Surgical Treatment for Insulinoma: a Study of 6 Cases

The authors treated six patients with insulinoma in our department during a period up to 1984, and performed seven operations including one re-operation. In this paper, the results of our study of the clinical symptoms, diagnosis and surgical formula in these cases are presented. Selective angiography and percutaneous transhepatic portal venous sampling (PTPVS) proved useful for pre-operative tumor localization diagnosis. Blood glucose monitoring during operation became a good index for the selection of the surgical formula. In the cases of surfacial and single tumors, enucleation alone was able to obtain satisfactory surgical results. In the cases, however, when re-operative, deep or multiple tumors were suspected, staged distal pancreatectomy under blood glucose monitoring was considered to be indicated. It was therefore thought that the preservation of the pancreas should be made as far as possible

Experimental Studies on Acute Gastric Mucosal Lesion Involved with Obstructive Jaundice: Mainly on the Changes of Amine Contents in the Gastric Mucosa on Cold Restraint Stress

The authors gave load of cold restraint stress to rats with obstructive jaundice and those on which biliary drainage was performed in order to examine the incidence of AGML, amine contents in the gastric mucosa, and gastric mucosal microcirculation, and the following results were obtained: 1) The incidence of AGML in the 3,4-week group of rats with obstructive jaundice and in the 4-week group of rats with biliary drainage after cold restraint for 30 min was increased markedly by 78% for each as compared with 22% in the control group. 2) The contents of histamine and serotonin in the gastric mucosa in the control group showed no significant change after cold restraint for 30 min, whereas the contents of both amines in the 3,4-week group of rats with obstructive jaundice and in the 4-week group of rats with biliary drainage were, respectively, significantly decreased after cold restraint. 3) Gastric mucosal microcirculation in the control group was prevented rather successfully, whereas that in the 4-week group of rats with obstructive jaundice after cold restraint for 30 min developed disturbance of gastric mucosal microcirculation due to congestion

Magnetic Resonance Imaging of Kernohan\u27s Notch in Chronic Subdural Hematoma: Significance of Coronal Images for Preoperative Diagnosis

A 67-year-old man presented with headache and gait disturbance. On admission, he was mildly confused but aroused by verbal stimulus, with normal motor function. A CT scan showed bilateral subdural hematomas (right >> left) and a midline shift to the left. One hour after admission, he suddenly became somnolent and developed right hemiparesis. While repeated CT examinations failed to reveal new findings, coronal MRI clearly depicted the left cerebral peduncle pressed against the free edge of the tentorium. Craniotomy was immediately performed to remove the right chronic subdural hematoma. Soon after the operation, neurological functions were markedly improved. When paradoxical (ipsilateral to the lesion) motor deficit is observed in patients with head injuries, including cases of chronic subdural hematomas, coronal MR imaging and magnetic resonance angiography should be immediately performed to detect Kernohan\u27s notch and to rule out other possible complications, such as diffuse axonal injury or cerebral stroke

Surgical Treatment of Pancreatic Cysts: Review of 21 Cases

Twenty one patients with the pancreatic cyst on whom operation was given in our department from 1965 to 1984 were divided into those with the inflammatory cyst (16 cases) and with the neoplastic cyst (5 cases), and the surgical results were examined. The surgical formulas of the inflammatory cyst were further divided into 9 cases of internal drainage of the cyst into the gastrointestinal tract, 1 case of external drainage, and 6 cases of cyst excision together with the resection of the pancreas, and the results were rather satisfactory. On the other hand, the cases of the neoplastic cyst were divided into 2 cases of cystadenocarcinoma, 1 case of cystadenoma and 2 cases of mucinous adenocarcinoma. The contents in the cyst were all mucinous. It is considered that, when the contents of the pancreatic cyst are mucinous, its malignant potential is high. Since examination during operation is often insufficient, we have been trying to recommend resection so far as possible

新しい膵頭十二指腸切除術犬モデルにおける BTPABA test による膵外分泌機能の変動

An experimental study on the changes in the pancreatic exocrine functions before and after pancreaticoduodenectomy (PD) for the treatment of periampullary carcinoma was performed. Pancreatic insufficiency models with pancreatic duct stenosis was prepared with dogs by giving them complete ligation of the minor pancreatic duct and intubation into the major pancreatic duct. After 3 months of pancreatic duct stenosis, intubation placed into the major pancreatic duct was withdrawn to drain the pancreatic juice. At the same time, approximately 50% pancreatectomy, with approximately 50 cm duodenojejunectomy, was performed to prepare a PD model. The results of the N-benzoyl-L-tyrosyl-p-aminobenzoic acid test (BTPABA test) showed reduction in what during stenosis of the pancreatic duct. Although the results of the BTPABA test shortly after reoperation showed reduction, a gradual recovery was noted, returning in 4-5 months to almost the same level as before the operation. The findings of the present study indicate that pancreatic exocrine insufficiency in periampullary carcinoma is due to pancreatic duct obstruction, and that the post-PD pancreatic exocrine function can be successfully maintained at the level close to that in normal sujects if drainage of the pancreatic duct functions effectively

PGC-1α-Mediated Branched-Chain Amino Acid Metabolism in the Skeletal Muscle

<div><p>Peroxisome proliferator-activated receptor (PPAR) γ coactivator 1α (PGC-1α) is a coactivator of various nuclear receptors and other transcription factors, which is involved in the regulation of energy metabolism, thermogenesis, and other biological processes that control phenotypic characteristics of various organ systems including skeletal muscle. PGC-1α in skeletal muscle is considered to be involved in contractile protein function, mitochondrial function, metabolic regulation, intracellular signaling, and transcriptional responses. Branched-chain amino acid (BCAA) metabolism mainly occurs in skeletal muscle mitochondria, and enzymes related to BCAA metabolism are increased by exercise. Using murine skeletal muscle overexpressing PGC-1α and cultured cells, we investigated whether PGC-1α stimulates BCAA metabolism by increasing the expression of enzymes involved in BCAA metabolism. Transgenic mice overexpressing PGC-1α specifically in the skeletal muscle had increased the expression of branched-chain aminotransferase (BCAT) 2, branched-chain α-keto acid dehydrogenase (BCKDH), which catabolize BCAA. The expression of BCKDH kinase (BCKDK), which phosphorylates BCKDH and suppresses its enzymatic activity, was unchanged. The amount of BCAA in the skeletal muscle was significantly decreased in the transgenic mice compared with that in the wild-type mice. The amount of glutamic acid, a metabolite of BCAA catabolism, was increased in the transgenic mice, suggesting the activation of muscle BCAA metabolism by PGC-1α. In C2C12 cells, the overexpression of PGC-1α significantly increased the expression of BCAT2 and BCKDH but not BCKDK. Thus, PGC-1α in the skeletal muscle is considered to significantly contribute to BCAA metabolism.</p></div