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Effect of biliary ligation on manganese accumulation in rat brain.

Neurologic and radiologic disorders have been reported to occur in miners inhaling manganese (Mn)-laden dust and in humans receiving long-term parenteral nutrition. These abnormalities have been attributed to Mn intoxication because of elevated serum Mn concentrations. Because the liver, by way of the bile, is the major route of Mn excretion, it is possible that anything that decreases biliary excretion could increase accumulation of Mn in the brain. The purpose of this study was to determine whether biliary ligation would increase Mn accumulation in the brain of rats that were exposed to deficient or adequate amounts of dietary manganese. The first experiment had a 2 x 3 factorial design, two levels of Mn (0 or 45 microg/g diet) and three surgical treatments (control, sham, or bile-ligation). Animals were sacrificed 10 d after being fed 54Mn. In experiment 2, animals that had a sham operation or bile-ligation were sacrificed at 8 time points after being injected intraportally with 54Mn complexed to albumin. The biliary-ligated animals had a significantly (p < 0.001) smaller percentage of the 54Mn in their brains (when expressed as a percentage of whole animal 54Mn) than the sham-operated animals. Mn deficiency had a similar effect. However, we did observe an increased accumulation of the radioisotope in the brain over time. Therefore, in short-term studies, biliary-ligated rats do not appear to be a good model for Mn accumulation in the brains of people with cholestatic liver disease.

Animals↗

Analyses on lipid-rich organelles of the rat liver after bile duct ligation.

A fraction of lipid-rich organelles of rat livers was analyzed to study the effect of bile duct ligation on lipid metabolism. The lipid fraction of the control rats consisted mainly of Golgi-derived dense bodies. Three days after the ligation, myelin-like figures and increased phospholipids and cholesterol were characteristic of the fraction. Two weeks ligation resulted in proliferation of lysosomal electron dense bodies. As their volume density expanded, phospholipids and cholesterol increased. Electrophoresis indicated a reduced rate of VLDL assembly after ligation. The Golgi-dominant phase is converted to the lysosomal phase in the heavy subfraction after the bile duct ligation. This subcellular change could be a consequence of secondary lipidosis: hepatocyte lysosomes have been exhausted in sorting accumulated lipids into secretory lipoproteins.

Animals↗

The effect of ligation of portal branch on the growth of implanted tumor of the liver in rats.

Small masses of Walker 2 56 carcinosarcoma were implanted into the liver lobe of wistar rats. And at same time, a branch of the portal vein of the involved liver lobe was ligated. After 18 days, the growth of implanted tumor in ligation group was much slower than that in control group, namely, the diameter and wet weight of implanted tumor in ligation group were much smaller and lighter than those in control group. Furthermore, there were no ascites and lung metastases in ligation group. These results suggested that simple ligation of portal branch could apparently inhibit the growth and development of implanted tumor in the liver.

Animals↗

Alteration of dorsal root ganglion P2X3 receptor expression and function following spinal nerve ligation in the rat.

One subtype of ATP-gated ion channel, the P2X(3) receptor, is expressed primarily on peripheral sensory neurons. While it is known that P2X(3) receptors can participate in certain forms of nociceptive signaling, their involvement in neuropathic pain transmission is not known. We have examined the expression and function of P2X(3) receptors in a rat spinal nerve ligation model of neuropathic pain. Fourteen days following L5/L6 spinal nerve ligation, the corresponding dorsal root ganglia (DRG) were removed from animals exhibiting mechanical allodynia, and these were studied using immunohistochemical and electrophysiological techniques. Using a polyclonal antibody to label the P2X(3) receptor, a significant reduction in neuronal P2X(3) immunoreactivity was observed in the ipsilateral (injured) L5 and L6 DRG following nerve ligation. In vitro electrophysiological analysis of acutely isolated DRG neurons revealed a similar decrease in functional P2X(3)-containing receptors. In small diameter (22-25 micro m) neurons, a significant reduction in the number of cells exhibiting a response to alpha,beta-meATP was observed. However, a subset of small diameter neurons retained P2X(3) responses of equal amplitude to those recorded from naive and sham control DRG neurons. Interestingly, P2X(3) immunoreactivity and P2X(3)-like responses were also detected in a subset of larger diameter (50 micro m) neurons and the number and amplitude of these responses were unchanged after spinal nerve ligation. These results suggest that, while there appears to be a decrease in fast desensitizing P2X(3) receptors following L5/L6 nerve ligation injury, certain subsets of small and large DRG neurons maintain normal P2X(3) receptor expression and function. These remaining receptors may provide a P2X(3) receptor-mediated component to neuropathic pain.

