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Perioperative outcome of laparoscopic left lateral liver resection is improved by using staple line reinforcement technique: a case report.

Current laparoscopic stapling technology still cannot prevent bile leakage (<55%) along the resection margin. A new staple line reinforcement technique was used in the present case. This technique incorporates an absorbable polymer membrane into the stapler system, such that it buttresses the transected solid organ. The objectives of this novel procedure are to decrease hemorrhage at the staple line and to prevent bile duct leakage after liver resection. A 47-year-old man followed for status post biliopancreatic diversion with duodenal switch presented with epigastric pain. On imaging, he was found to have a lesion in segment 2-3 of the left lobe of the liver, which measured at least 3 cm in diameter. He was admitted to the hospital to undergo a laparoscopic left lateral liver resection. This procedure involved laparoscopic ultrasonography of the liver and transection of the left liver lobe with endoscopic linear staplers. The staple height of 3.5, 60 mm long, reinforced with an absorbable polymer membrane was used for liver transection to catch the portal branches. This required multiple firings in the liver parenchyma and additional division of some tissue using the Harmonic scalpel. The larger branch in the middle of segment 2-3 and the left hepatic vein were both transected with the novel staple line reinforcement technique. Bleeding or any bile leakage in this area could not be visualized. No drains were left. The patient's postoperative course was uncomplicated, and he was discharged on postoperative day 3. Pathology results showed a cavernous hemangioma of 4.5 cm in diameter. Staple line reinforcement with the absorbable polymer membrane has the potential to decrease staple line hemorrhage and bile leakage.

Abdominal Pain↗

The phylogeny of proteinase 3/myeloblastin, the autoantigen in Wegener's granulomatosis, and myeloperoxidase as shown by immunohistochemical studies on human leukemic cell lines.

Proteinase 3/myeloblastin (Pr3/MBN) is a serine protease found in primary granules of neutrophilic granulocytes and monocytes in man. This enzyme has been identified as the main autoantigen in Wegener's granulomatosis. Pr3/MBN was earlier identified in the promyelocytic cell line HL-60 and was assumed to be at least partly responsible for controlling proliferation and differentiation within the granulocytic-monocytic system. We have investigated 98 leukemic cell lines representing all lineages of the hemopoietic system. Pr3/MBN was found to appear in mature myeloblastic precursors and in CD34+ immature monoblastic cells and was restricted to the granulocytic and monocytic lineage. Myeloperoxidase (MPO) was found to be expressed earlier in development in the granulocytic lineage, but appeared later than Pr3/MBN in the monocytic lineage. The identification of cell lines which contained Pr3 only or MPO only may make them useful for demonstration of anti-neutrophil cytoplasmic antibodies in primary vasculitides.

Autoantigens↗

P wave and far-field R wave detection in pacemaker patient atrial electrograms.

This study was undertaken to develop and test a morphology-based adaptive algorithm for real-time detection of P waves and far-field R waves (FFRWs) in pacemaker patient atrial electrograms. Cardiac event discrimination in right atrial electrograms has been a problem resulting in improper atrial sensing in implantable devices; potentially requiring clinical evaluation and device reprogramming. A morphology-based adaptive algorithm was first evaluated with electrograms recorded from 25 dual chamber pacemaker implant patients. A digital signal processing (DSP) system was designed to implement the algorithm and test real-time detection. In the second phase, the DSP implementation was evaluated in 13 patients. Atrial and ventricular electrograms were processed in real-time following algorithm training performed in the first few seconds for each patient. Electrograms were later manually annotated for comparative analysis. The sensitivity for FFRW detection in the atrial electrogram during off-line analysis was 92.5% (+/- 10.9) and the positive predictive value was 99.1% (+/- 1.8). Real-time P wave detection using a DSP system had a sensitivity of 98.9% (+/- 1.3) and a positive predictivity of 97.3% (+/- 3.5). FFRW detection had a sensitivity of 91.0% (+/- 12.4) and a positive predictivity of 97.1% (+/- 4.2) in atrial electrograms. DSP algorithm tested can accurately detect both P waves and FFRWs in right atrium real-time. Advanced signal processing techniques can be applied to arrhythmia detection and may eventually improve detection, reduce clinician interventions, and improve unipolar and bipolar lead sensing.

