Trans-mesosigmoid cutaneous ureterostomy.

BACKGROUND: A new method was developed in order to create a single stoma cutaneous ureterostomy in which both ureters traverse the abdominal cavity and yet are buttressed by the mesosigmoid and covered by its visceral peritoneum. METHODS: The long mesenterium which is attached to the most mobile part of the sigmoid colon was used for the bilateral ureteral pathway. Tunnels for the ureteral path were made just underneath the visceral peritoneum on the bilateral side of the mesosigmoid. Through the tunnels both ureteral ends were brought from the retroperitoneal space to the mesenterocolonic junction (MCJ) and the MCJ is then approximated and sutured to the inside of the ureteral tract through the abdominal wall. The ureters brought outside the skin, are conjoined and sutured to the V skin flap. Eight patients who carried a high risk for operation and/or had a bladder tumor judged to be incurable underwent this cutaneous ureterostomy. RESULTS: All cases except one with low urinary output could be managed without catheter indwelling during the follow-up period. Three patients suffered from paralytic ileus and one required laparotomy for mechanical ileus during the short postoperative period. Postoperative excretory urography evaluated 14 kidneys during the follow-up period from 2 to 61 months and showed normal upper urinary tract in 11 and a mildly hydronephrotic tract in three. CONCLUSIONS: Transmesosigmoid cutaneous ureterostomy provides a single catheterless stoma even when the available ureters are relatively short. It appears to be a good method for supravesical urinary diversion when indicated.

In situ perfusion by retrograde cannulation of a tumor artery for nephron-sparing surgery.

BACKGROUND: Although ice slush cooling or ex situ perfusion with bench surgery is most widely used for protecting ischemic renal damage which possibly accompanies complicated nephron-sparing surgery, each has its own disadvantages. The former does not allow excessively long ischemia and the latter requires complicated procedures as autotransplantation. In order to mitigate against these problems, we devised a novel method of in situ renal perfusion with intracellular hyperosmolar solution. METHODS: One renal segmental artery mainly supplying a tumor was isolated and cannulated with a small feeding tube. The tube was introduced through a small arteriotomy incision directed towards the proximal side, advanced until its tip remained in the main or first branch of the renal artery, and then it was anchored to that artery. After the main renal artery and vein were clamped, the kidney was perfused with cold Euro-Collins' solution through the tube, while the venous blood and perfusate were drained from the left gonadal vein or small venotomy incision of the right renal vein. RESULTS: In one case of renal cell carcinoma and three cases of angiomyolipoma, two of which ruptured, nephron-sparing surgery was carried out under in situ hyperosmolar perfusion. Ischemic time of these four cases was an average of 96 minutes, varying from 45 to 145 minutes. All the kidneys functioned well postoperatively. CONCLUSIONS: The method presented here is very simple, requires no unusual dexterity and safely allows for a long period of renal ischemia. This method is best indicated in cases where simple clamping of the renal pedicle with ice-slush cooling appears insufficient, yet ex situ surgery with autotransplantation seems excessive.

Changes in activity levels and isozyme patterns of isoleucine aminotransferase in response to experimentally induced hepatic lesion.

Branched-chain amino acid aminotransferase activities were measured in rats in which hepatic lesions were induced experimentally, that is, fatty liver produced by an orotic acid-containing diet and acute hepatic lesion induced by D-galactosamine injection into the abdominal cavity. The levels of the enzyme activities, using L-isoleucine as substrate, were elevated in both cases. Among the isozymes (enzymes I, II and III) of the enzyme, the activity of enzyme I was elevated by orotic acid treatment. However, with D-galactosamine treatment, another isoleucine aminotransferase activity was chromatographically separated from that of enzyme I and is considered to be enzyme III, and not enzyme II, based on its substrate specificity.

["Dismembered spiral flap pyeloplasty" for uretero-pelvic junction obstruction].

We report a new operative technique for plastic correction of uretero-pelvic junction (UPJ) obstruction: dismembered spiral flap pyeloplasty. It is similar to the method described by Culp & DeWeerd in that a flap is made spirally but different in that UPJ is detached. Relatively a long and wide spiral (oblique) flap, the apex of which directs cranioventrally or craniodorsally, is made using the dilated pelvis. The apex of the flap is reflected downward and anastomosed to the split ureteral end. Because the flap is made obliquely, one side of the flap base is approximated to the opposite pelvic margin; this helps to make gradual funnelling of pelvio-ureteric transition. The method seems to be fit for cases with considerably long stenosis of UPJ and with the UPJ locating relatively close to the medial margin of the renal parenchyma. Seven of 26 pyeloplasties were done by this method in our institute, and all the 7 cases had satisfactory results.

The binding activities of proteins that bind Ap4A, an alarmone, are stimulated in the presence of ethanol or phosphatidylethanolamine.

