Shinsuke Hata

A newborn rabbit model for total parenteral nutrition: effects of nutritional components on cholestasis.

A newborn rabbit model for total parenteral nutrition (TPN) was developed to examine the effects of nutritional components on cholestasis. Thirty-five newborn Japanese white rabbits were divided into five groups. Rabbits in group I received glucose-based TPN solution, Group II received lipid-based solution, group III received larger amounts of amino acids than group I, and group IV received larger amounts of nonprotein calories than groups I and II. Rabbits in group V were given mothers milk freely. After the duration of TPN for 7 days, blood samples and liver were obtained when rabbits were killed. In group IV, the serum level of T-Bil (1.44 +/- 0.68 mg/dliter) was significantly higher than those in other groups (group I: 0.28 +/- 0.04 mg/dl; group II: 0.49 +/- 0.12 mg/dl; group III: 0.21 +/- 0.04 mg/dl; group V: 0.28 +/- 0.07 mg/dl), and serum level of GOT (44.2 +/- 25.2 units) and total bile acid (20.6 +/- 8.9 nmol/ml) were significantly higher than those in groups I, II, and III (group I: 16.8 +/- 7.8 units and 6.7 +/- 3.3 nmol/ml, group II: 21.5 +/- 7.9 units and 12.5 +/- 6.4 nmol/ml, group III: 14.3 +/- 4.2 units and 8.4 +/- 5.0 nmol/ml, respectively). Furthermore, there was histological cholestasis characterized by bile plugs in bile ducts, and bile pigments in Kupffer cells and hepatocytes, whereas there were no, or scarce findings of cholestasis in the other groups. These results indicate that an excessive administration of nonprotein calories in TPN contributes to the occurrence of cholestasis. In addition this animal model may be useful in investigating the etiology of cholestasis.

Effect of amino acids in total parenteral nutrition on cholestasis in newborn rabbits

The effect of amino acids on total parenteral nutrition (TPN)-associated cholestasis was examined using a newborn rabbit TPN model. Twenty-nine newborn Japanese white rabbits were divided into four groups. Group I received a TPN solution with composition and total energy similar to that of rabbit breast milk. Group II received more dextrose than group I. Group III received a larger amount of amino acids than group II. Group IV was nourished by lactating mothers. After 7 days of TPN, blood samples and liver specimens were obtained. In group II, the serum total bilirubin level (1.44 +/- 0.68 mg/dL) was significantly higher than normal (0.28 +/- 0.07 mg/dL) and that of group I (0.49 +/- 0.12 mg/dL). In group II, histological cholestasis was present, characterized by bile plugs in bile ducts, bile pigments in Kupffer cells and hepatocytes, and nonprotein calorie overload changes in clear cell transformation of the hepatocytes. In group III, the serum total bilirubin level (0.23 +/- 0.05 mg/dL) was normal, and there were minimal cholestatic and nonprotein calorie overload changes (histologically) in the liver. These results indicate that cholestasis in this study was induced by nonprotein calorie overload and was prevented by an appropriate volume of amino acids.

The synthetic surfactants AS and LAS interrupt pregnancy in mice

Abstract Alcohol sulfate (AS) interrupted pregnancy when applied to the dorsothoracic area (2 × 3 cm) of pregnant mice from Day 1 to 10 of gestation. This effect was due to interference with development of the embryos during the cleavage stage, because when pregnant mice were treated with AS in the same way before implantation (from Day 0 to 3), significant numbers of embryos (29.1%) collected from the uteri and oviducts were deformed (dead or dying). Similar results were obtained with a linear alkylbenzene sulfonate (LAS). AS had no detectable teratogenicity in the offspring when applied to the mothers similarly from Day 1 to 17 or carcinogenicity when applied from Day 12 to 17. The offspring of mice treated with AS from Day 12 to 17 showed growth retardation, but this disappeared after weaning.

Killing of preimplantation mouse embryos by main ingredients of cleansers AS and LAS.

When main ingredients of cleansers, alcohol sulfate (AS) and linear alkylbenzene sulfonate (LAS), were applied to the dorsal skin of pregnant JCL:ICR mice during preimplantation period (days 0-2), significant numbers of embryos collected from the oviducts and uteri on day 3 showed severe deformity or remained at the morula stage. Most of abnormal embryos were fragmented or remained at the 1-8 cell stages, and they were either dead or dying. Even when these abnormal embryos were cultivated in the detergent-free medium, they were not recovered, while most growth-retarded embryos (morula) could grow and hatch with one or two days lag by the further in vitro cultivation. Similar results were observed with commercially obtained kitchen detergent and hair shampoo, although such embryocidal effects were not detected with natural soap and distilled water. Fertilized eggs may be specifically sensitive to synthetic detergents. Very low doses of X-rays also induced significant yields of abnormal embryos. Major difference between X-rays and detergents was that X-ray-induced abnormality appeared at the morula or blastocyst stage, while detergent-induced one did at the earlier stages.

