Retroperitoneal Tissue Research Articles

Proline Decreases the Suppressive Effect of Histidine on Food Intake and Fat Accumulation.

We recently suggested that proline might decrease the suppressive effect of histidine on food intake. Our purpose in the present study was to investigate the influence of proline on the suppressive effect of histidine on food intake and accumulation of body fat. Male Wistar rats were divided into four groups and allowed free access to the following diets for 3 wk: control (C), 5% proline (P), 5% histidine (H), or 5% histidine plus 10% proline (HP) diets. Food intake for 7 d and retroperitoneal fat tissue weight at the end of the experimental period of the HP diet group were greater than those of the H diet group, whereas no significant difference existed between the HP diet group and the C diet group. Our results indicate that proline inhibits the influence of histidine on food intake and accumulation of body fat.

Falciform ligament flap for the protection of the gastroduodenal artery stump after pancreaticoduodenectomy: A single center experience

Delayed hemorrhage, though rare, remains a significant source of morbidity and mortality after pancreaticoduodenectomy (PD). An important cause of this delayed hemorrhage is erosion or pseudoaneurysm formation of the gastroduodenal artery (GDA) by pancreatic enzymes and adjacent intra-abdominal sepsis. So protection of the GDA stump may avoid this devastating complication. This is a retrospective observational study. All patients, who underwent a PD between August 2007 and December 2014, were included in the study. We used pedicled falciform ligament flap to protect the GDA stump. After PD, pedicled falciform ligament flap was spread widely over the skeletonized hepatic artery including the GDA stump and was fixed to the surrounding retroperitoneal connective tissue. This procedure allowed complete separation of the GDA stump from the pancreatic stump. We performed 182 cases of PD during the study period. Although, 27 (15%) patients developed pancreatic fistula and six patients developed intra-abdominal abscess, no one experienced hemorrhage due to erosion or pseudoaneurysm formation of the GDA. The present surgical option seems to be an effective measure for the prevention of erosion and pseudoaneurysm formation of the GDA after PD.

ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report

Duodenal perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP) and is difficult to manage. Recently, endoscopic purse-string suture, using endoloops with endoclips, is a relatively new technology and has provided good clinical results. However, the study and use of endoscopic purse-string suture on duodenal perforation is less and its feasibility and safety are unknown. Here, we report a case of ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture. During ERCP, fluoroscopy revealed abnormal perinephric gas shadowing after breaking and extracting the stones with a stone-removal basket. Then duodenal endoscopy showed an approximately 2.0 cm × 1.5 cm perforation on the lateral duodenal wall, with visible retroperitoneal loose connective tissue. Titanium clips were used to attempt closure of the perforation but failed because of the long diameter of the injury. Therefore, an endoscopic purse-string suture, using endoloops with endoclips, was employed with an Olympus double-lumen endoscope. The perforation was successfully closed. At the 2-month follow-up visit, the patient had no complaints or symptoms. Our case once again proved its feasibility and safety and provided a new perspective for surgeons.

A Three-Step Method for Laparoscopic Mobilization of the Splenic Flexure.

Splenic flexure mobilization (SFM) is sometimes required for secure and tension-free anastomosis during laparoscopic colorectal surgery. Although several approaches have been used for laparoscopic SFM,1 it is still considered complicated and troublesome because of the lack of a standardized technique. We propose a three-step method for laparoscopic SFM, aimed at providing a simplified and standardized method, which is presented in the video. First, the mesocolon of the transverse and descending colon is dissected from the retroperitoneal tissue using a medial approach. The appropriate plane for dissection can be recognized just beneath the inferior mesenteric vein, and the gauze should be placed in the dissected space. Second, the transverse colon and transverse mesocolon are detached from the pancreas and spleen by means of an anterior approach. The lesser sac is opened, and the attachment to the pancreas or spleen is cut using the inserted gauze as a landmark. Third, the lateral attachment of the descending colon to the left abdominal wall is dissected cranially or caudally. Using this method, we performed laparoscopic SFM for 13 patients with colorectal cancer with no conversion to another approach or to open surgery. No intraoperative complications were reported, including bleeding from the spleen and injury of the pancreas. The mean time for SFM was 55 min. We consider this three-step method as being useful, and it might help the standardization of laparoscopic SFM.

