Type E2 Research Articles

Laparoscopic Cholecystectomy at Shree Birendra Hospital

Introduction: Since its introduction in Shree Birendra Hospital, laparoscopic cholecystectomy has gradually replaced its open counterpart. Along with its superior results, surgeons had to deal with the difficult challenges of managing bile duct injuries. Methods: A prospective study of all laparoscopic cholecystectomies performed in the General surgical unit of Shree Birendra Hospital from January 2003 to December 2010 was carried out from case records in a separate register kept for laparoscopic surgeries. Results: Out of the total number of 786 patients who underwent laparoscopic cholecystectomy during the study period, 21 (2.67%) required conversion to open procedure with the most common indication being unclear anatomy at Calot’s triangle. There were 14 major post operative complications (1.78%) with bile duct injuries occurring in 7 patients (0.89%). Among these injuries, 3 injuries were recognized during the primary operation. Laparotomy with t tube placement for 6 weeks was the mode of treatment in 2 patients with Strasberg type D injuries detected post operatively. Delayed repair after 3 months were carried out in 2 injuries- one hepaticojejunostomy (Type E2) and the other required anastamosis to the left hepatic duct (Type E3). In follow up, these patients have remained aniciteric and comfortable so far. Conclusion: Bile duct injuries continue to remain a major morbidity factor in laparoscopic cholecystectomy and its management a challenge to the surgeon. Though repair in a specialized hepatobiliary center is recommended, in the absence of such center in our country, it is being done in SBH with good results. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6444 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 15-19

Acupuncture of the sacral vertebrae suppresses bladder activity and bladder activity-related neurons in the brainstem micturition center

Acupuncture of the sacral vertebrae has therapeutic effects in patients with overactive bladders. The mechanism of these effects, however, remains unclear. The present study, using urethane-anesthetized rats, investigated the effects of acupuncture stimulation of the sacral vertebrae on bladder activity and bladder activity-related neurons in and around Barrington's nucleus. In 95 of 147 trials (64.6%), acupuncture stimulation of the sacral vertebrae for 1 min suppressed bladder contraction for 27–2347 s. Acupuncture-induced suppression of bladder contraction was blocked by intraperitoneal injection of bicuculline (Bic). Acupuncture stimulation strongly affected bladder activity-related neurons, including those which fired only prior to the start of contraction (Type E1), those whose firing was maintained during contraction (Type E2), and those whose firing was strongly suppressed during contraction (Type I). All Type E1 neurons and most (93.8%) Type E2 neurons decreased firing when bladder activity was suppressed by acupuncture stimulation. Four of 14 (28.6%) Type I neurons exhibited an excitatory response while 3 of 14 (21.4%) exhibited an inhibitory response. These findings suggest that acupuncture stimulation of the sacral vertebrae suppresses bladder contraction and changes the firing properties of bladder activity-related neurons in and around Barrington's nucleus, and that these changes are mediated by GABAergic systems.

Pulp pathosis in inlayed teeth of the ancient Mayas: a microcomputed tomography study

To evaluate three-dimensionally, using microcomputed tomography (μCT), the anatomical relationship between the cavity prepared to hold the inlay stone and the pulp chamber in the teeth of the ancient Maya. Six well-preserved teeth from Maya corpses found in an archaeological site in Guatemala (approximately 1600 year old) were selected and scanned using a high-resolution μCT system (SkyScan 1174v2; SkyScan N.V., Kontich, Belgium). The sample comprised six maxillary teeth: two canines, one premolar, two central incisors and one lateral incisor. All teeth had one or two inlay stones on the buccal surface of the crown. Each specimen was scanned at an isotropic resolution of 22.5 μm, a rotational step of 0.70°, a rotational angle of 180° and a 3.1-s exposure time, using a 1-mm-thick aluminium filter. Images of each specimen were reconstructed from apex to the crown with dedicated software (NRecon v1.6.1.5) in approximately 450 slices. CTan v1.11 and CTVol v2.1 were used for three-dimensional visualization and qualitative analysis of the external and internal anatomy of the teeth. The tooth modification in all samples was classified as type E1 (one stone on the buccal surface of the crown) or E2 (two stones on the buccal surface of the crown). In the canine teeth, the cavities created to insert the inlay stone did not reach the pulp chamber. Conversely, in the maxillary incisors, the cavities clearly perforated the pulp chamber resulting in massive internal inflammatory resorption or partial calcification of the pulp cavity. In the premolar tooth, a small perforation of the pulp chamber under the buccal cusp, without morphological alteration of the intraradicular dentine, was observed. Microcomputed tomography analysis of teeth of the ancient Maya civilization showed that the inlay cavities cut reached the pulp chamber in the maxillary incisors and premolar teeth, with the potential to cause pulp and periapical disease.

