Long-term results and prognostic factors after repair of abdominal aortic aneurysm with concomitant malignancy.

OBJECTIVE: Long-term results after repair of abdominal aortic aneurysm (AAA) with concomitant malignancy were reviewed, and factors which may affect survival were analyzed. DESIGN: Retrospective series with follow-up of three to 125 months. Setting. Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. PATIENTS: Among 112 consecutive repairs of AAA, 16 cases had concomitant malignancy. The malignant lesions included eight gastric cancers and eight other malignant tumours. The malignancies were divided using TNM Classification into an early stage (stage O or I) group (n=9) and an advanced stage (stage II, III, or IV) group (n=7). INTERVENTIONS: All aneurysms were successfully repaired, and simultaneous resection of the concomitant malignancy was performed in five cases. While 13 malignant lesions were resected completely, three could not be resected completely, but were treated by other surgical procedures. MEASURES: Survival rates were predicated using the Kaplan-Meier method. The log-rank test was used to compare survival rates. RESULTS: The one-, two-, and five-year survival rates after repair of AAA were 80%, 72% and 63%, respectively. The survival rates for the early stage group were significantly higher than those for the advanced stage group (p<0.05). Patients with concomitant gastric cancer or who underwent complete resection of the malignant lesion survived longer. CONCLUSION: In patients with concomitant AAA and malignancy, factors influencing survival for those with malignant lesions also affected survival after aneurysmectomy. Detection of early-stage concomitant malignancy and more aggressive treatment for the malignancy may improve the outcome.

Abnormally shaped arteries in the intestine of children with Hirschsprung's disease: etiological considerations relating to ischemic theory.

Abnormally shaped arteries were found in the intestines of 17 of 62 patients (27%) with Hirschsprung's disease. The histological characteristics of abnormal arteries included proliferation of collagen fibers and smooth muscle cells in the adventitia. The incidence of abnormal arteries in each type of aganglionosis was as follows: 25% (13 of 51) in short-segment aganglionosis; 0% (0 of 6) in long-segment aganglionosis; and 80% (4 of 5) in total-colon or extensive aganglionosis. The older the patients were at the time of resection, the higher the incidence of abnormal arteries (< 1 year old, 15%; 1-3 years old, 38%; > 3 years old, 75%). The abnormally shaped arteries were mostly located in the histological transitional zone. These findings suggest the following possibilities: (a) the craniocaudal migration of ganglion cells was interrupted by intestinal ischemia in the presence of abnormal arteries in utero; (b) an ischemic episode caused both the disappearance of neural cells and dysplasia of the artery; (c) the ganglion cells were destroyed by mild ischemia caused by the abnormal arteries; or (d) the tension caused by mechanical expansion resulted in a change in the vascular walls in the transitional zone.

[The detection of Helicobacter pylori by PCR in gastric diseases].

There are several methods for detecting Helicobacter pylori (H.pylori) infection, but all of them have both advantage and disadvantage. In this study, we investigated the usefulness of PCR as a routine screening method for H.pylori infection. We used PCR by identification of bacterial specific 16SrRNA gene. This test was performed on gastric biopsy specimens and gastric aspirate and stomatic mucus from 23 patients in gastric disease, and compared the sensitivity with other methods such as urease and culture test. We could detect H.pylori above 10(3)/ml of bacterial volume by PCR and H.pylori were positive in 96% of all gastric biopsy specimens. PCR was most sensitive and specific method for detecting H.pylori. Thus, PCR was considered to have a possibility of becoming an accurate routine screening method of H.pylori infection.

Management of colorectal polyps in children.

Forty-two patients each with a colorectal polyp have been treated in our hospital over the past 10 years. In twenty-two cases the polyps were noted in the rectum, nine in the sigmoid colon, seven in the descending colon and four in the transverse colon. Each patient had only one polyp. Hematochezia was the main symptom in 29 patients, prolapse of the polyp from the anus in 10, abdominal pain due to intussusception in two and no symptoms were observed in one. Auto-amputation of the polyp was considered to have occurred in five patients. Twelve rectal polyps were resected from a transanal operation, and another 25 polyps were removed endoscopically with electric cautery. We have had no experience of endoscopic complications such as bleeding or perforation. A histological examination revealed an adenoma in one patient. Other polyps were non-neoplastic and were classified as juvenile, inflammatory and hyperplastic in 30, two and four patients, respectively. There have been no recurrences of polyps to date.

Distribution of neuropeptide Y-like immunoreactivity in the normoganglionic and aganglionic segments of human colon.