Abdominal monophasic synovial sarcoma is a morphological and immunohistochemical mimic of gastrointestinal stromal tumour.

Synovial sarcomas may arise within retroperitoneal or pelvic tissues or, more rarely, within the luminal gastrointestinal tract. This case series aims to demonstrate how such primary abdominal synovial sarcomas may particularly mimic gastrointestinal stromal tumour (GIST) on both morphological and immunohistochemical grounds. Four cases of primary abdominal synovial sarcoma were reviewed morphologically and with immunohistochemistry, fluorescence in-situ hybridization with an SS18 break-apart probe, and KIT/PDGFRA mutation analysis. The four patients comprised two males and two females, with a median age of 42 years (range: 17-59 years). Two synovial sarcomas arose within the stomach, one within the small-intestine mesentery, and the fourth within the retroperitoneum. All four tumours showed only a monophasic spindle cell component in the tissues available for review. All four tumours showed DOG1 immunopositivity, and three coexpressed CD117. Three tested cases did not show activating KIT or PDGFRA mutations, whereas all four cases showed chromosomal rearrangement of SS18. A diagnosis of synovial sarcoma should be considered particularly if an abdominal spindle cell neoplasm shows a haemangiopericytomatous pattern and diffuse CD99 and CD56 immunopositivity. A confident distinction between abdominal synovial sarcoma and GIST requires KIT/PDGFRA mutation analyses and specific molecular testing for synovial sarcoma.

The Successful Treatment of Obstructive Uropathy Caused By Retroperitoneal Fibrosis with Steroids in the Latent Tuberculosis Case

Retroperitoneal fibrosis (RPF) is a rare disorder manifested by fibrosis and chronic inflammation in the retroperitoneal tissue. It has been reported that retroperitoneal fibrosis is induced by tuberculosis infection (4). We wanted to present a case of latent tuberculosis, who presented with anuria and developed by bilateral hydronephrosis depending on idiopathic RPF, and treated with steroid therapy, since it is a rare case.

Incidental detection of filarial worm in metastatic axillary lymph node from ductal carcinoma breast

Filariasis is a major disease of the tropics. Frequently, lymphatics of the lower limbs, retroperitoneal tissues, spermatic cord, epididymis, and mammary glands are involved. Simultaneous filariasis along with another underlying disease is rare. We present a rare case of filariasis of the axillary lymph node in a modified radical mastectomy specimen, which also showed metastatic deposits of ductal carcinoma breast. The case is presented due to its rarity.

Taurine ameliorates hypercholesterolemia but not obesity in rats fed a lard-based, high-fat diet.

The cholesterol-lowering effect of taurine differs based on species, types of hypercholesterolemia, and, in particular, the presence or absence of cholate in an individual’s diet. In this study, the cholesterol-lowering and anti-obesity effects of taurine were tested in rats fed a lard-based, high-fat diet, which was intended to be qualitatively similar to the diets of obese patients, rather than a high cholesterol/sodium diet with cholate intake. Sprague-Dawley (SD) rats were fed either a normal diet, a high-fat (HF) diet, or a taurine (2 %) diet for 12 weeks. After the experimental period, the rats’ organs were harvested and sera were collected to analyze changes in organ weight, histological changes, and serum lipid levels. The HF diet increased body-weight gain (g/day) and weight of epididymal and retroperitoneal fat tissue, while a taurine supplement did not influence weight increased by HF diet. Additionally, histological changes were not detected in the pancreas, liver, or adipose tissue. In contrast, the serum levels of triglycerides, total cholesterol, and LDL-cholesterol levels were significantly increased among rats fed a HF diet, while these levels decreased among rats fed a taurine diet. This result suggests that taurine supplementation is not effective at reducing obesity but it can reduce serum lipid levels that were previously elevated due to a high-fat diet. In conclusion, taurine supplementation may be helpful in ameliorating hyperlipidemia, one of the major risk factors of cardiovascular disease (CVD).

Retroperitoneal low-flow vascular malformations: characteristic MRI findings correlated with histopathological findings.

