RESUMO
BACKGROUND: Although intraoperative cholangiography has been recommended for avoiding bile duct injury during laparoscopic cholecystectomy, radiographic cholangiography is time consuming and may itself cause injury to the bile duct. Recently, a novel fluorescent cholangiography technique using the intravenous injection of indocyanine green (ICG) has been developed. METHODS: In 52 patients undergoing laparoscopic cholecystectomy, 2.5 mg ICG was injected intravenously 30 min before the patient entered the operating room or following intubation. A fluorescent imaging system, which consisted of a xenon light source and a laparoscope with a charge-coupled device camera that could filter out light wavelengths below 810 nm, was used. Fluorescent cholangiography was performed during dissection of Calot's triangle, and its ability to delineate biliary anatomy was compared with that of preoperative cholangiography. RESULTS: Fluorescent cholangiography delineated the cystic duct in all 52 patients, and the cystic duct-common hepatic duct junction was visible before dissection of Calot's triangle in 50 patients. Fluorescent imaging also identified all accessory bile ducts that had been diagnosed before surgery in eight patients. CONCLUSION: Fluorescent cholangiography enables real-time identification of biliary anatomy during dissection of Calot's triangle. This simple technique may become standard practice for avoiding bile duct injury during laparoscopic cholecystectomy, replacing radiographic cholangiography.
Assuntos
Sistema Biliar/diagnóstico por imagem , Colangiografia/métodos , Colecistectomia Laparoscópica/métodos , Corantes , Fluorescência , Verde de Indocianina , Adulto , Idoso , Doenças dos Ductos Biliares/diagnóstico por imagem , Doenças dos Ductos Biliares/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Radiografia IntervencionistaRESUMO
BACKGROUND: Stat3 is a member of the Janus-activated kinase/STAT signalling pathway. It normally resides in the cytoplasm and can be activated through phosphorylation. Activated Stat3 (p-Stat3) translocates to the nucleus to activate the transcription of several molecules involved in cell survival and proliferation. The constitutive activation of Stat3 has been shown in various types of malignancies, and its expression has been reported to indicate a poor prognosis. However, the correlation between the constitutive activation of Stat3 and the prognosis of cervical cancer patients has not been reported. METHODS: The immunohistochemical analysis of p-Stat3 expression was performed on tissues from 125 cervical squamous-cell carcinoma patients who underwent extended hysterectomy and pelvic lymphadenectomy, and the association of p-Stat3 expression with several clinicopathological factors and survival was investigated. RESULTS: Positive p-Stat3 expression was observed in 71 of 125 (56.8%) cases and was significantly correlated with lymph node metastasis, lymph vascular space invasion, and large tumour diameter (>4 cm) by Fisher's exact test. Kaplan-Meier survival analysis showed that p-Stat3 expression was statistically indicative of a poor prognosis for overall survival (P=0.006) and disease-free survival (P=0.010) by log-rank test. CONCLUSION: These data showed that p-Stat3 expression in cervical cancer acts as a predictor of poor prognosis.
Assuntos
Carcinoma de Células Escamosas/mortalidade , Fator de Transcrição STAT3/análise , Neoplasias do Colo do Útero/mortalidade , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/patologia , Colo do Útero/química , Feminino , Humanos , Interleucina-6/fisiologia , Metástase Linfática , Fosforilação , Prognóstico , Taxa de Sobrevida , Neoplasias do Colo do Útero/química , Neoplasias do Colo do Útero/patologia , Fator A de Crescimento do Endotélio Vascular/análise , Proteína bcl-X/análiseRESUMO
BACKGROUND: Although hepatic resection is the most reliable treatment for hepatocellular carcinoma, impaired liver function because of cirrhosis or chronic hepatitis contributes to relatively high rates of postoperative complications. We have reviewed a series of hepatectomies at our institution and investigated risk factors for complications after hepatectomy in patients with impaired liver compared with patients with normal liver. METHODS: From October 1994 to March 1998, 277 hepatectomies for hepatocellular carcinoma, cholangiocellular carcinoma, metastatic liver tumors, and other hepatic diseases were performed. In an attempt to clarify the safety of hepatectomy for the impaired liver at our institution, we did a comparative study of postoperative complications after hepatectomy in 2 groups: patients with impaired livers (187 hepatectomies) and patients with normal livers (90 hepatectomies). RESULTS: Of the 277 hepatectomies, bile leakage occurred in 25 patients (16 in impaired livers vs 9 in normal livers), abdominal infection in 45 patients (30 vs 15 patients), wound infection in 13 patients (9 vs 4 patients), pleural effusion in 52 patients (35 vs 17 patients), atelectasis in 26 patients (17 vs 9 patients), pneumonia in 4 patients (3 vs 1 patients), ileus in 6 patients (3 vs 3 patients), intra-abdominal hemorrhage in 3 patients (0 vs 3 patients), and hyperbilirubinemia in 5 patients (4 vs 1 patients). Hepatic insufficiency and hospital death were not experienced in this series. The mean postoperative hospital stay was 22.9 days (23.5 vs 23.1 days), and except for intra-abdominal hemorrhage there was no statistically significant difference between the 2 groups. CONCLUSIONS: Hepatectomy for the impaired liver is now as safe a procedure as for the normal liver, provided the overall guidelines outlined in our algorithm are followed.
Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Hepatite Crônica/complicações , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bile , Feminino , Hepatectomia/métodos , Hepatite Crônica/patologia , Humanos , Cuidados Intraoperatórios , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Hemorragia Pós-Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologiaRESUMO
HYPOTHESIS: An intraoperative bile leakage test will assist in decreasing postoperative bile leakage in patients undergoing hepatic resection. DESIGN: Randomized controlled trial. SETTING: University hospital. PATIENTS: One hundred three consecutive patients who were scheduled for hepatic resection without biliary reconstruction. Associated cirrhosis was present in 49 patients (48%), and only 24 (23%) had normal livers. Patients were randomized to undergo (n = 51) or to not undergo (n = 52) a bile leakage test, according to age, liver function, and hepatectomy method. The 2 groups were similar in baseline demographics. INTERVENTION: A bile leakage test was carried out by injecting isotonic sodium chloride solution through the cystic duct, and interrupted suturing was taken for a bile leak on the transected liver surface. MAIN OUTCOME MEASURES: The incidence of postoperative bile leakage and the length of the postoperative hospital stay. Bile leakage was defined as continuous drainage, with a bilirubin level of 86 micromol/L or more (> or =5 mg/dL), beyond 1 week. RESULTS: Twenty-one patients (41%) in the test group showed a bile leak, and a median of 1 site (range, 1-6 sites) was closed during the test. Postoperative bile leakage was observed in 3 patients (6%) in the test group and in 2 (4%) in the control group (P = .99). The odds ratio of the event was 1.53 (95% confidence interval, 0.25-9.44). The median postoperative hospital stay lasted 17 (range, 13-47) and 18 (range, 12-41) days for the test and control groups, respectively (P =.98). CONCLUSION: This randomized trial suggested no advantage in using a bile leakage test during hepatic resection.
Assuntos
Bile , Hepatectomia/efeitos adversos , Cuidados Intraoperatórios , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
HYPOTHESIS: Hepatic parenchymal transection is a technical priority in liver surgery. The use of an ultrasonic dissector for hepatectomy may result in less blood loss than conventional clamp crushing. DESIGN: Randomized controlled trial. SETTING: University teaching hospital. PATIENTS: The 132 patients scheduled to undergo partial hepatectomies were randomly assigned to receive hepatic transection by ultrasonic dissector or by clamp crushing (66 patients by each method). INTERVENTIONS: All resections were performed with inflow occlusion and were guided ultrasonographically. Hepatectomies were graded according to a predefined system based on 6 criteria (blood loss, transection time, technical error, surgical margin, landmark appearance, and postoperative morbidity), each with 3 scores (lower scores indicating higher quality). MAIN OUTCOME MEASURES: Blood loss and hepatectomy grade. RESULTS: No difference was found between the ultrasonic and clamp groups in median blood loss (515 mL [range, 15-2527 mL] vs 452 mL [range, 17-1912 mL]; P =.63), transection time (61 minutes [range, 16-177 minutes] vs 54 minutes [range, 7-205 minutes]; P =.58), or transection speed (1.1 cm(2)/min [range, 0.4-4.0 cm(2)/min] vs 1.0 cm(2)/min [range, 0.4-3.0 cm(2)/min]; P =.90). Ultrasonic dissection caused more frequent histologically proven tumor exposure at the surgical margin (9 vs 3 patients; P =.09), incomplete appearance of landmark hepatic veins on the cut surface after anatomical resection (12 vs 4 patients; P =.03), and postoperative morbidity (20 vs 14 patients; P =.32) than did clamp crushing. The hepatectomies with clamp crushing had significantly higher grades than those with ultrasonic dissection (P =.05), as indicated by the lower median sum score (4.0 [range, 0-12] vs 5.0 [range, 0-19]; 95% confidence interval for difference, -2.0 to 0; P =.03). The transection method independently influenced hepatectomy grade (adjusted odds ratio = 3.06; 95% confidence interval, 1.35-6.92; P =.01). CONCLUSIONS: Ultrasonic dissection offers no reduction in blood loss compared with clamp crushing for transection of the liver. Clamp crushing results in a higher quality of hepatectomy and is therefore the option of choice.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hepatectomia/instrumentação , Hepatectomia/normas , Fígado/diagnóstico por imagem , Instrumentos Cirúrgicos , Adulto , Idoso , Feminino , Humanos , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Resultado do Tratamento , UltrassonografiaRESUMO
