To clarify whether color doppler ultra sonography (CDUS) is useful for the diagnosis of shunt dysfunction after transjugular intrahepatic portosystemic shunt (TIPS), we investigated CDUS in 20 patients who were diagnosed as shunt dysfunction and 12 patients with patent shunt by follow-up portal pressure measurements. In patients with shunt dysfunction, maximum flow velocity in the portal vein (PV-Vmax) and maximum flow velocity in the shunt were significantly decreased in comparison to just after TIPS placement, but not in patients with patent shunt. Grade of color image of the shunt flow and flow direction in the portal vein branches were not significantly different between the shunt dysfunction group and the patent shunt group. Comparing the just after TIPS to the follow-up phase, the decreasing rate of PV-Vmax was negatively correlated with the increasing rate of portal vein pressure caused by shunt dysfunction. CDUS could detect shunt dysfunction in 95% sensitivity, 83% specificity and 91% overallaccuracy on the basis of a diagnostic criterion for shunt stenosis: more than 40% decrease of PV-Vmax from just after TIPS insertion. These results suggest that follow-up observation using CDUS is useful for the diagnosis of shunt dysfunction after TIPS procedure, and PV-Vmax is an especially important indicator to detect shunt dysfunction.
Numerical aberration of chromosome 17 of 14 cases of colorectal carcinoma with multiple primary cancer (: multiple cancer) was compaired with that of 35 cases of colorectal carcinoma without any other cancer (: single cancer). Fluorescence in situ hybridization with p17H8 was performed on touch smear from fresh materials. The proportion of aneusomy 17 (NCAI: numerical chromosome aberration index) in multiple cancers was significantly higher than that of single cancers (37.7±10.5% VS 46.1±8.0%; p<0.01). Although NCAI of single cancers conformed to cancer progression (26.1±4.7% in Dukes A, 33.1±7.1% in Dukes B, 39.9±6.9% in Dukes C, and 45.7±12.0% in Dukes D), that of multiple cancers was high in all stages (44.7±7.3%, 44.4±6.8%, 50.4±11.2%, and 49.6±5.6%, respectively). Furthermore, the multiple numerical aberration of chromosome 17 in multiple cancers was more often than that of single cancers (64.3% VS 22.9%; p<0.01).
We studied permeability of human small intestine to clarify the following questions. 1) Does indomethacin increase intestinal permeability (IP)? 2) Does ornoprostil (PGE1 analogue) prevent the increased IP due to indomethacin? 3) Does acemetacin (pro-drug) increase IP? Eleven healthy volunteers were studied before and after ingestion of indomethacin, acemetacin, ornoprostil. After an overnight fast, they drank an isotonic solution containing 1.5 g rhamnose and 10.5 g lactulose. IP was estimated with lactulose/rhamnose percentage excretion in urine for 5 hours. An administration of indomethacin (75 mg) for one day increased IP significantly, and the coadministration of indomethacin and ornoprostil showed no significant change in IP compared with those of controls. Pro-drug administration did not increase IP. It is suggested that simultaneous administration of ornoprostil prevent the mucosal damage caused by indomethacin clinically, and that the mechanism of this increase IP is due to lack of mucosal prostaglandins on the small intestine.