To evaluate the MRI findings of retroperitoneal low-flow vascular malformations (RLVMs) correlated with histopathological findings. Two radiologists reviewed the MRI findings of 4 RLVMs (3 with capillary malformations and 1 with a venous malformation). First, they evaluated the visibility, signal intensities, and signal homogeneity of each lesion on non-fat-suppressed breath-hold T2-weighted single-shot fast spin-echo (non-FS SSFSE) images and fat-suppressed T2-weighted fast spin-echo (FS T2-weighted FSE) images. Second, the kinetic patterns and the internal enhancement patterns were analyzed for each lesion on multi-phasic contrast-enhanced (CE) images. After these image analyses, the MRI findings were correlated with the histopathological findings. Histopathologically, the 4 RLVMs did not exhibit remarkable degeneration and were present in the retroperitoneal fat tissue without clear capsules. On the non-FS SSFSE images, 3 of the 4 RLVMs could not be discriminated from the surrounding retroperitoneal fat tissue (invisible), and the remaining lesion was barely visible with an indistinct margin. On the FS T2-weighted FSE images, however, all the RLVMs were clearly visualized as homogeneous high-signal intensities. On the multi-phasic CE images, all the capillary malformations exhibited fast enhancement, while a venous malformation showed slow enhancement. Furthermore, the RLVMs tended to exhibit a centripetal filling pattern. The RLVMs blended in with the surrounding retroperitoneal fat tissue on non-FS SSFSE images, like phantoms, whereas they were clearly visualized on FS T2-weighted FSE images. On multi-phasic CE images, the RLVMs tended to exhibit a centripetal filling pattern. These imaging features may be useful diagnostic clues for RLVMs.

Wilkie’s Syndrome: A Rare Cause of Duodenal Obstruction

Introduction: Wilkie’s syndrome, or superior mesenteric artery (SMA) syndrome, is a rare cause of partial or complete duodenal obstruction due to exterior compression of the third portion of duodenum by the SMA. Loss of retroperitoneal fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation between SMA and aorta. This is a true syndrome with characteristic clinical picture, which troubles patients suffering from it before a firm diagnosis is established. Case Report: A 17-year-old girl presents with abdominal pain and intractable vomiting following a significant weight loss after a hospitalization for pneumonia and 2 years of extensive investigation to no avail. CT of abdomen showed a narrow SMA-Aorta angle of 10 degrees (Figure 1), gastric dilatation, and a short SMA-Aorta distance of 5.5 mm (Figure 2), consistent with SMA syndrome. GI series showed severely delayed transit through the third portion of duodenum. Conservative management failed and the patient did well after duodenojejunostomy.Figure 1: CAT image showing the entrapment of the duodenum between the aorta and the SMA with an angle of 10 degrees.Figure 2: CAT scan showing the SMA and the aorta separated by 5.5 mm and severe gastric distension.Discussion: SMA syndrome is an atypical cause of proximal intestinal obstruction. Identification of this underestimated syndrome can be a diagnostic dilemma, and is frequently delayed, as in our case. Conservative approach is the first-line treatment. Should it fail, duodenojejunostomy is considered the operation of choice. Increased awareness is required to improve early recognition in order to reduce irrelevant tests and unnecessary treatments.

Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy.

Complete mesocolic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery [1]. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric vein (SMV), with division of the middle colic vessels, or their right branches, at origin [2]. Here, we present cranially approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy. The omental bursa is first opened wide, and the gastrocolic trunk of Henle is exposed, using the right gastroepiploic vessels and the accessory right colic vein (ARCV) as landmarks. After division of ARCV, SMV and middle colic vein (MCV) are identified. After dividing MCV at its root, LN dissection along SMV is conducted in a cranial-to-caudal manner. Concurrently, the middle colic artery, or its right branch, is exposed and divided at origin. The transverse colon is then raised ventrally, and LN dissection along SMV using a cranial-to-caudal approach is again performed. The ileocolic and right colic vessels are divided at origin. The ascending and transverse mesocolon, including the pedicles, are then separated from the retroperitoneal tissues, pancreatic head, and duodenum, using a medial approach. The key characteristics in this procedure consist of easy access to pancreas, early division of ARCV and middle colic vessels at origin, and easy dissection along SMV. We performed a laparoscopic colectomy using this approach for 18 patients with right-sided colon cancer. The mean operative time and blood loss were 288 min and 83 ml, respectively. The mean number of harvested LNs was 24. There were 6 cases with positive LN metastasis. There were no recurrent cases at a median follow-up period of 24 months. We consider this approach to be safe and useful for radical LN dissection along SMV for right-sided colon cancers.

