Hiromu Tsuge

Nitric oxide mediates cerulein-induced relaxation of canine sphincter of Oddi.

This study evaluates the hypothesis thatcerulein relaxes the sphincter of Oddi (SO) via nitricoxide (NO). The spontaneous motility and the response tocerulein on the canine SO were recorded using aconstant-perfusion technique.NG-L-arginine-methyl-ester (L-NAME) increasedthe spontaneous motility and dose-dependently reducedthe cerulein-induced inhibitory response of the SO.After treatment with L-NAME at higher doses, cerulein induced an excitatory response.This effect was reversed by treatment with excessL-arginine. Similar results were obtained usingcholecystokinin octapeptide in place of cerulein. Inseparate studies, cerulein generated increases inintracellular cAMP and cGMP levels in the SO. Thisindicates that the intracellular mechanism mediatingcerulein-induced relaxation involves the production ofcAMP and cGMP. On the other hand, treatment withL-NAME absorbed the increase in cAMP and cGMP levels bycerulein. These studies demonstrate that ceruleinrelaxes the canine SO mainly via NO, increasingintracellular cAMP and cGMP levels.

Vacuolar Hepatocyte Degeneration Induced by Infusion of 20% Glucose Solution with Insulin after Hepatopancreatectomy in Rats

To investigate the causes of hepatic dysfunction after extensive resection of the liver together with pancreatectomy, rats were subjected to sham operation, to 68% hepatectomy alone, to 90% pancreatectomy alone, or to 68% hepatectomy combined with 90% pancreatectomy (hepatopancreatectomy). Solutions of 5% or 20% glucose were infused post-operatively for 48 h at a constant rate (250 ml/kg body weight/day) under fasting conditions. To improve the survival rates of pancreatectomized and hepatopancreatectomized rats given 20% glucose, it was necessary to use insulin. In hepatopancreatectomized rats, infusion of 20% glucose with insulin (1 U/5 g glucose) induced prominent hepatocyte vacuolar degeneration and mitochondrial swelling, associated with reduced hepatic protein content. The severity of histological changes was proportional to the insulin dose and the activity of hepatic glucokinase, a key glycolytic enzyme. These histological changes were observed in pancreatectomized rats albeit in a milder form, but not in sham-operated or hepatectomized rats given 20% glucose nor in any rats given 5% glucose. Our results suggest that hepatopancreatectomy followed post-operatively by a high glucose load and exogenously administered insulin enhances the development of hepatocyte swelling.

The Long-Term Survival of Patients with Ductal Carcinoma of the Pancreatic Head and Body

Seventy-six patients with ductal carcinoma of the pancreatic head and body who underwent resection during the past 20 years were studied. Included were 1 patient in stage I, 5 patients in stage II, 27 patients in stage III, 24 patients in stage IVa, and 19 patients in stage IVb. Curative resection was achieved in 100% of the patients with stage I and II, 81.5% of stage III, 41.7% of stage IVa, and 10.5% of stage IVb. The surgical procedure involved pancreatoduodenectomy or total pancreatectomy with extensive skeletonization. Intraoperative radiotherapy and perioperative chemotherapy were seldom performed. Surgical mortality (deaths within 3 months after surgery) decreased from 19.4% before 1986 to 2.5% after 1987. There were 11 (18.6%) long-term survivors of more than 3 years among 59 patients and 7 (15.2%) survivors of more than 5 years among 46 patients. These long-term survivors were all found in the group that underwent pathologically curative resection, and there were no long-term survivors among patients with pathologically noncurative resection. In the group receiving curative resection, 28.9% (11/38) of patients survived more than 3 years and 24.1% (7/29) of patients survived more than 5 years. The 3-year-survival rates were 60% in stages I and II, 26.9% in stage III, 4.2% in stage IVa, and none in stage IVb; the 5-year-survival rates were 40% in stages I and II, 19.2% in stage III, and none in stage IV. Curative resection should be applied to patients with stages I, II, III, and IVa tumors, and excessive surgery should be avoided for patients with stage IVb.

Evaluation of sodium and water loading during and after hepatectomy in patients with liver cirrhosis.

肝硬変合併肝細胞癌で肝切除術を受けた8症例を対象とし, 水・ナトリウム利尿に相反作用を有するホルモンと全身循環動態の変化を測定し, われわれの行っている水・ナトリウム制限のない輸液管理について評価した. 硬変肝肝切除術後3日目は1日目に比べ心房性ナトリウム利尿ペプチド値は有意に上昇し血漿アルドステロン値は有意に低下した. 平均肺動脈圧と肺動脈喫入圧は術後3日目は1日目に比べ軽度だが有意に上昇した. これらの結果より硬変肝肝切除術での水・ナトリウム制限のない輸液管理は術後1日目は有効循環血液量不足を予防し, 3日目は軽度の増加を生じていた. 術後3日目からの水・ナトリウム制限が必要と思われた.