Kimiro Tanaka

Extended right lobectomy for Caroli's disease: report of a case and review of hepatectomized cases in Japan.

A 27-year-old man was admitted to Nagasaki University Hospital complaining of fever. Percutaneous trans-hepatic cholangiography revealed multiple cystic dilatations of the intrahepatic bile ducts of the right lobe, as well as three obvious cystic dilatations and several small dilatations of the intrahepatic bile ducts of the left lobe. An extended right lobectomy was performed. However, the patient later suffered from repeated cholangitis and required the administration of antibiotics as a result of remnant cystic dilatations and stricture of the extrahepatic bile duct following hepatectomy. A slight enlargement of the remnant cystic dilatations, but no new cystic dilatations, were also recognized in the regenerating liver. We reviewed nine cases of hepatectomy for Carolis disease reported in the Japanese literature, as well as our own case. Among these, four of the seven patients subjected to hepatic resection involving unilateral lobe demonstrated a good recovery. On the other hand, it is difficult to successfully treat Carolis disease involving both lobes of the liver by hepatic resection.

Alanyl‐glutamine provides beneficial nutritional support after orthotopic transplantation of the liver in pigs

We evaluated the nutritional status of pigs that received glutamine after orthotopic liver transplantation. After transplantation, one group of pigs received an oral diet (group I,n=5), one group received conventional total parenteral nutrition (group II,n=4), and one group received alanylglutamine supplemented parenteral nutrition (group III,n=7). We compared nutritional status, graft liver function, and ileal mucosal thickness in the three groups. There were no significant differences in nutritional parameters or serum chemistries among the groups. In terms of ileal integrity, mucosal thickness was reduced after liver transplantation in group II, whereas it was relatively well preserved in group III. The level of endotoxin in the portal venous blood was significantly lower in group III, than in group II on the 7th day after liver transplantation. Parenteral alanyl-glutamine appears to have beneficial effects in preserving the integrity of the ileal mucosa when oral intake of nutrients may not be feasible. This could prevent bacterial translocation in the portal vein.

Effect of Superoxide Dismutase Derivatives Modified with Monosaccharides on Reperfusion Injury of Orthotopic Liver Transplantation in Rats. Evaluaiton by Liver Na+, K+-ATPase Activity.

Superoxide dismutase (SOD) 誘導体のmannosylated SODは肝非実質細胞に, galactosylatedSODは肝実質細胞に取り込まれ, 肝由来の活性酸素の効果的な消去を期待しうる.そこで, ラット肝移植実験でこれらの単糖類で修飾したSODを使用し再灌流障害に対する効果を検討した.通常のSODと修飾型SODを肝移植再灌流直前に投与し再灌流30分後に犠牲死させ, 血液および肝組織を採取して血液一般肝機能, 肝組織Na+, K+-ATPase活性, 組織過酸化脂質 (LPO), 組織SOD活性を測定した.移植再灌流によって血中逸脱酵素の上昇と肝組織Na+, K+-ATPase活性の有意の低下, LPOの増加とSOD活性の低下を認めた.これらの障害は通常のSODでは抑制されず, 単糖類で修飾したSOD, ことにgalactosylated SODによりNa+, K+-ATPase活性低下は抑制され, 組織LPO, SOD活性の改善が認められ, 再灌流時に発生する組織障害の防止に有効と考えられた.