Alpha-feto protein (AFP) mRNA levels increase in hepatocellular carcinoma (HCC) cells as compared with non-neoplastic tissue. Therefore, detection of AFP mRNA in blood nuclear cells is useful for the evaluation of treatment efficacy and prognosis of HCC. In this study, simple and reproducible methods were developed to quantify AFP mRNA using the real-time RT-PCR assay (Taq Man assay). By using in vitro synthesized AFP and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) RNA, the sensitivity and dynamic range of the RT-PCR assay were established. AFP mRNA in both HCC and non-neoplastic tissue, as well as in cell lines, were measured using this assay system. The expression of the AFP mRNA level was normalized using the GAPDH house keeping gene product as an endogenous reference. AFP and GAPDH mRNA can be quantified in the range of 10-10(8) copies when using this quantitative assay. Among HCC cell lines, Huh 7 and HepG2 cells, respectively, represented 1.5x10(6) and 6.0x10(5) AFP mRNA/10(6) GAPDH mRNA, in contrast to 6, 23 and 230 AFP mRNA/10(6) GAPDH mRNA for HLE, HLF and PLC/PRF/5 cells, respectively. Other cell lines derived from stomach, pancreas, and colon cancers have 10 AFP mRNA copies/10(6) GAPDH mRNA. In liver tissue from patients with chronic hepatitis, and the non-neoplastic portion of the liver from HCC patients, AFP mRNA distributes from 2.5x10(3) to 5.8x10(4)/10(6) GAPDH transcripts. In contrast, AFP mRNA in tumor cells were more than 100-fold higher than that found in corresponding non-neoplastic portions in two patients who had a high level of AFP in serum. The establishment of the TaqMan quantifying system for AFP mRNA may have important clinical implications.
RESUMO
To find more confined criteria for use of passive and/or active immunization for preventing perinatal development of hepatitis B virus (HBV) carrier-state than maternal HBe antigenemia, maternal HBsAg-titers (R-PHA) around delivery and infantile HBeAg-titers-(EIA) are discussed. No children whose maternal HBsAg-titers around delivery were lower than 3(6) developed carrier-state in spite of maternal HBe antigenemia. In addition, at age 2 months serum HBeAg-titers of 6 children who had acquired persistent HBsAb were lower than 25, while those of 5 children who had developed carrier-state were higher than 70. These findings may contribute to the establishment of more confined indications for the administration of HBIG and/or HB vaccine to the children born to HBeAg-positive carrier women, saving not only HBIG and HB vaccine but all accompanied efforts of both patients and medical staff as well.
Assuntos
Portador Sadio/imunologia , Antígenos da Hepatite B/análise , Antígenos de Superfície da Hepatite B/análise , Antígenos E da Hepatite B/análise , Hepatite B/prevenção & controle , Feminino , Hepatite B/transmissão , Antígenos de Superfície da Hepatite B/imunologia , Antígenos E da Hepatite B/imunologia , Humanos , Imunidade Materno-Adquirida , Imunização , Recém-Nascido , GravidezRESUMO
We report here an investigation into the number of phalanges of the 2nd to 5th toes in a Japanese population. The number of phalanges in each of these toes is normally three, distal, middle and proximal. However, occasionally only two phalanges are observed. In this condition, known as symphalangism, the middle and distal phalanges are fused (synarthrosis of the distal interphalangeal joint). The incidence of symphalangism in the 488 feet was found to be 72.5% in the 5th toe, 11.9% in the 4th toe, 0.8% in the 3rd toe, and 0.0% in the 2nd toe. No left-to-right or sex differences were observed. The reported overall incidence of symphalangism in the 5th toe of the foot in the Japanese population (74.7%) is significantly higher than that in the European population (40.2%). In the present sample, the incidence of symphalangism of the 4th toe (11.9%) was significantly higher than that in Japanese population samples previously studied (4.2%).
