Role of Arterial Blood Supply in Orthotopic Whole and Partial Liver Transplantaion in the Rat

Aims: The hepatic artery (HA) thrombosis is a serious complication after liver transplantation (LT). In the present study, role of blood supply from HA to the grafted liver was experimentally investigated. Methods: Rats were grouped into 4: Group I-whole LT without HA reconstruction, Group II-partial (30%) LT without HA reconstruction, Group III - whole LT with HA reconstruction, and Group IV - partial (30%) LT with HA reconstruction. Results: In Group III, posttransplant elevation of serum levels of GOT and total bilirubin was minimal. Those levels in Groups I and II were significantly higher, compared to those in Groups III and IV. Dilatation of the bile duct and bile stasis were evident in 60% and 71% of rats in Group I and II, respectively. In Group II, histological examination demonstrated that proliferation of bile duct around the portal triad was prominent at early period after LT. Those findings were mild and there was no histological evidence of destruction of vascular and bile duct structures in Groups III and IV. Conclusion: These findings were suggestive that arterial blood flow to the grafted liver played an important role to feed nutrients to the biliary tree. In order to prevent damage in the biliary tract, successful reconstruction of HA is essential in LT

Technical Progress in Single-Incision Laparoscopic Cholecystectomy in Our Initial Experience

Single-incision laparoscopic cholecystectomy (SILC) has rapidly spread throughout the world because of its low invasiveness and because it is a scarless procedure. Various surgical methods of performing SILC are present in each institute; however, it is necessary to develop a standardized procedure that we can perform safely, such as the conventional 4-port laparoscopic cholecystectomy (LC). The SILC experiment in our institute was started by use of the commercial SILS Port and changed from a 3-port method via an umbilicus to a 2-port method to improve some problems. Although none of the conversions to conventional 4-port LC and also none of the complications such as bile duct injury occurred in each method, the 2-port method functioned best and was also economical. However, it is most important to adopt strict criteria and select the patients suitable for SILC to demonstrate SILC safety same as 4-port LC

Utilization of Jejunal Segment has Benefit for Reconstruction of the Extrahepatic Bile Duct in the Canine

The feasibility of utilization of the jejunal segment or appendix as the substitute for reconstruction of the common bile duct in biliary surgery was investigated in the canine. Four dogs were used the appendix for biliary reconstruction, and 3 died within 3 months because of cholangitis associated with a stenosis of the anastomotic portion. Nevertheless, 9 dogs, which were replaced by the jejunal segment, survived with no serious complications. Values of serum chemistries were within the normal range during the observation period of 12 months after surgery. No bile leakage, anastomotic stenosis or dilatation of the common bile duct were observed on fistulography from the T-tube examined after surgery. Postmortem histological examination of the graft tissue showed presence of clear distinction between the mucosa of the bile duct and the small intestine. In addition, the epithelium of the small intestine was atrophic and resemble to the adjacent biliary epithelium. Thus, replacement of the intestinal segment reformed by absorbable autosuture appears to be clinically useful for reconstructive bibiary surgery which can preserve the function of the papilla in selected patients

Phenotypes of pain behavior in phospholipase C-related but catalytically inactive protein type 1 knockout mice

Phospholipase C-related inactive protein (PRIP) plays important roles in trafficking to the plasma membrane of GABAA receptor, which is involved in the dominant inhibitory neurotransmission in the spinal cord and plays an important role in nociceptive transmission. However, the role of PRIP in pain sensation remains unknown. In this study, we investigated the phenotypes of pain behaviors in PRIP type 1 knockout (PRIP-1 -/- ) mice. The mutant mice showed hyperalgesic responses in the second phase of the formalin test and the von Frey test as compared with those in wild-type mice. In situ hybridization studies of GABAA receptors revealed significantly decreased expression of γ2 subunit mRNA in the dorsal and ventral horns of the spinal cord in PRIP-1 -/- mice, but no difference in α1 subunit mRNA expression. β2 subunit mRNA expression was significantly higher in PRIP-1 -/- mice than in wild-type mice in all areas of the spinal cord. On the other hand, the slow decay time constant for the spontaneous inhibitory current was significantly increased by treatment with diazepam in wild-type mice, but not in PRIP-1 -/- mice. These results suggest that PRIP-1 -/- mice exhibit the changes of the function and subunits expression of GABAA receptor in the spinal cord, which may be responsible for abnormal pain sensation in these mice

Extended collimator model for pencil-beam dose calculation in proton radiotherapy

We have developed a simple collimator model to improve the accuracy of penumbra behaviour in pencil-beam dose calculation for proton radiotherapy. In this model, transmission of particles through a three-dimensionally extended opening of a collimator is calculated in conjunction with phase-space distribution of the particles. Comparison of the dose distributions calculated using the new three-dimensional collimator model and the conventional twodimensional model to lateral dose profiles experimentally measured with collimated proton beams showed the superiority of the new model over the conventional one

Immunolocalization of antioxidant enzymes in high-pressure frozen root and stem nodules of Sesbania rostrata

