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COX-2 is necessary for venous ligation-mediated bone adaptation in mice.

In osteoblasts, cyclooxygenase 2 (COX-2) is the major isozyme responsible for production of prostaglandins. Prostaglandins are local mediators of bone resorption and formation and are known to be involved in bone's adaptive response to fluid shear stress (FSS). We have previously described a model of trabecular bone loss in hindlimb-suspended mice and rats and demonstrated partial protection from osteopenia by ligation of the femoral vein. The increased FSS resulting from this ligation drove bone adaptation in the absence of mechanical loading. In this study, we investigated the role of COX-2 in this adaptive response to FSS by use of COX-2 knockout mice. COX-2 knockout ("KO"), COX-2 heterozygote ("HET"), and COX-2 wild-type ("WT") animals all lost comparable amounts of trabecular bone from sham-operated limbs as a result of suspension. In WT mice, loss of trabecular BMD in the venous-ligated limb was significantly less than that of the sham-operated limb; this effect, however, was not seen in KO or HET mice. Percentage gain in femoral periosteal circumference was greater in the ligated limb than the sham-operated limb for WT mice. KO and HET mice already possess femora of larger periosteal circumference than their WT littermates and ligation in these bones did not result in an increase in perimeter relative to sham. Histomorphometry on embedded bones revealed thinner cortices and less mineralizing perimeter in KO femora than controls. In conclusion, this is the first in vivo study to show that fluid-flow-mediated bone adaptation, independent of mechanical strain, is COX-2 dependent.

Animals↗

A rat model of glaucoma induced by episcleral vein ligation.

To establish a reliable animal model of glaucoma, we examined if episcleral vein ligation in rat eyes can induce intraocular pressure (IOP) elevation and concomitant characteristic morphological features of glaucoma. IOP elevation was detected on the next day (30.1+/-4.4 mmHg: operated eyes; 21.0+/-1.8 mmHg: control eyes) and persisted at least 7 months after the procedure (24.5+/-2.3 mmHg: operated eyes; 19.7+/-1.9 mmHg: control eyes). These results suggest that episcleral vein ligation can induce very mild IOP elevation immediately after the operation, which can last over several months. Furthermore, it appears there was little variability in the patterns of IOP elevation among the individual eyes treated with episcleral vein ligation. Morphological changes were detected selectively in the retinal ganglion cell (RGC) layer and optic disc excavation was evident in the late stage of chronic IOP elevation. RGCs were selectively lost by apoptotic death. The number of RGCs was reduced by 18% at 12 weeks and eventually by 35% at 8 months postoperatively. Müller cells downregulated the expression of p27Kip1 and appeared to be partially in a reactive state even at the advanced stages of glaucoma. The expression of basic fibroblast growth factor and ciliary neurotrophic factor, which are neurotrophic factors implicated in the control of cell survivals and neuroprotection, significantly declined at the advanced stages. Taken altogether, these observations indicate that the episcleral vein ligation model based on the simple ligation procedure reproducibly provides a reliable glaucoma model and contributes to give insights into the underlying molecular and cellular bases of human glaucoma and to devise the new medication upon the disease.

Animals↗

Recovery of hepatic function determined by cytochrome P450-dependent drug metabolism lags after compensatory hepatic volume changes after portal vein ligation in rats.

BACKGROUND: Clinically, portal vein embolization has been proven to be useful as a preoperative treatment for major hepatic surgeries with impaired liver function. However, its effects on the metabolism and elimination of various drugs after portal vein embolization or ligation remain to be elucidated. MATERIALS AND METHODS: A portal vein branch that perfuses the central and left lobes of the liver of male Wistar rat was ligated, and changes in the weights of ligated and nonligated lobules as well as hepatic levels and activities of cytochrome P450 (CYP) isoforms, such as CYP3A2 and CYP2C11, were determined. To evaluate in vivo the effect of PVL on hepatic drug metabolism, the narcotic activity (sleep time) of midazolam, a specific substrate for CYP3A2, was measured. RESULTS: Although plasma levels of alanine aminotransferase and hepatic weight returned to basal levels at day 7 after the portal vein ligation, hepatic activities of CYP3A2 and CYP2C11 still remained low (53% and 54% of control levels, respectively), and returned to their initial levels after about day 14. The metabolism of midazolam was prolonged by approximately three times at day 7 after ligation and returned to basal levels at day 14. CONCLUSIONS: Because hepatic CYP-dependent drug metabolism by CYP isoforms recovered more slowly than the apparent recovery of hepatic volume and plasma alanine aminotransferase levels, the therapeutics of drugs metabolized by the CYP isoforms should be used carefully in patients who receive major hepatectomy with portal vein branch embolization.

