Blood Sugar in Relation to Endocrine Hormones During Hemorrhagic Shock in Dogs

Wiggers' standard method was used to induce hemorrhagic shock in eighteen anesthetized dogs by bleeding to a mean arterial pressure (MAP) of 50 mmHg for 2 hr and then to 30 mmHg for 1 hr, followed by reinfusion of the shed blood. The experimental protocol was designed to determine the sequence of changes in blood sugar during hemorrhagic shock and its relationship to variations in the underlying endocrine hormones, in particular the levels of insulin, catecholamines and cortisol. Venous blood samples were drawn from all experimental animals at specific regular time intervals for sugar and endocrine hormones determination. In early stages of hemorrhagic shock, blood sugar, catecholamines and cortisol were shown to be raised while insulin levels were not influenced by fluctuations in sugar levels. This suggested that, the effect of catecholamine inhibition on the synthesis of insulin is greater than the blood sugar stimulus on the secretion of insulin. Moreover pancreatic islet cells were shown to be intact at terminal stage by Electron microscopy. Corresponding elevated blood levels of sugar, catecholamines and cortisol were found to have a common goal towards increasing plasma osmolality to effect plasma refill. Persistent hypoglycemia in late stages of hemorrhagic shock was shown to be a major sign of failing neuroendocrine compensatory mechanisms against a shock insult. Electron microscopy revealed severe damage of the pituitary gland at the terminal stage

Impending Gastric Rupture in a Neonate with Gastric Outlet Obstruction due to Malrotation

This is a case report of a neonate with impending gastric rupture due to malrotation with gastric outlet obstruction. A preoperative plain abdominal X-ray showed expansion of the gastric bubble. A barium meal demonstrated an unusual bulging of the gastric wall extending from the fundus to the body of the stomach on the greater curvature side and malrotation of the duodenal loop. At operation a malrotation with volvulus and a rupture of the seromuscular layer with bulging of the mucosa in the stomach was found. We think that this unusual bulging of the gastric wall in the barium meal is an important radiological sign of impending gastric rupture

Pyogenic Liver Abscess: a Study of 18 Patients

Eighteen patients with pyogenic liver abscess were treated at Hiroshima University Hospital, First Department of Surgery and Hiroshima Memorial Hospital between 1979 and August 1984. The most frequent cause of the disease was infection of the biliary tract, accounting for 44%. The most useful diagnostic methods were echography and CT. The use of these, two techniques enabled us to establish diagnosis in almost all the patients. Sufficient drainage of the biliary tract was important in cases of hepatic abscess via the biliary tract. In other causes of hepatic abscess, drainage under echographic guidance was useful in treatment for solitary liver abscess. In cases of multiple liver abscess, it was also considered necessary to puncture the abscess under echographic guidance, to detect the causative organisms, and to use effective antibiotics against that organisms

The degree of microRNA-34b/c methylation in serum-circulating DNA is associated with malignant pleural mesothelioma

Objectives: Malignant pleural mesothelioma (MPM) is an aggressive tumor with a poor prognosis. microRNA-34b/c (miR-34b/c), which plays an important role in the pathogenesis of MPM, is frequently downregulated by DNA methylation in approximately 90% of MPM cases. In this study, we estimated the degree of miR-34b/c methylation in serum-circulating DNA using a digital methylation specific PCR assay (MSP). Materials and methods: A real-time MSP assay was performed using the SYBR Green method. The melting temperature (Tm) of each PCR product was examined using a melting curve analysis. For a digital MSP assay, 40 wells were analyzed per sample. A total of 110 serum samples from 48 MPM cases, 21 benign asbestos pleurisy (BAP) cases, and 41 healthy volunteers (HVs) were examined. Results: Positive range of Tm value for miR-34b/c methylation was defined as 77.71-78.79 degrees C which was the mean 3 standard deviations of 40 wells of a positive control. The number of miR-34b/c methylated wells was counted per sample according to this criterion. The number of miR-34b/c methylated wells in MPM cases was significantly higher than that in BAP cases (P = 0.03) or HVs (P < 0.001). Advanced MPM cases tended to have higher number of miR-34b/c methylated wells than early MPM cases. Receiver-operating characteristic (ROC) curve analysis revealed that three number of miR-34b/c methylated wells per sample was the best cut-off of positivity of MPM with a 67% of sensitivity and a 77% specificity for prediction. The area under the ROC curve was 0.77. Conclusions: Our digital MSP assay can quantify miR-34b/c methylation in serum-circulating DNA. The degree of miR-34b/c methylation in serum-circulating DNA is associated with MPM, suggesting that this approach might be useful for the establishment of a new detection system for MPM

