapidly after the operation and then returned to the preoperative level; whereas in a patient who had had an unsuccessful hepatectomy, the blood ketone body ratio did not decrease rapidly after the operation. In 70% hepatectomized rabbits, the blood ketone body ratio decreased maximally nine hours after hepatectomy and then returned gradually to a normal level. The blood ketone body ratio paralleled the hepatic energy charge after 70% hepatectomy in rabbits. The measurement of the blood ketone body ratio is very useful for evaluation of the energy status of the remnant liver.

Giant malignant phyllodes tumor with(99m)Tc-Ses-tamibi accumulation: Report of a case.

We report a case of a giant malignant phyllodes tumor examined by(99m)Tc-ses-tamibi (MIBI) mammoscintigraphy. The patient was a 51 year-old woman who complained of bleeding from a large mass in her right breast. The tumor was well circumscribed, with an ulcerized surface. The accumulation of(99m)Tc-MIBI in the tumor was recognized on(99m)Tc-MIBI scintigraphy. A standard radical mastectomy was performed with a wide margin of skin. The resected specimen measured 20 X 17 X 13 cm, weighed 2100 g and was histologically diagnosed as a malignant phyllodes tumor. The skin defect was reconstructed by a rectus abdominis musculocutaneous flap, with good cosmetic results.(99m)Tc-MIBI scintigraphy may have the potential to distinguish a malignant from benign phyllodes tumors.

Incidental 67Ga uptake into an appendiceal mucocele in a patient with sigmoid colon cancer.

We report a case of sigmoid colon cancer in which visualization of an appendiceal mucocele was unexpectedly found during 67Ga scintigraphy, and discuss a proposed mechanism of uptake.

Three patients with bilateral breast tumors examined by technetium-99m-sestamibi scintimammography.

We presented three patients with bilateral breast tumors (one with breast cancers, one with breast cancer and fibroadenoma, and one with fibroadenomas) examined by 99mTc-hexakis 2-methoxy-isobutylisonitrile (MIBI) scintimammography. In all cases 99mTc-MIBI uptake was recognized only in the breast cancers. 99mTc-MIBI scintimammography was useful in evaluating bilateral breast tumors since preoperative diagnosis is valuable in determining correct surgical treatment.

Technetium-99m-sestamibi scintimammography of benign and malignant phyllodes tumors.

We presented two cases of phyllodes tumor of the breast examined by 99mTc-sestamibi (MIBI) two-phase scintimammography. In the case with malignant phyllodes tumor, 99mTc-MIBI accumulation was recognized on both early and delayed images. In the case with benign phyllodes tumor, however, 99mTc-MIBI accumulation was recognized on only the early image. 99mTc-MIBI delayed imaging may have the potential to distinguish between benign and malignant phyllodes tumors.

99mTc-DTPA-HSA uptake in a case of splenic hamartoma.

Primary splenic tumors are very rare. The authors present a case of splenic hamartoma in which positive 99mTc-DTPA-HSA uptake was recognized with ultrasound, CT, MR and angiographic images. This case showed the need to consider hamartoma as well as hemangioma in the differential diagnosis of 99mTc-DTPA-HSA uptake in splenic tumors.

[Clinical studies on the prognosis of 150 cases of acute renal failure].

A survey has been made of 150 cases of acute renal failure (A.R.F.) seen between 1962 and 1981. The overall mortality was 43.3%. The patients ranged from 7 to 75 years old. The mean age of all the patients was 47.2 years old. The mean age of the patients seen between 1970 and 1981 was 58.1 years old, 20 years older than those seen between 1962 and 1969. Despite increasing expertise in management of the complications of surgical, medical, and obstetric disorders, and considerable technical advances in dialysis, there was no decrease in mortality over the 20-year period of survey. Many factors have been identified as having an adverse influence on prognosis, such as age of patient, surgical origin, and complications. Mortality rate was high in the patients over 71 years old, postsurgical group (55.6%), and hepatorenal syndrome group (92.3%). Five major complications had an adverse influence: septicemia (57.1%), respiratory infection (61.1%), cardiovascular disorder (46.3%), hemorrhage (59.6%), unconsciousness (62.2%), and hepatic dysfunction (56.8%). Between 1970 and 1981 the mortality in the patients dialyzed up to 3 times was 81.3%, compared with 26.5% in those dialyzed from 4 to 19 times (p less than 0.01). In the former group severity of the underlying disorder had an adverse influence on prognosis. Although the A.R.F. may be controlled in the earlier stages of illness, many of these patients die of overwhelming infection or other complications.

