Couinard's technics of liver resection

Six cases of major liver resections (five right lobectomies and one left lobectomy) are reported. In all these cases the technique described by Couinaud (of suprahilar intrahepatic ligation of the portal pedicle) was used. Although the technique could be simple and rapid, it may produce severe accidents, especially in patients with biliary anomalies. Five of the six cases had an uneventful postoperative course, while in the sixth case, obstructive jaundice developed postoperatively. The case was solved through reoperation and a Roux-en-Y anastomosis. The main conclusion is that the Couinaud technique could be used, because of its advantages (speed, less blood loss) but special precautions are necessary when biliovascular anomalies of the liver are present.     

Cryotherapy of the resection edge after liver resection for colorectal cancer metastases

A 35-year-old female was referred to our clinic with a complaint of left flank pain in 1993. Drip infusion pyelography showed a filling defect of 25 x 24 mm in size in the left ureteropelvic junction. Computed tomography and ultrasonography revealed it as the renal stone. Percutaneous nephroureterolithotomy and extracorporeal shock-were lithotomy were performed. The stone was composed of 2,8-dihydroxyadenine (DHA). The patient was diagnosed as having a partial deficiency of adenine phosphoribosyltransferase (APRT) from the low APRT activity and a genotype of a compound heterozygote APRT*J/APRT*Q0 by T-cell analysis. The urinary excretion of 2,8-DHA crystals disappeared by the postoperative treatment with allopurinol. Cases of 2,8-DHA urolithiasis reported in the Japanese literature are discussed.     

The puncture and catheterization of the peripheral vessels using ultrasonic scanning

1% acetylcholine (5.5 10 M--acetylcholine chloride) applied directly to the cortex of conscious non-immobilized rabbits was established to produce neuroglial reaction in motor area. Following 30 min long application the number of astrocytes was significantly increased. Application lasting for 2 hrs resulted in a reverse effect. The above-mentioned changes were observed in surface and deep cortical layers. They were functional and could be attributed to the cell tinctorial properties.     

The effects of FR167653 in extended liver resection with ischemia in dogs

PURPOSE: We assess the neovascularity of clinically localized prostate cancer by immunohistochemistry using the monoclonal antibody CD34 in an attempt to identify associations between angiogenesis and disease progression following radical prostatectomy. MATERIALS AND METHODS: Microvascularity was evaluated using the CD34 monoclonal antibody in archival paraffin embedded radical prostatectomy specimens from 149 patients followed from 3 to 10 years (mean 6.6). Vessels were quantified by counting a minimum of 2 selected microscopic fields (200x, 0.754 mm.2) from each tumor, area of prostatic intraepithelial neoplasia and prostatic hyperplasia, and given a numerical value representing the microvessel density count. RESULTS: Mean microvessel density count did not vary significantly with age or race. There was a significant association between the count and nuclear grade, Gleason sum and pathological stage. Cox survival analysis shows that microvessel density is significantly related to time to recurrence when considered as a continuous variable (p=0.03) as well as dichotomous variable (p=0.007) (microvessel density count less than 90 and 90 or greater). The 5-year recurrence-free survival was significantly higher for patients with a count less than 90 (71%) than for those with a count 90 or greater (51%) (p=0.006). The 5-year recurrence-free survival was also significantly different when microvessel density was used as a continuous variable (p=0.02). Controlling for stage, Gleason sum, race and nuclear grade, microvessel density remained significant in predicting recurrence (p=0.03) but when pretreatment prostate specific antigen was included in the model the count was no longer significant. The microvessel density count in the tumor area significantly increased with increasing Gleason sum and nuclear grade but it did not increase significantly in the adjacent benign prostate or areas of prostatic intraepithelial neoplasia in the same specimen. CONCLUSIONS: Microvascularity or neovascularity as measured by the CD34 antigen may be a prognostic marker of recurrence for prostate cancer patients after radical prostatectomy but more study in prostate specific antigen era patients with sufficient followup is needed.     