最近6年間に経験したボーダレック孔ヘルニア症例の検討

We treated 13 cases of neonatal Bochdalek's hernia at the 1st Department of Surgery, Hiroshima University Hospital in the 6 years from 1978 to 1983 and have studied on the factors responsible for mortality of neonatal Bochdalek's hernia. The following conclusions were obtained in this study. 1. Of the 13 patients, 7 survived and 6 died. The most frequent cause of death was persistent fetal circulation, the cause of 5 of the deaths. 2. All 3 of the premature newborns died. 3. The earlier the time of onset of symptoms, the higher was the mortality. 4. Five of the 7 patients who required respiratory control by intubation before hospitalization died. 5. The mortality rate for patients with pH less than 7.00, base excess less than－15 mEq/liter, and M index higher than 6 on admission was extremely high. 6. Three of the 7 patients persisting a distinct pressure difference on simultaneous measurement of preductal PaO2 and postductal PaO2 died. In the surviving patients, it was possible to maintain the postductal PaO2 at above 60 mmHg. 7. Trazoline was used on 2 patients, and both died. A thorough study of the time and mode of administration is considered to be necessary

放射線誘発肉腫の1例

This report describes a nine-year-old girl with postradiation sarcoma. The patient was found to have rhabdomyosarcoma in the right hip when she was one year and eleven months old, and received surgery. In addition to chemotherapy, the lesion was irradiated with 3300 rad of 10 Me V electron beam. Six years and eight months after irradiation, postradiation sarcoma arised from the right iliac bone in the irradiated field. Postradiation sarcoma is considered to be an important disease because of its rare occurrence and generally unfavorable prognosis. Therefore, this case report is presented

幼小児の孤立性肝のう種について : 軽微な腹部外傷により発生した2症例

Two cases of infantile solitary nonparasitic cyst of the liver caused by slight contusion were experienced. These cases showed a similar clinical course with symptoms including enlargement of the liver, abdominal pain, and anemia that probably resulted from intracystic hemorrhage. Abdominal echo examination and CT scanning were found effective for the diagnosis of this diseases. As treatment, it is advisable to first administer conservative treatment for improvement of anemia and inflammation and then perform operation. The surgical treatment should be selected so as to preclude recurrence and entail as little invasion as possible. Partial excision of the liver cyst combined with fenestration seemed to be the safest and most effective procedure

腐蝕性食道狭窄に併発した食道癌の1例

A case is presented of carcinoma of the esophagus (Im) which developed at a site of chronic corrosive stricture caused by ingestion of an alkaloid mixture about seventy years previously. Thoracic esophagectomy was performed and the antesternal route reconstruction with esophagogastrostomy was done. The carcinoma was confined to the muscula propria of the strictured esophagus and was surrounded by severe to mild dysplasia. The incidence of carcinoma among patients with chronic corrosive esophageal stricture is significantly higher than that in the general population. But in Japan, the incidence of this type of case has been less than ten. In this case report, we have emphasized that, (1) The risk of carcinogenesis is high after a lapse of 30 years following stricture of the esophagus and that careful examination is needed, (2) The primary cause of malignant transformation of corrosive stricture is long localized irritation in the area where physical esophageal peristalsis has been lost and (3) During surgical treatment for stricture of the esophagus, with or without carcinoma, esophageal resection with reconstruction is better than a bypass procedure for preventing subsequent development of carcinoma