Tatsuzo Hebiguchi

Action of pancreatic juice on the bile duct: Pathogenesis of congenital choledochal cyst

Babitt was the first to suggest that the anomalous arrangement of the pancreatico-biliary ducts might be involved in the etiology of congenital choledochal cyst. Since then, many authors have reported this condition frequently associated with congenital choledochal cyst. The reflux of pancreatic juice into the common bile duct due to this anomaly has been thought to be responsible for the formation of choledochal cyst. Our previous study using the animal model with anomalous arrangement of pancreaticobiliary ducts, has proven that pancreatic juice in the common bile duct caused cystic dilatation of the common bile duct. However, the mode of action of pancreatic juice on the biliary duct has remained unclear. The present study using peroxidase as a tracer for permeability of the biliary duct showed early damage of the intercellular junction of biliary epithelium exposed by pancreatic juice, followed by affection of submucosal tissue.

The effect of arginine supplementation on growth hormone release and intestinal mucosal growth after massive small bowel resection in growing rats

Four-week-old male Sprague-Dawley rats underwent a 90% small bowel resection. From the fourth day after surgery, they were divided into group 1 and 2, and pair-fed by elemental diets (0.8 kcal/mL, 50 mL/day) with L-arginine (n = 10) or L-glycine (n = 11) as an isonitrogenous and isoenergetic supplement for 3 weeks. They were compared with each other 3 weeks after surgery. A statistical analysis was performed using the unpaired Students t test and the one-way factorial analysis of variance (ANOVA) using Bonferroni/Dunn multiple comparison test. A Pvalue of < .05 was considered significant. There were no significant differences between the two groups in food intake, body weight, tail length, residual ileal length, and plasma IGF-I level. However, the mean height of ileal villi in group 1 showed higher than that in group 2 (P < .01). Growth hormone-releasing hormone (GHRH) provocative tests (1 microg per rat, intravenously) showed the more significant elevation of growth hormone IGH) secretion in the arginine supplement group than that of glycine supplement group at 5 minutes (P < .05). There were no significant differences between basal levels of plasma rat GH in both groups. It is suggested that arginine has a possible significant role of GH secretion and intestinal mucosal growth after massive small bowel resection.

Onset of Apoptosis in the Cystic Duct During Metamorphosis of a Japanese Lamprey, Lethenteron reissneri

A nonparasitic lamprey in Japan, Lethenteron reissneri, stops feeding prior to the commencement of metamorphosis. Resumption of feeding cannot take place due to major alterations in the digestive system, including loss of the gall bladder (GB) and biliary tree in the liver. This degeneration of bile ducts is considered to depend on programmed cell death or apoptosis, but molecular evidence of apoptosis remains lacking. Using terminal deoxynucleotidyl transferase dUTP nick‐end labeling (TUNEL) staining and immunohistochemistry with an antibody against active caspase‐3, we showed that epithelial cells of the cystic duct (CD) and GB became TUNEL‐positive by the early metamorphosing stage. Immunohistochemical staining of active caspase‐3, a key mediator in the apoptotic cascade, showed that the apoptotic signal was initiated in the region around the CD in the late larval phase. In later stages, active caspase‐3‐positive epithelial cells were also observed in the large intrahepatic bile duct (IHBD) and peripheral small IHBDs. At the early metamorphosing stage, bile canaliculi between hepatocytes were dilated and displayed features resembling canaliculi in cholestasis. Onset of apoptosis around the CD, which is the pathway for the storage of bile juice, and progression of apoptosis towards the large IHBD, which is the pathway for the secretion of bile juice, may lead to temporary intrahepatic cholestasis. The present study represents the first precise spatial and temporal analysis of apoptosis in epithelial cells of the biliary tract system during metamorphosis of any lamprey species. Anat Rec 293:1155–1166, 2010.

Gastric teratoma extending into the mediastinum

This is a case report of gastric teratoma of which a larger part extended into the mediastinum.

Elevated expression of transforming growth factor β3 in carbon tetrachloride-treated rat liver and involvement of retinoid signaling

Transforming growth factor (TGF) β is a pro-fibrotic cytokine. While three isoforms (TGF-β1, 2 and 3) are known, the functional differences between them are obscure. To investigate the roles of TGF-β isoforms during liver fibrogenesis, male Wistar rats were administrated carbon tetrachloride (CCl4) subcutaneously twice a week for two months. Livers were excised and sectioned for histochemical examinations. These livers were also used to quantitate the expression of genes associated with fibrogenesis, including TGF-β isoforms, as well as those associated with retinoid metabolism. Expression levels of Tgfb1 and Tgfb3 were up-regulated in CCl4-treated rat livers while that of Tgfb2 was not changed. The mRNAs for lecithin-retinol acyltransferase (Lrat) and retinoic acid hydroxylase, Cyp26a1, were also elevated. By immunohistochemical staining, TGF-β3 protein was found to be localized mainly in liver parenchymal cells (hepatocytes). These results indicate that retinoid mobilization likely takes place within the rats liver following CCl4 treatment, and suggest the possibility that the expression of Tgfb mRNA is regulated by retinoic acid receptors. Reporter analyses of a region of the Tgfb3 gene were performed using the rat liver parenchymal cell line, RLC-16, and a positively responsive region was identified within its intron.