The Variation of Hepatic Duct Confluence and Asymptomatic Common Bile Duct Stone with Routine Intraoperative Cholangiogram during Laparoscopic Cholecystectomy

Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct.

Ser120 of Ubc2/Rad6 Regulates Ubiquitin-dependent N-end Rule Targeting by E3α/Ubr1

In CHO cells, CDK1/2-dependent phosphorylation of Ubc2/Rad6 at Ser(120) stimulates its ubiquitin conjugating activity and can be replicated by a S120D point mutant (Sarcevic, B., Mawson, A., Baker, R. T., and Sutherland, R. L. (2002) EMBO J. 21, 2009-2018). In contrast, we find that ectopic expression of wild type Ubc2b but not Ubc2bS120D or Ubc2bS120A in T47D human breast cancer cells specifically stimulates N-end rule-dependent degradation but not the Ubc2-independent unfolded protein response pathway, indicating that the former is E2 limiting in vivo and likely down-regulated by Ser(120) phosphorylation, as modeled by the S120D point mutation. In vitro kinetic analysis shows the in vivo phenotype of Ubc2bS120D and Ubc2bS120A is not due to differences in activating enzyme-catalyzed E2 transthiolation. However, the Ser(120) mutants possess marked differences in their abilities to support in vitro conjugation by the N-end rule-specific E3α/Ubr1 ligase that presumably accounts for their in vivo effects. Initial rate kinetics of human E3α-catalyzed conjugation of the human α-lactalbumin N-end rule substrate shows Ubc2bS120D is 20-fold less active than wild type E2, resulting from an 8-fold increase in K(m) and a 2.5-fold decrease in V(max), the latter reflecting a decreased ability to support the initial step in target protein conjugation; Ubc2bS120A is 8-fold less active than wild type E2 due almost exclusively to a decrease in V(max), reflecting a defect in polyubiquitin chain elongation. These studies suggest a mechanism for the integrated regulation of diverse ubiquitin-dependent signaling pathways through E2 phosphorylation that yields differential effects on its cognate ligases.

DIVERSITY OF VEGETATIVE COMPATIBILITY TYPES, MATING TYPES AND OCCURRENCE OF HYPOVIRULENCE IN CRYPHONECTRIA PARASITICA POPULATIONS IN NW SPAIN

A survey was carried out to study the population biology of Cryphonectria parasitica in chestnut forests of Lugo and Ourense provinces (NW Spain), estimating the vegetative compatibility (vc) type and mating type diversity, and the occurrence of hypovirulent strains. A total of 610 isolates of C. parasitica were obtained, most showing a virulent phenotype. Only four isolates, from Lugo province, showed the presence of dsRNA, which was indicative of hypovirulence. Hypovirus molecular characterization of these isolates showed that all belonged to subtype E of Cryphonectria hypovirus 1 (CHV1-E). The diversity of vc types was very low. Only 9 vc types were found, being five of them present in both provinces. Four vc types were compatible with the European testers EU1, EU9, EU66 and EU72, and the other five corresponded to new undescribed types, named E1, E2, E5, E6 and E7. The dominant vc types in both populations were E1, E2 and E5. Two hypovirulent strains were compatible with vc type E1, one with vc type E2 and one with vc type E5. The study of mating types showed that the idiomorph MAT-1 was predominant in both populations.

