Shigehiko Shionoya

Clinicopathologic studies on perineural invasion of bile duct carcinoma

To elucidate the clinical significance of perineural invasion on bile duct cancer, a clinicopathologic study was performed on 70 resected patients with bile duct carcinoma. The overall incidence of perineural invasion in the resected specimen was 81.4%. There seemed to be no correlation between perineural invasion and site, size of the tumor, and lymph node metastasis. A significant correlation was observed, however, between macroscopic type, microscopic type, depth of invasion, and perineural invasion. Perineural invasion index (PNI) was defined as the ratio between the number of nerve fibers invaded by cancer and the total number of nerve fibers with and without cancer invasion. Perineural invasion index was significantly higher at the center compared with the proximal and distal part of the tumor (p less than 0.001). The 5-year survival rate for patients with perineural invasion was significantly lower (p less than 0.05) than that for those without perineural invasion (67% versus 32%).

Value of percutaneous transhepatic cholangioscopy (PTCS)

SummarySince July 1975, percutaneous transhepatic biliary drainage (PTBD) has been performed in 533 cases, and since April 1977 we have developed percutaneous transhepatic cholangioscopy (PTCS) as a diagnostic and therapeutic endoscopical tool in 198 cases of malignant disease and 195 benign cases. After dilating the sinus tract of PTBD using a 15-Fr catheter about 2 weeks after PTBD, PTCS was carried out through the sinus tract. PTCS has diagnostic advantages: the lesion can be accurately diagnosed histologically and the extent of cancer in the biliary tract can be assessed by taking biopsy specimens before the operation. PTCS has been applied for cholangioscopic lithotripsy in 145 cases of gallstone disease. In 44 cases, the Nd-YAG laser and/or electrohydraulic shock wave has been used to break up the stones. The PTCS morbidity was 6% and mortality was 0.3%.

Vascular lesions due to obstruction of the vasa vasorum.

DISTURBANCE of the vasa vasorum is probably a major factor in the aetiology of various vascular lesions such as cervical rib syndrome, medionecrosis, arteriosclerosis, and pulseless disease1. Various experimental methods of destroying the vasa vasorum have been reported2,3. These involve crushing or dissecting the adventitia, or applying acids and thermocautery to the outside of the vascular wall. We have found no references to any method involving disturbance of the vasa vasorum alone, however. This communication describes an experimental procedure designed to obstruct the vasa vasorum alone.

Pathogenesis of mycotic aneurysm.

Aneurysms are more frequently attributable to arteriosclerosis than to syphilis, trauma and bacterial Although mycotic aneurysms are relatively uncommon,2 it seems necessary to take more notice of mycotic aneurysms because, in contrast with arteriosclerotic aneurysms, most mycotic aneurysms occur in patients under 40 years old and have a tendency to rapid growth and rupture.2-5 The surgical procedure is difficult and the prognosis is poor for the inflammation in the involved vessel.2, 5, 6 Since the middle of the last century mycotic aneurysms have been the subject of increasing clinical investigation, and many investigators have discussed whether mycotic aneurysms are formed by the direct infection on the inner surface of the artery or by the infection through the vasa vasorum from the outer side of the arteries.3, 5, 7, 8 The purpose of this report is to describe vascular lesions caused by infection through the vasa vasorum by the new injecting method, and to discuss

Decrease in regeneration capacity of rat liver after external biliary drainage.

In order to discover the effect of external biliary drainage on liver regeneration, we have produced a model system carrying cannula in the common bile duct of rat liver and examined the regeneration capacity of liver after partial hepatectomy under various conditions. Previously we have shown that hepatic cells proliferate by obstructive jaundice alone without partial hepatectomy [Terasaki et al; Jpn J Cancer Res 1991;82:170-175]. In the present study, we showed that DNA polymerase-alpha was induced by partial hepatectomy of rats suffering from obstructive jaundice and the induced level was similar to that of the normal regenerating liver. The level of DNA polymerase-alpha activity corresponded well to the liver regeneration capacity estimated by mitotic index. Contrary to our expectation, external biliary drainage for obstructive jaundice markedly suppressed the regeneration capacity of the remaining liver which was estimated by DNA polymerase-alpha activity, mitotic index and [3H]thymidine incorporation. The suppression may be due to the external biliary drainage itself because the liver regeneration of normal rats without jaundice was also suppressed by the biliary drainage. These results suggest that the external biliary drainage seriously suppresses the regeneration capacity of liver at least at the early stage of obstructive jaundice.