Alanine Transaminase↗

Improved analysis of the vascular response to arterial ligation using a multivariate approach.

Ligation of the murine common carotid artery induces a reproducible remodeling response. The contribution of individual genes can be determined by comparison of the phenotypes of genetically modified mice. Although studies have shown the response to carotid artery ligation is influenced by many factors, individual analyses typically only consider a single factor, the presence of a gene of interest. Because of this limitation, measurements of the response to ligation show large variation, making the determination of significant difference between test groups difficult. In this study, we examine the hypothesis that the variation in the response to ligation is due to non-genetic factors in addition to genetic factors. Distance from the ligature, a variable common to all arterial ligation experiments, is an important source of variation and a significant predictor of the remodeling response. We find that the use of statistical regression is an improved analysis technique, as it allows the simultaneous consideration of multiple variables. We demonstrate this by showing improved sensitivity and novel findings in the analysis of the remodeling response in mice genetically mutant for the osteopontin gene. We conclude regression analysis provides a simple way to improve both comparative power and description of vascular remodeling.

Animals↗

Randomized trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein.

This prospective randomized study compared the treatment of greater saphenous vein insufficiency by stripping and local avulsions of varicose veins with high ligation of the saphenofemoral junction (crossectomy) combined with sclerocompression therapy. Of 156 consecutive patients, 89 legs were randomly allocated to stripping and 92 to high ligation. At follow-up of 3 months and 1, 2, and 3 years after treatment, clinical and Doppler ultrasound results, and complaints and cosmetic results, as judged by the patient and the surgeon, were scored. At 3 years, 69 limbs in the stripping group (78%) and 73 limbs in the ligation group (79%) were available to follow-up. The cosmetic results, both judged by the patient and the surgeon, were significantly better (P < 0.05) in the stripped limbs than in the limbs with high ligation and sclerotherapy. Clinical and Doppler ultrasound evidence of reverse flow in the saphenous vein was significantly less (P < 0.001) after the stripping operation. The results of treatment of isolated saphenous vein insufficiency by stripping operation, therefore, were superior to those obtained by high ligation combined with sclerotherapy.

Blood Flow Velocity↗

The effect of dietary consistency and water content on the parotid glands of submandibular and sublingual duct-ligated rats.

The aim here was to estimate the significance of oral sensation and mastication on functional changes in the parotid glands of partially desalivated rats. Submandibular and sublingual duct-ligated and sham-operated control rats were fed three diets of similar chemical composition but different physical presentations. Two were solid, either pellets or powder, and one was liquid. Water and food intakes were similar for both the duct-ligated rats and sham-operated control rats when they ate the pelleted or powdered-diet, though more food was wasted by the duct-ligated rats in the powdered-diet group than in the pelleted-diet group. No food was wasted in the rats fed the liquid-diet. Parotid gland weight and amylase activity were greatest with the submandibular and sublingual duct-ligated rats fed the powdered-diet and smallest with the duct-ligated and sham-operated control rats fed the liquid-diet. The amount of food wasted correlated positively with the parotid gland weight and parotid amylase activity of the rats. These findings support the view that it is the contact of dry food with the oral mucosa rather than the jaw movements involved in mastication that increases parotid gland weight and amylase activity in partial desalivated rats.