Retroperitoneal emphysema after endoscopic retrograde cholangiopancreatography

Retroperitoneal emphysema represents a pathological situation with an abnormal amount of air in the retroperitoneal tissue. The diagnosis is made radiologically.The cause is mostly an iatrogenic complication of different diagnostic or therapeutic procedures. The most common cause is a perforation after endoscopic retrograde cholangiopancreatography (ERCP). In cases of clinically suspected complications after a procedure prompt diagnosis with computed tomography (CT) scan of the abdomen and an interdisciplinary decision on the suitable therapeutic measures is warranted, as immediate therapy reduces morbidity and mortality of patients. For selecting the ideal therapy it is essential to understand the underlying pathophysiological mechanism of retroperitoneal emphysema and to take the clinical situation of the patient into account. Thus periampullary or bile duct lesions facing the retroperitoneum can be treated conservatively in clinically stable patients, whereas in unstable patients with abscess formation, interventional radiological or endoscopic procedures are indicated. In cases of a duodenal lesion an endoscopic closure of the perforation can be performed in stable patients but if the patient shows signs of peritonism or if the clinical situation deteriorates, operative therapy is necessary.

High pressure does not counterbalance the advantages of open techniques over closed techniques during heated intraperitoneal chemotherapy with oxaliplatin

Heated intraperitoneal chemotherapy (HIPEC) treats residual microscopic disease after cytoreductive surgery. In experimental models, the open HIPEC technique has shown a higher and more homogenous concentration of platinum in the peritoneum than achieved using the closed technique. A 25-cm H2O pressure enhances the penetration of oxaliplatin. Because pressure is easier to set up with the closed technique, high pressure may counterbalance the drawbacks of this technique versus open HIPEC, and a higher pressure may induce a higher penetration. Because higher concentration does not mean deeper penetration, a study of tissues beneath the peritoneum is required. Finally, achieving a deeper penetration (and a higher concentration) raises the question of the passage of drugs through the surgical glove and the surgeon's safety. Four groups of pigs underwent HIPEC with oxaliplatin (150 mg/L) for 30 minutes in open isobaric pressure and pressure at 25 cm H2O, and closed pressure at 25 and 40 cm H2O. Systemic absorption and peritoneal mapping of the concentration of platinum were analyzed, as well as in the retroperitoneal tissue and the surgical gloves. Blood concentrations were higher in open groups. In the parietal surfaces, the concentrations were not different between the isobaric and the closed groups (47.08, 56.39, and 48.57 mg/kg, respectively), but were higher in the open high-pressure group (85.93 mg/kg). In the visceral surfaces, they were lower in the closed groups (3.2 and 3.05 mg/kg) than in the open groups (7.03 and 9.56 mg/kg). Platinum concentrations were similar in the deep retroperitoneal tissue when compared between isobaric and high-pressure procedures. No platin was detected in the internal aspect of the gloves. The use of high pressure during HIPEC does not counterbalance the drawbacks of closed techniques. The tissue concentration of oxaliplatin achieved with the open techniques is higher, even if high pressure is applied during a closed technique. Open 25 cm H2O HIPEC achieved the highest tissue penetration of oxaliplatin, but did not enhance the depth of oxaliplatin penetration. High pressure did not enhance the risk of HIPEC.

Evaluation of thermal injury to liver, pancreas and kidney during irreversible electroporation in an in vivo experimental model.

