In situ expression of cell adhesion molecules in chronic gastritis with Helicobacter pylori infection

Helicobacter pylori infection of the stomach results in acute inflammation followed by chronic inflammation, but the mechanism is unknown. Adhesion molecules such as ICAM-1, Mac-1, and LFA-1 may help regulate interactions of immune cells and inflammatory cells. We used immunohistochemistry to locate these molecules in the gastric mucosa of patients with chronic gastritis arising from H. pylori infection. Biopsy specimens were taken from five H. pylori-negative healthy volunteers and 20 H. pylori-positive patients with chronic gastritis for immunohistochemical studies of adhesion molecules. In the gastric mucosa of patients with H. pylori-associated chronic gastritis, ICAM-1 expression was prominent in most of the vessels and inflammatory cells, such as lymphocytes and granulocytes, in the lamina propria. However, no intraepithelial lymphocytes and surface epithelial cells expressed ICAM-1. Antigen-presenting cells (APCs), such as macrophages, expressed ICAM-1 as well as HLA-DR antigen. LFA-1 and Mac-1 were strongly expressed in these immune and inflammatory cells. The number of vascular endothelial cells positive for P-selectin was also greater in H. pylori-positive mucosa. The expression of these molecules decreased remarkably after successful eradication of H. pylori. In conclusion, ICAM-1 is the predominant form among the cell adhesion molecules that are expressed in response to chronic H. pylori infection. The increased expression of ICAM-1 is linked with massive infiltration of inflammatory cells that express LFA-1 and Mac-1, and also with APCs that express HLA-DR, suggesting that ICAM-1 exerts a key role in immuno-inflammatory responses in gastric mucosa of patients with H. pylori-associated gastritis.

Resection of hepatic and pulmonary metastases in patients with colorectal carcinoma

BACKGROUND

Surgical resection of hepatic or pulmonary metastases has been accepted as appropriate therapy. However, whether aggressive surgery of both hepatic and pulmonary metastases from colorectal carcinoma is of value has not been verified in detail.

METHODS

The authors identified 156 patients who had undergone hepatic resection for colorectal carcinoma metastases. This study reviewed six of these patients who underwent resection of both hepatic and pulmonary metastases from colorectal carcinoma.

RESULTS

Five of the patients included four who underwent pulmonary resection for pulmonary metastases after initial hepatic resection for hepatic metastases and one patient who underwent hepatic metastasis resection after initial pulmonary metastasis resection. One additional patient underwent a simultaneous resection of hepatic and pulmonary metastases. The median interval between the 2 resections was 23 months. The median follow-up was 32 months after the second resection. At the time of last follow-up, 4 patients were alive and free of recurrent disease at 6, 7, 38, and 64 months, respectively, after their second resection. The remaining 2 patients died of disease at 17 and 32 months, respectively, after the second surgery.

CONCLUSIONS

The results of the current study suggest that hepatic and pulmonary resection can result in long term survival in select patients with hepatic and pulmonary metastases from colorectal carcinoma because surgery remains the only potentially curative treatment.

[C-MOS flat-panel sensor for real time X-ray imaging]

Flat-panel, self-scanning, solid state diagnostic x-ray imaging devices using complementary metal-oxide-semiconductor (C-MOS) arrays are under investigation. A unit device with a 5 cm by 5 cm sensor area was developed and tested. The device consists of a CsI scintillator and C-MOS detector arrays. The detector arrays are composed of a regular arrangement of pixels (256 x 256), each of which is made of a C-MOS photodiode sensor coupled to a C-MOS FET (field effect transistor). A common FET gate line is connected to all the FET gates along each column. A common date line is connected to all the FET drains of each row. The source contact of each FET is connected to that of its corresponding photodiode. A positive gate pulse applied to a gate turns on all FETs connected to the date lines. The readout continues column by column. Correlated double sampling circuits and an offset variance compensation circuit were installed to reduce noise. A sampling speed of 15 frames per second and spatial resolution of 2.5 line per mm were achieved. Noise level and maximum signal were 1.5 mV rms and 1.8 V, respectively. Image quality was considered acceptable for clinical use. It is also discussed how to fabricate a large area sensor with the unit device.

Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection?

BACKGROUND

It has been reported that surgical excision of hilar cholangiocarcinoma rather than palliative surgical therapy, chemotherapy, or radiotherapy caused prolonged survival in some patients, However, excision is associated with high operative morbidity and mortality rates, particularly when hepatic resection is also performed. The aim of this study was to evaluate the clinical implications of hepatic resection in hilar cholangiocarcinoma.