The localisation and distribution of neuropeptide Y (NPY)-like immunoreactivity were studied by use of immunohistochemical methods in gut tissues from 19 patients with Hirschsprung's disease, including 4 cases of long segment aganglionosis. In the normoganglionic segment, immunoreactive cell bodies and nonvaricose processes were seen within both myenteric and submucous plexuses. A scarce supply of varicose fibres was found in the lamina propria mucosae, muscularis mucosae and longitudinal muscle layer. NPY fibres were more frequently encountered in the circular muscle layer, although with a weakly immunostaining intensity. In addition, blood vessels in the submucosal connective tissue were surrounded by a typical plexus of varicose, NPY-positive fibres. Immunoreactive endocrine cells could be detected in the colonic epithelium. In the aganglionic segment, numerous nerve fasciculi comprising a small to moderate number of NPY fibres with varicosities were observed throughout the entire layer of the colonic wall. A few varicose, NPY-positive fibres were also contained in the relatively large, hypertrophic nerve fasciculi located in the intermuscular zone and submucosal connective tissue. NPY-immunoreactive fasciculi were more densely distributed in the distal aganglionic segment than in the proximal aganglionic one. On the other hand, the distribution of NPY-positive fibres in long segment aganglionosis was quite different from that in short segment type; in cases of long segment type, no immunoreactive nerve fibres were detected within the circular muscle layer of the proximal aganglionic segment near the oligoganglionic segment and only a few fibres were observed within the hypertrophic nerve bundle of the intermuscular zone.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic innervation of the intestine from a baby with megacystis microcolon intestinal hypoperistalsis syndrome: I. Immunohistochemical study.

A typical case of megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is reported. The patient, an infant girl, was fed only by total intravenous nutrition and is now 3 years old. The distribution of several gut peptides was examined in the resected small intestine using an immunohistochemical method. Vasoactive intestinal polypeptide (VIP) and peptide histidine methionine (PHM)-containing nerve fibers were decreased; however, substance P- and leucine enkephalin (Leu-ENK)-containing fibers were increased. The imbalance between several kinds of gut peptides might be one the causes of aperistalsis in MMIHS. This is the first report about the gut peptides of MMIHS.

Distribution and localization of glial fibrillary acidic protein in colons affected by Hirschsprung's disease.

The distribution and localization of glial fibrillary acidic (GFA) protein were examined by means of immunohistochemistry in normoganglionic, oligoganglionic, and aganglionic segments of colons from 25 patients with Hirschsprung's disease, including four cases of long segment aganglionosis. In normoganglionic segments, GFA protein-positive glial cells were densely distributed within the myenteric plexus, but sparse in the submucous plexus. Aganglionic segments were completely devoid of glial cells with GFA protein immunoreactivity, coinciding with the lack of enteric ganglia. Instead, GFA protein was found specifically in association with the hypertrophic nerve fasciculi and their branches, which were mainly located in the intermuscular zone and submucosal connective tissue in the distal aganglionic segment of diseased bowels. However, two types of short and long segment aganglionosis differed in the distribution pattern of GFA protein; the extrinsic nerve fasciculi in short segment disease extended toward the normoganglionic segment, but in long segment disease they did not reach this area. A moderate number of GFA protein-positive fasciculi were observed within the circular muscle layer of proximal aganglionic and oligoganglionic parts in short segment aganglionosis, while no immunoreactive fasciculi were encountered within the circular muscle layer of the corresponding parts in long segment aganglionosis. Immunohistochemistry for GFA protein can be of excellent diagnostic value for the aganglionic colon with Hirschsprung's disease, since GFA protein immunohistochemistry discloses exclusively extrinsic, hypertrophic nerve fasciculi, characteristic of the bowel in cases of Hirschsprung's disease.

[The report of the 12th and 13th clinical practical training of the Tsurumi University School of Dental Medicine].

This report concerns the state of the patients and the progress of the 12th and 13th clinical practical training. A questionnaire was carried out with the trainees of the 13th clinical practical training and their leaders. Consequently it was learned that a trainee was in charge of ten patients on the average a year. He was able to complete the treatments of 3.5 patients, but was obligated to discontinue them for 1.4 patients, while handling over treatments for 5.2 patients to the next year's trainees or doctors. The progress of the clinical practical training was slow during the first 9 months but the pace increased rapidly during the last 3 months. The results of the questionnaire showed 37% of the trainees were satisfied with the present clinical practical training, but 17% of the trainees were not satisfied. On the other hand 15% of the leaders were satisfied with it, but 48% of the leaders were not satisfied.