Clinical significance of hippurate-synthesizing capacity in surgical patients with liver disease: a metabolic tolerance test.

Changes in the amount of hippurate synthesized and excreted in the urine after 1.5 gm benzoate loading (intravenous hippuric acid test [HAT]) in patients with liver disease before surgery were studied in relation to arterial blood ketone body ratio (acetoacetate/beta-hydroxybutyrate) (BKBR), reflecting energy status of the liver. In these patients, the HAT values for 120 minutes were decreased significantly (1.088 +/- 0.129 gm, n = 9; 1.071 +/- 0.258 gm, n = 7; 1.258 +/- 0.126 gm, n = 10; in cirrhosis with liver tumor, cirrhosis with esophageal varix, and obstructive jaundice, respectively) as compared with the value in patients without liver disease (1.829 +/- 0.093 gm, n = 16, P less than 0.01). The correlation coefficient of the BKBR and the HAT value was 0.766, which was higher than that of the BKBR and albumin or the BKBR and choline esterase (r = 0.532 and r = 0.646, respectively). Serum levels of glutamic-oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase, leucine aminopeptidase, total and direct bilirubin, creatinine, and blood urea nitrogen were not correlated with the HAT values. Because hippurate is synthesized in liver mitochondria by the continuous supply of adenosine triphosphate through mitochondrial oxidative phosphorylation, HAT is considered to be a test that evaluates the energetic capacity of the liver to manage a metabolic load imposed on it.

Changes in mitochondrial redox state following an oral glucose load.

Changes in cytosol and mitochondrial redox state after an oral glucose load were studied in the liver of rats. The [NAD+]/[NADH] ratios increased 4-fold in the cytoplasm and 1.5-fold in the mitochondria 60 min after an oral glucose load, when serum IRI was maximally increased. It is suggested that an increase in mitochondrial redox state following an oral glucose load is due to an enhanced rate of removal of NADH by the respiratory chain, possibly due to an elevated level of insulin available to hepatocytes, and that an increase in cytosol redox state depends on an enhancement in mitochondrial oxidation of cytosol reducing equivalent.

An assessment of percutaneous transhepatic biliary drainage in the correction of the metabolic capacity of the jaundiced liver by hippurate-synthesizing test.

Hippurate-synthesizing ability was investigated in patients with jaundice with percutaneous transhepatic biliary drainage (PTBD) in relation to hepatic metabolic capacity. In 16 patients with PTBD because of obstructive jaundice and 11 patients without hepatic disease, 1.77 grams of sodium benzoate was injected and the amount of hippurate synthesized and excreted in the urine collected at 30, 60, 120 and 180 minutes was measured (hippurate test). In patients with jaundice and patients in the control group, an almost linear increase was observed in the level of urinary hippurate after benzoate loading. However, the values of the patients with jaundice at one and two hours after the benzoate loading were significantly lower than those of the patients in the control group. Serum levels of glutamate oxaloacetic transaminase, glutamate pyruvate transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin and direct bilirubin were significantly decreased during PTBD (p < 0.05). Bilirubin levels were closely correlated with hippurate test values (r = 0.567, p < 0.05). Values were also correlated with the period of PTBD before the hippurate test was performed (r = 0.632, p < 0.05). Recovery in hippurate synthesizing ability was observed when the total bilirubin levels decreased to less than 5 milligrams per deciliter or PTBD was maintained for more than three weeks. Because hippurate synthesis is dependent on adenosine triphosphate supply in the hepatic mitochondria, the value of the hippurate test reflects the metabolic viability of the liver in relation to energy metabolism. It is also suggested that the steady maintenance of PTBD for three weeks or more with a decrease in total bilirubin level less than 5 milligrams per deciliter is necessary for full recovery of the metabolic capacity of the jaundiced liver.