Laboratory experiment on drip emitter clogging with fresh water and treated sewage effluent

A laboratory experiment was carried out to study the emitter performance of three commonly used emitter types with the application of freshwater and treated sewage effluent (TSE). The three emitter types are the inline-labyrinth types of emitters with a turbulent flow (E1) and a laminar flow (E2) and the online pressure-compensation type of emitters (E3). The qualities of freshwater and TSE were measured, and the emitter performance was evaluated, using the relative emitter discharge, the reduction of emitter discharge ( q reduction), the coefficient of variation of emitter discharge (CV), the emission uniformity (EU), Christiansen uniformity coefficient (CU), and the percentage of emitter clogging ( P clog). Results showed that all indices were affected by water quality, emitter type and time of operation. The values of q reduction, CV and P clog for the TSE treatments were greater than those for the freshwater treatments. The values of EU and CU for the TSE treatment were lower than those for the freshwater treatments. The q reduction, CV and P clog increased and the EU and CU decreased as operational time increasing for the TSE treatment. For both freshwater and TSE treatments, the emitter clogging was more severe, the CV was greater, and the EU and CU were smaller for emitter type E2 than those for emitter types E1 and E3. Thus a more severe clogging was found for emitter type E2 due to its smaller flow-path dimension and higher manufacturing coefficient of variation in addition to the high pH values and relatively high total dissolved solids (TDS) values of the used water. Analyses of water quality and the precipitation components inside and at the outlet of emitters revealed that chemical precipitation was the main reason for emitter clogging due to high pH and ions’ concentration, especially in the TSE. Flushing emitters and drip pipes did not efficiently alleviate emitter clogging caused by chemical precipitation. In a conclusion, emitter type E3 showed a better anti-clogging function than emitter types E1 and E2 and was recommended for irrigation with TSE in the Beijing area of China.

Emission rate dependence on the electric field for two trap levels in proton-irradiatedn-type GaAs

The electron emission rate dependence on the electric field for two levels in proton bombarded $n$-type GaAs, E1 and E2, was measured at different temperatures. E1 shows an emission enhancement completely described by the phonon-assisted tunneling model. The behavior observed for E2 is described by the sum of a Poole-Frenkel part and a phonon-assisted tunneling contribution. These data support a $+/0/\ensuremath{-}$ charge state model for ${V}_{\text{As}}$ in GaAs, and the potential contribution of this defect to the implant isolation process is discussed.

Photocapacitance study of deep levels in thin CdTe PV devices

Steady state photocapacitance (PHCAP) was used to survey the deep levels in the energy range 0.73 eV to 1.38 eV with respect to the valence band in CdS/CdTe PV devices. The effect of the cadmium chloride treatment process on deep level densities is shown qualitatively. Estimates of the optical transition thresholds E p o for three deep minority type levels E1, E2, and E3 are given and a discussion of possible assignment to specific defects is presented. Preliminary results using deep level optical spectroscopy (DLOS) to measure the optical cross sections for holes σ p o of the E2 and E3 levels are given. The thermal emission rates e n t for electrons at 79 K are estimated for the E2 and E3 levels.

Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury

To discuss the surgical method and skill of biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury. From November 2005 to December 2006, eight patients with biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury were admitted to our hospital. Their clinical data were analyzed retrospectively. Bile duct injury was caused by cholecystectomy in the eight cases, including seven cases with laparoscopic cholecystectomy and one with mini-incision choleystectomy. According to the classification of Strasberg, type E1 injury was found in one patient, type E2 injury in three, type E3 injury in two and type E4 injury in two patients. Both of the type E4 injury patients also had a vascular lesion of the hepatic artery. Six patients received Roux-en-Y hepaticojejunostomy for the second time, and one of them who had type E4 injury with the right hepatic artery disruption received right hepatectomy afterward. One patient who had type E4 injury with the proper hepatic artery lesion underwent liver transplantation, and the remaining one with type E3 injury received external biliary drainage. All the patients recovered fairly well postoperatively. Roux-en-Y hepaticojejunostomy is still the main approach for such failed surgical cases with bile duct injury. Special attention should be paid to concomitant vascular injury in these cases. The optimal timing and meticulous and excellent skills are essential to the success in this surgery.

Engineering of N-glycosylation of hepatitis C virus envelope protein E2 enhances T cell responses for DNA immunization

N-linked oligosaccharides are known to be important in modulating immunogenicity of some viral proteins. However, the roles of N-glycans of hepatitis C virus (HCV) E2 envelope glycoprotein in specific cellular immune responses remain elusive. Previous studies showed that the epitopes aa481–500 and aa551–570 of E2 might be important for immunoreactivity and that the binding site of E2 for hCD81 is located at aa480–493 and aa544–551 within the E2 protein. Here, we made plasmids containing genes encoding either wild type or mutant E2 proteins in which N-glycosylation sites (N560NT and N576ST) close to these important regions were mutated separately or in combination. The immunogenicities of wild type E2 and three mutated E2 proteins were analyzed in BALB/c mice using DNA vaccination. The E2-M2 mutant (at N576ST) significantly enhanced (compared to control) E2-specific CTL activity ( P < 0.05), expression of IFN-γ ( P < 0.05) and suppression of tumor growth ( P < 0.05). Also, high IgG2a/IgG1 ratios were elicited in a Th1-type response. These results indicate that engineering of the N-glycosylation site N576ST of HCV E2 protein enhances specific cellular immune responses, providing insights into the development of E2-based DNA vaccines with enhanced immunogenicity.