Extremely short small bowel induces focal tubulointerstitial fibrosis.

Background Arginine becomes an essential amino acid after massive resection of the small bowel as a result of decreased biosynthesis of citrulline in the remaining small bowel. It is also reported that nitric oxide (NO) is synthesized from l -arginine by NO synthase (NOS), and NO is involved in the regulation of blood flow in the kidney. The authors observed a patient with an extremely short small bowel, showing focal tubulointerstitial fibrosis. The experiment was designed to clarify whether massive small bowel resection (SBR) produces focal tubulointerstitial fibrosis in the kidney. Methods An experimental study was performed using 4-week-old rats with 90% proximal SBR either with or without arginine supplementation for 6 weeks after surgery. Results In rats without arginine supplementation, low plasma levels of citrulline and arginine increased urinary excretion of orotate, and focal tubulointerstitial fibrosis was observed 6 weeks after 90% SBR. The data from plasma amino acid chromatography and increased excretion of urinary orotate suggested the presence of arginine deficiency. The kidney pathology was similar to that of our patient. Rats with arginine supplementation after 90% SBR and pair-fed control rats without 90% SBR showed almost normal glomeruli and tubulointerstitium. Conclusions Experimental study strongly suggests that arginine deficiency causes focal tubulointerstitial fibrosis in the kidney after massive SBR.

X‐linked adrenal hypoplasia congenita: Testicular histology before puberty

© 2007 Japan Pediatric Society DAX-1 is an orphan nuclear receptor that plays a key role in the development and function of the adrenal gland and hypothalamic – pituitary – gonadal axis. 1,2 Mutations of the DAX-1 gene cause X-linked adrenal hypoplasia congenita (AHC; OMIM:300200). 1,2 In this disease, hypogonadotropic hypogonadism (HHG) usually becomes apparent during adolescence with impaired or arrested pubertal development. Based on observations in some AHC patients, it was originally hypothesized that hypogonadism in AHC was due to defi cient gonadotropin secretion. However, combined gonadotropin therapy could not induce spermatogenesis in most AHC patients and only rare spermatogonia were found in testicular biopsies, although a normal testosterone response could be induced. 3 There have been only three reports describing testicular morphology in AHC patients. 4 – 6 Further investigation of the testicular tissue will be needed to determine the mechanism of hypogonadism in AHC by DAX-1 gene mutations. In the present report we histologically analyzed the biopsied testicular tissue of a 9-year-old AHC boy with undescended testes in prepubertal state.

Renal focal tubulointerstitial fibrosis with short bowel syndrome: report of a case.

Abstract.We report a male patient with short bowel syndrome (SBS) and renal focal tubulointerstitial fibrosis (FTIF). Seven years after surgery, he was introduced to us due to severe undernutrition, an impairment of growth hormone (GH) secretion, and abnormally low levels of plasma citrulline and arginine at 11 years 7 months of age, just before nutritional support using total parenteral nutrition (TPN) was begun. Thereafter, the support was changed to home TPN with GH supplementation. After an improvement of the disorders, GH was stopped at 17 years 3 months of age. However, hyperuricemia appeared and a renal biopsy revealed FTIF at 20 years of age. Home TPN was continued twice a week because the plasma arginine level was still low. His follow-up biopsy at 23 years of age showed morphometric amelioration. Arginine deficiency following SBS may be associated with FTIF. The cause of hyperuricemia after SBS therefore needs to be investigated in detail.

Transhiatal Jejunal Interposition Preserving the Whole Stomach and Vagal Trunk for a Benign Esophageal Stricture in a Male Adolescent : Report of a Case

Benign esophageal strictures are generally treated with medication and balloon dilation; however, when repeated dilations fail, surgery is the only option. When performing surgery for benign esophageal stricture in young patients, it is important to consider not only the surgical stress and likelihood of complications but also digestive function after reconstruction, the durability of the reconstruction, and the potential for cancerous change in the reconstructed organs. We describe how we treated a 14-year-old boy with benign esophageal stricture by performing transhiatal esophagectomy assisted by mediastinoscopy, preserving the whole stomach and vagus nerve, and interposing pedicled jejunum between the cervical esophagus and stomach through a posterior mediastinal route, with good long-term results.

Z-shaped skin incision applying Kraissl's lines for an axillary thoracotomy.

A Z-shaped skin incision applying Kraissls lines for a thoracotomy is presented herein. The center of the Z-shape is located on the intercostal space of the thoracotomy. Parallel Z-shaped lines are described on circular Kraissls lines in the axillary region. The oblique cross-line of the Z-shape is drawn from the dorsal edge of the cranial line to the anterior edge of the caudal line. The angle of the triangular skin flaps is adjusted to 30 degrees or greater in order to keep good microcirculation. The incision gives good exposure for the operative fields and results in a cosmetically satisfactory scar.