Masahiko Kawai

GTP‐binding protein involvement in membrane currents evoked by carbachol and histamine in guinea‐pig ileal muscle.

1. Single smooth muscle cells obtained by enzymic dispersion of the longitudinal muscle layer of guinea‐pig ileum were used for recording membrane currents under whole‐cell voltage clamp in response to carbachol (100 microM, unless otherwise stated) or histamine (100 microM) applied extracellularly. 2. At a holding potential of 0 mV, a transient outward current was evoked by carbachol and histamine. Responses to the two agonists were very similar in size and time course to the current response to caffeine (10 mM). The response to carbachol was virtually absent in the presence of histamine, and vice versa. Caffeine was without effect in the presence of either of these agonists. Inclusion of EGTA (10 or 20 mM) in the pipette abolished the responses to carbachol, histamine and caffeine. Thus, the outward current responses were considered to represent opening of Ca(2+)‐activated K+ channels in response to a massive release of Ca2+ from the same stores by these three agents. 3. An inward current was evoked by carbachol and histamine, but not by caffeine at a holding potential of ‐40 mV, which was considered to represent opening of cationic channels. The carbachol‐induced inward current was much longer in duration and larger in size than the histamine‐induced inward current. 4. Inclusion of GDP beta S (2 mM) in the pipette abolished the inward and outward current responses to histamine, but inhibited only part of those to carbachol. 5. When the holding potential was held at 0 mV with inclusion of GTP gamma S (0.1‐1 mM) in the pipette, spontaneous transient outward currents appeared immediately after break‐through but disappeared a few minutes later. Under these conditions, caffeine (10 mM) was almost without effect, suggesting that GTP gamma S had released Ca2+ stores. When the holding potential was held at ‐40 mV and GTP gamma S (0.1 or 0.2 mM) was present in the pipette, an inward current developed a few minutes after break‐through. During the GTP gamma S‐induced inward current, application of carbachol or histamine produced no further inward current. However, when 0.01 mM‐GTP gamma S was included in the pipette solution, carbachol‐ and histamine‐induced inward currents were potentiated. 6. Pretreated with 2‐5 micrograms/ml pertussis toxin (PTX) did not change noticeably the outward current responses to carbachol and histamine, but abolished or markedly reduced the inward current responses.(ABSTRACT TRUNCATED AT 400 WORDS)

Oscillations of receptor-operated cationic current and internal calcium in single guinea-pig ileal smooth muscle cells

In single cells isolated from guinea-pig ileal smooth muscle, held under voltage clamp at −40 mV or −50 mV by patch pipette in the whole-cell recording mode, carbachol (CCh) evoked an oscillatory inward cationic current. The frequency of current oscillations increased with increasing CCh concentration. CCh-evoked current oscillations were followed very closely by oscillations in intracellular free Ca2+ estimated from the Indo-1 signal, and were abolished by inclusion of EGTA in the pipette solution. Ryanodine and heparin, but not nifedipine, blocked the generation of current oscillations. CCh-evoked current oscillations were abolished upon withdrawal of extracellular calcium and restored upon its reintroduction. Inclusion of GTP[γS] in the pipette solution caused the generation of an oscillatory inward current, which was blocked by ryanodine. The present results are consistent with the hypothesis that CChevoked cationic current is gated by activation of a G protein and is steeply dependent on [Ca2+]i, fluctuations in the release of Ca2+ from stores during carbachols action produce oscillations in [Ca2+]i which cause similar oscillations in the cationic current.

Giant left-sided inguinoscrotal hernia containing the cecum and appendix (giant left-sided Amyand's hernia)

The present case involved a 62‐year‐old male with a large left‐sided inguinoscrotal hernia. A CT scan and a clinical examination led to a diagnosis of a giant left‐sided Amyands hernia. The hernia was repaired using the ULTRAPRO Hernia System (UHS), and the patient exhibited an uneventful postoperative course.

