Bovine nasal eosinophilic, granuloma with blood eosinophilia caused by Nocardia species

OBJECTIVE

To describe a case of nocardial nasal granuloma in a Holstein heifer.

CLINICAL FEATURES

The heifer showed laboured respiration and occasional coughing with granulomatous excrescences on the bilateral nasal mucosa, and a marked leucocytosis with eosinophilia. NECROPSY: Severe granulomatous inflammation with eosinophils, epithelioid cells, giant cells and Nocardia sp obstructed both nasal passages completely.

CONCLUSION

This lesion resulted from chronic infection with Nocardia sp and is distinct from other forms of bovine nasal granuloma, also called atopic rhinitis or chronic granular rhinitis, which we propose should be classified as bovine allergic granular rhinitis. The most appropriate name for the present disease is bovine nasal eosinophilic granuloma.

Haemangiopericytoma in a calf

After castration, a Japanese Black male calf developed subcutaneous tumours near the scrotum. They were surgically excised, and no recurrence was detected two years after surgery. The tumours were characterised by neoplastic cells concentrically arranged around blood vessels of various sizes. The neoplastic cells contained many cytofilaments, and the majority of the cells expressed smooth muscle actin, but focal densities were not found. On the basis of the immunohistochemical and ultrastructural features, the tumours were considered to be of pericyte origin.

Serum levels of interleukin-6, alpha1-acid glycoprotein, and corticosterone in two-week-old chickens inoculated with Escherichia coli lipopolysaccharide

The concentration of interleukin-6 (IL-6), alpha1-acid glycoprotein (alpha1-AG), and corticosterone (CORT) was investigated chronologically (0 h to 14 d) in the sera of 2-wk-old specific-pathogen-free chicks inoculated with Escherichia coli lipopolysaccharide (LPS). In the LPS group the IL-6 level was elevated from 1 h to 2 d and was the highest at 3 h. From 4 to 14 d the IL-6 level was low in the LPS group. In the PBS group, IL-6 was not detected except a mild increase from 1 h to 6 h. In the LPS group, the alpha1-AG level increased from 6 h to 4 d, and the peak was 2 d. In the PBS group the alpha1-AG level was always low. The CORT level in the LPS group was higher than that of PBS group at 1 h. This study suggests that E. coli LPS may elevate serum IL-6 and CORT, and that IL-6 and CORT may increase the alpha1-AG level in the chicks.

Pathogenesis of reduced egg production and soft-shelled eggs in laying hens associated with Leucocytozoon caulleryi infection

The pathogenesis of reduced egg production with soft-shelled eggs in laying hens naturally infected with Leucocytozoon caulleryi was investigated. Many large schizonts of L. caulleryi schizonts were seen in the ovary and oviducts of chickens. Granulomatous and lymphocytic inflammation, edema, and pressure atrophy were associated with these schizonts. The uterine region that secretes the egg shell exhibited the most severe damage. These lesions in the reproductive organs may explain the mechanism for causing the reduced egg production and soft-shelled eggs in laying hens infected with L. caulleryi.

The significance of esophageal variceal pressure in patients with cirrhosis

We measured the portal circulatory hemodynamic parameters in 10 cirrhotic patients with portal hypertension and esophageal varices to determine the significance of esophageal variceal pressure. In 4 patients (group I), the temporary portal vein occlusion produced significant elevations in both the esophageal variceal pressure and the portal venous pressure. The results of the portal circulatory hemodynamic assessment in this group were consistent with the predominance of the backward flow mechanism. In the remaining 6 patients (group II), however, portal vein clamping resulted in a slightly increased esophageal variceal pressure with an enormous increase in the portal pressure. The forward flow mechanism thus appeared to be predominant in group II. In other words, the results of the pressure measurements were consistent with the functional separation of the hemodynamics in the esophageal varices and portal trunk in group II and the functional hemodynamic continuity in group I. This functional separation between the esophageal varices and the portal trunk in group II might therefore have resulted from the increased blood flow in the lesser splanchnic region.

Hemodynamic and arterial blood gas changes during carbon dioxide and helium pneumoperitoneum in pigs

The effects of pneumoperitoneum with carbon dioxide and helium on systemic hemodynamics and arterial blood gases were investigated in pigs in an attempt to clarify the mechanisms by which pneumoperitoneum may induce organ dysfunction. A total of 16 anesthetized female pigs underwent pneumoperitoneum with carbon dioxide or helium (n = 8 each) in a stepwise fashion to intraabdominal pressures of 8, 10, 12, 16, and 20 mmHg. Changes in cardiac output; renal and hepatic blood flow; mean arterial, mean pulmonary arterial, mean pulmonary arterial wedge, inferior vena caval, and portal venous pressures; and total peripheral resistance were measured. Arterial blood samples were obtained at the same time the above parameters were determined. Urine volume was measured as an indicator of renal function. Pneumoperitoneum with either carbon dioxide or helium significantly increased venous pressures and simultaneously decreased cardiac output. These changes were associated with decreases in organ blood flow due to increased peripheral resistance. Urinary output was reduced to a similar degree in the two groups. Blood gas analysis revealed pneumoperitoneum-induced metabolic acidosis in both groups, although hypercapnia was observed only in the carbon dioxide group. These findings suggest that pneumoperitoneum-related organ dysfunction may be due to increased intraperitoneal pressure rather than to hypercapnia.