Assuntos
Povo Asiático , Osso e Ossos/anormalidades , Deformidades Congênitas do Pé/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Osso e Ossos/diagnóstico por imagem , Criança , Europa (Continente)/epidemiologia , Feminino , Deformidades Congênitas do Pé/diagnóstico por imagem , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Radiografia , Caracteres Sexuais , Dedos do Pé , População BrancaRESUMO
Skin temperature, 125 Hz vibratory sensibility and pinch strength of the hand were recorded continuously in adult men through water immersion tests ((1) 40 degrees C (2) 15 degrees C (3) 10 degrees C) and vibratory stress tests ((1) 32 Hz-2 g (2) 32 Hz-3g (3) 125 Hz-2 g) in climatic chambers ((1) 20 degrees C-50% humidity (2) 20 degrees C-50% (3) 30 degrees C-40% and 80%). As a stressor to the hand, the cold water immersion was the most effective. The warm water immersion was effective to slightly decrease the skin temperature and the vibratory sensibility. The younger group showed higher sensitivities of the digital functions than the older group.
Assuntos
Temperatura Baixa , Dedos/fisiologia , Imersão , Vibração , Adulto , Fatores Etários , Clima , Ambiente Controlado , Humanos , Masculino , Temperatura CutâneaAssuntos
Drenagem , Embolização Terapêutica , Icterícia/cirurgia , Sistema Porta , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/complicações , Colangiocarcinoma/cirurgia , Humanos , Icterícia/etiologia , Masculino , RetratamentoAssuntos
Transplante de Fígado , Doadores Vivos , Adolescente , Adulto , Criança , Pré-Escolar , Família , Feminino , Rejeição de Enxerto/epidemiologia , Hepatectomia/métodos , Hospitais Universitários , Humanos , Lactente , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodos , Tóquio , Resultado do TratamentoAssuntos
Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Imunossupressores/sangue , Transplante de Fígado/fisiologia , Tacrolimo/sangue , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressores/uso terapêutico , Transplante de Fígado/imunologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Tacrolimo/uso terapêuticoRESUMO
By applying hepatitis B (HB) immunoglobulin (HBIG) and HB vaccine (vaccine) to 43 infants born to HB e antigen (HBeAg)-positive HB surface antigen (HBsAg) carrier women intramuscularly, and sub-and/or intra-cutaneously, respectively, the clinical usefulness of combined passive and active immunization in preventing infantile development of the carrier state was evaluated. The results obtained in this study are summarised as follows: Of the 43 infants, 5 (11.6%) developed the carrier state and 38(88.4%) were persistent HBsAb-positive. This carrier-rate was found to be significantly lower than that of 78 non-treated infants (73.1%) born to HBeAg-positive carrier women (control). Four of 15 infants (26.7%), who received HBIG every 4 months, developed carrier state, while only one case (3.6%) fell into carrier state in 28 infants who received HBIG every 3 months. In 30 infants whose vaccination was started at 2 or 4 months of age, 93.3% of the cases became persistent HBsAb-positive within 12 months, while 76.9% of 13 infants who underwent the first vaccination at 12 months of age became persistent HBsAb-positive. No adverse effects of HBIG and HB vaccine were observed in this study. In addition, the mean values for serum glutamic pyruvic transaminase (SGPT) were 35 and 69mu/ml in the treated and control groups, respectively. Thus, the present study demonstrates that the infantile development of HBsAg carrier state by HB virus-vertical transmission could be safely, economically and easily prevented by early initiation of vaccination and re-administration of HBIG within 3 months.