Adenosine Triphosphate↗

Transcatheter occlusion of residual patent ductus arteriosus after surgical ligation.

The reported frequency of residual leaks after surgical ligation of patent ductus arteriosus (PDA) varies from 6% to 23%. Reports on percutaneous closure of PDA also involve patients with residual PDA after ligation, but specific data regarding this type of PDA are rare. Our objective was to assess retrospectively the characteristics of residual PDA relevant to transcatheter closure and occlusion results using three types of occluders. Twelve consecutive patients underwent transcatheter occlusion of residual PDA after surgical ligation at a median age of 4.6 years (range 3. 2-44.6 years) and median weight 16.5 kg (range 13-62 kg). Three types of occluder were used: Gianturco coils, detachable Cook PDA coils, and the new Amplatzer duct occluder. The median diameter of residual PDA after ligation was 1.5 mm (range 0.9-4.2 mm). All PDAs were of type A morphology. Thirteen devices were successfully placed in the 12 patients, without embolization. There were no complications. At 1 month and 1 year follow-up all residual shunts were completely closed. Coils are particularly suitable for complete closure of residual leaks after surgical ligation of PDA. A 100% closure rate was achieved with a low number of implanted coils.

Adolescent↗

The common bile duct ligation in rat: A relevant in vivo model to study the role of mechanical stress on cell and matrix behaviour.

Common bile duct ligation leads to bile accumulation and liver fibrosis. In this model, little attention has been dedicated to the modification of the common bile duct. We have studied by histochemistry and immunohistochemistry, 3 and 5 days after ligation, the connective tissue modifications of the common bile duct wall. After bile duct ligation, compared with normal bile duct, a strong increase of the bile duct diameter, due to bile stasis, and a thickness of the bile duct wall were observed; numerous myofibroblasts expressing alpha-smooth muscle actin appeared in parallel with the detection of many proliferating connective tissue cells. These myofibroblasts secreted very early high amount of elastic fibre components, elastin and fibrillin-1. Elastic fibre increase was also observed close to the epithelial cell layer. Procollagen type III deposition was also induced 3 days after ligation but decreased thereafter, underlining that myofibroblasts modify their synthesis of extracellular matrix components to comply with the request. We show here that common bile duct ligation represents an invaluable model to study myofibroblastic differentiation and extracellular matrix adaptation produced by an acute mechanical stress.

Actins↗

Expression of stem cell markers and transcription factors during the remodeling of the rat pancreas after duct ligation.

Ligation of the pancreatic duct has been shown to induce islet cell neogenesis from duct cells in the adult rat pancreas. The transcription factors that regulate islet cell neogenesis and the phenotype of putative precursor cells involved in neogenesis are unknown. We, therefore, studied the expression of the transcription factors Pdx1, Pbx1, Meis2, Nkx2.2 and the putative stem cell markers c-Kit and nestin in rat pancreata 3, 5 and 7 days after duct ligation. Immunocytochemical staining revealed a subpopulation of cells in the ligated portion of the pancreas that was positive for the putative stem cell markers c-Kit and nestin. The c-Kit immunoreactivity was upregulated, reaching a peak at day 3, while nestin expression peaked at day 7. The c-Kit-positive cells were located among the duct and islet cells, while nestin-expressing cells were found scattered in the duct epithelium at day 3 and around the ducts at day 7. Both c-Kit- and nestin-positive cells showed high proliferative activity, as determined by BrdU labeling. Pdx1 and Nkx2.2 were found predominantly in the duct cells of the ligated pancreas. There were significant changes in the expression patterns of Pbx1 and Meis2 in the ductular complexes. The findings indicate that the stem cell markers c-Kit and nestin as well as the transcription factors Pdx1 and Nkx2.2 are upregulated in compartments of the pancreas that are involved in islet cell neogenesis after duct ligation.

Animals↗

Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome.

