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.

New synthetic inhibitors of chymotrypsin.

4-Substituted carbonylphenyl ester derivatives were prepared and their inhibitory effects on chymotrypsin, trypsin, thrombin, plasmin, pancreatic kallikrein, and plasma kallikrein were examined. Among the various inhibitors tested, 4-[2-(dimethylamino)ethylaminocarbonyl]phenyl 1,2,3,4-tetrahydro-1-naphthoate hydrochloride (FK-316), 4-[(2-[4-pyrrolidinocarbonylmethyl)oxycarbonyl]-phenyl 5-methoxyindole-3-acetate dihydrochloride (FK-375), 4-[(2-[4-(piperidinocarbonylmethylpiperadino]ethyl)oxycarbonyl+ ++]phenyl 1-naphthylacetate dihydrochloride (FK-386), 4-[(2-[4-(2-[morpholino]ethyl)piperadino]ethyl)oxycarbonyl]p henyl 5-methoxy-2-methylindole-3-acetate trihydrochloride (FK-401) and 4-(4-isopropylpiperadinocarbonyl)phenyl 1,2,3,4-tetrahydro-1-naphthoate methanesulfonate (FK-448) were the most effective and specific inhibitors of chymotrypsin.

Cataract surgery in a patient with severe chronic iritis and corneal endothelial damage.

We report a patient with broad anterior synechias and corneal endothelial damage. The patient had chronic iritis and cataracts secondary to chronic iritis in both eyes. Because the right eye had broad anterior synechias and severe corneal endothelial damage, extracapsular cataract extraction and intraocular lens implantation were performed through the basal iris. Good postoperative visual acuity was obtained. The cornea showed little trauma from the surgery and remained clear 36 months postoperatively.

Changes in coenzyme Q level in mitochondria of cirrhotic rat liver.

In the cirrhotic rat liver induced by carbon tetrachloride and phenobarbitone, the concentrations of mitochondrial Coenzyme Q were measured in comparison with other respiratory components. The concentration of cytochrome a(+a3) and Coenzyme Q significantly increased in the cirrhotic liver, without any changes in the ratio of Coenzyme Q to cytochrome a(+a3). It is suggested that such increase of Coenzyme Q plays an important role as one of the adaptive responses to compensate for the prolonged metabolic overload on the mitochondrial respiratory assembly. Also, from the findings that the concentrations of cytochrome a(+a3) in the mitochondria of cirrhotic liver increase concomitant with the severity of cirrhosis, it is suggested that the rise of Coenzyme Q levels may be one of the indicators for the decreased functional reserve capacity in liver cirrhosis.

Promoting effect of the new chymotrypsin inhibitor FK-448 on the intestinal absorption of insulin in rats and dogs.

FK-448 is a potent and specific inhibitor of chymotrypsin, which enhances the intestinal absorption of insulin in rats and dogs resulting in a decrease in blood glucose levels in these animals. In dogs, the immunoreactive insulin (IRI) level of plasma rose proportionally to the decrease in blood glucose level. From in-vitro data, insulin was inactivated by pancreatic enzymes or the supernatants of intestine or liver homogenates. FK-448 suppressed the digestion of insulin by pancreatic enzymes and its enhancement of the intestinal absorption of insulin was found to be related to its inhibition of digestive enzymes, especially chymotrypsin.

Prophylactic perioperative treatment in a patient with colon carcinoma complicated by polycythemia vera.

A patient with colon carcinoma complicated by polycythemia vera (PV) who underwent a partial colectomy concomitant with prophylactic perioperative treatment resulting in successful outcome is herein described. Seven weeks after the cessation of the latest exacerbation of PV, a partial colectomy was performed. In order to prevent the development of disseminated intravascular coagulation and thrombotic complications, the following perioperative treatment was performed: administration of gabexate mesilate (2,000 mg/day), fresh frozen plasma (300 ml/day), heparin (5,000 IU/day) for 7 days and anti-thrombin-III for 4 days, and a potent antibiotic therapy for 12 days and graded elastic bandages around the bilateral lower extremities for 14 days. As a result, an uneventful postoperative course was achieved. The present case suggests that these treatments are useful in the perioperative management of PV patients.

Antitumor activity of Toxoplasma lysate antigen against methylcholanthrene-induced tumor-bearing rats.

Growth of the tumor autoinduced by 20-methylcholanthrene (MC) in rats was inhibited after administration of Toxoplasma lysate antigen (TLA). The antitumor activity of TLA was most obvious in the early stage of tumoral growth. When TLA was administered to rats before the appearance of tumour, tumor formation was delayed slightly. Histopathological studies revealed dense growths of spindle tumor cells in untreated control rat, while enlarged central necrosis with the infiltration of lymphocytes and neutrophils was apparent in TLA-treated rats. According to the immunohistological examination of tumor tissue with anti-Thy-1 antibody, the rats treated with TLA showed large Thy-1 positive granular cells, whereas the untreated rats indicated only a few small Thy-1 positive cells. These observations indicate that TLA is a useful modifier of biological responses to MC-induced tumors.

[Inflammatory vesicosigmoidal fistula. A case report].