Amylases↗

The nonadrenergic noncholinergic relaxation of anococcygeus muscles of bile duct-ligated rats.

Previous studies have shown the naloxone-induced withdrawal syndrome and the development of tolerance in the tissues of cholestatic animals. Increased neuronal nitric oxide synthase (nNOS) expression is reported to exist in morphine-tolerant animals. This, together with evidence for nitric oxide (NO) overproduction in cholestasis, suggested the possibility of an alteration of nonadrenergic noncholinergic (NANC) relaxation of anococcygeus muscles of cholestatic rats. To study this, we used three main groups of animals: unoperated, sham-operated and bile duct-ligated. Electrical field stimulation, in the presence of atropine and guanethidine, caused NANC relaxation in the anococcygeus muscle which was enhanced in bile duct-ligated animals. N(G)-nitro-L-arginine methyl ester (L-NAME), a NOS blocker, caused a dose-dependent inhibition of the NANC relaxation. The IC(50)'s of L-NAME in 7-day (7.30+/-0.87 microM), 14-day (6.98+/-0.70 microM) and 21-day (8.25+/-1.40 microM) bile duct-ligated groups were significantly different from those of unoperated (1.69+/-0.30 microM) and sham-operated groups (1.90+/-0.27 microM). L-NAME (100 microM) completely inhibited the NANC relaxation response, suggesting that NANC relaxation in the rat anococcygeus muscle is mediated mainly via NO. The contraction response of the intact muscle to phenylephrine, an alpha(1)-adrenoceptor agonist, and the relaxation response of the phenylephrine-contracted muscle to sodium nitroprusside, an NO donor, were not different in unoperated, sham-operated and 7-day bile duct-ligated groups. These results showed that the smooth muscle component of NANC relaxation is not altered in anococcygeus muscles of bile duct-ligated rats. It can thus be concluded that the NANC relaxation in the anococcygeus of cholestatic rats is more resistant to a NOS blocker, providing evidence for increased nitrergic neurotransmission in the anococcygeus muscles of cholestatic rats.

Adrenergic Fibers↗

Early changes in the electrocardiogram and vectorcardiogram and myocardial histology following coronary artery ligation in monkeys.

The ramus interventricularis anterior was ligated at different levels (upper, middle, low third) in 12 anesthetized monkeys (Macaca mulatta). Morphological changes and their localization were compared with the electrocardiogram (ECG) in 12 leads and vectorcardiogram (VCG) according to Akulinichev's 5-plane system). The observations were performed for 6-7 hours after ligation. It has been established that upper third ligation of the ramnus interventricularis anterior caused ECG changes chiefly limited to the chest leads. Normalization of the ECG and VCG may occur within 4-6 hours after middle third ligation. In this case, monkeys develop morphological changes in form of insignificant dystrophic changes in the myocardium. This localization of ligature does not seem to disturb collateral blood circulation ensuring myocardial blood supply. Low third ligation was never followed by any normalization. Pathological wave Q on the ECG and its equivalent on the VCG may be observed in case of myocardial damage without large necrotic foci. In such cases, wave Q may decrease after blood supply improvement in the damaged focus.

Animals↗

Changes in portal hypertensive gastropathy after endoscopic variceal sclerotherapy or ligation: an endoscopic observation.

To determine the effect of endoscopic variceal sclerotherapy or ligation on portal hypertensive gastropathy, 90 cirrhotic patients with esophageal variceal bleeding were randomized to receive sclerotherapy (n = 44) or ligation (n = 46). Follow-up endoscopic observations of the gastric mucosa were recorded at 3-month intervals after variceal eradication. Clinical characteristics in both groups were similar. Probability for a change in the severity of portal hypertensive gastropathy was not related to method of eradication. Most cases of portal hypertensive gastropathy that changed in severity returned to baseline status with time, but the return was faster after ligation than after sclerotherapy. According to the results of multivariate analyses, sclerosant volume was the only factor associated with a significant difference between the group with static gastropathy (n = 15) and that with dynamic change in gastropathy (n = 23) after sclerotherapy. No relevant factors were found in the patients receiving ligation. We conclude that changes in the severity of portal hypertensive gastropathy after endoscopic variceal sclerotherapy or ligation are reversible. Most cases of gastropathy return to baseline status sooner or later.

