Retroperitoneal Tissue Research Articles

Nestin expression correlates with nerve and retroperitoneal tissue invasion in pancreatic cancer

Nestin was first described as an intermediate filament protein expressed in neuroepithelial stem cells. Nestin expression has also been reported in brain tumors, schwannomas, gastrointestinal stromal tumors, and melanomas. In the pancreas, Nestin expression has been detected in exocrine and mesenchymal cells, including stellate cells, pericytes, and endothelial cells. In the present study, we examined Nestin expression in human pancreatic ductal adenocarcinoma and sought to determine its role in this malignancy. Reverse transcription-polymerase chain reaction analysis demonstrated the presence of Nestin mRNA in all 10 tested pancreatic cancer cell lines, and quantitative reverse transcription-polymerase chain reaction revealed that Nestin mRNA levels were highest in PANC-1 cells and lowest in PK-8 cells. Immunofluorescent analysis revealed that Nestin localized in the outer cytoplasm of PANC-1 cells. Nestin immunoreactivity was present in the cancer cells in 20 (33.3%) of 60 cancer cases, and its expression was confirmed by in situ hybridization. Nestin expression was also increased in peripheral nerve fibers adjacent to cancer cells and in peripheral nerve fibers invaded by cancer cells. Clinicopathologically, there was a statistically significant association between Nestin expression in pancreatic cancer cells and nerve invasion (P = .010) and the presence of cancer cells in the tumor resection margins (P = .003). Nestin-positive cases exhibited similar survival after resection by comparison with Nestin-negative cases, irrespective of whether they were given adjuvant therapy. These findings indicate that Nestin expression in pancreatic cancer cells may contribute to nerve and stromal invasion in this malignancy.

Laparoscopic Visualization and Dissection of Retroperitoneal Lymph Nodes after Patent Blue Dye Injection: A Pilot Study

Retroperitoneal lymph node dissection (RPLND) for testicular cancer is an important treatment modality for patients with stage I or IIA disease. Several urologists have previously reported the feasibility and usefulness of laparoscopic RPLND for such patients. The aim of this experimental pilot-feasibility study was to investigate whether visualization of retroperitoneal lymph nodes with patent blue violet (PBV) dye application is a feasible and an effective method during laparoscopic RPLND in a pig model. Four 12-month-old white male pigs were included in the study. After PBV dye injection into the spermatic funicular and intratesticular parenchyma, the color changes in the retroperitoneal region were examined during transperitoneal laparoscopic visualization of the retroperitoneum. The time interval between the injection and the staining of lymphatic structures was measured for each intervention. Blue-stained retroperitoneal nodal tissues were dissected and removed by the laparoscopic approach and histologic examination was performed. After PBV dye injection, intense staining of the ipsilateral retroperitoneal lymphatic vessels and nodes was seen. Distribution of the PBV and the color changes of the retroperitoneal lymphatic structures were examined under laparoscopic vision in all pigs. All blue-stained retroperitoneal nodular tissues were removed laparoscopically and examined histologically. Histopathologic examination noted all specimens as lymph nodes with no toxic effects of PBV dye. We demonstrated that spermatic funicular injection of PVB dye is an effective and accurate method for retroperitoneal lymph node visualization in pigs. The use of this technique in combination with a laparoscopic approach makes RPLND easier and more effective.

Fully-Covered Self-Expandable Metallic Stents Facilitate Effective Endoscopic Pancreatic Necrosectomy