BACKGROUND: No consensus exists as to the best endoscopic treatment for Mallory-Weiss syndrome. Endoscopic band ligation is a readily available and easily learned technique. This prospective study evaluated the efficacy and safety of endoscopic band ligation therapy for Mallory-Weiss syndrome. METHODS: From August 1998 to June 2005, a clinical trial assessed 37 patients with a diagnosis of Mallory-Weiss syndrome who had active bleeding, exposed vessels, or both. Their lesions were treated using endoscopic band ligation. RESULTS: Endoscopic band ligation was successful in 36 of 37 cases, with a follow-up period ranging from 1 to 24 months. The remaining patient had severe liver failure and disseminated intravascular coagulation. The patient bled again at 12 h and subsequently died. Except for this case, no recurrent bleeding, perforation, or other complications occurred. CONCLUSIONS: The study results suggest that endoscopic band ligation is an effective, safe, and easily learned procedure for treating upper gastrointestinal bleeding related to Mallory-Weiss syndrome.

Adult↗

Hemodynamic changes in stripping operation or saphenofemoral ligation of the greater saphenous vein for primary varicose veins.

The aim of this study was to assess early hemodynamic improvement after a stripping operation or saphenofemoral ligation by means of air plethysmography. This prospective study assessed 109 limbs of 71 patients treated between May 2000 and December 2001 for primary varicose veins due to greater saphenous insufficiency. Eighty-nine limbs were treated by stripping surgery (stripping group), and 20 limbs were treated with saphenofemoral ligation (saphenofemoral ligation group). To evaluate venous hemodynamic changes, air plethysmography was performed before surgery and 7-14 days after surgery. A significant decrease and normalization of the venous filling index and residual volume function was observed in the two groups. A decrease in venous volume was observed in the ligation group, but the change was not statistically significant. In contrast, a significant decrease in venous volume was observed in the stripping group. The ejection fraction was not improved in either of the groups. From these results we conclude that hydrostatic forces can be controlled by means of a stripping operation as well as by saphenofemoral ligation in the early postoperative period.

Case-Control Studies↗

Longitudinal multiple rubber band ligation: an alternative method to treat mucosal prolapse of the anterior rectal wall.

PURPOSE: The aim of this study is to present a new approach for the treatment of mucosal prolapse of the anterior rectal wall using a multiple longitudinal rubber band ligation procedure. METHODS: The therapeutic approach using multiple longitudinal rubber band ligations on anterior rectal wall was undertaken in 17 patients after failure of conventional medical treatment. RESULTS: Double rubber band ligation was undertaken in seven patients and triple ligation in nine patients. In a median follow up of 12 months fourteen patients (87.5 percent) showed complete and persistent remission of symptoms. Two patients remained symptomatic and were treated by a second session of rubber band ligation which was successful in one of them. No complications occurred in this present series except in one patient with internal rectal prolapse patient who complained of persistent pain for seven days. CONCLUSIONS: These encouraging results have suggested this method as an effective alternative in the relief of this usually very symptomatic disorder.

Adult↗

Bacterial endocarditis following rubber band ligation in a patient with a ventricular septal defect: report of a case and guideline analysis.

Rubber band ligation is a common option used to treat symptomatic internal hemorrhoids. Severe complications such as pelvic sepsis are a rare occurrence. We report a case of endocarditis leading to septic pulmonary and renal emboli following single-quadrant rubber band ligation. The patient had a known ventricular septal defect and developed low back pain and fever after ligation of a right anterior internal hemorrhoid. He was found to have septic pulmonary emboli, a renal wedge septic infarct, and a large vegetation on his membranous ventricular septal defect requiring operative intervention. Before this report, rubber band ligation has not been associated with endocarditis. According to several guidelines, this patient did not require antibiotic prophylaxis. It is unclear whether prophylaxis could have prevented this complication. Surgeons utilizing rubber band ligation need to be familiar with all potential complications.

Endocarditis, Bacterial↗

Uterine and renal renin release after ligation of the uterine arteries in the pregnant rabbit.