Adolescent↗

Electro-acupuncture improves behavior and upregulates GDNF mRNA in MFB transected rats.

Low and high frequency electro-acupuncture (EA) stimulation was used in rats that had been lesioned by medial forebrain bundle transection. Behavioral tests showed that both low and high frequency EA stimulation significantly reduced the amphetamine-induced rotation 2 weeks after the lesion but only high frequency EA improved the rotational behavior at 4 weeks. Analysis of the dopamine content in the striatum did not show any significant change after EA. In situ hybridization showed that high frequency EA stimulation up-regulated the glial cell line-derived neurotrophic factor (GDNF) mRNA in both sides of the globus pallidus, while low frequency EA only affected the unlesioned side. It suggests that the retrograde nourishment of GDNF to the dopaminergic neurons and the balanced activity of different nuclei in the basal ganglia circuit after EA may contribute to the behavioral improvement in these rats, which might be the factors that underlie the effectiveness of EA in the treatment of Parkinson's disease.

Amphetamines↗

A constant-field interrupted resonance system for percutaneous electromagnetic measurement of blood flow.

A combination of deformable flow probes of negligible lateral dimensions with an electronic circuit capable of providing a prolonged plateau of dB/dt = 0 and of sampling the flow signal at the end of this interval permits electromagnetic measurement of blood flow with a reliable zero base line secured by switching off the magnet. An extracorporeal magnet provides the magnetic field. The flow transducer is introduced into the vascular system percutaneously through a standard angiographic catheter by conventional technique. The idea of the current generator can be described as "principle of interrupted resonance." The current wave form can be described as a sequence of disconnected bisected sine waves joined at the apices by horizontal current plateaus where di/dt is strictly zero.

Animals↗

The effects of ionizing irradiation on the ciliated cells of the central nervous system (CNS) in man--a scanning electron microscopy study.

In order to investigate the effects of radiotherapy on the ciliated ependymal lining of the CNS, samples were taken at autopsy from the lateral ventricles down to the IVth ventricles in patients irradiated for Glioblastoma multiforme in one hemisphere. Doses higher than 20 Gy affected the cilia and the lesions were more pronounced the heavier the dose. No regeneration of cilia were found in those regions which had received more than 20 Gy. In the areas irradiated with 20 - 15 Gy the cilia had a more normal form and cilia irradiated with less than 15 Gy were considered to be normal.

Adult↗

Cyclic regulation of growth hormone gene transcription in vivo and in vitro.

The in vivo thyroid and glucocorticoid hormone regulation of GH gene transcription was compared with that found in cultured GH rat pituitary tumor cells. The GH cell lines have been widely used to study GH gene expression, but their relevance to the in vivo regulation of the gene has not been well established. The in vivo studies described here utilized rats that were both thyroparathyroidectomized and adrenalectomized to remove the organ sources of these hormones. The in vitro studies described utilized GC cells hormonally deinduced in medium lacking the hormones. Continuous administration of glucocorticoid or thyroid hormones to either system induced multiple cycles of GH transcriptional activation and deactivation. These cycles were accompanied by cycles of increasing and decreasing GH messenger RNA. In both systems, a brief transcription cycle occurred within hours of thyroid or glucocorticoid hormone addition, and a second broad occurred between 3 and 11 days later. These cycles were independent of changes in receptor levels. The similarities in the responses found in vivo and in cell culture suggest that the molecular mechanisms regulating expression of the GH gene appropriately function in GC cells, despite their transformed phenotype and prolonged maintenance in culture. Thus, these cell lines appear to be appropriate model systems for studies of thyroid and glucocorticoid hormone action.

Animals↗

Choroid plexus cyst and chordoid glioma. Report of two cases.