Background: Endoscopic necrosectomy of devitalized pancreatic tissue has been performed in selected patients with pancreatic necrosis. A limitation of endoscopic necrosectomy is not being able to remove sufficient necrotic retroperitoneal debris, which may be related to the size of the gastro-retroperitoneal (G-R) fistula. Prior reports have described the use of plastic pigtail stents to maintain the G-R track, necessitating subsequent dilation of the track before an endoscope can be passed. Using fully-covered self-expandable metallic stents (CSEMS) larger G-R tracks can be created and maintained. Methods: Patients with severe pancreatic necrosis that were referred to a tertiary-care center specialized in pancreatico-biliary disease were considered for endoscopic necrosectomy. Fluoroscopy and linear-EUS with color flow was used create a G-R fistula. After guidewire access and dilation of the G-R track, a CSEMS was deployed across the track. After maturation of the track, the CSEMS was removed and a therapeutic gastroscope was inserted into the retroperitoneum. Stone retrieval baskets, Roth nets, and cold snares were used to remove necrotic debris and devitalized pancreatic tissue. Results: Three male patients with severe pancreatic necrosis (ages 58, 60, 65) underwent endoscopic necrosectomy. Gallstones (n = 2) and a left-sided pancreatectomy for IPMN (n = 1) were the etiologies of necrotizing pancreatitis. The G-R track was stented with a Gore-Viabil CSEMS (10 × 60 mm or 10 × 100 mm) in two patients and with an Alimaxx-E CSEMS (22 × 70 mm) in one patient. CSEMS were left for a median of 45 days (range: 14-67 days) prior to stent removal and endoscopic necrosectomy. One patient with a 10 × 60 mm CSEMS had proximal stent migration into the stomach, requiring removal of the first stent and placement of a second 10 × 60 mm CSEMS 15 days later. That same patient also had significant bleeding from a pseudoaneurysm 34 days after deployment of the second CSEMS, which required embolization of the left GDA. All CSEMS were removed without complications. Follow-up CT imaging was available in two patients, which showed complete resolution of the necrotic retroperitoneal debris. Median duration of follow-up was 206 days (range: 14-232 days). In the patient with the 22 × 70 mm CSEMS, a 4-inch (10.0 × 3.5 × 2.0 cm), intact piece of devitalized pancreas was endoscopically removed from the retroperitoneum via the mouth without complications. Conclusions: The use of large-diameter CSEMS is effective in creating and maintaining G-R tracks for endoscopic pancreatic necrosectomy. CSEMS can be reliably removed and enable the debridement of large pieces of necrotic retroperitoneal tissue.

SURGICAL MANAGEMENT OF CARCINOMA OF THE HEAD OF PANCREAS: EXTENDED LYMPHADENECTOMY OR MODIFIED EN BLOC RESECTION?

Pancreatoduodenectomy for the treatment of periampullary cancer was described over 70 years ago. The technique has evolved in an attempt to improve the dismal prognosis for patients with pancreatic cancers. Radical regional resection has been proposed to decrease the incidence of local recurrence as well as to improve survival. These extended resections have failed to show a significant survival benefit in prospective randomized controlled studies. Furthermore, extended pancreatic resections may be associated with increased morbidity. The concept of modified en bloc resection has been advocated and is soundly based on anatomical and pathological principals. This procedure is a modification of the radical regional resection previously described. It involves resection of the peripancreatic retroperitoneal tissue and lymph nodes en bloc with the head of pancreas, in order to achieve an R0 resection but without the morbidity associated with an extended lymphadenectomy. Conceptually, this procedure may be the most appropriate technique for the management of pancreatic head cancers although the ultimate effect on long-term survival can only be judged after further clinical studies.

Retroperitoneal lymph node mapping with intratesticular injected patent blue dye in rats

Objectives Endolymphatic injection of several dyes have been previously studied to identify retroperitoneal lymphatic structure in animals and humans with malignant diseases. However, there have been no studies, to our knowledge, that demonstrate the utility of injecting patent blue dye into the testicular parenchyma to detect retroperitoneal lymphoid structure. The aim of this experimental study was to investigate whether intratesticular patent blue dye injection is feasible and is an accurate method for retroperitoneal lymph node mapping in rats. Materials and Methods Twenty male albino Wistar rats were included in the study and divided over two equal groups. The first group underwent patent blue violet (PBV) injection into the spermatic funiculus, while the second group underwent PBV injection into the testicular parenchyma. After the injection, the color changes in the retroperitoneal lymphatic structures and the urinary bladder were anticipated. The time interval between the injection and the staining of lymphatic structures and urinary bladder was measured for each intervention. Blue stained retroperitoneal nodal tissues were dissected and removed. These nodal tissues were examined histologically. Results After PBV injection, intense staining of the ipsilateral spermatic cord lymphatics was seen and anticipated color changes in the retroperitoneal lymphatic structures and urinary bladder were evaluated visually. Both application routes of dye resulted in the same distribution of retroperitoneal lymph nodes in the same time frame. All retroperitoneal nodular tissues removed were noted histologically to be lymph nodes and were found to be consistent with the ipsilateral lumbar lymph and the ipsilateral suprarenal lymph nodes according to the staining order in both groups. No toxic effects were observed histologically. There were no statistically significant differences in the time intervals between the two groups. Conclusions We demonstrated that both funicular and intratesticular injections of patent blue dye are feasible and accurate methods for retroperitoneal lymph node mapping in rats. This shows that intralymphatic dye injection is not absolutely necessary to detect retroperitoneal lymphatic structures and may have applications beyond testis cancer.