V-shaped lymph node dissection in laparoscopic distal gastrectomy; new technique of intra-abdominal dissection and surgical outcomes

BackgroundRecently, laparoscopic-assisted distal gastrectomy (LADG) has become popular for the treatment of early gastric cancer. Furthermore, the use of totally laparoscopic gastrectomy (TLG), a more difficult procedure than LADG, has been increasing in Japan. Laparoscopic-assisted distal gastrectomy is currently performed more frequently than laparoscopic distal gastrectomy (LDG) in hospitals in Japan.MethodReconstruction after LDG is commonly performed extra-abdominally and lymph node dissection of the lesser curvature is performed at the same time. We have developed a new method of intra-abdominal lymph node dissection for the lesser curvature.ResultsOur technique showed positive results, is easy to perform, and is reasonable in terms of general oncology theory.ConclusionIn oncological therapy, this technique could be a valuable surgical option for totally laparoscopic surgery.

A patient with spontaneous rupture of the esophagus and concomitant gastric cancer whose life was saved: case of report and review of the literature in Japan

A 71-year-old man suddenly developed abdominal pain and vomiting on drinking soda after a meal, and visited a physician. Cervical subcutaneous and mediastinal emphysemas were observed on CT, and the patient was transferred to the emergency medical center of our hospital on the same day. Esophagography was performed at our department. A ruptured region was identified on the left side of the lower thoracic esophagus, and surgery was emergently performed employing sequential left thoracoabdominal incision. The chest wall was adhered due to inflammation, and large amounts of residual food and sloughing were present in the thoracic cavity and mediastinum. Moreover, necrotic changes were noted in the superior through inferior mediastinum. An about 2-cm rupture site was confirmed on the left side of the lower thoracic esophagus and closed by suture and filling with pediculate omentum. The presence of a tumorous lesion located mainly in the body of the stomach and lymph node enlargement were also diagnosed before surgery, for which gastric and intestinal fistulae were inserted to prepare for the second-stage surgery. The patient was admitted to an ICU after surgery. ARDS and MRSA-induced pneumonia and enteritis concomitantly developed but remitted. Curative surgery for gastric cancer was performed at 40 POD. Spontaneous rupture of the esophagus is relatively rare and that complicated by gastric caner is very rare, with only six cases being reported in Japan. Herein, we report the case.

A CASE OF CECAL VOLVULUS COMPLICATED BY PERFORATED PERITONITIS

症例は51歳，男性．主訴は腹痛にて当院救命救急センターを受診した．腹部単純レントゲンにてfree airを認め穿孔性腹膜炎と診断され当科に紹介された．腹部CT検査にてfree air，小腸および大腸の著明な拡張像，大量腹水を認めた．また来院時脈拍180/分，呼吸数36/分，体温38.3℃とSIRS状態であり，緊急手術施行となった．術中所見では十二指腸球部にピンホール状の穿孔と約1,500mlの膿性腹水を認め，さらに盲腸を中心に同部が時計回りに360度回転した上に拡張しており，盲腸軸捻転症と診断した．術式は大網充填術および捻転部を解除し，盲腸固定術を施行した．術後ARDSおよびDICを併発したが，集中治療管理を行い，術後40日目に退院した．結語:穿孔性腹膜炎（十二指腸穿孔）に合併した盲腸軸捻転症は極めて稀であり，また術前診断にMDCTが有用であった．

Idiopathic Perforation of the Sigmoid Colon with Retroperitoneal Emphysema

後 腹膜 気腫 を伴 う特 発性S状 結 腸 穿孔 の1例 を経 験 したの で報告 す る。 症例:78歳,女 性 。主 訴:下 腹部 痛。 現病 歴:平 成13年7月11日,下 剤 を内服 した後,頻 便 とな った。便 は黒 色調 とな り下 腹部痛 も出現 したため7月13日 緊急 入院 した。入院 時,両 下腹 部痛 と圧 痛 を認め,腹 部 単純X線 写 真, 腹部CTで 後腹 膜 の気腫像 を認め た ため消化 管 穿孔 の疑 い で同 日緊急 手術 を施行 した。開 腹す る と,S状 結 腸 間膜 は緑 黒色 に変 色 し,腸 間 膜へ の穿孔 部 を認 め たため,S状 結腸 切 除術 と人工 肛 門造設術 を施 行 した。切 除標 本 では, 3.0×2.5cm大 の 穿孔部 が認 め られ たが,周 辺粘 膜面 に異 常 はみ られ なか った。また,組 織 学的検 査 で は軽度 の炎 症所 見 と明瞭 な粘 膜,筋 層 の断裂 がみ られ た ため,特 発 性 穿孔 と診 断 した。術後 経過 は良好 で,術 後20日 目に退 院 した。 本例 は術 前診 断 に腹部CTが 有用 で あ った。