Uteroplacental ischemia is associated with uterine renin release in pregnant nephrectomized rabbits. In the present study, uterine and renal renin release after uteroplacental ischemia were investigated in 10 Australian white rabbits at 24 to 28 days' gestation. Pentobarbital was administered, and both uterine arteries were ligated close to their origins. Blood samples were taken for plasma renin activity (PRA) determinations from the femoral artery, uterine vein, and right renal vein before ligation and at 30 and 60 minutes after ligation. Mean arterial blood pressure (MAP) was monitored throughout. In five additional pregnant rabbits renal blood flow (RBF) was measured with an electromagnetic flowmeter. The preligation uterine vein-artery PRA difference was not significant (1.9 +/- 1.1 ng/ml/hr). Postligation uterine vein-artery PRA was 11.4 +/- 3.2 at 30 minutes and 6.6 +/- 1.9 ng/ml/hr at 90 minutes (p less than 0.02). Preligation renal vein-artery PRA was 32.3 +/- 10.5 ng/ml/hr (p less than 0.02) and did not change significantly after ligation. MAP remained stable and RBF was unchanged after uterine artery ligation. These observations confirm the finding that the kidney is the primary source of renin in the normal pregnant rabbit and demonstrate that following acute uteroplacental ischemia there is significant uterine renin release even when the kidneys are intact.

Animals↗

Functional and morphological changes in the microcirculation of the dog following acute coronary artery ligation.

Acute ligation of the anterior descending coronary artery in the dog had little immediate effect on heat clearance but immediately lowered heat production, which fell to its minimum level in 1/2 hr, after which it began to recover; recovery was complete in 6 hr. After 1/2 hr heat clearance also began to fall and reached a minimum level in 1 1/2 hr. Ligation increased oxygen extraction but reduced oxygen consumption markedly though temporarily. Complete recovery followed. After 3 months, there was full recovery in flow, oxygen extraction ratio, and oxygen consumption mVO2. In morphological studies using Microfil injections soon after ligation, capillaries failed to fill retrogradely, though network vessels were perfused. After 1 hr of acute artery ligation, capillaries still did not perfuse but by 3 hr there was some reperfusion. After 6 hr there was marked capillary reperfusion. In dogs kept for 3 months after ligation the microcirculation was normal. These studies confirm that immediate circulatory failure occurred in capillaries (probably critical closure) which accounts for the immediate fall in venous outflow, heat production, and mVO2. Flow continued in network vessels which traversed the ischemic zone without perfusing capillaries. These results are contrasted with the findings of some other workers who found a continued functional decline leading to infarction. The present results were accounted for by closure and reopening to capillaries.

Animals↗

Computed tomographic demonstration of the effect of proximal parent artery ligation for giant intracranial aneurysms.

Four patients with giant intracranial aneurysms, which measured over 2.5 cm in diameter, were treated by ligation of the proximal parent artery. The location of the aneurysms were intracavernous in two patients, paraophthalmic in one patient, and vertebral in the other patient. The effect of ligation was followed by repeated computed tomography scans with angiographic correlation. The aneurysms thrombosed soon after ligation, and with time, gradually organized with a reversal of the mass effect. Five years after the ligation, one aneurysm thrombosed completely and lost its mass effect upon the adjacent structures. For giant aneurysms treated with ligation of the proximal parent artery, computed tomography scans are a useful method for continuing review, producing precise information concerning actual size, thrombus formation, and various pathological changes.

Adult↗

Response of spinal cord blood flow and motor and sensory evoked potentials to aortic ligation.

To produce spinal cord ischemia in the lamb, ligation of the thoracic aorta was performed for 15, 30, and 45 minutes in three animals each. Spinal cord blood flow and motor and sensory evoked potentials were measured before, during, and after aortic ligation. Ischemia with a blood flow of zero during ligation was encountered in the thoracic and lumbar cords, followed by hyperemia upon release of the ligature. Both somatosensory and motor evoked potentials were obliterated during aortic ligation and gradually recovered following resumption of flow. Motor and sensory evoked potentials behaved similarly to high aortic ligation.

Animals↗

Inhibition by spinal morphine of the tail-flick response is attenuated in rats with nerve ligation injury.