Exercise training decreases in vitro stimulated lipolysis in a visceral (mesenteric) but not in the retroperitoneal fat depot of high-fat-fed rats

The purpose of the present study was to determine the effects of an exercise training programme in high-fat-fed rats on in vitro lipolysis in a visceral (mesenteric) and a non-visceral fat depot (retroperitoneal) and its relationship to perilipin content. Two groups of female rats were fed a high-fat diet (42 % as energy) for 8 weeks, one remaining sedentary (Sed) and the other being exercise trained (Tr) for this entire period. Rats were killed after 2 and 8 weeks of their respective treatment. The significantly (P < 0.01) higher levels in mesenteric and retroperitoneal fat pad weights, plasma leptin, NEFA and glucose observed with time in Sed high-fat-fed rats were significantly (P < 0.05) attenuated in Tr animals. Isoproterenol-stimulated (10- 5-10- 4 m) lipolysis in the mesenteric, but not in the retroperitoneal tissue, was significantly (P < 0.05) lower (about 57 %) in Tr than in Sed rats after 8 weeks of high-fat feeding. The isoproterenol-stimulated lipolysis in the mesenteric tissue of 8-week Tr high-fat-fed rats was lowered to the level measured in 2-week fat-fed rats although mesenteric fat accumulation was still significantly (P < 0.01) higher in 8- than in 2-week Tr rats. Perilipin content (Western blot) was not affected by the exercise training programme. These results indicate that exercise training resulted in a reduction in the high-fat diet-induced elevated levels of lipolysis in the mesenteric tissue. This response appears to be independent of the perilipin content.

Effects of Thermally Processed Oil on Weight Loss in Rats

We have previously proposed that thermally processed oil holds promise as a dietary supplement intended for weight loss. We employed a thermal process whereby oil was heated to 180 degrees C for 10 h in the absence and presence of gluten. We compared the effects of three diets, untreated oil, heated oil, heated oil and gluten on body weight, retroperitoneal weight and lipid composition and fecal lipid contents. Ten week-old male Wistar rats were fed ad libitum a diet containing 7 wt% of the oil for 12 weeks. The oil heated with gluten showed low levels of food efficiency and oil absorption ratios, and high levels of fecal oil excretion, oil content and bile acid content. Diets containing thermally treated oils resulted in significantly lower retroperitoneal tissue weights and lipid contents as compared to the control group; the groups fed the heated oil and gluten diets showed a general decrease in the fatty acid (especially linoleic acid) amount. In conclusion, oil heated with gluten was not fully digested and thus excreted without showing any detrimental effects on either the organs or feces. This resulted in safe and effective weight loss in growing adult rats.

Secondary aortoduodenal fistula

Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.

PERIRENAL EFFUSION IN DOGS AND CATS WITH ACUTE RENAL FAILURE

Perirenal fluid accumulation has been described as an ultrasonographic feature of urine leakage, hemorrhage, abscessation, or neoplasia. The purpose of this retrospective study was to report perirenal effusion as an additional ultrasonographic finding in canine and feline patients with acute renal failure. The causes of acute renal failure in 18 patients included nephrotoxicity (4), leptospirosis (3), ureteral obstruction (2), renal lymphoma (2), ureteronephrolithiasis (2), prostatic urethral obstruction (1) and interstitial nephritis and ureteritis (1). An underlying cause was not identified in three patients. The sonographic finding of perirenal fluid was bilateral in 15 patients. Unilateral perirenal fluid was identified ipsilateral to the site of ureteric obstruction in two patients. Large effusions extended into the caudal retroperitoneal space. Additional sonographic findings suggestive of renal parenchymal disease included mild (5), moderate (5) or severe (2) pyelectasia, increased renal echogenicity (11), increased (9) or decreased renal size (2) and ureteral and/or renal calculi (3). There did not appear to be an association between the volume of perirenal fluid and the severity of renal dysfunction. All patients with large effusions underwent euthanasia. Perirenal fluid developing in acute renal failure is thought to be an ultrafiltrate associated with tubular back-leak into the renal interstitium that overwhelms lymphatic drainage within the perirenal and retroperitoneal connective tissues although obstruction to urine flow may also play a role. Localized perirenal retroperitoneal free fluid may be a useful ultrasonographic feature to assist with the characterization of, and determination of prognosis in, patients with suspected renal disease.

