Hachinen Akita

Surgical aspect ot cystic dilatation of the bile duct. An anomalous junction of the pancreaticobiliary tract in adults.

Twenty-two cholangiograms of adults with congenital dilatation of the common bile duct were studied and analyzed. Diagnosis of this disease was established by endoscopic retrograde cholangiopancreaticography in nine patients, by percutaneous transhepatic cholangiography in two patients, and by operative cholangiography in 11 patients. All patients, except one with Carolis disease, were classified as type I according to Alonso-Lej. An anomalous junction of the pancreaticobiliary ductal system (AJPBDS) was observed in 15 cases. In nine patients the common bile duct joined the main pancreatic duct, and in the remaining six patients, the pancreatic duct was noted to join the common bile duct. These anomalies are considered to be an important etiologic factor in the development of choledochal dilatation. Total cyst excision and hepaticojejunostomy in a Roux-en-Y fashion is recommended as the procedure of choice in those cases with AJPBDS. This is based on the high incidence of cholangitis and the high propensity to induce malignancy of cystic wall following simple drainage.

Ruptured venous aneurysm of the persistent left superior vena cava.

A 24-year-old female with venous aneurysm of the persistent left superior vena cava and the left subclavicular vein has been reported. Spontaneous closed rupture of the venous aneurysm, secondary to thrombosed obstruction, occurred into the posterior mediastinum and the extrapleural thoracic wall. The symptom was aggravated rapidly because of absent communicating vein between the persistent left superior and the right superior venae cavae. Surgical intervention was not considered for the reason of difficulty in approach. Fortunately an open rupture of the venous aneurysm into the thoracic cavity was not seen. A conservative treatment for 4 months resulted in a successful outcome with absorption of a large hematoma and building of collateral circulation.

Patch Closure of the Ductus Arteriosus: An Improved Method

An improved surgical procedure for patch closure of the ductus arteriosus under cardiopulmonary bypass is presented. A patch with a Fogarty catheter inserted through its center is used. The catheter is insinuated into the aorta through a pulmonary arteriotomy under normothermic cardiopulmonary bypass. An inflated intraaortic balloon is made to plug the orifice of the ductus using gentle traction on the catheter. The catheter may be slanted in any direction that is convenient to provide satisfactory visualization of the operative field.

Cardiac Lymph in Electrical Ventricular Fibrillation: An Experimental Study

The flow velocity of cardiac lymph during electrical ventricular fibrillation under normothermic cardiopulmonary bypass was studied experimentally in dogs. The time needed for the cardiac lymph node to become stained after injection of dye into the apex myocardium of the left ventricle was measured as an indicator in determining flow velocity of cardiac lymph. The flow velocity was markedly decelerated immediately after the commencement of electrical ventricular fibrillation. It was accelerated, however, after 2 hours of continuous electrical ventricular fibrillation. The difference between the two values was significant (p less than 0.01). Absent contractility of the heart influenced the deceleration of flow velocity of cardiac lymph immediately after the commencement of electrical ventricular fibrillation. Acceleration after 2 hours involved stasis of cardiac lymph as a result of absent contractility and increment of lymph production due to the nonphysiological condition of the myocardium.

Portopulmonary shunt by splenopneumopexy for portal hypertension in children.

Portopulmonary shunting by splenopneumopexy was successfully performed on seven children with portal hypertension, associated with extrahepatic portal vein occlusion in six and congenital hepatic fibrosis in one. Technically, this procedure is very simple and safely performed even in infancy. No operative mortality has been encountered to date. All children with portal hypertension treated by this portopulmonary shunt are doing very well, without any disturbances in their growth. Their postoperative survival ranges from 8 years and 9 months to 17 years and 9 months. Splenic pulp pressure was reduced to a postoperative mean value of 306 +/- 40.7 mmH2O from a preoperative mean value of 402.9 +/- 35.7 mmH2O. Hemorrhages esophageal varices were completely controlled postoperatively. Postoperative liver function tests were essentially unchanged from the preoperative values.

