Toshiya Ito

Preparation of polyamine antibody and its use in enzyme immunoassay of spermine and spermidine with β-D-galactosidase as a label

An enzyme immunoassay for polyamines is described which uses beta-galactosidase labeled spermine and antiserum raised in rabbits against spermine-bovine serum albumin synthesized by coupling spermine to mercaptosuccinylated bovine serum albumin with a bifunctional cross-linker, N-(gamma-maleimidobutyryloxy)-succinimide. The lower limit of detection by this assay, which involves a double antibody technique for the separation of antibody-bound and free antigen, was 1 ng of spermine per tube. The anti-spermine serum showed 88% cross-reaction with spermidine but only 0.13% with putrescine, 0.08% with 1,3-diaminopropane, and 0.04% with cadaverine. The method has been used to measure serum polyamine levels in healthy subjects and cancer patients, in whom mean concentrations of 58.1 ng/ml and 94.8 ng/ml (as spermine), were respectively noted. This enzyme immunoassay is specific, accurate and easy to perform, and appears suitable for routine clinical use.

Hyperbaric oxygen therapy in the treatment of refractory peripancreatic abscess associated with severe acute pancreatitis

SummaryFive patients with peripancreatic abscesses associated with severe acute pancreatitis were treated by hyperbaric oxygen therapy (HBO). In 3 patients, the course after surgical mobilization of the pancreas and drainage of the pancreas bed was complicated by peripancreatic abscesses. HBO was conducted under a pressure of 2.8 atmospheres for two hours dialy. Four of the 5 patients showed a progressive improvement in their condition. In one patient who failed to respond despite seven sessions of HBO, Pseudomonas aeruginosa was isolated from the discharge, and resection of necrotic tissue and drainage were performed. The main effects of HBO were the alleviation of high spiking fever, the improvement of white blood cell count and serum amylase levels, and the reduction of the abscess size. We recognized HBO to be a successful treatment for peripancreatic abscess associated with severe acute pancreatitis and better results were obtained than in cases that did not receive HBO.

SARCOMA BOTRYOIDES ARISING FROM THE BILIARY TRACT OF CHILDREN — A CASE REPORT WITH REVIEW OF THE LITERATURE

Sarcoma botryoides (embryonal rhabdomyosarcoma) originating from the common bile duct is reported in a 4‐year‐old girl. Grossly, the tumor is characterized by multiple polypoid and grape‐like projections into the lumen of the common bile duct and shows plate‐like thickening of the common bile duct wall. On multiple cut‐sections these polypoid masses are soft and light yellow white except for multifocal hemorrhage. Histologically the tumor consists of undifferentiated mesenchymal cells with a myxomatous appearance; rhabdomyoblasts with varing degree of maturation are scattered here and there within the matrix. These cells are characterized by a strap and racket shape with abundant eosinophilic cytoplasm and elongated cytoplasm with cross striations. The histogenesis of the tumor may be related possibly to an abnormal differentiation of the primitive mesenchymal cells toward striated muscle cells.

ULTRASTRUCTURAL STUDIES OF HUMAN ACUTE PANCREATITIS

SummaryThe pancreatic tissue from a patient with acute hemorrhagic necrotizing pancreatitis was studied by routine electron microscopic observation.The remarkable change was the destruction of pancreatic acinar units.1)The acinar lumen was dilated with filling of fibrillar materials, which occasionally contained degenerated cellular components or neutrophils.2)Accumulations of fibrillar materials were present at the periphery in the acinar cells, especially depositted thickly at the basal portion.3)In some acinar cells, the accumulation of fibrillar materials occupied the entire acinar cell, accompanied by disappearance of luminal margin, and the intracellular fibrillar materials were mixed with acinar lumen contents.4)The acinar units which showed above described changes had almost intact basal lamina.

Ultrastructural studies of experimental acute pancreatitis.

SummaryAcute pancreatitis was studied by electron microscopy after retrograde infusion of either trypsin, and/or β-glucuronidase into the canine pancreatic duct.Marked changes were induced by the mixture of trypsin and β-glucuronidase. (1) The acinar cells were initially excavated from the acinar lumen and formed cystic bodies in themselves. The cystic bodies were then disrupted at their marginal membranes, and the acinar cells were filled with a large amount of fibrillar materials which originated from the contents of the cystic bodies. At this time, the luminal margin of the acinar cells completely disappeared. (2) The cellular organellas and the intracellular fibrillar materials in the acinar cells were discharged into the interstitial space through the disrupted basal lamina. Infection in the pancreatic ductal system was considered to play an important role in the pathogenesis of acute hemorrhagic pancreatitis.