Irreversible electroporation (IRE) is a new technique for tumour cell ablation that is reported to involve non-thermal-based energy using high voltage at short microsecond pulse lengths. In vivo assessment of the thermal energy generated during IRE has not been performed. Thermal injury can be predicted using a critical temperature model. The aim of this study was to assess the potential for thermal injury during IRE in an in vivo porcine model. In vivo continuous temperature assessments of 86 different IRE procedures were performed on porcine liver, pancreas, kidney and retroperitoneal tissue. Tissue temperature was measured continuously throughout IRE by means of two thermocouples placed at set distances (0·5 cm or less, and 1 cm) from the IRE probes within the treatment field. Thermal injury was defined as a tissue temperature of 54°C lasting at least 10 s. Tissue type, pulse length, probe exposure length, number of probes and retreatment were evaluated for associations with thermal injury. In addition, IRE ablation was performed with metal clips or metal stents within the ablation field to determine their effect on thermal injury. An increase in tissue temperature above the animals' baseline temperature (median 36·0°C) was generated during IRE in all tissues studied, with the greatest increase found at the thermocouple placed within 0·5 cm in all instances. On univariable and multivariable analysis, ablation in kidney tissue (maximum temperature 62·8°C), ablation with a pulse length setting of 100 µs (maximum 54·7°C), probe exposure of at least 3·0 cm (maximum 52·0°C) and ablation with metal within the ablation field (maximum 65·3°C) were all associated with a significant risk of thermal injury. IRE can generate thermal energy, and even thermal injury, based on tissue type, probe exposure lengths, pulse lengths and proximity to metal. Awareness of probe placement regarding proximity to critical structures as well as probe exposure length and pulse length are necessary to ensure safety and prevent thermal injury. A probe exposure of 2·5 cm or less for liver IRE, and 1·5 cm or less for pancreas, with maximum pulse length of 90 µs will result in safe and non-thermal energy delivery with spacing of 1·5-2·3 cm between probe pairs.

Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes?

Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept. Using serial or semi-serial transverse sections from 29 human fetuses at the 5th-25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients. Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th-12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues. Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis.

Anterior retroperitoneal rami: Until now unnamed direct branches of the abdominal aorta

The aim of the study was to gain a thorough knowledge of the topography and distribution of until now officially unnamed minute direct branches from abdominal aorta, stemming from its ventral and lateral aspects, supplying surrounding tissue, and to comprise it to the existing studies. The study was performed in fixed cadaverous material collected from India ink injections of abdominal aorta samples with large surrounding retroperitoneal tissue. The 25 samples were dissected under magnifying binocular glass, followed by graphic reconstruction; statistical analysis, and the study was preceded with detailed review of branches from abdominal aorta. For systematization of the segmental anatomy of the abdominal aorta and infrarenal segment of inferior vena cava, we defined three levels in this area. The retroperitoneal branches were most frequently situated simultaneously within all three predefined levels according to renal and inferior mesenteric arteries origin. There were 18% of retroperitoneal branches within Level 1, 39% within Level 2 and 43% within Level 3. They were branches not only from the abdominal aorta, but also from the testicular/ovarian artery, common iliac artery and in one case from the right accessory renal artery. Paired arrangement was recorded mainly cranially to the origin of inferior mesenteric artery, unpaired branches were more frequently found caudally. In conclusion, due to the terminological disunity of these arteries in the clinical literature and total absence in the anatomical literature, we propose to denominate them as anterior retroperitoneal branches of abdominal aorta (rami retroperitoneales anteriores aortae abdominalis).

Laparoscopic repair for a previously unreported form of ventral hernia on the right iliac fossa in an elderly emaciated woman

An 81-year-old emaciated woman was admitted to our hospital with a one-year history of recurrent bilateral inguinal swellings. Palpable lumps were observed not only in bilateral groin areas, but also on the right iliac fossa (RIF) of her abdomen. During a planned transabdominal preperitoneal laparoscopic herniorrhaphy, a previously unreported form of ventral hernia was observed at a position lateral and cranial to the right internal inguinal ring, which probably corresponded to the palpable lump on the RIF. The hernia orifice was 2 cm in diameter, and a vascular structure ran through the orifice. The contents of the hernia consisted of fatty tissue arising from the retroperitoneal tissue. Routine exploration revealed orifices of the following hernias: left indirect, right direct, bilateral femoral, bilateral obturator, and right Spigelian hernia. Her postoperative course was uneventful and a mass on the right lower quadrant disappeared after operation.