METHODS

The study involved 76 patients with hilar cholangiocarcinoma who were undergoing surgical resections. Twenty-one patients (28%) underwent a combined resection, with reconstruction of the portal vein in 20 patients and reconstruction of the hepatic artery in 7 patients. Sixty-five patients undergoing seven different types of hepatic resection with extrahepatic bile duct resection (BDR) and 11 patients undergoing BDR only were retrospectively compared for background, operative morbidity and mortality, and survival.

RESULTS

Curative resection was obtained in 5 of 11 (45%) patients undergoing local resection and in 49 of 65 (75%) patients undergoing hepatic resection (p < 0.05). The surgical morbidity rates were 34% and 27% for hepatic and local resection, respectively. The 30-day mortality and hospital mortality rates were 4.6% and 15% for hepatic resection and 0% and 0% for local resection, respectively. The 5-year survival rate was 26% for all resected patients (76 patients); it was 40% versus 0% for curative versus noncurative resections (p < 0.05). No significant difference in surgical resection rates was revealed between hepatic and local resection among resected and curative resected patients.

CONCLUSIONS

Aggressive surgical approaches to obtain curative resections could bring about a better prognosis in hilar cholangiocarcinoma independently of whether hepatic resection or local resection is performed.

Portable-type stereo fluoroscope for surgery

A prototype of a portable stereo fluoroscope was devised. This system has two X-ray tubes and one image intensifier. To create a three-dimensional view, the system alternately exposes the X-ray from left and right X-ray tubes 15 times per second (7.5 pairs/s) to obtain left and right eye images with parallax. Each image is stored in video-RAM (random access memory) and left and right images are alternately displayed on a monitor at 120 frames/s (60 pairs/s). A liquid crystal modulator mounted on the monitor and special polarizing glasses worn by the surgeon convey the appropriate image to the proper eye. It was applied in a simulation of interlocking intramedullary nails and fixation of femoral neck fracture using phantom femurs. The three-dimensional view in real-time makes it easy to understand the shape of the bone phantom and to determine the spatial relationship between it and the instruments used without moving the C-arm.

Resection of hepatic and pulmonary metastases in patients with colorectal carcinoma

BACKGROUND

Surgical resection of hepatic or pulmonary metastases has been accepted as appropriate therapy. However, whether aggressive surgery of both hepatic and pulmonary metastases from colorectal carcinoma is of value has not been verified in detail.

METHODS

The authors identified 156 patients who had undergone hepatic resection for colorectal carcinoma metastases. This study reviewed six of these patients who underwent resection of both hepatic and pulmonary metastases from colorectal carcinoma.

RESULTS

Five of the patients included four who underwent pulmonary resection for pulmonary metastases after initial hepatic resection for hepatic metastases and one patient who underwent hepatic metastasis resection after initial pulmonary metastasis resection. One additional patient underwent a simultaneous resection of hepatic and pulmonary metastases. The median interval between the 2 resections was 23 months. The median follow-up was 32 months after the second resection. At the time of last follow-up, 4 patients were alive and free of recurrent disease at 6, 7, 38, and 64 months, respectively, after their second resection. The remaining 2 patients died of disease at 17 and 32 months, respectively, after the second surgery.

CONCLUSIONS

The results of the current study suggest that hepatic and pulmonary resection can result in long term survival in select patients with hepatic and pulmonary metastases from colorectal carcinoma because surgery remains the only potentially curative treatment.

Tumor specific contrast enhancement study of Mn-metalloporphyrin (ATN-10)--comparison of rat brain tumor model, cytotoxic and vasogenic edema models

ATN-10, Mn-metalloporphyrin, has been developed as a tumor selective contrast agent for magnetic resonance (MR) imaging. To investigate the tumor specificity of ATN-10, we produced three experimental in vivo models; rat bran tumor (9L glioma) model, vasogenic (cold injury) and cytotoxic brain edema (24-hour MCA occlusion) models. The time course of contrast enhancement was compared after intravenous injection of ATN-10 or Gd-DTPA, measuring the signal intensity of the region of interest. After ATN-10 administration, the 9L glioma model showed early (5 min) and delayed (24 hr-) peak enhancement whereas the cold injury model showed only early enhancement and the 24-hour MCA occlusion model did not show significant enhancement. After Gd-DTPA administration, all three models showed similar pattern of only early enhancement. As a contrast agent for MR imaging, ATN-10 showed different behavior than Gd-DTPA in demonstrating the blood-brain barrier disruption and moreover ATN-10 showed selective enhancement in experimental brain tumors.