Three proteins binding Ap4A which is known to increase in the heat-shocked cells or to trigger DNA synthesis in G1-arrested eukaryotic cells were purified from E. coli cell extract. For the binding activities of the proteins, glutathione or dithiothreitol and manganese or iron ion were absolutely required. Glutathione, which exists in relatively high concentration in the cells and had been reported to be related to oxidant shock, was far more effective than an artificial antioxidant, dithiothreitol. Ethanol, which has an effect similar to heat or oxidant shock on microbial or eukaryotic cells, enhanced several fold the Ap4A-binding activity. Phosphatidylethanolamine, a major component of phospholipids of cytoplasma and membrane of E. coli cell also stimulated the Ap4A-binding activity.

DNA replication by novel macromolecular complexes involving DNA polymerase III holoenzyme activity.

A fraction (P1) which showed DNA polymerase III holoenzyme activity was obtained by partial purification including Polymin P fractionation from extracts of E. coli K-12 wild type (pol A+, pol B+) cells. The P1 fraction was composed of three macromolecular complexes, 11 S, 18 S and 24 S, all of which possessed holoenzyme activity. The activity of the P1 fraction was maximal at about 70 mM NaCl. The synthesis of long-chain poly(dT) with a poly(dA) oligo(dT)10 primer was dependent on the presence of ATP, but not on the presence of spermidine, suggesting that the single-stranded DNA binding protein (SSB) was present in the fraction. The intermediate lengths of the products in the absence of ATP and NaCl also suggest the functioning of DNA polymerase III'.

Benign neoplasms of the larynx. A 10-year review of 38 patients.

We reviewed the clinical records of 38 patients with benign neoplasms or tumors of the larynx that were examined in the Department of Otolaryngology, Kurume University Hospital during the 10-year period from 1971 to 1980. There were 24 patients with papilloma, 4 amyloid tumor, 2 hemangioma, 2 chondroma, 1 neurofibroma, 1 pleomorphic adenoma, 1 eosinophilic granuloma, 2 non-specific swelling of the ventricular fold, and 1 so-called prolapse of the ventricle. Some of these conditions, such as chondroma, neurofibroma, pleomorphic adenoma and eosinophilic granuloma, are vary rare.

Cysts of the larynx. A 10-year review of 94 patients.

We reviewed the clinical records of successive 94 patients with laryngeal cysts who were examined in the ENT clinic of Kurume University Hospital during the 10 years from 1971 to 1980. Cysts were located in the epiglottis in 48, the vocal fold in 43, and the ventricular fold in 3 patients. Results were summarized as follows: 1) Epiglottis cysts were more frequent in males (32 patients) than in females (16 patients). Age ranged from 33 to 74 years with a high incidences in the fifth decades or older. Twelve patients were surgically treated. 2) Vocal fold cysts were also more frequent in males (26 patients) than in females (17 patients). Age ranged from 8 to 74 years with a mode in the fifth and sixth decades. Twenty-five patients underwent surgical treatments. Of these 25 patients, 22 (88%) recovered normal voice, 2 (8%) had their voice improved and 1 (4%) had no improvement. 3) All of the 3 patients with ventricular fold cysts were females. The youngest age was 3 years and the oldest, 82 years. All patients underwent surgical treatments. Two patients recovered normal voice and the other was lost to follow up.

Non-specific granuloma of the larynx. A 10-year review of 63 patients.

During the 10 years from 1971 to 1980, 63 cases of non-specific granuloma of the larynx were examined at the Department of Otolaryngology, Kurume University Hospital. Of the entire 63 cases, 51 were intubation granulomas, 5, contact granulomas and 7, granulomas of unknown etiology. A review of the clinical records of these patients was completed. The results are summarized as follows; 1) In intubation granulomas, there was a significant preponderance of females over males (43 to 8). The age ranged from 9 to 72 years. The lesion was bilateral in 21 cases and unilateral in 30. All the granulomas but one were located at the cartilaginous portion. Twenty-one (75%) of the 28 cases which were surgically treated got healed, 6 (21%) developed a recurrence and 1 was lost to follow up. 2) All 5 patients with contact granulomas were males. Their lesions were unilateral. Three patients were surgically treated. Two of these 3 had no recurrence while the other developed a recurrence, which disappeared following conservative treatments. One patient was successfully treated with conservative modalities. 3) Granulomas of unknown etiology were found in 5 males and 2 females. Their age ranged from 19 to 70 years. The lesion was unilateral in all 7 cases. Three patients were surgically treated. Two of these 3 required repeated surgeries. One patient was successfully treated by means of conservative therapy.

Tuberculosis of the larynx. A 10-year review of 14 patients.

A retrospective review of 14 patients with tuberculosis of the larynx seen at the Department of Otolaryngology, Kurume University Hospital during the 10 years from 1971 to 1980, was completed. Of these 14 patients, 11 were male and 3, female. All the patients were adults. Hoarseness was the commonest symptom. The laryngeal lesion was tumor-like in 5, granular in 7 and polyp-like in 2 patients and grayish in color in all the patients. Eight patients were admitted in our department. Chest X-rays revealed pulmonary tuberculosis and erythrocyte sedimentation rate was accelerated in all 8 patients. It should be emphasized that, even at present, there exist tuberculosis of the larynx.