Giant epiphrenic diverticulum in a boy with Ehlers-Danlos syndrome.

We treated a 12 year old boy with Ehlers-Danlos syndrome. There were multiple diverticula in the oesophagus, stomach, colon and urinary bladder. Most prominent was the giant epiphrenic diverticulum of the oesophagus, a rare finding as a complication of Ehlers-Danlos syndrome.

An immunohistochemical study of somatostatin-containing nerves in the aganglionic colon of human and rat.

The distribution of somatostatin-like immunoreactive (SOM-LI) nerves was elucidated immunohistochemically in the gut tissues from patients with Hirschsprung's disease and congenital aganglionosis rats. In the normoganglionic human colon, SOM-LI nerve cell bodies were found to a greater extent in the submucous plexus and to a lesser extent in the myenteric plexus. However, they were rarely observed in both the plexuses of the oligoganglionic segment. SOM-LI nerve fibres were widely distributed in the aganglionic bowel. The circular muscle layer of the distal aganglionic segment was densely innervated by SOM-LI nerve fibres which are probably derived from the extrinsic, hypertrophic nerve bundles. A decreased number of the intramuscular nerves fibres were seen in the proximal aganglionic segment. In the colon and rectum from adult and 21-day-old rats, SOM-LI cell bodies were numerous in both plexuses. On the other hand, enteric neurons were completely lacking from the colon and rectum of congenital aganglionosis rats of 21 days old. No neuronal elements staining for SOM were disclosed in these aganglionic segments of mutant rats. A possible origin and pathophysiological role of the extrinsic nerve fibres containing SOM in the diseased bowel are discussed. It is concluded that SOM-LI nerves in the human distal colon comprise both intrinsic and extrinsic elements, while SOM nerves in the rat colon and rectum are of only intrinsic origin.

Efficacy of absolute ethanol injection for upper gastrointestinal massive bleedings with hemorrhagic shock.

We applied the absolute ethanol injection method in 182 cases of massive bleeding with hemorrhagic shock before the performance of emergency endoscopy in 627 cases of upper gastrointestinal bleeding at our department and five related institutions since June 1979. Following results were obtained: Temporary hemostasis could not be obtained in only 2 (1.1%) out of 182 cases; in the remaining 180 cases bleeding was ceased. Rebleeding was seen in 15 cases (8.2%) and new bleeding in 17 cases (9.3%). In 21 (66%) of these cases hemostasis was obtained again by the absolute ethanol injection method. Eight patients (4.4%) underwent emergency operation and 4 patients (2.2%) died from bleeding. The complete hemostasis was obtained in 170 cases (93.4%).

An immunohistochemical study of serotonin-containing nerves in the colon of rats.

The localization of the serotonin-like immunoreactive nerves of the rat colon was investigated by means of immunohistochemistry, utilizing an antibody against serotonin. In non-treated colons, serotonin-positive neuropils were consistently detected around the myenteric plexus. In pargyline-treated colons, serotonin-like fibres were demonstrated in association with either the small intramural blood vessels of the submucosa or the extramural nerve bundles. Treatment with 5-hydroxytryptophan (5-HTP) permitted the visualization of additional serotonin-immunoreactive fibres around the large extramural blood vessels. Immunoreactive nerve cell bodies were demonstrated in the myenteric plexus of colons treated with 5-HTP or colchicine. From these observations, it is suggested that the serotoninergic nerves of the rat colon comprise both intrinsic and extrinsic elements.

Catecholaminergic differentiation associated with S100 protein-positive elements in human neuroblastoma.

The intratumorous distribution of catecholaminergic tumour cells and S100 protein-positive elements of 8 neuroblastomas, 8 ganglioneuroblastomas and 2 ganglioneuromas were studied using catecholamine fluorescence and immunohistochemical staining, respectively. The elements of catecholamine fluorescence were observed in all tumour specimens, even in urinary VMA-negative cases, but the patterns of distribution were not uniform. Catecholamine fluorescence was observed in both tumour cell bodies and neurofibres, and the appearance of the latter but not that of the former correlated with the histological grade of differentiation, thereby suggesting the occurrence of catecholaminergic differentiation within the tumour. S100 protein-positive elements also correlated with the histological differentiation, and were distributed mostly in the area where the catecholamine-containing neurofibres were located. The possible correlation between catecholaminergic differentiation and the appearance of S100 protein-positive elements in neuroblastoma requires close attention.