Several types of mass lesions may occur in the third and lateral ventricles. Typically they arise from the lining of the ventricular cavity or from contiguous structures, by extension into the ventricle. The authors describe two patients, each of whom presented with a different rare lesion of the ventricular system. The first was a 53-year-old woman with a history of hypertension who sustained a blunt traumatic injury to the occipital region and subsequently developed a progressively worsening right-sided headache. Radiological examinations over the next 2 years revealed an enlarged right lateral ventricle and, ultimately, a choroid plexus cyst in its anterior and middle third, near the foramen of Monro, which is a rare location for these lesions. The cyst was removed en bloc, and follow-up examinations showed a significant improvement in her headache and a minimal differences in size between right and left ventricles. The authors also describe a 57-year-old man with hypertension, diabetes mellitus, and an old mycardial infarct, who presented to an outside institution with a progressively worsening headache, generalized malaise, and loss of olfactory sensation. Diagnostic imaging revealed a 1.5-cm oval lesion centered in the lamina terminalis region, an open craniotomy was performed, and evaluation of a biopsy sample demonstrated the mass to be a chordoid glioma of the third ventricle, a recently described glioma subtype. Two days after surgery, he suffered a left parietal stroke and an anterior mycardial infarction. After convalescing, he presented to The University of Texas M. D. Anderson Cancer Center for radiotherapy and follow up; 7 months later he was readmitted complaining of headache, short-term memory loss, and worsening confusion and disorientation. Neuroimaging revealed progression of the tumor (now 2 cm in diameter), which was removed by gross-total resection. His headache resolved immediately, and 2 months later his only complaint was of episodes of confusion. Three weeks later he died of a massive myocardial infarction. These two patients represent the sixth case of an adult with a choroid plexus cyst in the anterior lateral ventricle and the 19th case of an adult with a chordoid glioma of the third ventricle, respectively.

Brain Diseases↗

Oval cells--hepatocytes relationships in Dipin-induced hepatocarcinogenesis in mice.

During Dipin-induced hepatocarcinogenesis in mice there is powerful and prolonged proliferation of oval cells which are arranged in duct-like structures. Ultrastructure and differentiation pathways of oval cells depend on their location in the liver lobule. The major part of oval cells is represented by duct lining cells morphologically similar to biliary epithelial cells. They form the system of branching anastomozing ducts and expand into the parenchyma from portal to central veins. Later these ducts disintegrate. In the periportal areas, three stages of oval cell differentiation can be distinguished: (1) low differentiated cell similar to cells of terminal biliary ductules in their size and ultrastructure, (2) transitional cells and (3) young hepatocytes. Cells with ultrastructural characteristics of sequential stages of hepatocyte differentiation are located within the ducts surrounded by the basal lamina. Our data suggest that oval cells are the committed cell precursors capable of differentiating into hepatocytes or biliary epithelial cells in the periportal microenvironment.

Animals↗

Adequacy of the International 10-20 electrode system for computed neurophysiologic topography.

The adequacy of the International 10-20 System is reviewed in light of demands imposed on the accuracy of lead placement by improvements in spatiotemporal brain electrical activity mapping technology. Computed tomography (CT) and magnetic resonance imaging (MRI) studies reveal that the most frequent sources of inaccuracy of electrode locations are difficulties in defining the inion, variance in the anatomy of the occipital bone, inconspicuous sagittal deformities, variance of sulcal pattern, and brain width asymmetries. Owing to these factors, electrodes placed bilaterally and equidistant from the nasion-inion line may not be homotopically located. Therefore, the authors suggest that practitioners who employ the 10-20 System in order to gain precise and more individualized laterality information do so with extreme caution until the range of placement and interpretative errors is more precisely determined using CT/MRI-assisted EEG.

Brain↗

Neuroanatomical localization for clinical SPECT perfusion brain imaging: a practical proportional grid method.

For the purpose of facilitating anatomical localization in interpretation of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission tomographic (SPECT) scans, a stereotaxic proportional grid system was applied in the form of an interactive computer program. This method takes advantage of a rotating gamma camera system which permits planar scout imaging for the determination of anatomical reference lines, and standardization of tomographic slices for brain size. Using measurements made on a lateral planar HMPAO image, proportional grids were constructed onto standardized transaxial images. This method was implemented for 33 clinical HMPAO SPECT studies. It required less than 15 min of an operator's time. This simple and practical neuroanatomical localization technique can be instrumental as an aid to the interpretation of routine clinical HMPAO SPECT images.

Adult↗

Silencing of a viral RNA silencing suppressor in transgenic plants.