Nerve ligation injury in rats produces increased sensitivity and exaggerated responses to nociceptive stimuli (hyperalgesia) as well as nociceptive responses to normally innocuous stimuli (allodynia) analogous to clinical conditions of neuropathic pain. However, the effect of nerve injury on acute nociception has not been extensively studied. Nerve ligation injury was produced by unilateral ligation of the L5 and L6 spinal roots of the sciatic nerve of male Sprague-Dawley rats. Intrathecal (i.th.) catheters were inserted for spinal drug administration. Response to acute nociception was measured by determining the latency to a rapid flick of the tail (TF) after immersion into a 55 degrees C water bath before (control) and after i.th. morphine administration. No change in baseline response to the nociceptive stimulus was observed in either sham-operated or nerve-injured rats. In sham-operated rats, morphine produced dose-dependent antinociception with a 97 +/- 2.3% maximal possible effect (MPE) at a 60 microgram dose; in these controls A50 (95% CL) was 22 micrograms (17-30 micrograms). Morphine administered to rats with nerve injury also produced dose-dependent increase in TF latency, but an MPE of only 60 +/- 17% was obtained at 100 micrograms; higher doses elicited signs of behavioral toxicity. While it was not possible to produce a proper dose-response curve with i.th. morphine in animals with nerve injury, an estimation of the A50 showed approximately a four-fold loss of potency compared to sham-operated controls. Antinociception was readily reversed by naloxone (5 mg/kg, i.p.) in both groups. These data indicate that nerve ligation injury reduces the potency and efficacy of i.th. morphine. While the reasons for this loss of morphine activity in nerve injured animals are unknown, it is possible to speculate that (a) degeneration of primary afferents subsequent to nerve ligation injury might result in a loss of presynaptic opioid (mu?) receptors in the dorsal horn, thereby reducing the antinociceptive activity of morphine at the spinal level; (b) changes in the efficiency of post-receptor transduction may occur following nerve injury which can reduce opioid efficacy; (c) changes in levels of spinal neurotransmitters (e.g., cholecystokinin) may act to diminish opioid action; or (d) sustained afferent input from the site of the injury may be important in limiting the activity of opioids.

Analgesics, Opioid↗

Effects of peripheral nerve ligation on expression of mu-opioid receptor in sensory ganglion neurons: an immunohistochemical study in dorsal root and nodose ganglion neurons of the rat.

The present study was attempted to examine if mu-opioid receptor (MOR) might be transported by axonal flow peripherally through peripheral axons of somatic sensory ganglion neurons. After unilateral ligation of the sciatic nerve or the vagus nerve distal to the dorsal root ganglion (DRG) or nodose ganglion (NG), MOR-like immunoreactivity (MOR-LI) of neuronal cell bodies in the DRG of the fourth and fifth lumbar nerves, NG, ambiguus nucleus (Amb) and dorsal motor nucleus of the vagus nerve (DMV) on the side of the ligation was apparently reduced within 1 week after the nerve ligation. However, within 24 h after the nerve ligation, a transient enhancement of MOR-LI was observed in cell bodies of DRG neurons, sciatic nerve stump proximal to the ligature, and cell bodies of NG neurons on the side of the ligation; such a transient enhancement of MOR-LI was not detected in the Amb and DMV. The results suggest that MOR undergoes centrifugal axonal flow in peripheral axons of somatic and visceral sensory ganglion neurons, and that MOR synthesis in sensory ganglion neurons is vulnerable to damage of the peripheral axons.

Analgesics, Opioid↗

Ligation and extraanatomic arterial reconstruction for the treatment of aneurysms of the abdominal aorta.

PURPOSE: Since Blaisdell et al. first described axillobifemoral bypass and aortic exclusion to treat patients at high risk with abdominal aortic aneurysms in 1965, this approach has been controversial. To help define the appropriate application of this procedure, the recent experience of the authors was reviewed. METHODS: Twenty-six patients underwent operation between March 1980 and August 1992. Mean age was 71 +/- 7 years. Average aneurysm diameter was 7.0 +/- 1.5 cm. Sixty-nine percent of the aneurysms were symptomatic; 21% were suprarenal. All patients had serious comorbid factors. All underwent axillobifemoral bypass with iliac artery ligation; the infrarenal aorta was also ligated in 62%. RESULTS: There were two postoperative deaths (7.7%). One- and two-year survival rates were 59% and 38%, respectively. Three patients died of aneurysm rupture (11.5%); the aorta had not been ligated in two of these patients. The remaining late deaths were due to comorbid conditions. Extraanatomic bypass grafts thrombosed in five patients; no limbs were lost. CONCLUSIONS: Axillobifemoral bypass without aortic ligation does not effectively reduce the risk of aneurysm rupture. However, axillobifemoral bypass with aortic ligation is an acceptable treatment for patients with severe medical problems and symptomatic, anatomically complicated, or large abdominal aortic aneurysms. Because the risk of aneurysm rupture is not completely eliminated, this procedure should be reserved for patients with high-risk aneurysms who would not tolerate direct aortic replacement.

Aged↗