Studies on the Control of Hyperacute Rejection in Hyperimmunized Rat: Combination of Donor Specific Blood Transfusion (DST) and Immunosuppressive Drugs

In order to decrease preformed cytotoxic antibodies, which are the main cause of hyper-acute rejection, donor specific blood transfusion (hereafter designated as DST) was performed. Immunosuppressants were administered at the same time to examine whether the combined treatment with DST can inhibit rapid reproduction of antibodies in the serum of a sensitized recipient. Hyper immunized Fischer rat recipients were used as experimental models. Blood of ACI rat was transfused to the recipients as DST. Beta-methosone and Anti-lymphocyte serum (hereafter designated as ALS) were given as immuno suppressive drugs combined with DST. The heart of ACI rat was transplanted to the hyperimmunized Fischer recipent treated as described above. The cardiac graft survival time was observed and the change in cytotoxic antibody titer of the recipient was determined with the elapse of time. Performed cytotoxic antibodies formed by hyperimmunization were adsorbed or diminished, by DST, and the heart graft survivied for about 54 hr in the group treated with DST, while it was hyperacutely rejected after about 0.4 hr in controls. However, DST was effective only when it was performed once. Transfusion after that acted as a booster, inducing reproduction of anti T-cell warm cytotoxic antibody (CA-TW). Therefore repeated transfusion was thought to be contraindication. Beta-methasone or ALS were administered after adsorption of antibodies by DST in order to prevent antibodies from being rapidly formed again in the serum of a sensitized recipient. The suppressive effect was greatest in the group treated with combination of DST and ALS, and the heart graft survivied for 94 hr. In this group, the pattern of rejection was not hyperacute rejection but acute to accerelated one. It wa revealed that hyperacute rejection can be depressed to some extent

Relationship between the Decrease of Cytotoxic Antibody with the Elapse of Time and Hyperacute Rejection in Hyperimmunized Rats

Preformed cytotoxic antibody which causes hyperacute rejection is formed on gestation, blood transfusion and infection. It is an important problem whether or not transplantation is possible in the recipients sensitized like this. We studied the decrease of preformed cytotoxic antibody with the elapse of time in sensitized recipients and its influence on graft survival time, using inbred rats. Inbred ACI rats and Fischer rats were used as experimental models. Hyperimmunized Fischer rat recipients were prepared by skin grafting and spleen lymphoid cell booster. In order to observe the course of decrease or disappearance of the antibody after sensitization, anti T cell warm cytotoxic antibody (CA-TW) was assayed in rat groups which were hyperimmunized one week, one, three and six months before, respectively. The hearts of ACI rats were transplanted to the groups of hyperimmunized Fischer rat recipients to study the relationship between graft survival time and cytotoxic antibody. 1. Controls: The heart of ACI rat transplanted to nontreated Fischer recipient showed graft survival time of 8.1 ± 1.4 days. 2. Group of rats hyperimmunized one week before: The transplanted ACI heart was hyperacutely rejected 0.55 ± 0.38 hr after grafting in all recipients. 3. Group of rats hyperimmunized one month before: The transplanted ACI heart was hyperacutely rejected in five of the 12 recipients. The graft survival time was 17.2 ± 9.2 hr. 4. Group of rats hyperimmunized three months before: Hyperacute rejection was observed in three of the 12 recipients. The graft survival time was 43.0 ± 28.1 hr. 5. Group of rats hyperimmunized six months before: Hyperacute rejection was not observed. The graft survival time of the transplanted heart was 96.0 ± 37.5 hr. The pattern of rejection varied from accelerate to acute rejection. 6. Spontaneous decrease of preformed cytotoxic antibody after hyperimmunization: Fischer rats were hyperimmunized by skin grafting from ACI rat and five booster shots of spleen lymphoid cell. The change of their antibody titer was examined. CA-TW of the groups hyperimmunized three and six months before, respectively were significantly lower than that for the group hyperimmunized one week before the transplantation. 7. Relationship between preformed cytotoxic antibody titer and graft survival time of transplanted heart: There was a negative correlation between CA-TW titer and graft survival time; r = —0.7274. To sum up, cytotoxic antibody generated by hyperimmunization was decreased with the passage of time. It was thought that the decrease of CA-TW closely related to graft survival time. It was revealed that hyperacute rejection no longer occurred after a lapse of six months after sensitization and that the graft was taken for more than 90 hr and then rejected either by accelerate or by acute rejection

Rare Case of a Giant Hamartomous Polyp of Brunner's Gland

During an investigation of the upper digestive tract of a 61-year-old female patient mainly complaining of hematemesis and melena, a peduculated polyp was discovered in the duodenum, and was surgically removed. Histologically, the polyp was recognized as a hamartomous polyp of Brunner's gland. Concerning the cases reported as so-called "Brunner's gland adenoma" it seems that there is a considerable difference in the histo­logical findings between Japanese cases and Western experiences, and this point is discussed in this paper, referring mainly to our case and other cases reported in Japan

