RESUMEN
Recent developments in imaging technology have enabled CT and MR cholangiopancreatography (MRCP) to provide minimally invasive alternatives to endoscopic retrograde cholangiopancreatography for the pre- and post-operative assessment of biliary disease. This article describes anatomical variants of the biliary tree with surgical significance, followed by comparison of CT and MR cholangiographies. Drip infusion cholangiography with CT (DIC-CT) enables high-resolution three-dimensional anatomical representation of very small bile ducts (e.g. aberrant branches, the caudate branch and the cystic duct), which are potential causes of surgical complications. The disadvantages of DIC-CT include the possibility of adverse reactions to biliary contrast media and insufficient depiction of bile ducts caused by liver dysfunction or obstructive jaundice. Conventional MRCP is a standard, non-invasive method for evaluating the biliary tree. MRCP provides useful information, especially regarding the extrahepatic bile ducts and dilated intrahepatic bile ducts. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRCP may facilitate the evaluation of biliary structure and excretory function. Understanding the characteristics of each type of cholangiography is important to ensure sufficient perioperative evaluation of the biliary system.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico por imagen , Sistema Biliar/diagnóstico por imagen , Colangiografía/métodos , Pancreatocolangiografía por Resonancia Magnética/métodos , Intensificación de Imagen Radiográfica , Adulto , Anciano , Sistema Biliar/anomalías , Sistema Biliar/patología , Enfermedades de las Vías Biliares/patología , Enfermedades de las Vías Biliares/cirugía , Neoplasias del Sistema Biliar/diagnóstico por imagen , Neoplasias del Sistema Biliar/patología , Neoplasias del Sistema Biliar/cirugía , Colangiografía/efectos adversos , Pancreatocolangiografía por Resonancia Magnética/efectos adversos , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Atención Perioperativa/métodos , Medición de Riesgo , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodosRESUMEN
A lesion was discovered in the tail of the pancreas by ultrasonography performed during a health checkup for a 59-year-old Japanese man. Abdominal contrast-enhanced computed tomography (CE-CT) revealed strong enhancement in a 4-cm tumor in the pancreatic tail and in a 1-cm tumor in the pancreatic body. Serum glucagon levels were elevated to 54,405 pg/mL and a preoperative diagnosis of glucagonoma was made. The pancreatic tail and spleen were resected en bloc, along with a protruding tumor in the pancreatic body. However, histopathological evaluation revealed diffuse glucagonoma throughout the pancreas. When we retrospectively reviewed abdominal CE-CT after the operation, the entire pancreas was seen to be enlarged and diffusely enhanced by strong spots. Immunohistochemical examination using anti-CD31 demonstrated rich microvessels in two solid glucagonomas as well as microglucagonoma throughout the entire pancreas, indicating hypervascularity. Enlarged pancreas and diffuse enhancement of the pancreas by strong spots may be characteristic features of diffuse glucagonoma on abdominal CE-CT.
Asunto(s)
Glucagonoma/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Glucagón/sangre , Glucagonoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/cirugía , Radiofármacos , Tomografía Computarizada por Rayos XAsunto(s)
Carcinoma Hepatocelular/patología , Hiperplasia Nodular Focal/patología , Cirrosis Hepática Biliar/patología , Neoplasias Hepáticas/patología , Adulto , Diagnóstico Diferencial , Femenino , Hiperplasia Nodular Focal/diagnóstico por imagen , Humanos , Cirrosis Hepática Biliar/complicaciones , Cirrosis Hepática Biliar/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
This study, utilizing rats subjected to two-thirds partial hepatectomy or sham operation, was designed (1) to investigate the content of basic fibroblast growth factor (bFGF) in the subcellular fractions of regenerating and sham-operated rat livers by immunoblot experiments and enzyme-linked immunosorbent assay (ELISA), (2) to show that bFGF immunoreactivity and proliferating cell nuclear antigen (PCNA) immunoreactivity are markers for hepatocellular mitosis before and after partial hepatectomy, and (3) to observe the location and fine structure of the bFGF immunoreaction within the regenerating liver with special attention to bFGF immunoreactivity in the nuclei of regenerating hepatocytes. Immunoblot experiments and ELISA showed a transient increase in high-molecular-weight forms of bFGF in the nuclear subcellular fraction of regenerating liver 48 h after partial hepatectomy. By light microscopy, bFGF and PCNA immunoreactivities were detected in the nuclei of regenerating hepatocytes. Electron microscopy demonstrated bFGF-like immunoreactivity mainly in the nuclear euchromatin and rarely in the heterochromatin or nucleoli of regenerating hepatocytes. The transient increase in high-molecular-weight forms of bFGF in the nuclear euchromatin of regenerating hepatocytes, together with the concomitant expression of PCNA in the regenerating liver, suggests an important role of the high-molecular-weight forms of bFGF in hepatocyte proliferation and/or mitosis, although authentic bFGF with a molecular form of 18 kDa is not considered to be involved in hepatic regeneration.
Asunto(s)
Núcleo Celular/metabolismo , Endotelio Vascular/metabolismo , Factor 2 de Crecimiento de Fibroblastos/biosíntesis , Regeneración Hepática , Hígado/metabolismo , Animales , Anticuerpos , Biomarcadores , Núcleo Celular/ultraestructura , Cromatina/ultraestructura , Endotelio Vascular/citología , Endotelio Vascular/ultraestructura , Ensayo de Inmunoadsorción Enzimática , Factor 2 de Crecimiento de Fibroblastos/análisis , Hepatectomía , Immunoblotting , Inmunohistoquímica , Hígado/citología , Hígado/ultraestructura , Microscopía Inmunoelectrónica , Mitosis , Fragmentos de Péptidos/química , Fragmentos de Péptidos/inmunología , Antígeno Nuclear de Célula en Proliferación/análisis , Antígeno Nuclear de Célula en Proliferación/biosíntesis , Ratas , Ratas WistarRESUMEN
Platelet factor 4, which has a potent affinity for heparin, has been shown to inhibit the binding of basic fibroblast growth factor to the cell surface receptor and to counteract the biological activities of basic fibroblast growth factor in certain peripheral tissues. In the present in vitro [125I]basic fibroblast growth factor binding experiments, platelet factor 4 consistently inhibited the binding of iodinated basic fibroblast growth factor to cell membranes of the gerbil hippocampus. To investigate the in vivo function of endogenous basic fibroblast growth factor and/or basic fibroblast growth factor receptor possibly activated in the ischemic gerbil brain, we infused platelet factor 4 continuously into the left lateral ventricle with an osmotic minipump. When platelet factor 4 infusion was started within three days after a 3-min ischemic insult, it significantly enhanced ischemia-induced learning disability and ischemic neuronal loss in the CA1 region of the hippocampus, as demonstrated by the results of the step-down passive avoidance task and by subsequent histological examinations. Infusion of platelet factor 4 into the cerebral ventricle of intact gerbils did not affect learning ability or CA1 neuron number. Basic fibroblast growth factor-neutralizing antibody, when infused continuously in the cerebral ventricle, also exhibited a neurotoxic effect in ischemic but not intact gerbils. Basic fibroblast growth factor co-infused with heparin, but not basic fibroblast growth factor alone, rescued a significant number of ischemic neurons which were destined to degenerate without the infusion of heparinized basic fibroblast growth factor, and it prevented ischemia-induced learning disability.(ABSTRACT TRUNCATED AT 250 WORDS)