False aneurysm of the superficial temporal artery

Abstract A case of false aneurysm with fistula of the superficial temporal artery is reported, and the English literature is reviewed.

Pattern of Arterial Occlusion in Buerger's Disease

The pattern of arterial occlusion in Buergers disease was analyzed by simultaneous bilateral femoral arteriography in 210 limbs of 105 patients with Buergers disease. In 55 limbs of 42 patients, the femoropopliteal segment was affected in addition to the infrapopliteal arterial obstructive lesion. The pattern of crural arterial occlusion was similar in about 40% of both the patients with femoropopliteal occlusion and the patients with crural occlusion. Toes were ulcerated in 4 of 58 limbs with continuous arterial flow, and ulceration occurred in 86 of 152 limbs with a discontinuous flow. The rate of occurrence of bilateral trophic lesion in the group with an arterio graphically similar occlusion pattern was not significantly higher than that in the group with a different pattern. The pattern of arterial occlusion in Buergers disease seemed to be fixed mainly within 1 year after the onset of symptoms, and the skip-lesion in the main artery was favorable to proximal progression of the disease.

Microcirculatory characteristics in patients with Buerger's disease

The most characteristic pathophysiologic change in Buergers disease or thromboangiitis obliterans (TAO) is considered the breakdown of microcircula tion in the extremity, but this has not yet been proven. The purpose of this study is to examine the damage of microcirculation in TAO objectively, by means of intra-arterial injection of two kinds of radioisotope. In 7 TAO and 4 infraingui nal arteriosclerosis obliterans (ASO) patients, thallium 201 chloride (201 Tl) and 99mTc macroaggregated human serum albumin ( 99mTc-MAA) were administered through bilateral common femoral artery injections. In the planar image of the foot, rectangular regions of interest (ROIs) were placed on the foot muscles and toes. Normalized counts of 99m Tc-MAA in each ROI were divided by that of 201Tl, and the result was defined as the microcirculation damage index, based on their different kinetics. The damage index of the foot muscle was not differ ent between ASO and TAO, but that of the toe was lower in TAO than ASO patients. Lumbar sympathectomy was performed in 5 TAO patients, but it did not improve the damage index. It is concluded that there is breakdown of the microvascular defense system from the beginning of the disease, and critical ische mia make the regional cell function deteriorate as if a precursor to a trophic lesion. Lumbar sympathectomy did not immediately improve microcirculation.

Induction of DNA Replication and Cell Growth in Rat Liver by Obstructive Jaundice

Obstructive jaundice, produced by ligating the common bile duct, induced a transient DNA replication followed by cell proliferation in rat liver. At 48 h after the operation, DNA polymerase α activity started to increase and reached its maximum level (more than twice the control) at day 4. At day 7, the enzyme level had decreased to the control level. Pulse‐labeling experiment using radioactive thymidine showed that the rate of DNA synthesis increased approximately 2.5‐fold in the same pattern as that of DNA polymerase α The mitotic index in hepatocytes also increased 10‐fold at day 4 and then decreased. The proliferation of liver cells induced by obstructive jaundice mimics the regeneration of partially hepatectomized liver, although the response was slightly delayed and the proliferation was transient.

Aneurysm of the extracranial internal carotid artery caused by fibromuscular dysplasia

A case of aneurysm of the extracranial internal carotid artery (ICA) caused by fibromuscular dysplasia (FMD) is reported. The patient also had an aneurysm of the contralateral intracranial ICA, but the renal arteries were normal. A review of the literature shows extracranial ICA aneurysms to be uncommon, with only 3% caused by FMD. The surgical management of such difficult lesions at the base of the skull is discussed.