Ultrastructure of botryoid sarcoma of the common bile duct

SummaryA case of botryoid sarcoma of the common bile duct in a 4-year-old girl was reported. Electron microscopic examination disclosed that the neoplasm consisted of three types of cells: polygonal, elongated, and small cells. The former two contained moderate to large amounts of poorly developed myofibriles in the cytoplasm with occasional A, I and Z-bands. The small cells contained mitochondria and dilated rough endoplasmic reticulum but few myofilaments. Deposits of glycogen granules were constant components of the neoplastic cells. Mitosis was striking in the small cells. Abnormal multilaminar endoplasmic reticulum was observed in the small cells in the mitotic stage.

Complete avulsion of the papilla of Vater and gastroduodenal artery due to blunt abdominal trauma: report of a case.

A case of traumatic avulsion of the papilla of Vater and gastroduodenal artery successfully treated by pancreaticoduodenectomy is presented herein. The mechanism of this rare injury appeared to be a shearing force applied to the common bile duct and gastroduodenal artery. Thus, when the liver is driven cephalad by compression of the abdomen and by the deceleration force, the common bile duct and gastroduodenal artery are avulsed from the fixed duodenum and pancreas. The mechanism of this rare injury is postulated on the basis of operative and histological findings. Our case is thought to be the first of traumatic avulsion of the papilla of Vater and gastroduodenal artery to be reported in Japan.

Portal hypertension due to hepatic artery-portal vein arteriovenous fistula--a case report.

A case of portal hypertension secondary to traumatic hepatoportal arteriovenous fistula with portal fibrosis was successfully treated by ligation of the afferent hepatic arteries which decreased significantly portal pressure and corrected the abnormal blood inflow to the portal vein via A-V fistula resulting in a recovery of the disturbed liver function. Collateral blood supply from the left hepatic artery into the right hepatic lobe was found to be quite satisfactory after the ligation of the hepatic artery. Hemodynamic data and clinical findings of the present case suggest that the mechanism responsible for the portal hypertension is the inflow block resulting from the interruption of portal venous flow by the inflow of arterial blood via A-V fistula and the subsequent increased blood pressure in portal vein radicals.

The surgical technique of retroperitoneal lavage for the treatment of extended necrotizing pancreatitis

For cases of extended necrotizing pancreatitis which involve the spread of infectious or hemorrhagic necrotic lesions to the retroperitoneal tissue, we recommend sequestrectomy and subsequent retroperitoneal lavage via the retroperitoneal access. For successful retroperitoneal lavage, as much liquefactive infectious necrotic tissue as possible should be removed from the retroperitoneal cavity during the operation. In addition, the necrotic cavity should be opened, adequately washed out, and catheters placed in the retroperitoneal cavity by retroperitoneal access. Although we have only applied this ideal technique in two patients so far, the details are presented herein. The significance of retroperitoneal lavage lies in the fact that it cleans the retroperitoneal foci of infection and necrosis, and that it eliminates the necrotic material, bacterial deposits, and biologically active substances produced after surgery. Ultimately, wound healing is markedly promoted, leading to improvement in the systemic condition.

Retroperitoneal Lavage in the Treatment of Infectious Necrotizing Pancreatitis. Report of a Case.

症例は50歳の男性で, 腹痛, 発熱を主訴として来院し, 諸検査の結果, 重症急性膵炎と診断され, ICU管理のもとで輸液, 薬剤, 高圧酸素療法を行う. その結果, 全身状態と臨床検査成績は急速に改善の方向に向かった. しかし, 入院3週目より, 再び腹痛, 高熱力が出現し, WBC15,500, CRP強陽性, computed tomographyによる画像所見の増悪傾向を示したので, 感染性膵壊死の診断で開腹した. 手術は後腹膜ルートで膵を含む後腹膜腔に存在する融解した感染壊死組織を用手的に除去し, 術後に持続的後腹膜灌流を行った. 後腹膜灌流期間は8週を要した. なお, 壊死巣よりStaphylococcus aureusを検出した. 本法は今までに例をみない新しい術式であり, その意義は後腹膜の感染壊死巣の浄化とともに, 術後に新しく産生される感染壊死物質や生物学的活性物質の排除であり, その結果, 創傷治癒が促進され, 全身状態が改善される.