A surgical shunt closure via the lumen of an intrahepatic portal aneurysm was successfully performed in a 70-year-old Japanese woman with hepatic encephalopathy due to hyperammonemia. She had a ...4-month history of repeated hepatic encephalopathy which persisted after treatment with oral medicine. Color Doppler ultrasonography and computed tomography revealed a cystic peripheral portal aneurysm, 4 cm in diameter, connecting the posterior branch of the portal vein to the short hepatic vein in the right lobe.
While performing the Pringle maneuver and clamping the inferior vena cava below the liver, the wall of the portal aneurysm was opened, and the site of inflow from the portal vein and the site of outflow to the hepatic vein via the lumen of the portal aneurysm were closed with interrupted sutures.
The patient's postoperative course was uneventful, and she was discharged 12 days after surgery. 12 months after surgery, she had no recurrence of hyperammonemia or hepatic encephalopathy.
Surgical shunt closure via the lumen of a portal aneurysm can be performed safely, easily, and completely with good vision.
OBJECTIVE: To investigate the binding of antibodies against negatively charged phospholipids (antiphospholipid antibodies) to human placenta, we tested the reactivity of three mouse monoclonal ...antiphospholipid antibodies against first-trimester human placenta.
STUDY DESIGN: Formalin-fixed and frozen sections of first-trimester placentas were stained by immunoperoxidase with three mouse monoclonal antibodies. Each monoclonal antibody reacted differently with cardiolipin and phosphatidylserine, 3SB9b reacted with phosphatidylserine, D11A4 reacted with cardiolipin, and BA3B5C4 reacted with both.
RESULTS: 3SB9b reacted strongly with the syncytiotrophoblastic layer of both formalin-fixed and frozen placental tissue. Sporadic reactivity was observed against the cytotrophoblastic layer. BA3B5C4 reacted strongly and specifically with cytotrophoblastic cells. D114A reacted minimally or, more commonly, not at all.
CONCLUSION: The trophoblastic layer directly in contact with the maternal circulation is most reactive with antiphospholipid antibodies that react with phosphatidylserine rather than cardiolipin, suggesting that the trophoblasts may potentially be directly damaged by antiphospholipid antibodies through mechanisms unrelated to thrombosis. In addition, the differential reactivity of 3SB9b and BA3B5C4 suggests that the antigenic conformation involving phosphatidylserine on the cytotrophoblast is altered concurrent with fusion into the syncytium.
An ohmic-heating laser ion source with a thin ionizer of thickness of 30 μm has been developed for the TIARA-ISOL. It can form an electric field of 4–5 V/cm inside the ionizer. The properties of the ...laser ion source were tested on- and off-line with aluminum isotopes. The FWHM of the time distribution of the bunched photoions from the ion source was about 4 μs for
27Al. In on-line experiment, a photoionization efficiency of about 0.1% for
25Al was obtained.
A new type of linear ion trap system in combination with a sextupole ion beam guide (SPIG) has been developed for the accumulation of a continuous ion beam. An axial trapping potential is generated ...by three cylindrical electrodes mounted outside, but concentric to, the SPIG. The ions in a continuous beam are trapped in the potential well via collisions with He gas. This linear ion trap is called the “SPIG-trap”. The properties of the SPIG-trap were tested off-line with a discharge ion source in a gas cell. Up to 10
6 ions were trapped and extracted as a bunch with an efficiency of 10% for 10 ms of accumulation. The SPIG-trap system was then connected to a gas filled recoil mass separator (GARIS) and tested with an energetic primary beam from a cyclotron (
16O, 107 MeV). The overall efficiency of the SPIG-trap including ion losses in an energy degrader, which was placed in front of the He cell, was measured to be of the order of 10
−5 for 10 ms accumulation.
The effectiveness of systematized hepatectomy with transection of Glisson's pedicle at the hepatic hilus in patients with small nodular hepatocellular carcinoma (HCC) has not been confirmed.
