Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection.

Although many reports have described laparoscopic minor liver resections, major hepatic resection, including right or left lobectomy, has not been widely developed because of technical difficulties. This article describes a new technique for performing laparoscopy-assisted right or left hepatic lobectomy using hilar Glissonean pedicle transection. Laparoscopic mobilization of the right or left hepatic lobe is performed, including dissection of the round, faliciform, triangular, and coronary ligaments. The right or left Glissonean pedicle is encircled and divided laparoscopically. A parenchymal dissection is then performed though the upper median or right subcostal incision, through which the resected liver is removed. We successfully performed this procedure in 6 patients without blood transfusion or serious complications. Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection can be feasible and safe in highly selected patients.

Overexpression of glucose transporter 1 in esophageal squamous cell carcinomas: a marker for poor prognosis.

SUMMARY: Recently, Glut1 (human erythrocyte glucose transporter) expression has been demonstrated in various tumors. The aim of this study is to evaluate the prognostic utility of Glut1 expression in esophageal carcinomas. We studied Glut1 expression by immunohistochemistry of paraffin sections from 63 esophageal squamous cell carcinomas. All 63 carcinomas expressed Glut1. The mean percentage of positively stained tumor cells was 77.8% (median, 84.7%). There were two staining patterns in positive cells: 'strongly positive' and 'weakly positive'. The percentage of 'strongly positive' cells (%Glut1-SP) ranged from 0% to 95.6% (mean, 32.3%; median, 27.4%). The 5-year survival rate for patients with a high %Glut1-SP (> 30%) was significantly lower than that for patients with a low %Glut1-SP (< 30%) (P < 0.01). Statistical analysis revealed that the relative risk of death for patients with high %Glut1-SP was 2.02 times that for patients with low %Glut1-SP (P = 0.064), suggesting a possible independent predictive value for %Glut1-SP.

[Primary renal non-Hodgkin's lymphoma presenting as immune thrombocytopenia].

A 25-year-old man was admitted to our hospital because of hematuria, anemia and thrombocytopenia. Laboratory examinations revealed an increased number of bone marrow megakaryocytes and an increased level of platelet-associated immunoglobulin G, suggesting immune thrombocytopenia. Computed tomography of the abdomen showed enlargement of the bilateral kidneys with multiple low-density areas, although neither lymphadenopathy nor hepatosplenomegaly was evident. After amelioration of the thrombocytopenia by prednisolone therapy, open renal biopsy was performed and a diagnosis of diffuse large B-cell non-Hodgkin's lymphoma was made. The patient achieved complete remission after CHOP therapy. This was thought to be a rare case of primary renal non-Hodgkin's lymphoma initially presenting as immune thrombocytopenia, which was treated successfully by chemotherapy.

A method for measuring specific IgE in sera by direct ELISA without interference by IgG competition or IgG autoantibodies to IgE.

BACKGROUND: In measuring specific IgE levels in sera by direct ELISA, competition with coexisting IgG often impedes an exact IgE determination; additionally, IgG autoantibodies to IgE (IgG-IgE) in sera affect the assay. In this paper, we attempt to determine accurate specific IgE levels by selective removal of IgG with a protein G-immobilized gel (PG) and by acid treatment of the PG to compensate for the unintended removal of IgE, probably due to the PG binding IgG-IgE. METHODS: IgG in sera was removed using PG at pH 7.0. Then, the PG was treated with citrate buffer at pH 3.0 for 5 min to liberate IgE from IgG-IgE complexes, after IgG-binding sites on the PG were saturated with bovine IgG, since PG came to bind IgE at acidic pHs. IgE levels were then measured by ELISA. RESULTS: The PG treatment of sera removed the effect of inhibitory competition by coexisting IgG, especially at higher concentrations of sera, to improve specific IgE detection by direct ELISA. However, PG treatment alone sometimes reduced IgE levels (39% of sera tested), even though PG does not bind IgE at pH 7.0, which indicated the presence of IgG-IgE complexes. The reduction in IgE returned almost to their original levels in the sera by acid treatment of the PG. By combining the PG treatment with acid treatment, specific IgE measurement in sera was improved significantly (p < 0.01, Wilcoxon signed rank test). CONCLUSION: Measurement of specific IgE in sera by direct ELISA was improved by using the PG and acid treatment technique.

