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.     

Nitrergic innervation of the cat liver

The aim of this work was to study the nitrergic innervation in the liver of the cat using immunocytochemical procedures. At the hepatic hilus, a rich plexus of neuronal nitric oxide synthase immunoreactive (nNOS-IR) nerve fibers and ganglia was detected around the interlobular branch of the bile duct. nNOS-IR nerve fibers were observed running with the components of the intralobular portal triads located close to the hepatic hilus, as well as with a few vessels and ducts of the deeper parenchyma. These latter fibers, beside others located in Glisson's capsule, occasionally showed short ramifications entering the parenchyma itself. The present results suggest that, in the cat liver, nNOS is involved in the autonomic control of hepatic blood flow, with a limited role in the regulation of hepatobiliary excretory activity and hepatocellular metabolic function.     

Evaluation of a rapid immunochromatographic test for diagnosis of dengue virus infection

A rapid (<7-min) immunochromatographic test for immunoglobulin M (IgM) and IgG antibodies to dengue viruses was evaluated by using hospital admission and discharge sera from 124 patients. The reference laboratory diagnosis was based on the results of virus isolation, hemagglutination-inhibition assay (HAI), and enzyme immunoassay (EIA). By the standard assays, patients experienced primary dengue virus infection (n = 30), secondary dengue virus infection (n = 48), Japanese encephalitis (JE) virus infection (n = 20), or no flavivirus infection (n = 26). The rapid test demonstrated 100% sensitivity in the diagnosis of dengue virus infection and was able to distinguish between primary and secondary dengue virus infections through the separate determinations of IgM and IgG. For all patients with primary dengue virus infection a positive test for IgM to dengue virus and a negative test for IgG to dengue virus were obtained, whereas for 46 of 48 patients (96%) with secondary dengue virus infection, a positive test for IgG to dengue virus with or without a positive test for IgM to dengue virus was obtained. The remaining two patients with secondary dengue virus infection had positive IgM test results and negative IgG test results. Furthermore, the rapid test was positive for patients confirmed to be infected with different dengue virus serotypes (12 infected with dengue virus serotype 1, 4 infected with dengue virus serotype 2, 3 infected with dengue virus serotype 3, and 2 infected with dengue virus serotype 4). The specificity of the test for nonflavivirus infections was 88% (3 of 26 positive), while for JE virus infections the specificity of the test was only 50% (10 of 20). However, most patients with secondary dengue virus infection were positive for both IgM and IgG antibodies to dengue virus, while no patients with JE virus infection had this profile, so cross-reactivity was only a concern for a small proportion of patients with secondary dengue infections. The rapid test demonstrated a good correlation with the reference EIA and HAI and should be useful for the rapid diagnosis of dengue virus infections.     

Evaluation of the FlexSure HP whole blood antibody test for diagnosis of Helicobacter pylori infection

OBJECTIVE: Rapid, inexpensive, reliable tests are needed to facilitate the diagnosis of Helicobacter pylori infection. We evaluated the accuracy of the new FlexSure HP whole blood test (SmithKline Diagnostics, Inc.), a rapid, qualitative in-office test for the detection of antibodies to H. pylori utilizing whole blood obtained from a fingerstick. METHODS: Five North American sites enrolled patients not previously treated for H. pylori who underwent upper endoscopy. Patients had not received antibiotics, bismuth, or proton pump inhibitors within 4 wk before study enrollment. Bacterial infection was established by the presence of H. pylori in gastric biopsies (minimum of two) or positive rapid urease test of antral tissue. The presence of IgG antibodies was determined using FlexSure HP whole blood tests with blood obtained by fingerstick and FlexSure HP serum and ELISA (HM-CAP) tests with serum obtained from venipuncture. RESULTS: Three hundred ninety-three patients were enrolled (56% male; mean age, 46.8 +/- 16.0 yr). H. pylori infection was present in 187 (48%). Compared with the standard of histology and rapid urease test, sensitivity for FlexSure HP whole blood, FlexSure HP serum, and HM-CAP EIA were, respectively, 84%, 90%, and 95% (p < 0.05 compared with FlexSure HP whole blood). There were no statistical differences in specificity or overall accuracy between the three tests. CONCLUSIONS: FlexSure HP whole blood demonstrated an accuracy not significantly different from the FlexSure HP serum test but had sensitivity significantly lower than the HM-CAP EIA. FlexSure HP whole blood may be useful for in-office H. pylori diagnosis.     