Clinical course of a case of inflammatory vesicosigmoidal fistula is presented. The patient, a 44-year-old-male, had chief complaints of pollakisuria and pain upon voiding. Fistula was identified with colon-fiberscopic examination. Primary resection of lesion was performed and postoperative course was uneventful. Histological findings of the specimen were compatible with those of nonspecific inflammation. There was no evidence of neoplastic change. Twenty nine cases of inflammatory vesicosigmoidal fistula were reported in the recent 5 years. It was remarkable that the cases of vesicosigmoidal fistula due to sigmoidal diverticulitis have increased.

[Sedative premedication is necessary for infants in anesthetic induction under the presence of mother].

We examined the necessity of sedative premedication for elective operation of childhood when induction was performed beside the mother. One hundred and nine patients (aged from 2 to 8 years) were assigned randomly to two groups; midazolam (0.5 mg.kg-1, orally, n = 56) was administered 45 min before induction in Group M, and vehicle was administered (n = 53) in Group C. The differences between the two groups about their calmness and behavior were investigated using double blind method, and analyzed according to their ages, as infants (2 to 4 years), kindergarteners (5 to 6 years) and school children (7 to 8 years). The significantly higher incidences of agitation or alertness were observed in infants of Group C (P < 0.05) and all other patients were calm and well sedated. We conclude that sedative premedication is necessary in infants even if induction is performed beside patient's mothers.

Three-dimensional ultrasound imaging of the equine fetus.

The objective was to assess the optimal procedure for real-time, three-dimensional (3D) ultrasound (US) imaging for assessing the equine fetus during the first half of gestation and the possibility of using 3D US imaging of the equine fetus in clinical applications. Seventeen pregnant mares were examined by 3D US between Days 35 and 180 of gestation. Abdominal and endo-vaginal real-time 3D transducers used in human medicine were used for transrectal and transvaginal examinations, respectively. Images were recorded by both 3D stationary and real-time movies. In a comparison of four methods, transrectal examination with a bulb-shaped abdominal 3D transducer enabled the equine fetus to be clearly visualized, and did not require sedation of the mare. Therefore, this approach was the most suitable procedure for examining equine fetuses during the first half of gestation. Each scan required only a few seconds and an entire examination took <10 min in total. The 3D volume image was easy to restore after the examination and could be rotated to any angle the examiner desired. Fetal surface structures, including the head, body, limbs, and genital tubercle, were observed as 3D images which enabled fetal development to be characterized. For early (Days 60-70), but not later (Days 90-150) periods, 3D ultrasonography was not able to evaluate fetal structure in detail as well as conventional 2D ultrasonography. In conclusion, 3D ultrasonography of the equine fetus was a valuable adjunct to 2D ultrasonography and a convenient modality for more detailed assessment of fetal structures.

Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery.

In three patients with a previous history of pulmonary thromboembolism, inferior vena caval filters were inserted before elective laparotomies to prevent a recurrent pulmonary thromboembolism. Two patients had colon cancer and underwent colectomies, while the other had myoma uteri, which might have been the cause of deep vein thrombosis, and thus a hysterectomy was performed. In spite of their poor risks, their postoperative courses were fairly good owing to perioperative management including anticoagulant therapy, and no recurrence has been observed since the operation in every case. A pulmonary thromboembolism is a fatal complication which follows deep vein thromboses. In patients with such a previous history, the risk is much higher after a laparotomy because of long-term bed rest, hypercoagulability, and so on. The mortality rate after a recurrence of pulmonary thromboembolism is reported to reach 30% without adequate therapy, whereas it is reduced to 8% with anticoagulant therapy, and to 0.8% with additional inferior vena caval filter placement. Considering the feasibility of insertion and the low incidence of complications, preoperative inferior vena caval filter placement is thus recommended for patients having a previous history of either pulmonary thromboembolism or deep vein thrombosis.

Massive periretinal proliferation in retinal detachment in relation to diabetes mellitus.

The relationship between the 'diabetic state' and massive periretinal proliferation (MPP) in idiopathic retinal detachment was examined. In 18 (3.5%) of 508 cases of idiopathic retinal detachment, MPP occurred before or after retinal detachment surgery. In 24 cases of retinal detachment, a diabetic or suspected diabetic state was found. 11 of the 24 were receiving treatment for diabetes and never developed MPP, while 5 of the 13 patients who were not being treated had MPP. This suggests that MPP in retinal detachment may easily be induced by the diabetic state and prevented by treatment for diabetes. Additional causes of MPP in retinal detachment were giant tears, massive vitreous hemorrhages at operation and frequent recurrence.

Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case.

We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.

Effect of hepatic artery embolization on the adenylate energy charge level and the redox state of the cirrhotic liver.

Hepatic energy charge ((ATP + 1/2ADP)/(ATP + ADP + AMP)) and arterial blood ketone body ratio (acetoacetate/3-hydroxybutyrate) were measured after hepatic artery embolization in carbon-tetrachloride-induced cirrhotic rats. In normal livers, energy charge slightly decreased at 3 h and returned to normal levels at 6 h. By contrast, in cirrhotic livers, energy charge was drastically decreased at 3 h after embolization and was not completely recovered at 6 h. Blood ketone body ratio, reflecting hepatic mitochondrial redox (NAD+/NADH) state, also decreased at 3 h after embolization in both groups, and its recovery was not observed in cirrhotic group at 6 h.