Anthropometric and Biochemical Parameters of Rats Treated with a Low-carbohydrate Diet

The aim of this study was to induce obesity in rats and then feed them a carbohydrate-restricted diet and assess its effects on anthropometric and biochemical parameters. Forty-eight weanling male Wistar rats were divided into three groups: Control (n = 18); Experimental 1 (n = 15) and Experimental 2 (n = 15). The experiment was divided into two phases of 60 days each. For the first 60 days, the Control Group received a control diet and Experimental Groups 1 and 2 received an obesity-inducing diet containing 17% lipid, 0.5% cholic acid and 1% cholesterol. Diet and water were offered ad libitum and the animals were weighed three times a week. Over the final 60 days, Experimental Group 1 started to receive the control diet and Experimental Group 2 started to receive a carbohydrate-restricted diet containing 40% protein and 50% lipid. During phase I, the animals of the Experimental Groups showed greater weight gain, hepatic steatosis, increased retroperitoneal and perigonadal tissue and increased total cholesterol and LDL. During phase II, Experimental Group 2 showed a higher weight gain, hepatic steatosis, and higher total and LDL cholesterol values compared to Control and to Experimental Group 1. We conclude that the goal of first phase, which was to induce the rats to obesity through fat diet containing cholesterol and cholic acid was hit because was a increasing body weight, retroperitoneal and perigonadal fat and hepatic steatosis. The carbohydrate-restricted diet was not effective in terms of weight loss, with the presence of hepatic steatosis and increased retroperitoneal and perigonadal tissue

Effects of Passiflora nitida Kunth leaf extract on digestive enzymes and high caloric diet in rats

The present study investigated inhibition of pancreatic lipase and metabolic effects of high caloric diet in rats. The Passiflora nitida hydroethanol leaf extract (PNE) was used in in vitro assays or administered to rats to study dyslipidemia. Inhibition of lipase in vitro was studied by a spectrophotometric assay using orlistat as the positive control. The effects of PNE on reduction of postprandial triglyceride were studied by oral fat-overloading in rats. Metabolic alterations were induced using the cafeteria diet and 4 weeks post-treatment with PNE or orlistat and blood samples were collected and biochemical analyses were performed. Liver and retroperitoneal fat tissues were obtained to analyze weight and steatosis. IC50 (lg/mL) values for pancreatic lipase inhibition were 21.2 ± 0.8 and 0.1 ± 0.01 for PNE and orlistat, respectively. Oral administration of lipid emulsion resulted in postprandial hypertriglyceridemia at 3 h postadministration and when rats were then administered PNE and orlistat there was decreased of triglyceride levels by 15 % compared to control. Although the energy consumption by the cafeteria diet had been higher, there was no significant weight gain observed in the study groups. The cafeteria diet resulted in a significant increase of weight in the retroperitoneal fat and hypertriglyceridemia levels that could be significantly reduced by PNE and orlistat treatment. We hypothesized that PNE administration prevented the hypertriglyceridemia in rats with a high caloric diet, possibly owing to reduction of lipid absorption and pancreatic lipase inhibition.

Immunoglobulin G4-related Retroperitoneal Fibrosis: A New Name for an Old Disease

lthough retroperitoneal fibrosis (RF) was first described by the French urologist Albarran in A1905,1 it is the American Urologist John Kelso Ormond (1886-1978) who is credited with the first detailed description of the disease in the English literature in 1948. He described 2 patients with diffuse fibrosis of the retroperitoneal tissues. His description of the clinical and pathological features of idiopathic retroperitoneal fibrosis established the condition as a clinical entity. The idiopathic or primary type occurs in patients aged 40-60 years with a male:female ratio of 2-3:1, and in over 70% of cases the cause is unknown. The fibrosis may extend into the thoracic cavity and pelvis. Initially, the patient presents with nonspecific symptoms (eg, loss of appetite, weight loss, and low-grade fever). Dull, noncolicky pain in the lower back, loin, or abdomen has been reported in up to 90% of cases. The pain may respond to nonsteroidal anti-inflammatory drugs. The pain is not affected by movement and, early in the disease, there are hardly any urinary symptoms. In later stages, the presentation of RF is characterized by progressive ureteric obstruction (usually bilateral) with loin pain, which may be colicky in nature. If not diagnosed, symptoms of renal failure and uremia prevail. Urine examination is often normal in early stages. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) are raised even during the early stages of the disease. Anemia may occur and, in the early stages, is because of the acute inflammatory phase but in advanced cases, it is because of the uremia. Antinuclear antibodies are positive in 60% of cases. Imaging usually demonstrates that the retroperitoneal involvement is typically not entirely diffuse, presenting primarily as inflammatory masses that often predominantly involves the kidneys, the ureters, which are usually medially displaced, or the abdominal aorta. Ureteric obstruction with hydronephrosis is a common associated finding.