Therapeutic regimens in acute experimental pancreatitis in rats: effects of a protease inhibitor, a beta-agonist, and antibiotics.

The osmolality of contrast injected retrograde into the rat pancreatic duct did not affect the severity of the pancreatitis (Urografin, 1,300 mOsm/kg, and Hexabrix, 580 mOsm/kg). The severity of the pancreatitis induced in rats was assessed by survival rate, histologic grading, wet lung ratio, and serum levels of amylase, lipase, and trypsin-like activity. Rats with pancreatitis induced by retrograde injected Urografin, lipopolysaccharide, taurocholic acid plus enterokinase were treated with either intravenous (i.v.) FUT-175 (Nafamstat Mesilate), FUT-175 administered by retrograde pancreatic injection, i.v. terbutaline, i.v. piperacillin sodium, piperacillin sodium by retrograde pancreatic duct injection, or a combination of FUT-175 plus terbutaline and piperacillin. Survival among the rats was increased and the incidence of pancreatic infection reduced in rats treated with i.v. piperacillin or with a combination of FUT-175 plus i.v. terbutaline, plus i.v. piperacillin compared to controls.

Intraoperative evaluation of the depth of invasion of gallbladder cancer.

BACKGROUND: It is sometimes very difficult to diagnose the depth of invasion of gallbladder cancer preoperatively. Therefore, we investigated intraoperative examinations to diagnose the depth of invasion. METHODS: A total of 104 patients were included in this study. The relation between macroscopic morphology and the depth of invasion and evaluation of the depth of invasion by intraoperative ultrasonography and frozen section examination were investigated. RESULTS: In all cases of a pedunculated type and a subpedunculated type with thin base, invasion remained within the mucosa. In other types, the depth of invasion was various. The accuracy of diagnosing the depth of invasion by intraoperative ultrasonography and frozen section examination was 73.9% and 85.7%, respectively. CONCLUSIONS: The cancer classified as a pedunculated type or a subpedunculated type with thin base can be diagnosed to remain within the mucosa. In other types, intraoperative ultrasonography and frozen section examination are useful in the diagnosis of the depth of invasion.

Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography.

BACKGROUND: Transabdominal ultrasonography (US) has made the detection of gallbladder polyps easier, but the differential diagnosis of polyps less than 20 mm remains difficult. Therefore, we evaluated the usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of gallbladder polyps. METHODS: Among patients with gallbladder polyps less than 20 mm, we reviewed 89 patients who underwent US and EUS before surgery and assessed the results of differential diagnoses by them. RESULTS: In all, 86.5% of these polyps were precisely diagnosed by EUS. However, only 51.7% were diagnosed by US. Sensitivity, specificity, and positive and negative predictive values of EUS at the diagnosis of carcinoma were 91.7%, 87.7%, 75.9%, and 96.6%, respectively. Those of US were 54.2%, 53.8%, 54.2%, and 94.6%, respectively. CONCLUSIONS: EUS may markedly improve the accuracy of the differential diagnosis of gallbladder polyps. Therefore, EUS is thought to play an important role in determining the treatment strategy for gallbladder polyps.

Oral and maxillofacial reconstruction using the free rectus abdominis myocutaneous flap. Various modifications for reconstruction sites.

The rectus abdominis myocutaneous flap consists of the skin paddle, anterior rectus sheath, rectus muscle and deep inferior epigastric artery and veins. Of these four components, the skin paddle, rectus sheath and rectus muscle could all be adjusted appropriately for reconstruction sites. Only one or two large perforators in the paraumbilical region could easily supply the large abdominal wall. The bulkiness of the rectus abdominis flap is reduced by removal of subcutaneous fat and rectus muscle. These possibilities can provide many modification of the flap for various reconstruction sites. 16 cases were reconstructed primarily and secondarily using this flap after oral and maxillofacial tumour ablation. The results of these cases indicated a very favourable and reliable vascularity. The rectus abdominis myocutaneous flap was considered to be one of the most suitable flaps for oral and maxillofacial reconstruction. Various modifications for different reconstruction sites are mainly discussed.

Bisubsegmental liver resection for gallbladder cancer.

BACKGROUNDS/AIMS: The ultimate goal was to determine the therapeutic value and indications of resection of segment IV inferior and segment V in patients with advanced gallbladder cancer. METHODOLOGY: Indications for systematic resection of the liver, particularly segment IV inferior and segment V as defined by Couinaud (1) or Healey (2), in patients with advanced gallbladder cancer, were examined in a total of 201 patients with advanced gallbladder cancer who underwent surgical resection were studied. RESULTS: All primary tumors invaded the subserosa of the gallbladder wall or deeper. Liver invasion and liver metastasis were studied clinicopathologically, and the long-term outcome was analyzed according to the procedure used for liver resection. CONCLUSION: The clinicopathological result suggests that resection of segment IV inferior and segment V of the liver may be beneficial in patients with liver bed type invasion less than 20 mm in depth.