Evaluation of a serological test for diagnosis of Helicobacter pylori infection in children

A serological test for the diagnosis of Helicobacter pylori infection (Cobas Core Roche, IgG, 2nd Generation; Roche, France) was compared with the examination of biopsy samples (culture and histology) obtained after endoscopy in 115 children to assess its value. In 94 children (42 positive and 52 negative), results were concordant. In 10 children a positive serological test was associated with an absence of Helicobacter pylori, while in 11 others a negative serological test was associated with a positive culture. Sensitivity of the test was 79.2% and specificity 83.9%. A relationship between IgG titers and age (r = 0.31, p < 0.05) was found. Serological tests could be useful for the diagnosis of Helicobacter pylori infection, but a negative test result does not rule out infection, particularly in children under 10 years of age.     

Endo-anal sonography in diagnosis of fecal incontinence

Endoanal ultrasound is a new imaging technique in the diagnostic work-up of patients suffering from anal incontinence. A standardised examination as well as hardware specific reference values for the sphincter muscles are of paramount importance to allow correct interpretation of the continence organ. At the University Hospital of Würzburg from 1.2.1993 to 31.7.1994 90 patients (50 male, 40 female; age: 16-81 y.) with normal continence underwent endosonographic assessment of their sphincter complex. We measured the internal anal sphincter (IAS), puborectalis muscle as well as the three separate parts of the external anal muscle (EAS). Apart from establishing reference values we found a significant increase in thickness of both EAS and IAS with increasing age. However, no correlation was seen between muscle thickness, sex, height or weight. We also examined 29 patients with a history of incontinence. 13 (45%) had a morphological sphincter defect, most of which were due to obstetric trauma or previous proctological operations. 10 (35%) patients suffered from so called idiopathic incontinence. Anal ultrasound in these patients revealed muscle hypotrophy of the structurally intact sphincters.     

Evaluation of a commercial PCR kit for diagnosis of cytomegalovirus infection of the central nervous system

We evaluated the AMPLICOR cytomegalovirus (CMV) PCR kit for the diagnosis of neurologic CMV infections on 43 positive and 112 negative archived cerebrospinal fluid specimens originally tested by an in-house PCR method. The AMPLICOR kit showed sensitivity and specificity of 95 and 100%, respectively, versus the home-grown assay, indicating its utility in this clinical setting.     

认真开展设备故障诊断,有效防止设备事故发生

随着设备现代化管理的逐步深入，设备监测与故障诊断已成为设备管理必不可少的手段。本文详细介绍了湘潭钢铁公司对几种现场常见故障的诊断、判断、分析及结论。     

Evaluation of serological methods for diagnosis of Puumala hantavirus infection (nephropathia epidemica)

Nephropathia epidemica (NE), Puumala (PUU) virus infection, is a febrile disease which is commonly associated with acute renal impairment. To differentiate NE from other acute febrile illnesses, a rapid and reliable serological diagnosis is important, and a number of different protocols have recently been introduced. In the present report we describe a comparative evaluation of six PUU virus immunoglobulin M (IgM) and seven IgG enzyme-linked immunosorbent assay (ELISA) protocols based on native, Escherichia coli-expressed, or baculovirus-expressed nucleocapsid protein (N). Neutralization and immunofluorescence assays were included for comparison. Equally high sensitivities and specificities were obtained with three mu-capture-based IgM ELISAs using native, baculovirus-expressed, and E. coli-expressed N antigens, respectively, and by an ELISA based on purified E. coli-expressed full-length N adsorbed to solid phase. The assays based on truncated amino-terminal N proteins, including a commercially available PUU virus IgM ELISA, all showed lower sensitivities. For detection of PUU virus-specific IgG, ELISAs based on monoclonal antibody-captured native or baculovirus-expressed N antigens showed optimal sensitivities and specificities, while the assays based on E. coli-expressed N did not detect all PUU virus IgG-positive serum samples. A commercially available PUU virus IgG ELISA based on E. coli-expressed amino-terminal N showed a significantly lower sensitivity than those of all other IgG assays.     

Evaluation of the dye test, IgM-IFAT, and ELISA for the diagnosis of toxoplasmic infection in pregnancy

This study was undertaken to determine, first the relationship between the Sabin-Feldman dye test and the enzyme-linked immunosorbent assay (ELISA) as far as the antitoxoplasmic IgG antibodies are concerned, and secondly the relationship between the indirect immunofluorescence test and the ELISA as regards the antitoxoplasmic IgM antibodies. The results achieved through this research show a good relationship between the dye test and IgG-ELISA, especially satisfactory with the low and medium values of the antibody titers. Furthermore, a very good agreement could be documented between IgM-ELISA and IgM-IFAT in the detection of IgM-specific antibodies in the early phases of toxoplasmic infection.     