Idiopathic retroperitoneal fibrosis: Clinicopathologic features and differential diagnosis

Idiopathic retroperitoneal fibrosis (IRF) is a rare disease often causing obstructive uropathy. We evaluated the clinicopathologic features of 24 patients with IRF to characterize the histopathology of the disease and to provide a framework for the differential diagnosis with other retroperitoneal fibrosing conditions. Retroperitoneal specimens were analyzed by light and electron microscopy and by immunohistochemistry. Most patients presented with abdominal/lumbar pain, constitutional symptoms, and high acute-phase reactants. Overall, 20 had ureteral involvement and 13 developed acute renal failure. The retroperitoneal tissue consisted of a fibrous component and a chronic inflammatory infiltrate with the former characterized by myofibroblasts within a type-I collagen matrix. The infiltrate displayed perivascular and diffuse patterns containing lymphocytes, macrophages, plasma cells, and eosinophils. The perivascular aggregates had a central core of CD20(+) cells and a mantle of CD3(+) cells in equal proportions. In the areas of diffuse infiltrate, CD3(+) cells outnumbered the CD20(+) cells. Most plasma cells were positive for the IgG4 isotype. Small vessel vasculitis was found in the specimens of 11 patients. Our study indicates that a sclerotic background with myofibroblasts associated with a diffuse and perivascular infiltrate mainly consisting of T and B lymphocytes may be a pathological hallmark of IRF.

Retroperitoneal fibrosis: A rare vascular and immune entity disclosed by chronic lombalgia

Retroperitoneal fibrosis is a rare inflammatory and fibrotic process in the retroperitoneal peri-aortic tissues, associated with ureters and other abdominal organs' entrapment. Here we report an original observation of a 55-year-old patient presenting with chronic lombalgia disclosing idiopathic retroperitoneal fibrosis. After one-year follow-up, treatment with corticosteroids led to a complete clinical, biological, and radiological response. Pathogenesis and therapeutic options in idiopathic retroperitoneal fibrosis are discussed.

Evidence for parasympathetic innervation of white adipose tissue, clearing up some vagaries

to the editor: Recently, we reported that fat tissue receives not only sympathetic but also parasympathetic innervation ([5][1]). Using microsurgery, transneuronal retrograde tracing, and hyperinsulinemic euglycemic clamps, we demonstrated that parasympathetic innervation of fat tissue has an

Wrapping of skeletonized and divided vessels using the falciform ligament in distal pancreatectomy

Background A pancreatic fistula is a major cause of morbidity in patients undergoing distal pancreatectomy (DP). A pancreatic fistula may expose skeletonized or divided vessels directly to pancreatic juice, creating a setting for vessel erosion and delayed intra-abdominal hemorrhage (DIH). With the aim of protecting vessels near the pancreatic stump from potential pancreatic fistulas, we have adopted a surgical option by which these vessels are wrapped using a pedicled falciform ligament. Methods After completing DP, the pedicled falciform ligament is spread out widely on major vessels exposed during resection near the pancreatic stump, and fixed to the surrounding retroperitoneal connective tissue. These procedures allow the complete separation of these vessels from the pancreatic stump. We reviewed the cases of 8 patients who underwent DP including these procedures. Results The mobilization of the falciform ligament and the wrapping of the vessels were successfully performed without any complications. Although 2 patients (14.5%) developed pancreatic fistulas, DIH did not occur in any of the patients. Conclusions The wrapping of the skeletonized and divided vessels using a pedicled falciform ligament is simple and easy, and may be an effective prophylactic measure against DIH following DP.

Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers

Although laparoscopic surgery is one of the treatment options for colorectal cancer, certain technical problems remain unresolved for the radical dissection of regional lymph nodes (LNs), which is essential to improve treatment outcome. We present a safe procedure for laparoscopic right hemicolectomy to dissect the regional LNs along the superior mesenteric vein (SMV). The key characteristic of our procedure is that all right and middle colic vessels are cut along the surgical trunk using only a medial approach. First, the pedicle of ileocolic vessels is identified and the mesocolon is dissected between the pedicle and the periphery of the SMV to expose the second portion of the duodenum. The ileocolic vessels are then cut at their roots. The ascending mesocolon is separated from the retroperitoneal tissues, duodenum, and pancreatic head up to the hepatocolic ligament cranially. The important detail in this procedure is the wide separation between the pancreatic head and the transverse mesocolon. This procedure uncovers the course of the right colic artery, veins, and the gastrocolic trunk. The right colic artery and veins can then be safely cut at their roots. For an extended right hemicolectomy, the middle colic vessels can easily be identified below the lower edge of the pancreas and cut at their roots. We performed curative resections in this manner for 16 consecutive patients with advanced right-sided colon cancer without any serious intraoperative complications. The median number of retrieved lymph nodes was 31 (range = 9-57). The median operative time and intraoperative blood loss were 274 min (range = 147-431 min) and 45 g (range = 0-120 g), respectively. The postoperative course of all patients was uneventful. Four of 16 patients had node-positive disease. With a median follow-up period of 272 days, all patients are alive without recurrence. We consider this a safe method for radical LN dissection during laparoscopic right hemicolectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00464-007-9305-x) contains supplementary material, which is available to authorized users.

Retroperitoneal Schwannomas: Diagnostic and Therapeutic Implications

Schwannomas are a rare group of soft-tissue tumors that are derived from the peripheral nerve sheath and rarely develop in the retroperitoneum. We reviewed the clinicopathological features of 4 patients referred to our unit between October 1999 and March 2004 who on radiological examination were diagnosed with pancreatic, adrenal, psoas and retroperitoneal fat tissue tumors and subsequently underwent surgical treatment. The preoperative diagnosis was incorrect in all cases. At time of surgery, we found a mass probably arising from the adrenal gland in 2 patients, a lesion originating from the femoral nerve in 1 patient, and a retroperitoneal mass without a clear site of origin in 1 patient. Pathological evaluation revealed schwannomas in all cases, with no signs of malignancy. Complete surgical excision was performed in all patients without any major postoperative complications. At the time of writing all patients are alive with no evidence of local or distant recurrence. Radical surgical excision is considered the best treatment for these neoplasms, resulting in a very good longterm prognosis.

Mediastinal Necrosis in Acute Pancreatitis - Case Report

Ascites, pseudocyst, necrosis of the retroperitoneal fat tissue and pancreatopleural fistula with left sided pleural effusion may complicate pancreatitis. However, steatonecrosis of the mediastinum and right side pleural effusion are rather rare complications of pancreatitis. We present a case of a patient with alcohol induced pancreatitis. Chest x-ray showed right sided pleural effusion. Although high levels of amylase in pleural fluid made the diagnosis of pancreatopleural fistula most likely, necrosis of the mediastinal fat tissue with right side pleural effusion was found postmortem.

Mycophenolate mofetil combined with steroids: New experiences in the treatment of idiopathic retroperitoneal fibrosis

[corrected] Idiopathic retroperitoneal fibrosis (IRF) is an uncommon disease characterized by a retroperitoneal fibrotic tissue that often involve the ureters, leading to the obstructive nephropathy and variable impairment of renal function. Findings strongly suggest an autoimmune etiology. Surgery, medical treatment with immunosuppressive drugs, or a combination of both are proposed. The optimal treatment has not been established yet. The aim of this study was to present our experience with combined immunosuppressive therapy of IRF, steroids (S) and mycophenolate mofetil (MMF). We prospectively followed four patients with IRF from January 2004 to December 2006. Three patients had an active disease with bilateral hydronephrosis. In the two of them acute renal failure was presented, and ureteral catheters were inserted in one in order to manage ureteral obstruction. One patient has came to our unit with a relapse of IRF and incipient chronic renal failure after the prior therapy with ureterolysis and immunosuppressive drugs (azathioprine and tamoxifen). All patients received steroids and MMF. Two patients were treated with intravenous methylprednisolone pulses (250 mg each), for three consecutive days, followed by oral prednisone 0.5 mg/kg/day. The other two patients received oral prednisone at the same dose. Prednisone was gradually tappered to a maintenance dose of 10 mg/kg/day. Simultaneously, all patients received MMF, initially 1 g/day with the increase to 2 g/day. After four weeks of the therapy all symptoms disappeared, as well as a hydronephrosis with a decrease of erythrocyte sedimentation rate and Creactive protein (CRP) to normal level in all patients. Three patents remain in remission untill the end of the follow up. One patient had a relapse because of stopping taking the therapy after six months. He was treated by oral prednisone 0.5 mg/kg/day, which was gradually decreased. After twelve weeks hydronephrosis disappeared and CRP returns to the normal level. The combination of steroids and mycophenolate mofetil led to the remission of IRF with a strong and quick immunosuppressive effect. It also provided avoiding the long-term use of high steroid dose and surgical procedures.