Assuntos
Portador Sadio/prevenção & controle , Hepatite B/prevenção & controle , Imunidade Materno-Adquirida , Imunização Passiva , Complicações Infecciosas na Gravidez , Vacinas contra Hepatite Viral/uso terapêutico , Portador Sadio/transmissão , Feminino , Hepatite B/transmissão , Antígenos de Superfície da Hepatite B/análise , Humanos , Lactente , Recém-Nascido , Masculino , GravidezRESUMO
A pure yolk sac tumor (endodermal sinus tumor) of the dysgenetic gonad developed in a 23-year-old woman whose karyotype was mosaic 45X/46X + mar Turner's syndrome is reported. Molecular biological studies showed that the patient's DNA contained a fragment of Y chromosome. This case seems to be extremely rare case of developing a pure yolk sac tumor in a patient with mosaic Turner syndrome with a Y-chromosomal fragment.
Assuntos
Tumor do Seio Endodérmico/genética , Mosaicismo , Neoplasias Ovarianas/genética , Síndrome de Turner/genética , Cromossomo Y , Adulto , DNA/análise , DNA de Neoplasias/análise , Tumor do Seio Endodérmico/complicações , Tumor do Seio Endodérmico/patologia , Feminino , Humanos , Cariotipagem , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Reação em Cadeia da Polimerase , Síndrome de Turner/complicaçõesRESUMO
A case with cervical myelopathy caused by massive calcifications of ligamenta flava is presented. The round radiopaque nodules were found on conventional cervical radiography. Following examination by computed tomography, the nodules were diagnosed as calcified ligamenta flava in the cervical spine. The findings were confirmed at surgery and by histological investigations.
Assuntos
Calcinose/diagnóstico por imagem , Vértebras Cervicais , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Ligamentos , Doenças da Coluna Vertebral/diagnóstico por imagemRESUMO
Our serial physiological studies on "the hand and environment" have been reported these last three years. As a stressor to the hand, cold water immersion was the most effective, and the lower the room temperature was, each stressor became the more effective. As a detector for the function of the hand, the digital temperature was the most valuable. However, for studying the digital temperature, the room temperature should be set at more than 20 degrees C. The counting numbers were reduced by aging and colder temperatures. The nerve conduction velocity SCV or MCV became slower in a colder room, but showed no differences between the two age groups in this study.
Assuntos
Ambiente Controlado , Mãos/fisiologia , Temperatura Cutânea , Estresse Fisiológico/fisiopatologia , Adulto , Fatores Etários , Temperatura Baixa , Dedos/fisiologia , Humanos , Imersão , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Temperatura , Nervo Ulnar/fisiologia , VibraçãoRESUMO
Using the PAP technique, the location of two new membrane-associated placental tissue proteins, MP1 and PP4 was studied in the placenta, its membranes, decidua and umbilical cord of human and cynomolgus monkeys. The results were the same throughout pregnancy. MP1 was located in the syncytiotrophoblast and trophoblastic cells of the reflected chorion. Other placental tissue components (cytotrophoblast, amnion, decidua, and umbilical cord) were negative. At present, MP1 appears to be specific for trophoblast. PP4 was located in the syncytiotrophoblast. Furthermore clear positive staining for PP4 was found in the villous cytotrophoblast, reflected and basal chorion, amnion, umbilical cord and decidua. In addition, PP4 was positive in some granulocyte-like blood cells in the intervillous space. Immunocytochemically, the most positive staining for both proteins was observed in the membrane of villous syncytiotrophoblastic cells. The findings in the placenta of cynomolgus monkeys were similar to those in women. The monkey could, thus, serve as a model for the investigation of these new membrane-associated placental tissue proteins.
Assuntos
Macaca fascicularis/metabolismo , Macaca/metabolismo , Placenta/análise , Proteínas da Gravidez/análise , Animais , Anexina A5 , Membrana Celular/análise , Vilosidades Coriônicas/análise , Citoplasma/análise , Decídua/análise , Feminino , Idade Gestacional , Humanos , Técnicas Imunoenzimáticas , Gravidez , Proteínas da Gravidez/imunologia , Especificidade da Espécie , Trofoblastos/análise , Cordão Umbilical/análiseRESUMO
We determined the optimum 13C-labeling position in phenacetin for use in a breath test to diagnose liver disease based on infrared spectroscopy detection of 13CO2 in exhaled air. ([1-13C]Ethoxy)phenacetin gave the best result. This compound was also employed in a urine test using 13C-NMR spectroscopy. In the urine test, healthy subjects gave a higher signal of phenacetin than of its metabolite, phenetidine, whereas in patients with liver disease the situation was the reverse. The combination of the breath and urine tests may be a valuable new tool for the diagnosis of liver disease.