Review article: acute inorganic mercury vapor inhalation poisoning.

Mercury contamination is a serious environmental problem worldwide. Two primary sources of contamination are dumping of large quantities of inorganic mercury and exposure in the mining industry. Although the actual fatal level of mercury vapor is not known, exposure to more than 1-2 mg/m3 of elemental mercury vapor (Hg0) for a few hours causes acute chemical bronchiolitis and pneumonitis. Two hours after exposure, lung injury appears as hyaline membrane formation, and finally, extensive pulmonary fibrosis occurs. Clinical findings correlate with the duration of exposure, the concentration of mercury, and the survival time after exposure. There is no correlation between pathological findings and the concentration of mercury in the tissues. Necrosis of proximal convoluted tubules may be attributed to the disruption of the enzyme systems of Hg2+-sulfhydryl compounds. Metallothionein protein (MT), induced by the accumulation of Hg2+ in the kidneys, may play an important role in detoxication after it forms a non-toxic Hg2+-MT compound. Despite the deposition of mercury in the brain, compared with organic mercury, inorganic mercury did not seem to damage the neurons. Drugs such as chelating agents and corticosteroids appear to effectively decrease the inflammation and delay pulmonary fibrosis.

Properties of a YAP powder scintillator as alpha-ray detector

A YAP scintillator (YAlO3: Ce crystal) for alpha counting has been produced in powder form and this paper describes its performance characteristics. By measuring pulse-height and rise-time distributions, it was found that the YAP powder, as a fast detector for alpha rays, could clearly distinguish alpha events from beta and gamma events. In addition, the YAP powder was used in a phoswich detector combined with a YAG (Y3Al5O12: Ce) crystal for beta and gamma detection.

Semen specific gamma-glutamyltransferase carries ABH antigens: a sandwich ELISA for simultaneous semen detection and its ABO blood typing.

Semen type of gamma-glutamyltransferase (gamma-GTP) is different from the membrane bound type of the enzyme in both biochemical and immunological properties, and consists of two subunits (150 and 95 kDa). We found that anti-ABH antibodies recognize a 150-kDa subunit of seminal gamma-GTP by Western blot and immunoprecipitation analyses. Using SG2, one of anti-semen specific gamma-GTP monoclonal antibodies which we had produced, and anti-ABH antibodies, we established a sandwich ELISA for identifying human seminal gamma-GTP and its ABO type simultaneously. This sandwich ELISA allows ABO typing of highly diluted semen. The dilutions for ABO typing were 10(5) times for A or O, and 10(4) times for B. Furthermore, ABO typing of semen was successfully performed by this ELISA, even in the mixed presence of vaginal fluid, saliva and blood. Thus, seminal gamma-GTP carries ABH antigens and the sandwich ELISA with SG2 and anti-ABH antibodies enables ABO typing of semen. The sandwich ELISA is extremely useful for ABO typing originated from semen in the mixture of biological fluids.

Reconstruction of defects of the entire vermilion with a buccal musculomucosal flap following resection of malignant tumors of the lower lip.

We reconstructed a defect of nearly the entire lower vermilion using a buccal musculomucosal flap following resection of a malignant tumor of the lower lip and obtained satisfactory results. The buccal musculomucosal flap was semi-spindle shaped and pedicled at the angle of the mouth. A flap measuring as much as 1.5 cm in width and 5 cm in length could be raised while ensuring that fibers of the buccinator muscle extended over its entire length. Using this technique, it was possible to reconstruct a wide defect following tumor resection and removal of almost the entire lower vermilion by means of only a transposition of a unilateral buccal musculomucosal flap after about one-quarter of the lower lip had been excised and sutured primarily. Reconstruction with this technique is a two-stage operation, and a secondary minor touch-up operation is performed on the angle of the mouth at the same time as repair of the dog-ear of the pedicle. Advantages of this technique are that food can be taken orally soon after the operation, hemodynamics in the flap are maintained stably because the flap contains fibers of the buccinator muscle, and the vermilion is given a natural eminence. In addition, postoperative drooling is minimized, and sensation returns to the vermilion within the early postoperative period. Based on these advantages, we think our technique should be the first choice for carrying out reconstruction of defects that are located mainly in the lower lip vermilion because this is a safe and reliable method with which we performed 12 cases of vermilion reconstruction without flap necrosis and with satisfactory aesthetic and functional results.