[Indications for and operative outcome of hepato-pancreatoduodenectomy in the treatment of carcinoma of the gallbladder].

The indications for hepatopancreatoduodenectomy (HPD) are still controversial. Opinion is divided especially concerning the need to perform pancreatoduodenectomy (PD) for lymph node dissection, with some investigators claiming that the peripancreatic lymph nodes can be dissected adequately without PD. Detailed studies of resected specimens in our department have shown that preservation of the head of the pancreas carries an increased risk of leaving behind cancer cells in small lymph nodes and ducts remaining in the peripancreatic region. We therefore perform HPD in all patients at increased risk for metastasis to peripancreatic lymph nodes, as indicated by subserosal invasion with distinct evidence of lymph node involvement, tumor location at the neck or both fundus and body of the gallbladder, and serosa exposure to tumor irrespective of tumor location and lymph node involvement. When the outcome was compared between HPD and hepatic resection plus dissection of peripancreatic lymph nodes (HR), we found that the operative results of HPD were poor with extended lobectomy plus PD because of high rates of postoperative complications and operative mortality. However, the results have gradually improved with the introduction of percutaneous transehepatic portal embolization and advances in perioperative care. Although overall there is no difference between HPD and HR in long-term outcome, the outcome with HPD is significantly better in node-positive patients and patients without hepatoduodenal ligament involvement, there by demonstrating the value of performing peripancreatic lymph node dissection by PD. However, there is no difference between HPD and HR in patients with hepatoduodenal ligament involvement, and attempts to develop other new and effective means of treatment should continue.

[The study for the surgical treatment on distal bile duct carcinoma].

The surgical result in 74 patients with resected distal bile duct carcinoma was reviewed to clarify the surgical strategy of distal bile duct carcinoma. The clinicopathological record was according to the General rules for surgical and pathological studies on cancer of biliary tract(the 3rd edition, edited by the Japanese society of biliary surgery). 58 patients underwent standard pancreatoduodenectomy and 16 patients had pylorus-preserving pancreatoduodenectomy. The curative resection was performed in 38 patients (51.3%). The overall 5-year survival rate (operated death included) was 35.8%. The 5-year survival rate in curative resection was 56.6%. The survival rate of patients with curative resection was significantly better than that of the patients with relative non-curative (p < 0.05) or absolute non-curative resection (p < 0.01). We concluded that the Long-term survival after surgical resection was mostly correlated with curability. To obtain curative resection, the free surgical margin of hw and ew was essential. As for free "hw", intraoperative frozen dissection was indispensable. For free "ew", the dissection of the soft tissues in retroperitoneum at the back of pancreas head was necessary. On the lymph node dissection, the lymph nodes of No 8, 12, 13, 14 should be removed.

The significance of hepatectomy for primary intrahepatic stones.

The objective of this study was to evaluate the significance of performing hepatectomy for primary intrahepatic stones. Observations on the morphology of the bile ducts, histopathological findings of the excised liver, and treatment results were reviewed in 29 of 35 patients with primary intrahepatic stones. The remaining 6 patients (17.1%) were excluded because they had intrahepatic cholangiocarcinoma. The subjects were classified into two groups according to the morphological characteristics of the bile ducts; one group comprised 25 patients having strictures in the central bile duct, and another group comprised 4 patients having no biliary stricture, but a localized dilatation in the distal bile duct. Calcium bilirubinate stones were found in all the patients with a biliary stricture, whereas cholesterol stones were found in those without a biliary stricture. Hepatectomy was performed in 25 of the 29 patients (86.2%), the results of which were excellent. In fact, during the past 10 years, no postoperative complications have occurred, nor have there been any retained or recurrent stones. Moreover, the postoperative hospitalization period was as short as 15.3 days. The findings of this study indicate that hepatectomy allows treatment for primary intrahepatic stones to be completed within a short period of time without incurring serious postoperative complications, and serves as a useful prophylactic technique for recurrent stones.

Variant sublines with different metastatic potentials selected in nude mice from human oral squamous cell carcinomas.

Variant sublines LMF3, LMF4 and LMF5 with high metastatic potential were established from a human oral squamous carcinoma cell line HSC-3. These sublines metastasized to the draining lymph nodes after subcutaneous inoculation into nude mice. They were obtained by sequential selection in vivo from the parent HSC-3. At each step, the cells which metastasized to lymph nodes were cultured and reinoculated into nude mice. Two other cell lines HSC-2 and HSC-4 were also established from other patients, that had neither invasive nor metastatic potential. Biologic properties were compared among high metastatic, low metastatic and non-metastatic cells. Metastatic cells grew rapidly and invaded into surrounding tissues at the inoculated site. The incidence of pulmonary colonization after intravenous injection of tumor cells was high in selected variants. Metastatic cells formed diffuse colonies in type I collagen matrix and had a higher tendency to adhere to type IV collagen network.