Surgical ...outcomes were reviewed in 204 patients with single nodular HCCs less than 5 cm in greatest diameter, including 68 patients with tumors that showed extranodular growth and 136 patients with tumors that did not, who had undergone curative hepatectomy (partial hepatic resection, n = 114; systematized hepatectomy, n = 90) from 1990 through 1994.
The rates of microscopic vascular invasion and intrahepatic metastasis were significantly higher in patients who had single nodular HCCs with extranodular growth (34% and 49%) than in patients who had single nodular HCCs without extranodular growth (13%, P = .001, and 4%, P < .001). The 5-year survival rate in patients who had single nodular HCCs with extranodular growth was significantly greater after systematized hepatectomy (67%) than after partial hepatic resection (21%, P = .0002). Multivariate analysis showed that the type of operation was an independent prognostic factor in patients with single nodular HCCs with extranodular growth (P = .0008).
Systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus should be performed in patients who have single small nodular HCCs with extranodular growth because these tumors often invade within the liver sector containing the tumor. (Surgery 2001;130:443–8.)
In remote areas of the Amazon Region, diagnosis of malaria by microscopy is practically impossible. This study aimed to evaluate the performance of two rapid diagnostic tests (RDTs) targeting ...different malaria antigens stored at room temperature in the Brazilian Amazon Region.
Performance of the OptiMal Pf/Pan test and ICT-Now Pf/Pan test was analyzed retrospectively in 1,627 and 1,602 blood samples, respectively. Tests were performed over a 15-month period. Kits were stored at room temperature in five community health centres located in the Brazilian Amazon Region. RDT results were compared with thick blood smear (TBS) results to determine sensitivity, specificity, and accuracy of the RDT.
The sensitivities of the OptiMal Pf/Pan test were 79.7% for Plasmodium falciparum malaria diagnosis and 85.7% for non-P. falciparum infections. The results showed a crude agreement of 88.5% for P. falciparum, and 88.3% for non-P. falciparum infections (Kappa index = 0.74 and 0.75, respectively). For the ICT-Now Pf/Pan test (CI 95%), the sensitivities were 87.9% for P. falciparum malaria diagnosis and 72.5% for non-P. falciparum infection. Crude agreement between the ICT-Now Pf/Pan test and TBS was 91.4% for P. falciparum and 79.7% for non-P. falciparum infection. The Kappa index was 0.81 and 0.59 for the final diagnosis of P. falciparum and non-P. falciparum, respectively. Higher levels of parasitaemia were associated with higher crude agreement between RDT and TBS.
The sensitivities of RDTs stored at room temperature over a 15-month period and performed in field conditions were lower than those previously reported.
Control of blood loss is a crucial problem during hepatectomy. Bleeding from the inflow system can be controlled by the Pringle maneuver or selective vascular occlusion. Bleeding from the outflow ...system is closely related to central venous pressure (CVP). Therefore, in this study, we evaluated whether vascular outflow control by clamping the inferior vena cava (IVC) below the liver (IVC clamping) during hepatectomy is a safe and effective method to reduce blood loss and CVP.
We reviewed the outcomes of 103 consecutive patients whose CVP values were >5 cm H
2O and who had undergone right or left hemihepatectomy between 1995 and 2000. Forty-seven patients who underwent hepatectomy with IVC clamping (Group A) between 1998 and 2000 were compared with the previous 56 patients who underwent hepatectomy without IVC clamping between 1995 and 1997 (Group B).
The CVP decreased by 3.7 cm H
20 after IVC clamping. Estimated blood loss was 910 mL in Group A and 1177 mL in Group B. (
P
=
.008) No severe renal or cardiovascular damage occurred after IVC clamping.
IVC clamping is very effective in reducing blood loss during hepatectomy when the CVP is elevated and cannot be reduced pharmacologically or by fluid restriction.
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