Effects of prostaglandin E1 on cultured dermal fibroblasts from normal and hypertrophic scarred skin.

To investigate the role of prostaglandin (PG) E1 in preventing scar formation as well as that of the related cytokines, we culture fibroblasts from hypertrophic scar tissue (SDF) and normal dermis (NDF) collected from patients with scar contracture. We have compared the type I collagen synthesis, type I collagenase activity, and the production of interleukin (IL)-6, IL-8 and transforming growth factor (TGF)-beta(1) in two types of cultured fibroblasts before and after addition of PGE1. Our results demonstrated that levels of type I collagen and TGF-beta(1) production were higher and that type I collagenase activity and IL-8 production were significantly lower in the culture supernatants of SDF. There was no significance difference in IL-6 production between SDF and NDF culture supernatants. On the other hand, PGE1 significantly increased type I collagenase activity and IL-8 production in the SDF culture supernatants and it increased IL-6 and TGF-beta(1) production in both types of fibroblasts. However, there was no effect on synthesis of type I collagen in either group. To further investigate the role of TGF-beta(1) in NDF and SDF, exogenous recombinant human (rh) TGF-beta(1) was added. In NDF group, rhTGF-beta(1) induced a decrease in the type I collagenase/type I collagen ratio, while rhTGF-beta(1) had no effect on the same ratio in the SDF group. These results suggest that PGE1 may have a role in the prevention of hypertrophic scar by increasing the activity of type I collagenase.

Primary maxillary reconstruction after radical maxillectomy using a combined free flap and secondary dynamic suspension.

We report a case of maxillary reconstruction aimed at optimizing facial contour, oral function, and facial animation after radical maxillectomy. In the first stage, using combined latissimus dorsi serratus anterior flaps attached with ribs, we performed a three-dimensional restoration for midface defects. In the second stage, we performed dynamic reconstruction of the nasolabial fold and upper lip using a temporal muscle transposition. As a result, the upper lip was able to be elevated as much as 10 mm when the patient clenched his teeth, and the outcome was judged to be both aesthetically and functionally satisfactory.

An operation for Stahl's ear.

We devised an operation to correct Stahl's ear, a rare but difficult to treat auricular malformation. First, a wedge excision is made of the anterior skin and cartilage of the abnormal, third crus prominence. The abnormal, flat part of the helix is excised. A conchal cartilage graft is used to support the area after closure of the defect, including advancement of the helical edges. The procedure has been used in five cases with satisfactory results.

Effects of cytokines in burn blister fluids on fibroblast proliferation and their inhibition with the use of neutralizing antibodies.

Recent studies have shown that tissue exudates, such as burn blister fluid and donor site wound fluid, have promotive effects on wound healing. In the present study, results obtained with enzyme-linked immunosorbent assays showed that at least three cytokines, transforming growth factor-beta1, transforming growth factor-alpha, and interleukin-6, exist at high concentrations in burn blister fluids. It was also found that these exudates were able to greatly enhance the rate of human fibroblast proliferation. However, neutralizing antibodies to transforming growth factor-beta1, transforming growth factor-alpha, interleukin-6, and platelet-derived growth factor failed to prevent this proliferative effect. Ultrafiltration of the exudates showed these cytokines to be in the high molecular weight fractions (30 to 300 kDa and >300 kDa) and that these fractions retained mitogenic activity toward fibroblasts. Therefore it was postulated that the cytokines were bound to high molecular weight substances such as serum proteins in these exudates and could escape neutralization by antibodies directed against them.

Clinical effectiveness of an ointment containing prostaglandin E1 for the treatment of burn wounds.