MODIFIED EXTENDED PANCREATODUODENECTOMY: EN BLOC RESECTION OF THE PERIPANCREATIC RETROPERITONEAL TISSUE AND THE HEAD OF PANCREAS

Malignant periampullary tumours often invade into retroperitoneal peripancreatic tissues and a positive resection margin following pancreatoduodenectomy is associated with a poor survival. For complete extirpation of the tumour, en bloc resection of the pancreatic head with all retroperitoneal peripancreatic tissue is essential to achieve negative resection margin. A modified radical pancreatoduodenectomy technique that aims to resect all peripancreatic retroperitoneal tissue en bloc with the head of the pancreas is described. We have used this new technique in the last 30 consecutive cases of pancreatoduodenectomy with excellent results as presented in this paper. This technique allows complete en bloc resection of retroperitoneal peripancreatic tissues while preserving normal functional tissue. This technique's advantage is that the resection can be carried out without breaching the retroperitoneal tumour extension plane, thereby minimizing tumour cell spillage.

Time course of changes inin vitrolipolysis of intra-abdominal fat depots in relation to high-fat diet-induced hepatic steatosis in rats

The purpose of the present study was to determine the time course of changes in in vitro lipolysis and in perilipin content (Western blot) in the mesenteric and/or the retroperitoneal fat depots in relation to the development of hepatic steatosis in high-fat diet-fed rats. Female Sprague-Dawley rats were submitted to a high-fat diet (HF diet; 42 % as kJ) or a standard diet (SD diet) for 1, 2, 3 or 8 weeks. Fat accretion in the mesenteric and retroperitoneal tissues was higher (P<0.01) in HF diet-fed than in SD diet-fed rats as soon as 1 week after the beginning of the diet. Liver triacylglycerol concentrations were significantly (P<0.01) higher in HF diet-fed than in SD diet-fed rats throughout the experiment, the highest values being reached at week 2 of the diet. Basal and stimulated lipolysis (10(-4) to 10(-7) M-isoproterienol) in the mesenteric and retroperitoneal fat depots was not changed during the first 3 weeks, regardless of the diet. Lipolysis in the mesenteric adipose tissue in the basal and stimulated states was, however, higher (P<0.01) in HF diet-fed than in SD diet-fed rats after 8 weeks of the diets. There were no significant (P>0.05) effects of diet and time on perilipin content of mesenteric tissue. In spite of a rapid fat accretion, the present results do not provide any evidence of a rapid (3 weeks) increase in in vitro lipolysis in intra-abdominal fat depots upon the undertaking of an HF diet at a time where liver lipid infiltration is the most significant.

Early diagnosis and treatment of iatrogenic injury in distal part of common bile duct

目的 探讨医源性胆总管远段损伤早期诊断的方法及处理方式.方法对我院于1990至2004年间收治的15例医源性胆总管远段损伤病人的临床资料进行回顾分析.结果15例中术中发现胆管损伤14例,1例术中未及时发现.术前B超检查14例,MRCP检查2例,6例在胆道探查后行胆道镜检查.10例行胆总管穿孔修补加T管引流,2例行Oddi括约肌切开成形术,2例行胆肠吻合术.胆管损伤后术中表现为胆道探异位于胆管壁外,胆道镜见到胆管远段有2个或多个孔隙,经T管注水见腹膜后水肿和积液,注入美蓝出现腹膜后蓝染.治愈13例.术后并发症包括并发十二指肠瘘1例,切口感染1例,死亡2例:1例死于感染性休克,1例死于胃切除术后再出血.结论早期诊断胆总管下段损伤并进行及时治疗可以取得较好效果,应根据损伤的不同程度采用不同的手术方式,术前完善的影像学检查及在做胆道探查前胆道镜检查有可能减少胆总管远段损伤。