Transumbilical laparoscopic-assisted appendectomy for children and adults

Dear Editor: In 1983, Semm reported the first laparoscopic appendectomy. Since then, several randomized controlled trials and metaanalyses have demonstrated that laparoscopic appendectomy is associated with fewer wound infections, less pain, faster recovery, earlier return to work, and cosmesis compared with open appendectomy. However, the longer operation time and increased hospital costs relative to open appendectomy continue to fuel the debate over these techniques. The use of single-port laparoscopic surgery is steadily increasing and several authors have reported the feasibility of single-port laparoscopic appendectomy. However, this technique is technically demanding and requires special devices that increase costs. Transumbilical laparoscopic-assisted appendectomy (TULAA) was first reported by Pelosi and colleagues in 1992 as “Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy)”. The authors claimed that, in some cases of appendicitis, the appendix could be pulled out through a small umbilical incision and be resected, and the special laparoscope enabled easy exteriorization of the appendix. However, TULAA is still not routinely performed. One reason is the need for a special laparoscope, in which 5-mm laparoscopic forceps can be inserted through its mounted operative channel. Another reason is the notion that it is difficult to extract the appendix from the umbilicus in adult patients, which has led many surgeons to limit TULAA to children. We modified the TULAA technique by using a usual laparoscope. Additionally, we extended the indication of TULAA to adults and analyzed the relationship between feasibility and body habits. With the patient under general anesthesia, we made a 15−20-mm longitudinal incision in the umbilicus and attached a wound protector. The right lower quadrant abdominal wall was then lifted with a thin surgical retractor to provide a working space in the peritoneal cavity. Pneumoperitoneum was not used, eliminating the need for any ports. We inserted a 5-mm laparoscope and 5-mm laparoscopic forceps through the incision. When the appendix was identified under laparoscopy, it or the mesoappendix was grasped and exteriorized through the incision. The mesoappendix and appendix were then dissected and ligated as in open appendectomy. Finally, we washed the peritoneal cavity with saline and closed the wound cosmetically. We converted to a laparoscopic approach if a complicated inflammatory mass was found or when the appendix and mesoappendix could not be exteriorized because of immobility of the appendix. When a massive abscess and/or severe adhesion were found, the operation was converted to an open appendectomy. All of the surgeons were 3–5-year postgraduates while the first assistants were surgeons with at least 7 years of experience. Yoshinori Kagawa, Shinsuke Hata, Junzo Shimizu, Mitsugu Sekimoto, and Masaki Mori contributed equally to this work. Y. Kagawa (*) :M. Sekimoto :M. Mori Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2–2 Yamadaoka, Suita, Osaka 565–0871, Japan e-mail: ykagawa@gesurg.med.osaka-u.ac.jp

A Pediatric Amino Acid Solution for Total Parenteral Nutrition Does Not Affect Liver Function Test Results in Neonates

Abstract.Purpose: We studied the effects of an amino acid mixture used for total parenteral nutrition (TPN) in pediatrics, on the liver function test results (LFTs) of neonates.Methods: Thirty neonatal surgical patients were randomly divided into three groups according to the dose of amino acids given: group H (n= 12, 3.45 ± 0.07 g/kg per day), group M (n= 8, 2.59 ± 0.07 g/kg per day), and group L (n= 10, 1.72 ± 0.06 g/kg per day). All patients received the same amount of dextrose (average 21.5 g/kg per day) and no lipid.Results: There were no significant differences in LFTs, namely, direct bilirubin, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, γ-glutamyl transpeptidase, and total bile acids, among the three groups on the tenth day of TPN.Conclusion: These findings indicate that this amino acid solution for pediatrics has no significant effect on LFTs in neonates, even when high doses of amino acids (3.5 g/kg per day) are infused.

Effects of dietary histidine and methionine loading in rats with a portacaval shunt

To elucidate disturbances of brain amine metabolism in hepatic coma, the effects of dietary histidine and methionine loading on the brain levels of amino acids and transmitter amines and on behavior were examined in rats with a portacaval shunt (PCS rats). Surgical construction of a portacaval shunt exaggerated the increase in brain histamine caused by dietary histidine loading 4 weeks after operation. Although the marked increase in the brain level of methionine itself did not affect on the brain levels of catecholamines, serotonin, and histamine, brain level of 5-HIAA was decreased in PCS rats on methionine-enriched diet. Diminished spontaneous activity was observed in PCS rats on either diet, which could not be related to the disturbance of brain amine metabolism caused by excess histidine and methionine. These results indicated that histamine was involved in the derangement of brain amine metabolism in PCS rats, and that direct effect of dietary methionine loading on the brain levels of transmitter amines was not observed in PCS rats. The etiological relation of these substances to hepatic coma should be further investigated.

A method to detect tumors and presumed somatic mutations in mice.

A method was tested to detect both tumors and somatic mutations in mice. When HT-A/J F1 embryos were treated with ethylnitrosourea on day 11 of gestation, a single injection was enough to induce tumors and presumed somatic mutations of coat color in significantly high incidence. Urethane, treated in a similar way, induced somatic mutations and malformations in the offspring. Tumor incidence was also increased but was not significantly different from controls. Treatment on day 13 was too late to induce somatic mutations and malformations, while high incidence of tumors were induced.

Neonatal caliceal diverticulum associated with hydronephrosis

Caliceal diverticula (CD) are rarely associated with hydronephrosis (HN), and prenatal diagnosis of CD has not been reported. We present a case of neonatal CD associated with HN that was detected before birth. This rare association should be borne in mind in the differential diagnosis of cystic renal lesions.

Congenital diaphragmatic eventration detected by antenatal ultrasound: Rationale for early operation

A rare prenatal case of congenital diaphragmatic eventration is reported. Fixed elevation of the right hemidiaphragm since the early fetal period suggests irreversibility of the eventration. A rationale for early surgical plication in symptomatic congenital eventration is proposed.