We performed 13 pediatric liver transplants from ABO-incompatible living related maternal or paternal donors using a combination of preoperative removal of isohemagglutinin and postoperative immunosuppressive therapy with FK506 and prophylactic OKT3. Tissue near-infrared spectroscopy was applied to evaluate hemodynamics using the hemoglobin of red cells in the sinusoids as an index. The data obtained indicated that the preoperative removal of isohemagglutinin prevented hyperacute humoral rejection with hemorrhagic infiltration in the sinusoids in 10 successful cases. The incidence of acute rejection was not significantly different among ABO-identical, -compatible, and -incompatible groups. The estimated 1-year survival rate of the ABO-incompatible group was 77%.
Abstract Background : The rapid urease test and touch cytology have been used for the rapid detection of Helicobacter pylori infection. Recently, a modified rapid urease (MRU) test, which provides results in 20 min has been available on a commercial basis. To date, few reports have evaluated the accuracy of this test. This study evaluated the sensitivity, specificity, and accuracy of the MRU test and touch cytology to detect H. pylori in relation to the density of H. pylori infection determined semi‐quantitatively by using immunohistochemical stains. Methods : Biopsy specimens obtained from a total of 60 patients who underwent endoscopy for evaluation of gastroduodenal diseases were studied by using the MRU test, Giemsa stain for touch smear tissue and histological methods. An immunohistochemical stain was used as a standard, and the density of H. pylori infection was graded according to the number of individual bacteria seen as follows: grade 0 = 0; grade 1+ = 1–9; grade 2+ = 10–29; grade 3+ = 30–99; grade 4+ ≥ 100. The severity of gastritis was evaluated histologically in each specimen and compared with the density of H. pylori infection. Results : The MRU test had an overall sensitivity of 73%, specificity of 100% and accuracy of 85%. The Giemsa stain had a sensitivity of 91%, specificity of 100% and accuracy of 95%. The sensitivities of the MRU test and Giemsa stain decreased in mild H. pylori infection. In the MRU test, the sensitivity was 47% when the density of H. pylori infection was 1+, while 80–100% sensitivities were obtained when the densities of infection were ≥ 2+. With the Giemsa stain, the sensitivity was 80% when the density was 1+, while the sensitivity increased to 100% when the densities were ≥ 2+. The severity of gastritis determined by the Rauws scores showed a positive correlation with the density of H. pylori infection as evaluated by immunohistochemical staining. Conclusions : The MRU test had high sensitivity and specificity for moderate to severe H. pylori infection, but it may result in false‐negative results in tests for mild infection. As the MRU test has the advantages of shorter incubation times and low cost, a combination of the MRU test and the Giemsa stain for touch cytology may be the most time‐ and cost‐efficient tests in a clinical setting for the diagnosis of H. pylori infection.
Eighty-one cases with adhesion ileus were examined by ultrasonography from January 1983 to July 1987. In this study, the association of ultrasonographic findings with surgical indications for adhesion ileus was evaluated. The subjects were divided into three groups: Group I, consisting of 29 cases of simple ileus improved by conservative treatment; Group II, 24 cases of simple ileus which required surgical treatment and Group III, 28 cases of strangulation ileus. In comparison with Group I, Group mean value of II + III which required surgical treatment showed a significantly larger maximum diameter of the dilated intestine (3.2 +/- 0.7 cm for Group I vs 3.8 +/- 0.5 cm for Group mean value of II + III) and significantly higher incidences of wall thickening and ascites (respectively 21% and 31% from Group I vs 54% and 73% from Group mean value of II + III). In comparison with the cases of simple ileus (Group mean value of I + II), those of strangulation ileus (Group III) showed significantly higher incidences of akinetic dilated intestine and ascites (respectively 17% and 43% from Group mean value of I + II vs 93% and 86% from Group III). These results make us conclude that ultrasonography is highly useful in deciding surgical indications for adhesion ileus.
We reviewed the problem of Segment IV in using left lobes from living related donors, in 18 left‐lobe transplants performed on pediatric patients who ranged in age from 6.0 to 17.3 yr, and in body weight from 19.8 to 58.0 kg. The separate monitoring of oxygen saturation of hemoglobin in the liver sinusoid of segments, using a spectrophotometric technique, demonstrated a delay in re‐oxygenation of Segment IV after the portal reflow, and revealed its return to comparable oxygenation with Segments II and III by the re‐arterialization. Hemoglobin content, which was determined by the same technique, occasionally increased in Segment IV during the operation, implying sluggish microcirculation caused by inadequate hepatic venous drainage. These characteristic profiles on tissue oxygenation and hemodynamics in Segment IV should be considered when using left lobes as living related liver grafts.
The rapid changes in extracellular oxygenation and intracellular oxidation during ischemia and reflow were measured in deep liver tissue by a novel method combining tissue near-infrared spectroscopy with multicomponent curve-fitting analysis. This method enabled us to make real-time measurements of oxygen saturation (SO2) and amount (THB) of hemoglobin in the liver sinusoid as parameters of extracellular oxygenation state and of redox transition of cytochrome aa3 as intracellular oxidation state. Clamping of the hepatic artery in rabbit decreased the THB with a transient fall of SO2. Clamping of the portal vein decreased both SO2 and THB. The decreases of SO2 and THB caused by Pringle's maneuver were larger than the sum of decreases by hepatic artery and portal vein. These changes in SO2 were correlated with intramitochondrial oxidation state as measured by cytochrome aa3. These results indicate the presence of an interrelationship of oxygen supply by hepatic artery and portal vein. This method was clinically applied during and after clamping of hepatic artery and portal vein in 19 cases of hepatic resection with or without chronic hepatic diseases. The decrease in SO2 values before and after clamping (SO2D) and the slope of SO2 recovery (SO2R) after release were calculated. SO2D and SO2R values of the portal vein in cirrhotics were significantly higher and lower, respectively, than those in the normal liver. These data indicate that the present method provides a rapid and reliable method of quantifying hepatic oxygenation during liver surgery and its perioperative management.