Abnormal spermatogenesis in the common liver fluke (Fasciola sp.) from Japan and Korea

INTRODUCTION: Radiofrequency current (RFC) application is a widely used procedure for treatment of supraventricular arrhythmias. The purpose of this study was to investigate late electrophysiologic sequelae of RFC lesions at immature atrial myocardium in pigs, as they have not yet been systematically investigated in vitro. METHODS AND RESULTS: RFC application (temperature guided) was performed in seven piglets (mean age 6 weeks) by a steerable 6-French electrode catheter positioned at the lateral aspect of the tricuspid valve annulus. After 12 months, hearts were removed, and lesions with surrounding tissue were isolated. The viable tissue at the border of the specimen was paced with a cycle length of 500 and 600 msec. One hundred fifty impalements were performed on each specimen using capillary microelectrodes to record action potential characteristics from the lesion's surface and the surrounding tissue. In all seven specimens, no transmembrane action potentials from the fibrotic surface of each of the lesions could be recorded. The surrounding viable tissue was sharply demarcated electrically. No areas of slow conduction were detected. Action potential characteristics as mean maximum diastolic transmembrane potential, mean action potential duration at 90% repolarization, and upstroke velocity of phase 0 of the action potential were all normal. CONCLUSION: No evidence of areas of slow conduction 12 months after RFC application at immature atrial myocardium suggests that this technique is safe regarding occurrence of late atrial tachyarrhythmias after the procedure.     

Evaluation of immunochromatography-based rapid detection kit for fecal Escherichia coli O157

Results of cardiac surgery in renal transplant patients are not well documented. Immunosuppression as well as associated conditions in these patients, and the increased susceptibility of the renal allograft to the extracorporeal circulation (ECC) may alter the prognosis of renal transplant patients submitted to cardiac surgery. To evaluate this hypothesis, we reviewed the files of 24 patients (18 Male, 6 Female; age: 49 +/- 12 years) operated under ECC between 1978 and 1997. Twenty patients underwent coronary artery bypass surgery, 5 patients a valve replacement procedure (aortic and/or mitral), and one patient necessitated a Cabrol procedure for an ascending aorta aneurysm. Preoperatively, the majority of patients were in functional class (NYHA) IV (16 patients), and ejection fraction was > 50% in 18 patients. Two operative deaths secondary to cardiogenic shock were encountered. Five patients (23%) were reoperated for bleeding; 5 patients (23%) sustained a major infection (2 pneumonias, 2 mediastinitis and one wound infection) resulting in death in one patient; 5 patients (23%) were treated for arythmia; and 2 patients (9%) suffered a perioperative myocardial infarction. Serum creatinine levels did not increase significantly during hospitalization (p = 0.41 between extreme values). Mean follow-up (41 +/- 28 months) of the 20 survivors revealed recurrent angina in 5 patients and late death in 4 patients, cardiac-related in 3 cases. CONCLUSION: Cardiac surgery in renal transplant patients is subjected to a high morbidity and mortality. Mid-term prognosis is reserved especially in presence of associated conditions.     

Evaluation of PCR for diagnosis of melioidosis

Previously published PCR-based diagnostic tests for melioidosis were evaluated for clinical usefulness. A Burkholderia pseudomallei 16S rRNA-derived primer set had a sensitivity approaching 100% for clinical samples from 22 culture-confirmed cases of melioidosis and enabled diagnosis of 3 culture-negative cases. However, samples from 10 of 30 inpatients from Royal Darwin Hospital with other diagnoses were positive by PCR, giving a specificity of 67% and a positive predictive value of only 70%. Although there are a number of intriguing possible explanations for our results, concerns of inappropriate therapy resulting from a positive result by PCR have led us to forgo the advantage of rapid PCR diagnosis for melioidosis until a better system is validated.     

Cholinoreception in Ascaris suum (Nematoda) ascarids and the liver fluke Fasciola hepatica (Trematoda)

Homogenates of synaptically rich structures of the body (the anterior end of A. suum and F. hepatica, as well as narrow strips of the anterior part of A. suum with median nerves and innervation processes of muscle cells) have been tested for the presence of acetylcholine receptor protein (AchR). Strips of the A. suum muscle tissue with low content of synaptic structures served as a control. AchR was detected by the decrease in the optic density at 260 nm and by the decrease in the reactivity of AchR SH-groups in the presence of Ach. Using both methods, AchR was found in water-soluble fraction of tissue homogenates rich in synaptic structures. No AchR was detected in tissues which do not contain synpatic structures. The data obtained are discussed in relation to the function of Ach as a mediator in helminths.     