This report discusses the effectiveness of conservative treatment of burns using applications of prostaglandin E1 (PGE1) containing ointment (PGE1 ointment) to the wound site. Fourteen patients with superficial dermal burns (SDB), deep dermal burns (DDB) and full-thickness dermal burns (DB), who were treated with repeated applications of this ointment, showed rapid epithelialization of the affected tissue. Hypertrophic scarring after epithelialization was less than that expected after other therapies. The degree of scarring was graded as 'none', 'mild', 'moderate' or 'severe'. The results of this therapy revealed no scarring in two sites (8.7 per cent), mild scarring in 16 sites (69.6 per cent), moderate scarring in one site (4.3 per cent) and severe scarring in four sites (17.4 per cent) out of 23 sites distributed among the patients. The application of PGE1 ointment in combination with skin grafting surgery was found to improve functional and aesthetic results in the patients with DDB and DB, by minimizing the area of the donor site; it was especially useful for children with extensive burns because of the shortage of available tissue as donor site material for skin grafting.

Studies on cytokines related to wound healing in donor site wound fluid.

This study was performed to evaluate cytokines in donor-site wound fluids and to determine their effect on wound healing. A film dressing was applied to the donor-site wound of 24 patients immediately after a split-thickness skin graft was taken. On the 5th day after treatment, 2-3 ml of the fluid retained under the film dressing was collected by means of puncture with a syringe. Growth factors and cytokines considered to accelerate wound healing were present in relatively large amounts in the exudate. Very low concentrations of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) were detected by a commercially-available enzyme-linked immunosorbant assay (ELISA) kit. However, the presence of both growth factors in wound fluid could not be confirmed because of the possible cross-reactivity of the antibodies to other EGF and FGF family growth factors. In contrast, platelet derived growth factor (PDGF), interleukin-6 (IL-6), transforming growth factor-alpha (TGF-alpha) and TGF-beta were present in relatively large amounts. The finding that certain cytokines coexist in a balanced state under the film dressing suggests that epithelization can proceed, since an adequate balance would insure proper regulation by the cytokine network. Our present study increases the likelihood that film or hydrocolloid dressings will be used more frequently in the future for treatment of burn wounds, ulcers or donor-site wounds since these dressings were shown to be more capable than ointments of retaining cytokines, particularly intrinsic growth factors secreted at the wound site.

A sandwich enzyme-linked immunosorbent assay for human seminal gamma-glutamyl transpeptidase.

A sandwich enzyme-linked immunosorbent assay (ELISA) was developed for detecting human seminal gamma-glutamyl transpeptidase (gamma-GTP) using a combination of anti-seminal gamma-GTP monoclonal antibodies. These monoclonal antibodies did not react with human ovary or uterus in immunohistochemical study. Optimal assay condition, resulting in a sensitive assay with a low background, is presented. The detection limit of this assay was estimated to be 1 ng/ml of seminal gamma-GTP corresponding to about 100,000 times dilution of seminal sample. This ELISA was specific for seminal gamma-GTP, without cross-reactivity to renal or hepatic gamma-GTP, normal blood serum, non-coital vaginal fluid or saliva. The recovery of seminal gamma-GTP added to various biological fluids were also examined.

Pneumocephalus caused by fistulas of the mastoid air cells treated with a temporoparietal fascial flap.

Using a temporoparietal fascial flap and hydroxyapatite ceramics, we treated a patient for complications after a neurosurgical operation for glossopharyngeal neuralgia. These consisted of pneumocephalus and cerebrospinal fluid rhinorrhea resulting from fistulas of mastoid air cells associated with a subcutaneous dead space. By means of the temporoparietal fascial flap, we were able to fill the dead space and reinforce the repaired dural and mastoid lesion as well. Hydroxyapatite ceramics were also useful for closing the mastoid air cell fistulas.

A study of cytokines in burn blister fluid related to wound healing.

This report indicates that retention fluid from blisters of partial skin thickness burns, which contains relatively large amounts of cytokines and growth factors, stimulates the wound healing process. Although epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) levels were low, relatively large amounts of cytokines including platelet derived growth factor (PDGF), interleukin (IL-6) and transforming growth factor (TGF) alpha were present and these exercised stimulatory effects on wound healing. TGF beta, which plays an important role in collagen metabolism and in scar formation, was also detected. Contrary to our expectations, IL-1 alpha and beta, both of which initiate inflammation, were detected at relatively low levels whereas IL-8 levels were rather high. Various cytokines were shown to coexist in a balanced state in the retention fluids, suggesting that epithelialization might be regulated via a cytokine network operating on the wound surface. The growth of keratinocytes in culture significantly increased with the addition of 1 per cent or more of blister fluid to the medium.