The role of glucagon in the gastric hyperdynamic circulation of cirrhotic portal hypertensive rats

The role of glucagon as a mediator of gastric hyperdynamic circulation, induced by carbon tetrachloride (CCl4), was assessed in cirrhotic rats. A selective elimination of pancreatic glucagon from the circulation was achieved by the intravenous infusion of a glucagon antiserum. Gastric blood flow was measured by laser-Doppler flowmetry. The glucagon antiserum had no effect on the blood flow in the stomach in control rats, while in cirrhotic portal hypertensive rats, the glucagon antiserum significantly reduced gastric blood flow (30%). The glucagon antiserum did not completely exclude the gastric hyperdynamic state in the cirrhotic rats. It would thus appear that glucagon contributes to a portion of the gastric hyperdynamic circulation associated with cirrhotic portal hypertension.

Clinical significance of esophageal variceal pressure in patients with esophageal varices

In 40 patients with esophageal varices, esophageal variceal pressure was assessed endoscopically using a pneumatic pressure sensor. The effects of vasopressin or nitroglycerin on variceal pressure and endoscopic findings were also assessed in two groups of seven patients. The results were as follows: (1) Variceal pressure was increased above 250 mmH2O in all patients who had bled, and the mean variceal pressure was significantly higher in patients who had bled than in those who had not (301 +/- 47 vs. 230 +/- 58 mmH2O respectively, p < 0.001). (2) Variceal pressure correlated with endoscopic findings, determined using the criteria of the Japanese Research Society for Portal Hypertension. It was significantly higher when varices with a feature of F2-F3 or RC(+2)-RC(+3) were compared to those with a feature of F1 or RC(-)-RC(+), respectively. (3) Both groups given vasopressin or nitroglycerin had significant reductions in variceal pressure; however, there was little improvement in endoscopic findings in those given nitroglycerin, compared to the improvement in those given vasopressin. Thus, use of a pneumatic pressure sensor proved to be a pertinent tool for assessing esophageal varices, along with endoscopic signs.

"Early-stage" cirrhotic liver can withstand 75 minutes of inflow occlusion during resection

The cirrhotic liver is sensitive to prolonged hypoxia. We treated two patients with hepatocellular carcinoma in association with early stage of liver cirrhosis. Resection of segment VII, and segments V plus VII, respectively, was done, with no untoward effects, under 75 minutes of "uninterrupted" portal triad occlusion. The tolerance of the cirrhotic liver to normothermic inflow occlusion is discussed.

In situ and surface liver cooling with prolonged inflow occlusion during hepatectomy in patients with chronic liver disease

OBJECTIVE

We examined in situ and surface liver hypothermia with continuous and prolonged inflow occlusion during hepatic resection (segmentectomy or subsegmentectomy).

PARTICIPANTS

Eight patients with cirrhosis and three with chronic hepatitis.

METHODS

In situ chilling was achieved by introducing cold Ringer's lactate solution through the portal vein, under conditions of portal triad occlusion.

RESULTS

The liver tissue temperature fell to a mean of 28.4 degrees C 5 minutes later. The time of ischemia ranged from 32 to 52 minutes (mean +/- SD, 47.8 +/- 5.6 minutes). The mean blood loss was significantly lower than in our conventional hepatectomy series (680 vs 1520 mL, P < .02).

MAIN OUTCOME

There were no serious complications, and hypoxia-induced liver injury was ameliorated, as shown by liver function tests.

CONCLUSION

Hepatectomy with prolonged inflow occlusion is justified in low-risk patients with chronic liver disease if it is combined with liver hypothermia, such as simple in situ and surface cooling.

[Choice of left gastric vena caval shunt for esophageal varices--its rationale and clinical results]

We have surgically treated esophageal varices, particularly by left gastric vena caval shunt (LGCS) as the first choice in patients with good liver function (n = 40). The correlation between clinical outcomes and preoperative splanchnic hemodynamics, and therapeutical plans were evaluated: 1) Operative mortality was nil with recurrence rate of 15.0% and rebleeding noted in only one case. 2) The liver function according to Child's classification showed no significant changes before and after operation. Survival rate was more than 70% with good rehabilitation rate (over 90%). 3) The presence of hyperdynamic splanchnic circulation (left gastric venous flow and gastric wall microcirculation) lead to successful clinical results. 4) Combined use of sclerotherapy was efficacious in case of persistent and recurrent varices. We conclude that LGCS is successful in treating esophageal varices in the setting of hyperdynamic portal circulation with acceptable liver function.

Kanji words are easier to identify than katakana words

The effects of script (kanji and katakana), lexicality (word and nonword), and string length (1, 2, and 4 characters) on the identification of briefly exposed kanji and katakana strings were examined. It was found that identifiability is far higher for kanji words than for katakana words, even though the former are visually more complex than the latter. However, the superiority of kanji completely disappeared in a nonword context, suggesting that it is not visual perceptibility that enhances identifiability of kanji words, but something else, perhaps inferability. Differing effects of visual complexity and form were also found. A theory that explains these results is presented.