Functional evaluation of 6-hydroxydopamine-induced sympathectomy in the liver of the cat

Intraportal injection of 6-hydroxydopamine (25 mg/kg) results in nearly complete functional sympathectomy in the cat liver 1 week after the injection. Functional sympathectomy was verified by comparing the changes in liver blood volume (measured in vivo in a plethysmograph) resulting from direct stimulation of the hepatic nerves in control and pretreated animals. Pretreatment prevented the large reductions in hepatic blood volume normally seen with nerve stimulation while the response to infused noradrenaline was not reduced. Lack of morphological changes in right atrial nerve endings and an unaltered pressor response to bilateral carotid arterial occlusion indicate that sympathectomy at sites other than the liver did not occur.     

Unusual transmission of the liver fluke, Fasciola hepatica, by Lymnaea glabra or Planorbis leucostoma in France

Cases of fasciolosis in ruminants have been recorded in several French farms in the absence of Lymnaea truncatula, which is considered the only snail intermediate host in western Europe. These farms harbored other species of freshwater snails in large numbers (Lymnaea glabra, Physa acuta, or Planorbis leucostoma) and, in many cases, had cattle or sheep infected by another trematode (Paramphistomum daubneyi). These other freshwater snails may serve as intermediate hosts for F. hepatica due to a coexisting infection with P. daubneyi. We have demonstrated that L. glabra, either infected with F. hepatica alone or coinfected by P. daubneyi, was capable of developing a F. hepatica infection. A broader range of L. glabra size classes (up to 10 mm in height) were susceptible to infection if simultaneously infected with P. daubneyi. Planorbis leucostoma can only serve as an intermediate host for F. hepatica, if infected with P. daubneyi. Lastly, P. acuta smaller than 4 mm cannot serve as an intermediate host. These results may explain, in part, the maintenance of low-level F. hepatica infections in the absence of the normal intermediate host, L. truncatula.     

Evaluation and treatment of constipation and fecal impaction in adults

Constipation is a common complaint that physicians encounter. Understanding the patient's definition of constipation and focusing the history and physical examination provide clues to the underlying cause. Initially, an empiric treatment trial is recommended. For patients with warning symptoms or those in whom treatment fails, a limited diagnostic work-up is suggested. Tests of physiologic function are reserved for patients whose condition is refractory to therapy. Fecal impaction can be considered extreme constipation. The pathophysiologic features of fecal impaction are discussed, and recommendations are provided for treatment and prevention.     

Evaluation of an ultramicroELISA system for the diagnosis of rubella

An indirect Ultramicro ELISA assay, previously standardized in our laboratory, for detecting antibodies IgG to the rubella virus was assessed in comparison to the hemagglutination inhibition technique. This assessment allowed to determine its efficacy in the National System for Epidemiological Surveillance of this entity. One hundred and ninety serum pairs of clinically suspected cases of rubella were studied and a high percent of coincidence (99.4%), specificity (99.4%), and sensitivity (100%) was found between both techniques. In addition, 73 serum samples of blood donors were processed using an indirect microELISA system (Berhing) which was compared to the Ultramicro ELISA technique for rubella and it showed a 100% of sensitivity, specificity, and coincidence.     

Evaluation of a commercial enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody in diagnosis of human leptospiral infection

The PanBio Leptospira immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) is a commercially available screening test for the diagnosis of acute leptospiral infection. The ability of the test to diagnose early or recent Leptospira interrogans infection was assessed by testing sera with known microagglutination test (MAT) titers to serovars pomona, hardjo, copenhageni, and australis. The IgM ELISA detected all 41 cases of early or recent leptospiral infection (sensitivity, 100%), with a positive ELISA result seen in many cases before MAT antibody titers reached 1:50. Thirty-eight of 41 patients showed seroconversion (fourfold or greater increase in titer by MAT, 2 of 41 patients had a single sample with elevated titer, and 1 patient from whom leptospires were isolated from a blood sample failed to show MAT titers, despite a seroconversion (negative to positive result) in the ELISA. Follow-up sera obtained from 8 of 12 patients (67%) for 3 to 48 months after the acute stage of illness showed persisting IgM antibody. However, the range of levels detected in these samples (maximum ELISA ratio, 2.0) was lower than the range seen when infection was recent. Reactivity in the IgM ELISA was observed for only 1 of 59 serum samples from asymptomatic donors (specificity, 98%) and 16 of 233 serum samples from patients with Ross River virus, brucella, Epstein-Barr virus, cytomegalovirus, mycoplasma, Q-fever, toxoplasma, hepatitis A virus, Treponema pallidum, or Borrelia burgdorferi infection (specificity, 93%), with the majority of these patients showing lower levels of IgM in comparison to those in patients with leptospiral infection. We conclude that this ELISA is sufficiently sensitive for use as an initial screen for leptospiral infections, with subsequent confirmation of positive test results by MAT.