The safety of continuous hepatic inflow occlusion during major liver resection

Relocation of elderly clients between residential establishments can be unsettling, although good preparation can help reduce negative effects and contribute to successful transfer. However, it is less clear whether preparation is feasible for residents with cognitive deficits and clarification of this issue was the objective of the study. Results indicated that with the exception of those with severe cognitive deterioration, residents generally retained awareness of impending relocation and reported feelings appropriate to the situation. Implications for the types of preparation are discussed.     

运用多媒体手段进行大学英语教学的优势比较与制约因素

高校英语教学中运用多媒体教学手段的优势分析,包括对学习者态度的影响、教学目标的影响,以及具体实行上的限制因素分析、现阶段可以利用的技术手段。     

The advantages of all-round pressure

Hot, cold or warm, isostatic presses can offer lower tooling costs and better-quality, stronger green parts formed to close tolerances, says Erwin Vermeiren of press manufacturer EPSI…     

On the advantages of using powder metallurgy in new light metal alloy design

Historically, the production of metallic components for the automotive and aerospace industries has been dominated by wrought and ingot metallurgy metal forming practices. These technologies offer considerable design flexibility to engineers and are readily amenable to ferrous and nonferrous alloys alike. However, in applications that require precise dimensional control, the tolerances attainable are generally inadequate. This represents a formidable limitation and mandates the incorporation of expensive secondary machining. Furthermore, because these processes are carried out under conditions that approach those of equilibrium, these technologies are also faced with rather strict limitations on the range of alloy chemistries that can be employed. As the demands for improved material performance and process economics increase, the aforementioned shortcomings become increasingly important. Consequently, considerable attention has and continues to be focused on alternate metal forming techniques such as powder metallurgy (P/M). Using the P/M approach, dimensional tolerances are commonly improved by one to two orders of magnitude and alloy chemistry limitations are essentially eliminated. The work described herein provides an overview of select P/M techniques developed by the authors, initially to enhance the hardness and tensile properties of aluminum-based P/M alloys through a mineral dissociation/diffusion process. This is expanded through alloy development research wherein a P/M processing route designed to simulate industrial practices is used in the most recent work based on the effects of rare earth additions on selected mechanical properties of aluminum P/M alloys. These results include a compilation of theoretical calculations (thermodynamics and diffusion rates) that are supported by experimental data using techniques that include electron microprobe analyses, X-ray diffraction, tensile testing, and wear testing. Specific findings are that minerals/compounds such as wollastonite and silver nitrate can be successfully reacted to enhance selected mechanical properties of aluminum P/M alloys and that wear resistance may be improved through a P/M approach applied to AA2014. This article is based on a presentation made in the symposium entitled “Fourth International Alloy Conference,” which occurred in Kos. Greece, from June 26 to July 1, 2005, and was sponsored by Engineering Conferences International (ECI) and co-sponsored by Lawrence Livermore National Laboratory and Naval Research Laboratory, United Kingdom.     

Ambiguous and obscure problems of liver resection

Earlier work has suggested that up to 25% of children undergoing tonsillectomy because of recurrent sore throats are relatively deficient in IgA immunoglobulin and that they do less well after the operation than 'normal' children. Measurements of serum immunoglobulin levels were carried out in 96 children undergoing tonsillectomy for recurrent sore throats. Levels of IgA, IgM and IgG were found to be similar to those in healthy children, 7-29% of those studied had 'low' IgA serum levels. There was a significant relationship between serum IgA levels and the age of the child. No relationship could be established between IgA levels and pre- or postoperative clinicaal state of the children. Low IgA serum levels are probably the result of delayed immunological maturation rather than a true immunodeficient state. IgA estimations, therefore, have no bearing on selection for operation or the prognosis after operation.     

Increased blood amylase levels in the postoperative period after liver resection

Preoperative and postoperative values of amylase were assessed in patients submitted to hepatic resections for primary or secondary liver tumours. Among these 40 had underlying liver cirrhosis and 18 normal liver. Preoperative serum amylase levels were increased in patients with cirrhosis. Postoperative amylase levels were found to be overlapping to preoperative one both in patients with normal and cirrhotic liver when no Pringle's manoeuvre was used in the course of surgery. A significant postoperative increase in serum amylase levels was detected in the group of patients where liver resection was carried out under Pringle's manoeuvre. Two patients of the cirrhotic group developed mild pancreatitis. It is suggested that portal congestion relates morphological changes of pancreas and hyperamylasemia and that Pringle's manoeuvre, if prolonged, carries a potential risk of pancreatitis especially in patients with underlying liver cirrhosis.     