High expression levels of the helper component proteinase (HC(pro)), a known virus suppressor of RNA silencing, were attained in Nicotiana benthamiana transformed with the HC(pro) cistron of Potato virus A (PVA, genus Potyvirus). No spontaneous silencing of the HC(pro) transgene was observed, in contrast to the PVA coat protein (CP)-encoding transgene in other transgenic lines. HC(pro)-transgenic plants were initially susceptible to PVA and were systemically infected by 14 days post-inoculation (p.i.) but, 1 to 2 weeks later, the new expanding leaves at positions +6 and +7 above the inoculated leaf showed a peculiar recovery phenotype. Leaf tips (the oldest part of the leaf) were chlorotic and contained high titres of PVA, whereas the rest of the leaf was symptomless and contained greatly reduced or non-detectable levels of viral RNA, CP and transgene mRNA. The spatial recovery phenotype suggests that RNA silencing is initiated in close proximity to meristematic tissues. Leaves at position +8 and higher were symptomless and virus-free but not completely resistant to mechanical inoculation with PVA. However, they were not infected with the virus systemically transported from the lower infected leaves, suggesting a vascular tissue-based resistance mechanism. Recovery of the HC(pro)-transgenic plants from infection with different PVA isolates was dependent on the level of sequence homology with the transgene. Methylation of the HC(pro) transgene followed recovery. These data show that the transgene mRNA for a silencing suppressor can be silenced by a presumably 'strong' silencing inducer (replicating homologous virus).

Blotting, Northern↗

Generation and characterization of Rgs4 mutant mice.

RGS proteins are negative regulators of signaling through heterotrimeric G protein-coupled receptors and, as such, are in a position to regulate a plethora of biological phenomena. However, those have just begun to be explored in vivo. Here, we describe a mouse line deficient for Rgs4, a gene normally expressed early on in discrete populations of differentiating neurons and later on at multiple sites of the central nervous system, the cortex in particular, where it is one of the most highly transcribed Rgs genes. Rgs4(lacZ/lacZ) mice had normal neural development and were viable and fertile. Behavioral testing on mutant adults revealed subtle sensorimotor deficits but, so far, supported neither the proposed status of Rgs4 as a schizophrenia susceptibility gene (by showing intact prepulse inhibition in the mutants) nor (unlike another member of the Rgs family, Rgs9) a role of Rgs4 in the acute or chronic response to opioids.

Animals↗

A large outbreak of Legionnaires' disease due to an inadequate circulating and filtration system for bath water--epidemiologic manifestations.

OBJECTIVE: To study the epidemiologic manifestations of a large outbreak of Legionnaires' disease due to an inadequate circulating and filtration system for bath water. PATIENTS: In June 2000 at Ishioka City, Ibaraki Prefecture, a large outbreak of Legionnaire's disease occurred, as a result of an inadequate circulating and filtration system for communal bath water. This outbreak was the worst ever experienced in Japan, involving a total of 34 patients (20 confirmed, 14 probable), 3 of whom died. MEASUREMENTS AND RESULTS: Legionella pneumophila serogroup 1 was isolated from sputum culture in two patients. Bacteriological culture of the public bath water subsequently yielded large numbers of Legionella species. Cleavage of genomic DNA showed that restriction fragment patterns coming from clinical and environmental isolates of L. pneumophila serogroup 1 were closely related, focusing the inquiry to a public bathhouse where a circulating filtration system was suspected as the source of infection. CONCLUSIONS: It was later concluded that the circulating filtration system adopted for bath water was marred by a serious design flaw that subsequently caused the mass outbreak. Specifically, a line of the bath water was being returned to the bath without undergoing heat exchange or sterilization by chlorine; and the Legionella species that had proliferated in the filter and the bright stone filtration unit were allowed to return to the bath, eventually culminating in a mass infection.

Adult↗

Identification and its vicissitudes.