[Correlation between gastric microcirculation and mucosal injury after surgical therapy of esophageal varices]

The correlation between gastric microcirculation and mucosal injury was studied in patients who underwent surgery for esophageal varices. Both mucosal and submucosal blood flow at the lower esophagus, gastric body and antrum was measured using hydrogen gas clearance method through endoscopy in 55 patients including 33 cirrhotics, 10 idiopathic portal hypertensive patients and 12 controls. In 20 cases with esophageal varices, 10 patients were treated with transabdominal esophageal transection (transection group) and 10 with left gastric vena caval shunt (shunt group). The patients with portal hypertension, showed a reduced blood flow in gastric mucosa but increased flow in the submucosa, as compared with the controls. When comparing the postoperative changes in gastric mucosal flow between the two groups, the transection group showed a reduction of mucosal flow by approximately 30% during surgery, and 20% for 4 weeks after operation. In shunt group, the mucosal flow was well preserved with reduction rate less than 10%. Postoperative mucosal injury was endoscopically and histologically found in almost all patients who showed a reduction rate of more than 20%. This study suggests that active protection against possible gastric mucosal lesion should be kept in mind in the setting of surgical therapy for esophageal varices.

[A case of recurrent hepatocellular carcinoma successfully treated by arterial chemoembolization in combination with local hyperthermia]

We report a long-term survival case of recurrent hepatocellular carcinoma (HCC). A 40-year-old woman suffering advanced HCC underwent right hepatic tri-segmentectomy. After the surgery, HCC recurred in the remnant liver and lung. An arterial infusion of Lipiodol emulsion of anti-cancer agents and regional hyperthermia therapy were repeatedly performed. Administration of FT and PSK were also started. After this combined therapy, AFP levels decreased and recurrent lesions in the liver as well as pulmonary metastases disappeared on image studies. The patient is doing well 4 and half years later with no evidence of recurrence.

[The implication of hyperglucagonemia and -insulinemia in liver cirrhotics]

Glucagon and insulin metabolism was studied in 9 cirrhotic patients and 4 non-cirrhotic controls. Net output of glucagon and insulin into portal circulation was calculated from difference between portal venous and systemic arterial concentrations multiplied by portal plasma flow. Metabolic clearance rate was also calculated as the ratio of the output to systemic concentration. Portal blood flow was measured by the continuous local thermodilution method. The results were as follows: 1) Arterial glucagon concentration was elevated in liver cirrhotics compared with non-cirrhotic-controls. Glucagon output in cirrhotics was higher than in controls [46.3 +/- 11.8 vs. 13.2 +/- 2.5 ng/min (mean +/- SEM), p less than 0.05]. Metabolic clearance rate of glucagon was not significantly different between the two groups. 2) There was a significant correlation between glucagon output and portal venous concentration of norepinephrine (r = 0.625, p less than 0.05). 3) Insulin levels in systemic arterial blood were higher in cirrhotic patients than non-cirrhotic subjects. Insulin output was not significantly different between the two groups, however, metabolic clearance rate of insulin in cirrhotics was reduced in comparison with the controls (274.5 +/- 44.3 vs. 557.7 +/- 108.6 ml/min, p less than 0.05).

[Clinical studies on effect of cefbuperazone on surgical infections]

We conducted clinical studies on the efficacy and safety of cefbuperazone (CBPZ) on surgical infections with the following results. 1) In evaluable 32 patients, CBPZ was evaluated to be clinically effective in 23 (71.9%) and the efficacy rate was better in those who were administered 4 g/day of CBPZ (87.5%, 14/16) than in those who were given 2 g/day (57.1%, 8/14). 2) Antibacterial activity of CBPZ was evaluated in 41 isolated bacterial strains. Pathogen eradication rate by bacterial species was 75.6% (31/41). CBPZ exerted excellent antibacterial effects on Escherichia coli (100%, 8/8) and anaerobic bacteria such as Bacteroides (88.9%, 8/9). Resistant bacteria to CBPZ were Enterococcus faecalis and Pseudomonas aeruginosa. 3) No serious side effects were noted in any of the 34 patients who entered in this study. Abnormal laboratory test results were noted in 2 patients (5.9%) and they were transient elevation of transaminases and alkaline phosphatase. From the results shown above, CBPZ appears to be a highly useful antibiotic for the treatment of surgical infection.

Simple alkaline treatment induces intestinal metaplasia in the stomach of rats

By infusing caustic soda (NaOH) into the stomach of rats, the gastric mucosa fell off and regeneration could be induced. In 18 of 26 rats, intestinal metaplasia associated with goblet cells was observed in the regenerative epithelium. Recently, induction of intestinal metaplasia by weak carcinogenic agents are reported with some emphasis on its precancerous meaning. However, our results suggest that, as intestinal metaplasia can be induced by a benign process of regeneration, it is not directly related with carcinogenesis.