Diagnostic laparoscopy and liver disease: experience of 200 cases

BACKGROUND: Laparoscopy is an old technique that is frequently used by gastroenterologists in America and Germany. With modern equipment it is now possible to perform this technique under local anaesthesia. AIM: To evaluate the usefulness and safety of laparoscopic liver biopsy. METHODS: Liver biopsy was routinely performed by laparoscopy under local anaesthetic and sedation. A standard 5 mm laparoscope was used and a pneumoperitoneum induced with nitrous oxide. RESULTS: Two hundred consecutive patients were laparoscoped and underwent liver biopsy. In five patients the liver could not be visualised due to adhesions. Two patients had bleeds related to the procedure. Twenty-five patients had malignancy diagnosed by guided biopsy. Eight of these had been missed by ultrasound prior to laparoscopy. Cirrhosis was diagnosed laparoscopically in 72 patients. Histology was unable to confirm this diagnosis in four patients. CONCLUSION: Laparoscopy can be performed safely and comfortably on patients with local anaesthetic and sedation. The visualisation of the liver can add valuable information to liver biopsy.     

The advantages and disadvantages of the cytokinesis-block micronucleus method

Until recently, chimpanzees were considered susceptible to human immunodeficiency virus type 1 (HIV-1) infection, but refractory to disease induction based on the asymptomatic status of all experimentally infected chimpanzees after over 10 years postinfection (PI). However, a decline in peripheral CD4+ T cells was noted in one chimpanzee (C499) of the Yerkes cohort of HIV-1 infected apes, after 11 years PI concurrent with increasing plasma viral load. These clinical signs were followed by the occurrence of opportunistic infections, thrombocytopenia, and progressive anemia leading to euthanasia. A second chimpanzee (C455) was transfused with blood from C499 collected during the symptomatic stage. Shortly thereafter, this second animal showed a rapid decline in peripheral CD4+ T-cell levels and sustained high viral load. Hematological analyses showed a 50% decrease in CFU-GM for both apes during the symptomatic phase and a reduction of 40% and 73% of the total CFU despite normal levels of CD34+ cells in the bone marrow. Cryopreserved sequential PBMC samples from these two chimpanzees were analyzed for constitutive and PHA-P induced levels of cytokines and chemokines. Data show that whereas there were no detectable constitutive levels of mRNA coding for IL-2, 4, and 10, there appears to be a transient increase in IFN-gamma message level coincident with increased viremia and this IFN-gamma synthesis decreased with disease progression. PHA-induced cytokine mRNA analysis showed low or undetectable levels of IL-4 and IL-10 mRNA in all samples and a marked decrease in the levels of IL-2 shortly after HIV infection. In addition, there was also a gradual decrease in IFN-gamma mRNA with progression of disease. Of interest were the findings of high to normal levels of PHA-induced synthesis of the chemokines MIP-1alpha, MIP-1beta, and RANTES in samples during the asymptomatic and early symptomatic period, which also dramatically decreased at late stages of the disease. These data suggest important roles for IL-2, IFN-gamma, and the chemokines in the regulation of immune responses in HIV-1-infected chimpanzees.     

The conditioning of the N100-P200 component of the human visual evoked potential by using biofeedback

Subjects were instructed to modify their N100-P200 component of VEP (in Cz recording) within selected time window. The aim was to increase the number of VEPs for which the amplitude of segment in question exceeded the definite threshold. The success in task performance suggests several modifications of the to-be-conditioned segment through different mechanisms. Of our 26 subjects, 14 were able to modify their VEPs according to the task demands. However, the latter subjects could be divided into 2 groups on the basis of the rate of increase in the number of correct responses under conditioning. Subjects which did not succeed in task performance could be also classed into 2 groups: one group with statistically negligible changes and the other decreasing the number of correct responses. ANOVA has shown significant distinctions in task performance for the groups with different levels of self-estimation of tiredness after experiment and different personal strategies. The success in task performance is likely to be dependent on the values of Eysenck questionnaire scales and topography of alpha activity.