The treatment of 'identification' in the American literature is conveniently divided into three eras: (1) The Pioneers (1915-1945). (2) The Synthesizers (1945-1975). (3) Current Commentators (1975-1985). For the Pioneers, concepts and terminology were diffuse, reflecting the diversity of clinical material, methodology and theories accompanying the rapid expansion in analytic experience over a half century. The achievement of an integrated survey by Otto Fenichel in 1945 marked the transition from a fragmentary to a synthesizing approach to identification and its inherent aspects of incorporation and ejection, introjection and projection, internalization and externalization. The Synthesizers brought to the force developmental and adaptive viewpoints which traced along longitudinal lines the processes of maturation from the earliest mother--child unit to later phases of life. The differentiation of the self (one's own person) from systemic functioning within the Freudian ego (Hartmann) and a corresponding importance accorded to reciprocal self-object relationships, proved eventful for the conceptualization of identification. A broadening of traditional analytic frameworks with respect to both normal and abnormal forms of behaviour was a correlated achievement in placing identificatory processes between the inner and outer worlds. The Commentators extended the synthesizing trends, reviewed historical perspectives accordingly, and selected such areas as individual and group identify, the correlation of direct observation with analytic reconstructions and the personal and professional functioning of the analyst himself for special study.

History, 20th Century↗

Cardiac expression of polysialylated NCAM in the chicken embryo: correlation with the ventricular conduction system.

The neural cell adhesion molecule (NCAM) and its polysialic acid moeity (PSA) affect cellular interactions during the development of the nervous system and skeletal muscle. NCAM has also been identified in the embryonic heart of various species including humans. However, knowledge regarding the role of NCAM and its function-modulating PSA in cardiogenesis is limited. The distribution of NCAM and its PSA in the ventricular myocardium of chicken embryos was determined by indirect immunofluorescence staining. The NCAM polypeptide was found throughout the cardiac myocardium. In contrast PSA was located in discrete regions in stage 20 to 44 embryos (during and after septation). Myocardium at the subendocardial regions of the atrioventricular canal and ventricular trabeculae were PSA positive by stage 20. At later stages, transverse sections of the postseptation heart just below the level of the atrioventricular interface revealed a PSA-positive bundle of myocardium in the septum. This bundle was continuous with two branches at a more apical level which in turn were continuous with the PSA-positive subendocardial myocardium lining the left and right ventricles. This pattern of PSA in the myocardium was similar to that of the ventricular conduction system configuration defined in the adult heart. Electron micrographs of the subendocardium of the ventricular septum revealed PSA positivity on myofibril-containing cells with the ultrastructural location of Purkinje fibers. At later stages (35-44) a subset of cells within PSA-positive regions was stained by an antibody against an isoform of the myosin heavy chain found in adult Purkinje fibers. These cells and surrounding tissue lacked PSA in the adult heart. Thus polysialylated NCAM may be modulating cell-cell interactions during the development of the ventricular conduction system.

Animals↗

Quality assurance of interstitial brachytherapy technique in lip cancer: comparison of actual performance with the Paris System recommendations.

This study takes a quality assurance approach to assessing staff application of Paris System recommendations for brachytherapy. Between 1988 and 1992, 72 patients were treated with brachytherapy for cancer of the lip at Hospital Clinic in Barcelona. Because of the relatively high number of total local recurrences (11%) and the fact that several radiotherapists had come from other hospitals to join the staff, we analysed the technique actually used compared with the recommendations of the Paris System. Results indicate our staff did not, in fact, use the active length prescribed by the Paris System in 71% of cases but that the discrepancies had no observable impact on the actuarial local control in the short follow-up period (28 +/- 15 months). When we compared, in time sequence, the first 35 patients treated between 1988 and 1989 (Early group) with the last 37 treated between 1990 and 1992 (Later group), we saw that staff members had improved their application of the therapy by more often using the recommended length of active lines. Staff performance in the Later group was still far from ideal, however, as the actual length used differed from the length recommended in 51% of the cases. At present we are insisting on stricter application of the Paris System guidelines for lip brachytherapy. Our study suggests that auditing performance is worthwhile and we recommend that radiotherapists apply this analytical quality assurance method, especially when several new physicians join a department.

Aged↗

[Relation between changes in the breathing of patients with aneurysmal and stenotic lesions of the major cerebral vessels and the side of the lesion].

In patients with aneurysmal and stenosing injuries to the main vessels of the brain, there are significant differences in the duration of respiration arrests, respiration rate, systole frequency, basic metabolism, thermoregulation reflexes depending on the lateralization of vascular injury. Asymmetry manifested most distinctly in the pathology of the anterior cerebral artery. In women, functional asymmetry was pronounced to a greater extent than in men. Lateralization of the neurological symptomatology is also of importance for the line of ventilatory changes.

Autonomic Nervous System↗