34 Pags.- 7 Figs.- 1 Tabl. The definitive version is available at: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1469-8137The activities and localizations of superoxide dismutases (SODs) were compared in root and stem nodules of the semi-aquatic legume Sesbania rostrata using gel-activity assays and immunogold labelling, respectively. Nodules were fixed by high-pressure freezing and dehydrated by freeze substitution. Stem nodules showed more total and specific SOD activities than root nodules because of the presence of chloroplastic CuZnSOD. Most of the total SOD activity of stem and root nodules resulted from 'cytosolic' CuZnSOD, localized in the cytoplasm and chromatin, and from MnSOD in the bacteroids and in the mitochondria of vascular tissue. FeSOD was present in nodule plastids and in leaf chloroplasts, and was found to be associated with chromatin. Superoxide production was detected histochemically in the vascular bundles and in the infected tissue of stem and root nodules, whereas peroxide accumulation was observed in the cortical cell walls and intercellular spaces, as well as within the infection threads of both nodule types. These data suggest a role of CuZnSOD and FeSOD in protecting nuclear DNA from reactive oxygen species and/or in modulating gene activity. The enhanced levels of CuZnSOD, MnSOD and superoxide production in vascular bundle cells are consistent with a role of CuZnSOD and superoxide in the lignification of xylem vessels, but also suggest additional functions in coping with superoxide production by the high respiratory activity of parenchyma cells.This work was supported by the Royal Society (UK), Ministerio de Educación y Ciencia-Fondos Europeos de Desarrollo Regional (AGL2005-01404 and AGL2008-01298) and Gobierno de Aragón (group A53). E.K.J. thanks the Royal Society (UK) and Gobierno de Aragón-Caja Inmaculada (Spain) for funding a sabbatical leave (‘Programa Europa’). M.C.R. was the recipient of a postdoctoral contract (Program I3P) of Consejo Superior de Investigaciones Científicas-Fondo Social Europeo.Peer Reviewe

Single-incision laparoscopic distal pancreatectomy.

Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery, and rapidly evolving in the field of abdominal surgery. However, SILS is not a common procedure for pancreatic surgery. We describe our first experience with a SILS approach in a patient with a metastatic pancreatic tumor. We performed a SILS distal pancreatectomy (SILS-DP) using 3 trocars placed through a single port at an umbilical incision. In our case, the most important surgical technique was the stomach-hanging method to obtain a favorable laparoscopic view of the pancreas. Although SILS-DP is a safe and feasible procedure, further studies are required to determine the advantages of this procedure in comparison with the standard laparoscopic method

A Non-Randomized Comparative Study of Laparoscopy-Assisted Pancreaticoduodenectomy and Open Pancreaticoduodenectomy

Background/Aims: Laparoscopic surgery for periampullary disease is still a challenging operation. The aim of this study was to compare the perioperative outcomes of patients undergoing conventional pancreaticoduodenectomy (PD) with the outcomes of those undergoing laparoscopy-assisted PD. Methodology: A retrospective analysis was conducted on 51 consecutive patients who underwent laparoscopy-assisted or open PD for periampullary disease. Results: There were no significant differences in the preoperative demographic or clinical data of the two study groups. Although there were no significant differences in the operative time between the two study groups, blood loss in the laparoscopy-assisted PD group was significantly smaller than that in the open PD group. There were no significant differences in the occurrence of postoperative complications between the two groups. Conclusions: Laparoscopy-assisted PD is a feasible and safe surgical procedure that provides the advantages expected from a minimally invasive surgery including less blood loss

Ex vivo hepatic venography for hepatocellular carcinoma in livers explanted for liver transplantation

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) is supposed to have a venous drainage system to a portal vein, which makes intrahepatic metastasis possible. However, the mechanism of extrahepatic recurrence, including the possibility of a direct route to the systemic circulation from the HCC nodules, remains unclear. Therefore, we performed retrograde hepatic venography for HCC in livers that had been explanted for liver transplantation in order to explore the possible direct connection between the hepatic vein and HCC nodules.</p> <p>Methods</p> <p>Of 105 living-donor liver transplantations (LDLT) performed up to July, 2009 at the Department of Surgery, Nagasaki University Hospital, dynamic hepatic venography was performed with contrast media under fluoroscopy for the most recent 13 cases with HCC. The presence of a tumor stain for each HCC case was evaluated and compared with the histological findings of HCC.</p> <p>Results</p> <p>Hepatic venography revealed a tumor stain in 2 of 13 cases (15%). Neither showed any microscopic tumor invasion of HCC into the hepatic vein. In the other 11 cases, there were 4 microscopic portal venous invasions and 2 microscopic hepatic venous invasions. No patients have shown HCC recurrence in follow-up (median period, 13 months).</p> <p>Conclusion</p> <p>Using <it>ex vivo </it>hepatic venography, a direct connection to the hepatic vein from HCC in whole liver was revealed in 2 cases without demonstrated histopathological invasion to hepatic vein for the first time in the literature. The finding suggests that there is direct spillage of HCC cells into the systemic circulation via hepatic vein.</p