Flow Velocity of Cardiac Lymph and Contractility of the Heart: An Experimental Study

The flow velocity of cardiac lymph in various abnormal conditions of the heart and in control situations was studied experimentally in dogs. The time needed for the cardiac lymph node to become stained after injection of contrast medium into the muscle layer of the left ventricular apex was measured as an indicator in determining flow velocity of cardiac lymph. Left ventricular contractility was studied simultaneously. The hypoxic dogs had a short staining time with a vigorous cardiac beat. (Short staining time means accelerated lymph flow through the heart). The hearts in which the coronary sinus was ligated revealed the shortest staining time with an insignificant contractile change. The exsanguinating dogs had a long staining time with reduced contractility. The dogs with ventricular fibrillation had the longest staining time. When the heart rate was fixed by pacing, the staining time reflected contractile change. The contractile force of the heart plays an important role in the flow velocity of cardiac lymph.

The contribution of pancreas and kidney in regulating serum amylase levels in dogs

SummaryAmylase activity in canine serum before and after total pancreatectomy with or without additional removal of duodenum and other small intestines were determined and resulted that pancreas would provide approximately fifty per cent of amylase detected in the canine serum. Serum amylase levels were also measured before and after intravenous injection of canine pancreatic juice as a source of pancreatic amylase into normal or nephrectomized dogs in order to investigate the mode of disappearance of amylase from circulating blood and following result was obtained that intravenously injected amylase were removed from the blood by extraurinary mechanism in dogs.

Pathophysiological aspect of the liver in acute obstructive suppurative cholangitis

SummaryThis study is prompted in order to clarify the pathophysiological aspect of the liver in acute obstructive suppurative cholangitis (AOSC). An experimental model of AOSC, was prepared by intracholedochal infusion of endotoxin in dogs with and without obstructive jaundice. In the patients with AOSC, liver function was aggravated remarkably compared with that in the stage of non suppurative cholangitis. A rapid fall of platelet count occurred.Experimentally, after intracholedochal infusion of endotoxin, liver function revealed significant hepatic cellular damage. A considerable increase in the S-OCT level was accompanied by a marked rise in blood ammonia concentration. Liver damage due to obstructive jaundice was further aggravated by endotoxin infusion.The level of serotonin in the liver tissue increased markedly after endotoxin infusion. This was accompanied by a rapid fall of platelet counts. Serotonin is considered to be a factor which may cause an impairment of hepatic microcirculation and then hepatic cellular damages.It may be concluded that AOSC is induced by cholangio-venous reflux of endotoxin. Liver function is impaired remarkably due to increased bile canalicular pressure, to the direct affect of endotoxin on liver cells during the process of cholangio-venous reflux, and to impairment of hepatic microcirculation in endotoxin shock.Liver dysfunction contributes to develop this clinical entity and play an important role to make its outcome fatal.

Sternal dehiscence: “Delayed primary closure” for complicated cases

Abstract“Delayed primary closure” of the wound in cases of sternal dehiscence is reported. This technique includes a thorough debridement, continuous antibiotic lavage, and air tight force suction of the debrided space, using a portable wound suction unit. Healing process of the complicated sternal dehiscence is thus facilitated. A discussion is made of reasons for failure and missed chances in “early primary closure” of the sternal dehiscence.

The Twenty-Second Autumn Meeting of the Japanese Society of Gastroenterology

The 22nd Autumn Meeting of the Society will be held under the chairmanship of Prof. Hachinen AKITA, M.D., the 2nd Department of Surgery, Kagoshima University School of Medicine, Kagoshima City, from October 22 to 24, 1980, together with the 18th Autumn Meetings of The Japanese Societies of Gastrointestinal Endoscopy and Stomach Mass Survey, under the presidencies of Prof. S. SHINOHARA, M.D., and Prof. S. HASHIMOTO, M.D., respectively.