Esophageal and Gastric Varices↗

Endoscopic variceal ligation in pediatric patients with portal hypertension secondary to liver cirrhosis.

BACKGROUND: Endoscopic variceal ligation is the initial treatment of choice in the management of esophageal varices. Few reports include its use in the pediatric population. We review our experience with this therapeutic modality in pediatric patients with end stage liver disease and esophageal varices. METHODS: We reviewed the medical records of pediatric patients with end stage liver disease who underwent endoscopic variceal ligation from January 1994 until December 1996. RESULTS: Thirty-two endoscopic variceal ligation procedures were performed in six pediatric patients during the period of study. In all patients, the esophageal varices classification was improved at the end of treatment. Only one patient had an episode of bleeding from esophageal varices during the period of study; only one patients had a complication associated with endoscopic variceal ligation. CONCLUSIONS: Endoscopic variceal ligation is feasible, safe, and effective for the management of esophageal varices in pediatric patients with end stage liver disease.

Child↗

Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis.

BACKGROUND: Esophageal band ligation is considered to be as efficient as endoscopic sclerotherapy, with a lower complication rate, including bacteremia. There are few studies comparing the two methods. The aim of this study was to compare the incidence of bacteremia after both treatments in patients with portal hypertension secondary to schistosomiasis. METHODS: Endoscopic sclerotherapy and band ligation were performed using standard techniques. Blood samples were obtained 5 and 30 minutes after endoscopic band ligation or sclerotherapy and cultured for aerobic and anaerobic organisms. RESULTS: In the sclerotherapy group 2 of 43 (4.6%) blood cultures were positive (Peptostreptococcus sp and Streptococcus mitis). A similar result was obtained in the band ligation group: 2 of 35 (5.7%) had positive cultures, both with Staphylococcus aureus. CONCLUSIONS: There is no difference in the frequency of bacteremia after treatment of esophageal varices with endoscopic sclerotherapy or endoscopic band ligation in patients with portal hypertension secondary to schistosomiasis.

Adult↗

Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage.

BACKGROUND: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. We present the preliminary results of an open trial using endoscopic band ligation for non-variceal, non-ulcer bleeding in the gastrointestinal tract. METHODS: Eighteen patients were treated by band ligation between June 1996 and November 1997. The lesions treated were: arteriovenous malformations in 10, Dieulafoy's lesions in 4, Mallory-Weiss tear in 2, and post-colonic polypectomy bleeding in 2. RESULTS: Endoscopic band ligation was successful in 17 of 18 cases, with a follow-up period ranging from 2 to 18 months. The remaining case, a duodenal Dieulafoy's lesion, bled again at 24 hours but was successfully treated by adrenalin injection. CONCLUSIONS: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.

Aged↗

Gastric variceal ligation: a new technique.

BACKGROUND: Gastric variceal bleeding is a serious complication of portal hypertension. The role of endoscopy in its management is still controversial. However, band ligation of gastric varices has not been evaluated. This study prospectively describes gastric variceal ligation as a new endoscopic technique for the management of different types of gastric varices. METHODS: Gastric variceal ligation was performed in 27 patients with gastric varices: 3 patients had type 1 gastroesophageal varices, 14 had type 2, 8 had isolated gastric varices, and 2 had both type 1 and type 2 gastroesophageal varices. The etiology of portal hypertension was schistosomiasis in 9, post hepatic cirrhosis in 3, and mixed cirrhosis in 15 patients. The Child-Pugh classification was grade A in 6, B in 17, and C in 4 cases. Active variceal bleeding was present in 18 patients, whereas nonbleeding varices were encountered in 9 patients. RESULTS: Emergency gastric variceal ligation arrested bleeding in 16 of 18 patients (88.8%). Recurrent bleeding was noted in 5 of 27 (18.5%). Six patients died (22.2%), 3 due to recurrent bleeding and 2 to liver failure. Variceal obliteration was achieved in all patients who underwent repeated elective sessions. The number of sessions needed for obliteration of varices was significantly less in patients with isolated gastric varices when compared with those with type 1 gastroesophageal varices ( p < 0.04). No serious complications occurred. CONCLUSION: Gastric variceal ligation is a safe and effective treatment for the different types of gastric varices but especially isolated gastric varices.