Ascitic Bile Acids in Patients with Liver Cirrhosis

Ascitic bile acids of 8 patients with liver cirrhosis were analyzed in order to elucidate the clinical significance. The results were as follows. 1) Ascitic bile acid concentrations in intractable ascites were high, although low in tractable ascites. 2) Among the 8 patients, 4 had serum bile acid analysis performed and a significant correlation of bile acid concentration was found between ascites and serum (P<0.01). 3) Ascitic bile acid concentration was positively correlative with ascitic protein concentration (P(0.05). 4) In one patient whose group separation on Piperidinohydroxypropyl Sephadex LH-20 was determined, free bile acids were found to predominate the major part of the ascitic bile acids. These results suggest that ascitic bile acids reflect serum bile acids, and that bile acids with protein are filtered into ascitic fluid. Further patient studies will be necessary to shed light on the relationship between intractability of ascites and high ascitic bile acid concentrations

Liver Functional Tests in Patients with Liver Cirrhosis and Chronic Hepatitis Diagnosed by Operative Biopsy of the Liver

The results of the liver functional tests in 45 cases of liver cirrhosis (LC) and 29 cases of chronic hepatitis (CH) confirmed by liver biopsy during operation were compared and studied. It was recognized that there were significant differences of albumin (p < 0.05), prothrombin time (p < 0.01), cholinesterase (p < 0.01) and KICG (p < 0.05) between LC and CH. The rate of hospital death in LC group proved to higher that that in CH group. Therefore, in the cases where LC is diagnosed before or during operation and the decrease in the above four parameters were low, careful consideration for the selection of surgical formulas and post-operative treatment are required

A Rare Case of Appendiceal Mucocele with Myxoglobulosis

A 63-year-old man was admitted with an abdominal mass in the right lower quadrant. The tumor was diagnosed as mucocele of the appendix after admission and surgically removed. The appendix containing gelatinous mucus with numerous round bodies was distended to the size of an egg. Therefore, a diagnosis of myxoglobulosis was postoperatively made. This is a rare disease and the diagnosis has been preoperatively made in none of patients in Japan. The present case could present an echographic pattern characteristic of this cyst. Studies on all available echograms from previous patients could provide information necessary for preoperative diagnosis of myxoglobulosis

Differential Diagnosis of Nodular Goiter by Means of Aspiration Biopsy Cytology: Results in recent five years

A series of the aspiration biopsy cytology (ABC) was conducted on 1092 patients with nodular goiter, and the accuracy of diagnosis obtained preoperatively by the ABC method was studied using 277 cases firmly diagnosed by the surgical operations. As to determination whether a nodule is benign or malignant, 5.5% was noted as false positive, 11.8% as false negative, the overall accuracy being 92.1 %. Upon diagnosis by ABC, much of them were mutually misdiagnosed between papillary proliferation and papillary carcinoma of epithelial cells partially observed in adenomatous goiter, showing the most part to be false positive and false negative. Occult carcinoma was predominated in the false negative cases. In general, although a question remains in a little more false negative cases, ABC itself indicates a high diagnosability with no expected complications. Specially as to malignant nodules, it was superior in nontraumatic determination of histological types, being able to determine the mode of operation already at the stage of examinations for outpatients

Mesenteric Bleeding due to a Ruptured Aneurysm of the Middle Colic Artery

An outpatient with repeated colic attacks of unknown cause was hospitalized and was subjected to CT scan, ultrasound inspection, cytodiagnosis via abdominocentesis, resulting in the diagnosis of epigastrial hematoma. Further angiographical investigation evidenced the presence of middle colic artery. Aneurysm was also detected in the right colic artery. Other celiac arteries, however, were normal. The aneurysms detected were surgically removed with a portion of the intestinal tract. The pathological investigation of the resected aneurysm in the present cast could not prove the association with several other diseases which have been mentioned as possible causes for aneurysm. While only 10 cases of aneurysm at the superior mesenteric arterial branch have been reported, the authors believe that angiographical inspection should indispensably be attempted for diagnosis in cases of abdominal pain or abdominal tumors of unknown causes

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

Gastric Mucosal Lesions in Cases of Nonshunting Procedures for Esophageal Varices

Gastric mucosal lesions in 74 patients with esophageal varices for whom the nonshunting procedure was given in our institute from 1973 to 1983 were studied. Out of 9 patients of operative death, the direct cause of death in 2 patients was acute gastric mucosal lesion (AGML), and both patients belonged to Child C according to Child's Classification. The rate of complication of gastric mucosal lesion before operation was 42%, while it was 64% after operation, and all cases were complicated with liver cirrhosis. Among 31 cases in whom the condition before and after operation in the same case was compared, and found that gastric mucosal lesions were aggravated after operation in 12 patients (39%). The rate of post-operative aggravation of gastric mucosal lesions classified by the surgical formula was 18.8% of esophageal transection, and in comparison Hassab's operation was a high as 61.1%. In patients with liver cirrhosis, the defensive factors of the gastric mucosa had been reduced. Hassab's operation which changes the gastric mucosal blood flow by periesophago-gastric devascularization has a high possibility of aggravating gastric mucosal lesions