Minoru Numata

Effect of Ticlopidine on Graft Patency Following Arterial Reconstructive Surgery in the Lower Extremity: A Multicenter Three-Year Prospective Study

A multicenter, randomized, prospective trial was conducted to determine the clinical efficacy of ticlopidine, an antiplatelet agent, in the prevention of graft occlusion following vascular reconstructive surgery of the lower extremity for arteriosclerosis obliterans. Ticlopidine was administered for two years to one group of patients (112 reconstructed arterial segments) while a control group received no antithrombotic therapy (108 segments). There was no significant difference between the treated and control groups in the overall cumulative patency rates for both suprainguinal and infrainguinal reconstructions. In the treated group, however, there was a significant reduction of occlusions in pa tients with rest pain or ischemic gangrene (p < 0.1) and in those with hyperlipi demia (p < 0.05). Ticlopidine-treated patients with infrainguinal arterial reconstructions developed more occlusions than controls between three and twelve months after surgery, but the controls had more occlusions both immedi ately after surgery and in the second postoperative year. It appeared, therefore, that ticlopidine reduced graft failure due to neointimal fibrous hyperplasia or progression of the underlying condition but caused an adverse effect by delaying graft healing. The clinical usefulness of antiplatelet therapy is limited, but it may be effective in the prevention of graft occlusion when administered to the selected patient groups above mentioned. Controversy about antiplatelet ther apy and future research on adjuvant drug therapy after arterial reconstruction are discussed.

Free radicals in reperfusion injury after acute aortic occlusion

This investigation aims to evaluate the role of free radicals and the influence of radical scavengers in reperfusion injury of the skeletal muscle in male Wistar rats. Various parameters, including tissue blood flow, serum and calf muscle tissue levels of thiobarbituric acid (TBA) reactants, and the water content of calf muscles, were measured in the experimental setting, where infrarenal abdominal aorta was occluded for two hours followed by reperfusion with and without intraperitoneal administration of radical scavengers (superoxide dismutase or catalase). The rats were divided into four groups: group A: single laparotomy; group B: two-hour occlusion; group C: two-hour occlusion with superoxide dismutase; group D: two-hour occlusion with catalase. The increases in both serum and calf muscle tissue levels of TBA reactants following reperfusion were diminished in groups C and D as compared with those in group B. The water content of calf muscles showed a significant increase after reperfusion in group B, whereas it did not change in group D. The calf muscle tissue blood flow after reperfusion was significantly lower in group C than that in group B. These results indicate that oxygen-derived free radicals may be responsible for reperfusion injury in the lower extremity and that the attenuated blood flow during reperfusion produced by these scavengers seems to play an important role in reducing lipid peroxidation . In a clinical setting, limiting the rate of reperfusion blood flow may reduce the reperfusion injury in skeletal muscle.

Exogastrically Developed Pedunculated Epithelioid Leiomyoma of the Stomach

Epithelioid leiomyomas of the gastrointestinal tract are difficult to diagnose before surgery and their malignancy is not readily evaluated. The tumor is of smooth muscle origin, arising from the muscularis propria, and frequently develops in the gastrium, occasionally extending into the gastrocolic ligament or greater omentum. Malignancy is evaluated from the numbers of mitotic cells per 50 high power fields. However, even a tumor with few mitoses may metastatize. Thus, we propose that the malignancy of the tumor should be decided in terms of location, size, pattern of growth, invasion of the mucosa, cellularity, mitotic rate, and anaplasia. We reported a case of epithelioid leiomyoma that was pedunculated, with exogastric expansion. The literature is reviewed.

Renal cell carcinoma: oncocyte type.

A case of oncocyte-type renal cell carcinoma was reported. The tumor had developed from the upper posterior portion of the left kidney and was well circumscribed. However, the tumor showed expansion into the intraparenchymal space, invasive growth, and venous invasion. Marked cell atypia was not observed.

A Case Report of Frequent Familial Aggregation of Polycystic Liver Disease.

心窩部膨満感および上腹部腫瘤を主訴とする48歳の女性の多発性肝嚢胞症に対して, 1985年に嚢胞壁前壁切除術と開窓術を施行した.ひき続き本症例の姉も多発性肝嚢胞で当科にて同様の手術を行った.家族歴を詳細に調べたところ家系内に疑診者1名を含め計7名の多発性肝嚢胞症の集積を認めた.本家系のように濃厚な本症集積例の報告はまれである.遺伝様式の追究も含め嚢胞性疾患の家系内調査は必ず行うべきと考える.さらに本症例は初回手術3年後に, 症状が再燃し画像診断上も遺残嚢胞の増大と嚢胞壁前壁切除部の腹壁との癒合を認めたため, 超音波誘導下嚢胞内純エタノール注入療法が行われた.約10個の嚢胞に対しておのおの1～4mlのエタノールを注入し再排液しない方法で行ったが, 今日まで嚢胞は縮小したままである.類似症例に対して本法を積極的に行うつもりである.

The Role of Neostigmine in Development of Acute Gastric Mucosal Lesion in Dogs with Live Bacterial Flora-Induced Shock

SummaryThe factors that frequently cause the development of acute gastric mucosal lesions (AGML) were studied in 37 mongrel dogs. Bacterial shock was induced by bolus injection of E. coli live bacterial flora (1010 cells/kg body weight) under parietal cell-stimulated condition by intravenous administration of 0.008 mg/kg per hour of pentagastrin. In addition, 0.01 mg/kg per hour of neostigmine sulfate was administered intravenously during the experiment. Frequent development of AGML was observed in the neostigmine-administered canines without significant changes in the gastric corporal and antral tissue blood flow. In the neostigmine-administered group, AGML was observed in the antrum, although in the other group AGML was mostly observed in the corpus. These results suggest that a neostigmine-induced systemic vagostimulated condition by intravenous administration of neostigmine plays an important role in the development of AGML in dogs subjected to bacterial shock.

Papillotubular adenoma of the ampullary region.

Papillotubular adenoma of the ampullary region in a rare tumor which has the potential for malignant transformation. Although reported more frequently nowadays, ampullary tumors are difficult to diagnose before operation unless they cause obstructive jaundice. Occasionally they are detected by ultrasonography, computed tomography or ERCP in patients who complain of nonspecific upper abdominal discomfort. We report a case of a periampullary papilotubular adenoma causing generalized pruritus and weight loss but no jaundice. The tumor was extirpated by pancreaticoduodenectomy, and the patient has remained healthy for over five years.

Small Intestinal Evisceration through the Anus due to Spontaneous Rupture of the Rectosigmoid

A case of intestinal evisceration through the anus due to spontaneous rupture of the rectosigmoid is reported. The patient was a 76-year-old widow with habitual constipation. The episode of eviscerati