Esophageal and Gastric Varices↗

Mesenteric lymph duct ligation prevents shock-induced RBC deformability and shape changes.

OBJECTIVES: The exact mechanisms that lead to RBC deformability and shape changes after trauma/hemorrhagic shock remain unknown. We hypothesize that RBC injury is caused in part by gut injury and is mediated by gut-derived factors carried in the intestinal lymph. MATERIALS AND METHODS: RBC deformability was measured by a laser-assisted ektacytometer before and after trauma/hemorrhagic shock (T/HS) in 6 rats whose mesenteric lymph duct had been ligated and in 10 rats subjected to T/HS without duct ligation. In this assay a decrease in the elongation index is a marker of decreased RBC deformability. RBC shape was examined by scanning electron microscopy. RESULTS: In the T/HS rats, the RBC elongation index decreased after T/HS from a preshock value of 0.064 +/- 0.011 to 0.052 +/- 0.009 (P < 0.01) and remained low (0.049 +/- 0.010) even at 3 h after resuscitation. In contrast, the elongation index did not decrease after T/HS in the lymph duct-ligated rats (0.062 +/- 0.004 vs. 0.056 +/- 0.005, P = NS). Likewise, the T/HS rats, but not the duct-ligated T/HS rats, had a significant increase in the percentage of abnormally shaped RBCs when studied by electron microscopy. CONCLUSIONS: Interruption of lymph flow from the gut into the bloodstream by lymph duct ligation prevents T/HS-induced RBC damage. Because decreased RBC deformability contributes to impaired perfusion of the microcirculation, preservation of RBC deformability may decrease the incidence of T/HS-induced organ dysfunction.

Animals↗

Long-term effects of prepubertal testicular vessel ligation on testicular function in the rat.

To determine the effects of unilateral testicular vein and artery ligation in the immature rat on the function and final location of the testis at adulthood, 10-day-old male rats underwent either a sham operation or unilateral ligation of these vessels of the still undescended testis. Testicular location, blood flow, size and histology as well as ventral prostate weights were measured 50 days later at adulthood. At age 60 days, it was determined that all testes were descended into the scrotum, and there were no differences in testis and ventral prostate weights, intratesticular sperm counts and mean seminiferous tubular area between the control and sham operated animals. However, there was an 18% reduction in testicular blood flow (ml. per 100 gm. per minute +/- standard error of mean) in the operated animals when compared to the sham (20.43 +/- 1.10 versus 16.69 +/- 0.74, p less than 0.02). These data indicate that although there is a slight but significant reduction in testicular blood flow at adulthood when the testicular artery and vein are ligated early in life, this diminution is not sufficient to alter the ultimate location, testicular weight and spermatogenic function of the testis. This would suggest that after ligation of the main testicular vessels to the immature testis, the collateral blood supply is able to compensate with time to allow normal growth and development of the testis. These experimental observations provide additional support for the 2-staged approach to the high undescended testis whereby the testicular vessels are initially ligated and a subsequent procedure is performed to place the undescended testis into the scrotum.

Animals↗

Technical consideration in radical retropubic prostatectomy: blood loss after ligation of dorsal venous complex.