PGE2 amplifies the effects of IL‐1β on vascular smooth muscle cell de‐differentiation: A consequence of the versatility of PGE2 receptors 3 due to the emerging expression of adenylyl cyclase 8

Transition of vascular smooth muscle cells from a contractile/quiescent to a secretory/proliferative phenotype is one of the critical steps in atherosclerosis and is instigated by pro-inflammatory cytokines released from macrophages that have infiltrated into the vascular wall. In most inflammatory diseases, cell activation induced by these compounds leads to a massive production of type E2 prostaglandin (PGE2) which often takes over and even potentiates the pro-inflammatory cytokine-related effects. To evaluate PGE2 incidence on atheroma plaque development, we investigated whether and how this compound could enhance the dedifferentiation of smooth muscle cells initially induced by interleukin-1beta (IL-1beta). To address this issue, we took advantage of vascular smooth muscle cells in primary culture and tracked two markers: PLA2 secretion and alpha-actin filament disorganization. In such a context, we found that PGE2 synergizes with IL-1beta to further enhance the phenotype transition of smooth muscle cells, through cAMP-protein kinase A. As indicated by pharmacological studies, the full PGE2-dependent potentiation of IL-1beta induced PLA2 secretion is associated with a change of regulation exerted by the subtypes 3 G(i)-coupled PGE2 receptors toward adenylyl cyclase(s) activated by the subtype 4 G(s)-linked PGE2 receptor. Whereas on contractile cells, stimulated subtypes 3 inhibit type 4-dependent PLA2 secretion, this negative regulation is switched to positive on IL-1beta-treated cells. Using real time PCR, pharmacological tools and small interfering RNA (siRNA), we demonstrated that the different integration of PGE2 signals depends on the upregulation of calcium/calmodulin stimulable adenylyl cyclase 8.

Atomic data from the iron project

Radiative decay rates (A) and line strengths (S ) are presented for a large number of electric dipole allowed (E1) and forbidden electric quadrupole (E2), octupole (E3) and magnetic dipole (M1) transitions in Fe IV. The ion is amongst the most complex iron ions and exhibits effects of strong electron correlation. It has closely spaced fine structure levels from seven configurations: 3s 2 3p 6 3d 5 ,3 s 2 3p 6 3d 4 4s, 3s 2 3p 6 3d 4 4p, 3s 2 3p 6 3d 4 4d, 3s 2 3p 6 3d 3 4s4p, 3s 2 3p 6 3d 3 4s4d, 3s 2 3p 5 3d 6 before an energy gap could be noted. Atomic parameters are presented for multipole radiative transitions among the 1275 fine structure levels dominated by these seven configurations. A total of approximately 173 000 transitions of type E1, E2, E3 and M1 are presented, The set of intercombination and forbidden transitions complements the earlier extensive set of dipole allowed (∆J = 0, ±1, ∆L = 0, ±1, and ∆S = 0) fine structure transitions in Fe IV. The results are obtained in the relativistic Breit-Pauli approximation using an updated atomic structure code SUPERSTRUCTURE. Transition probabilities are compared with the existing results and varying degrees of agreement are found. The total number of transitions presented should provide a reasonably complete set for modeling of most optical to ultraviolet Fe IV spectra of astrophysical sources.

Sequence Analysis of Chloroplast chlB Gene of Medicinal Ephedra Species and Its Application to Authentication of Ephedra Herb

Chloroplast chlB gene encoding subunit B of light-independent protochlorophyllide reductase was amplified from herbarium and crude drug specimens of Ephedra sinica, E. intermedia, E. equisetina, and E. przewalskii. Sequence comparison of the chlB gene indicated that all the E. sinica specimens have the same sequence type (Type S) distinctive from other species, while there are two sequence types (Type E1 and Type E2) in E. equisetina. E. intermedia and E. prezewalskii revealed an identical sequence type (Type IP). E. sinica was also identified by digesting the chlB fragment with Bcl I. A novel method for DNA authentication of Ephedra Herb based on the sequences of the chloroplast chlB gene and internal transcribed spacer of nuclear rRNA genes was developed and successfully applied for identification of the crude drugs obtained in the Chinese market.

Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience.

Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 1.4% incidence of bile duct injuries during laparoscopic cholecystectomy. The aim of this study was to report on an institutional experience with the management of complex bile duct injuries and outcome after surgical repair. Data were collected prospectively from 40 patients with bile duct injuries referred for surgical treatment to our center between April 1998 and December 2003. Prior to referral, 35 patients (87.5%) underwent attempts at surgical reconstruction at the primary hospital. In 77.5% of the patients, complex type E1 or type E2 BDI was found. Concomitant with bile duct injury, seven patients had vascular injuries. Roux-en-Y hepaticojejunostomy was carried out in 33 patients. In two patients, Roux-en-Y hepaticojejunostomy and vascular reconstruction were necessary. Five patients, one with primary nondiagnosed Klatskin tumor, required right hepatectomy. Two patients, both with bile duct injuries and vascular damage, died postoperatively. Because of progressive liver insufficiency, one of them was listed for high-urgency liver transplantation but died prior to intervention. At the median follow-up of 589 days, 82.5% of the patients are in excellent general condition. Seven patients have signs of chronic cholangitis. Major bile duct injuries remain a significant cause of morbidity and even death after laparoscopic cholecystectomy. Because they present a considerable surgical challenge, early referral to an experienced hepatobiliary center is recommended.

Modulation by desmopressin of neuronal activity in brainstem micturition center

Objectives To examine the effect of desmopressin (DDAVP) on bladder contraction and on the neurons that fire in relation to spontaneous bladder contraction (bladder-related neurons) in and around Barrington's nucleus, the micturition center. DDAVP is used for the treatment of nocturnal enuresis because of its antidiuretic action, but the mechanism of this action has not been proved. Methods Urethane-anesthetized Sprague-Dawley male rats (n = 20) were used. DDAVP was infused intravenously or as an intracerebroventricular infusion into the lateral ventricle. Results We encountered three types of bladder-related neurons: those that fired before the start of the contraction (type E1), those that fired synchronous with the bladder contraction (type E2), and those that fired during bladder relaxation (type I). Intravenous infusion caused inhibition in three of five type E1 neurons, excitation in two of five type E2 neurons, and excitation (one neuron) and inhibition (one neuron) of four type I neurons. With intracerebroventricular infusion into the lateral ventricle, two of four type E1 neurons were inhibited, and one of seven type E2 neurons and three of four type I neurons were excited. Bladder contraction was suppressed in 4 of 12 rats by intravenous infusion and in 2 of 8 rats by intracerebroventricular infusion into the lateral ventricle. In all cases, when the bladder contraction was suppressed, an electroencephalogram of larger amplitude and slower frequency appeared. Conclusions DDAVP seems to regulate bladder activity by affecting bladder-related neurons in the micturition center.

Therapeutic immunisation with COPV early genes by epithelial DNA delivery

Following challenge with COPV (canine oral papillomavirus), DNA plasmids encoding COPV L1, E1 or E2 protein were delivered into oral mucosal and cutaneous sites in beagles using particle-mediated immunotherapeutic delivery (PMID). Two weeks post-challenge, a priming dose of 8 μg DNA was delivered followed by a booster dose after a further two weeks. A group of control dogs were vaccinated using plasmid DNA encoding Hepatitis B virus surface (HBVs) gene. All of the control animals developed warts at the vast majority of sites (94%). All of the animals given wild type L1, E1, or E2 developed warts at most sites (88%, 75%, and 88%, respectively). The animals given codon optimised E2 however, were protected from wart growth with only one tiny lesion seen on a single animal that persisted for only a few days. The E1 codon optimised group was also significantly protected with a far lower number of smaller warts (48%) that persisted for a shorter duration. These data suggest that therapeutic immunisation by PMID with papillomavirus early genes is effective and emphasizes the importance of antigen load in the generation of protective responses to papillomavirus proteins.