The estimated blood loss and blood transfused in 641 patients undergoing bilateral pelvic lymphadenectomy and radical retropubic prostatectomy were analyzed to compare ligation and nonligation of the deep dorsal venous complex. Group 1 (325 men) had no attempt at deep dorsal vein ligation and group 2 (316) had ligation of the deep dorsal venous complex. Group 2 was subdivided into group 2a-137 men in whom an attempt at a nerve-sparing procedure was made and group 2b-179 in whom no such attempt was made. Estimated intraoperative blood loss was significantly different between the groups: group 1--mean loss 1,262 ml. and group 2--mean loss 1,020 ml. (p less than 0.0001). The amounts of blood transfused intraoperatively were significantly different: group 1-1.73 units and group 2-1.21 units (p less than 0.0002). Intraoperative blood loss was not significantly different between subgroups 2a and 2b but the mean amount of blood transfused intraoperatively was lower in group 2a than in group 2b (0.99 and 1.39 units, respectively p less than 0.02). The greatest amounts of blood lost and transfused were in group 1 (no ligation) and the least amounts were in group 2a (ligation and nerve-sparing), representing highly statistically significant differences (p less than 0.0001).

Adenocarcinoma↗

Dysmenorrhea after bilateral tubal ligation: a case of retrograde menstruation.

BACKGROUND: Endometriosis, arising de novo, is believed to be uncommon in women who have undergone bilateral tubal ligation because the occluded tube prevents outflow of blood and menses. CASE: A woman 10-year status-post bilateral tubal ligation suffered from dysmenorrhea and menorrhagia that began within 1 year after sterilization. At the time of bilateral tubal ligation, no endometriosis was observed. A recent magnetic resonance imaging scan showed no pelvic abnormalities, and the patient underwent a diagnostic laparoscopy in anticipation of finding endometriosis, yet none was found. At laparoscopy performed on day 3 of her menstrual cycle, the proximal segments of her occluded fallopian tubes were dilated with blood. As this was the only abnormality found, we postulated that her dysmenorrhea might be related to the dilated proximal tubal stumps. We evacuated the bloody fluid and occluded the proximal tube at the cornua with Filshie clips. One year after surgery, the patient remains asymptomatic. CONCLUSION: This case is unique because bilateral tubal ligation combined with retrograde menstrual flow appears to have caused dysmenorrhea. Women who have undergone tubal ligation and who have dysmenorrhea may benefit from a diagnostic laparoscopy during menstruation to evaluate the possibility of retrograde menstruation dilating the proximal tubal stumps.

Dilatation, Pathologic↗

Bilioenteric anastomosis reverses hyperkinetic circulation in bile duct-ligated cirrhotic rats.

BACKGROUND/AIMS: The chronic bile duct-ligated rat is used to study hemodynamic changes in cirrhosis but suffers from total biliary obstruction and deep jaundice. The extent of reversibility of hemodynamics and histology following bile flow reconnection is controversial. We aimed to characterize the hemodynamics and histology of bile duct-ligated cirrhotic rats in which bile flow was reconnected by a Roux-en-y choledochojejunostomy. METHODS: Operations created four groups: double sham (control), bile duct ligated, and two reconnected groups. Cardiac index and regional blood flows were measured by radioactive microspheres 4 weeks following the last operation in the first three groups and 8 weeks afterwards in the second reconnected group. Liver histology was assessed by a computer-aided scoring program. RESULTS: Cardiac index, mean arterial pressure, and systemic vascular resistance in the reconnected groups were different from bile duct-ligated rats and returned to control values. Portal pressures in the reconnected groups (4-weeks, 10.0 +/- 0.5 and 8-week, 9.7 +/- 0.6 mmHg) were significantly lower than in bile-duct-ligated rats (13.7 +/- 0.6) but remained elevated compared to controls (7.0 +/- 0.3). Portal pressure in the reconnected rats was correlated with cardiac index and mesenteric blood flow, r = 0.66 and r = 0.45, respectively. Liver histology was improved in the reconnected rats, with decreased bile duct proliferation, fibrosis and apoptosis. CONCLUSIONS: We conclude that many of the histological features of secondary biliary cirrhosis are reversible after bilioenteric anastomosis. Furthermore, the hyperdynamic circulation is also largely reversible and is related to the degree of portal hypertension.

Alanine Transaminase↗