Breit–Pauli R-matrixcalculations for electron impact excitation of Fe XVII: a benchmark study

We have studied low-energy electron impact excitation of Ne-like Fe16+with emphasis on relativistic and resonance effects using a Breit–PauliR-matrixcode. Processes with one electron excited into the M shell, i.e. involvingthe closed-shell ground state and 36 more fine-structure levels (37CC),are compared with those from a target extended to the N shell(n = 4,89CC—CC indicating a close coupling approach to a partial wave expansion). Incontrast to previous work the 37CC and the 89CC collision strengths exhibit farricher structure. All N-shell levels give rise to Rydberg resonant states dippingright to all M-shell thresholds. This will modify all 37CC collision strengthsdown to every excitation threshold, not merely over the extended targetenergy range, thus significantly affecting the collision strengths for theprimary x-ray and EUV transitions among the first 37 levels. Extensivestudy of other effects on the collision strength is also reported: (i) electricand magnetic multipole type transitions E1, E2, E3 and M1, M2, (ii)J-partialwave convergence of dipole and non-dipole transitions, (iii) high-energy behaviourcompared to other approximations. Theoretical results are benchmarked againstexperiment to resolve long-standing discrepancies—collision strengths for thethree prominent x-ray lines 3C, 3D and 3E at 15.015, 15.262 and 15.450 Å are ingood agreement with two independent measurements on electron beam ion traps(EBITs). Finally, line ratios from a collisional–radiative model using the newcollisional rates are compared with observations from stellar coronae and EBITsto illustrate potential applications in laboratory and astrophysical plasmas.

Firing of micturition center neurons in the rat mesopontine tegmentum during urinary bladder contraction

Micturition is controlled by a network of brainstem neurons involving the Barrington’s nucleus. To depict clearly the brainstem system for micturition control, the present study was designed to record single neuronal activity in the mesopontine tegmentum including the Barrington’s nucleus, and to observe its precise timing in relation to bladder contraction recorded simultaneously. About 1/5 of neurons encountered had firing modulated in relation to bladder contraction. Three types of neurons were distinguished; those which fired only prior to the start of contraction (type E1), those whose firing started shortly prior to and was maintained during contraction (type E2), and those whose firing was strongly suppressed during contraction (type I). Type E2 neurons were most frequently observed in the Barrington’s nucleus and its close vicinity, while the neurons of the other two types were scattered widely in the mesopontine tegmentum. The results show clearly that direct neural signals to induce bladder contraction may arise from the Barrington’s nucleus, and that the nucleus may receive regulatory inputs from wide areas of the mesopontine tegmentum. In addition, the present study clarified that the noradrenergic and cholinergic neurons, which are located in nuclei adjoining the Barrington’s nucleus and function to control sleep/wakefulness, may not be concerned in controlling micturition directly.

Surgical treatment of iatrogenic lesions of the proximal common bile duct.

Between January 1979 and September 1999 a series of 96 patients were operated on at our institution for iatrogenic biliary injuries, and among them 62 involved the proximal biliary tract. Injuries, according to the Strasberg classification, were type E2 in 18 patients, type E3 in 29 patients, and type E4 in 15 patients. The most frequent primary surgical procedures were laparoscopic cholecystectomy in 27 of the 62 patients (43.6%) and open cholecystectomy in 30 patients (48.3%). Previous repair had been attempted in 25 patients (40.3%). A total of 58 cholangiojejunostomies were performed. Repair had been performed directly, and a T-tube had been left in the main bile duct in four patients with E2 Strasberg lesions. Postoperative death occurred in four patients (6.4%). Outcome was graded as excellent, good, or poor depending on clinical symptoms, liver function tests, and the need for reintervention due to anastomotic stricture. The final outcome was evaluated in 54 patients. The mean follow-up was 5.9 +/- 0.3 years, with the longest follow-up 10.2 years. Following our first repair 49 of the 54 patients (90.7%) had excellent results, 1 (1.9%) had good results, and 4 (7.4%) had poor results. None of the patients who underwent immediate or early repair had complications. Diagnostic and therapeutic courses are given on the basis of the type of lesion and the timing of repair. We emphasize the importance of timing (i.e., carrying out surgical repair as soon as possible) and of cholangiojejunostomy reconstruction in respect to defined technical principles. Moreover, we believe that repair treatment at a hepatobiliary center with multidisciplinary competence greatly influences the final long-term outcome.