[Management and delivery of radiation dose distribution images using the Internet]

Dose distribution images play important roles in the management of cancer patients. To date hard copies of these images have been stored and referred to by radiation oncologists as needed. In most cases, these images were not available to medical personnel outside the radiation oncology department. We have developed a mechanism in the hospital to access these dose distribution images via WWW (World Wide Web). A screen snapshot of a dose distribution image on the CRT of a treatment planning machine is copied to the WWW server and converted to a GIF image. Similarly, we can register dose volume histograms and digitally reconstructed radiographs on the WWW. Medical personnel throughout the hospital can access the images through the WWW browser. As a result, radiation oncologists are given detailed information on target definition in treatment planning by expert physicians. The system also helps co-medical staff in understanding dose distributions and predicting radiation injuries. At the same time, it actualizes an electronic archive of dose distribution images, which is a database for quick and reliable review, evaluation and comparison of treatment plans. This technique also furthers a close relationship among radiation oncologists, physicians, and co-medical personnel.

Routes of hepatic metastasis of gallbladder carcinoma

This clinicopathologic study aims to clarify routes of hepatic metastasis of gallbladder carcinoma. Nineteen liver specimens obtained by extensive hepatectomy performed for the treatment of advanced gallbladder carcinoma were analyzed. We defined hepatic metastasis as a discrete hepatic lesion separate from the primary tumor and paid special attention to portal tracts at the margins of direct hepatic invasion. Eleven early metastatic foci were demonstrated histologically in 6 cases, most commonly in segments adjacent to the gallbladder. All cases with hepatic metastasis had direct hepatic invasion. Nine of the 11 metastatic lesions were located within the portal tracts or accompanied by invasion into the portal tracts. Because they are in continuity with areas of direct hepatic invasion, the portal tracts at the invasive margin often were involved by cancer cells that spread along these tracts. These results suggest that the most important route in development of hepatic metastasis from gallbladder carcinoma is along the portal tracts after direct hepatic invasion.

Immunohistochemical localization of a urokinase-type plasminogen activator system in squamous cell carcinoma of the oral cavity: association with mode of invasion and lymph node metastasis

The binding of urokinase-type plasminogen activator (uPA) to its receptor (uPAR) has been implicated in cancer invasion and metastasis. This activity is known to be regulated by several inhibitors such as plasminogen activator inhibitors (PAIs). To elucidate the participation of the uPA system in the malignant behaviour of squamous cell carcinoma (SCC) in the oral cavity, uPA, uPAR, PAI-1 and -2 expression and localisation in 34 primary oral cancers were examined immunohistochemically. The results were then compared with clinicopathological findings. The positive rates of uPA, uPAR, PAI-1 and -2 expression were 23.5, 29.4, 29.4 and 11.8%, respectively. uPA expression correlated with mode of cancer invasion according to Yamamoto-Kohama's criteria (p < 0.01) and with secondary regional lymph node metastasis. uPAR expression also correlated with mode of invasion. In particular, the tumours of both uPA- and uPAR-positive [uPA(+)/uPAR(+)] cases were highly invasive. In the present study, neither PAI-1 nor PAI-2 expression correlated with clinicopathological parameters. However, PAI-2 negative cases of uPA(+)/uPAR(+) were significantly more invasive (p < 0.0001). Such uPA(+)/uPAR(+)/PAI-2(-) cases almost always showed secondary lymph node metastasis (p < 0.01). These results indicate that the uPA system plays a significant role in the invasive and metastatic processes of oral SCC, and that this system may be a powerful aid in evaluating the clinical course or prognosis of patients with oral cancer.

Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of His

OBJECTIVE

We investigated whether the angle of His influences gastroesophageal reflux after distal gastrectomy.

METHODS

Thirty-eight patients having distal gastrectomy and 10 controls underwent upper gastroesophageal fluoroscopy to measure the angle of His, and gastroesophageal reflux was assessed by scintigraphy. The association between scintigraphic reflux and the angle of His was then evaluated.

RESULTS

In distal gastrectomy patients with and without reflux symptoms, the angle was 108.82 +/- 21.88 degrees and 96.07 +/- 13.25 degrees, respectively; it was 74.14 +/- 10.85 degrees in the controls. The angle was significantly larger in the patients than in the controls (p < 0.01). In addition, the angle in the symptomatic gastrectomy group tended to be larger than in the asymptomatic group. The angle was also significantly larger in patients with a scintigraphic reflux index > or =6% than in those with an index <6% (p < 0.05).

CONCLUSIONS

These findings suggest that the angle of His plays a role in reflux after distal gastrectomy and that the severity of reflux may be estimated by measuring this angle.

Analysis of treatment results of hypopharyngeal cancer

Sixty-three patients with squamous cell carcinoma of the hypopharynx were treated at the University of Tokyo between 1985 and 1993. Twelve patients were treated with surgery alone, 16 with preoperative irradiation, 26 with postoperative irradiation, and nine with irradiation alone. A tumor dose of 50 Gy (25 fractions/5 weeks) was used in postoperative irradiation, 40-60 Gy in preoperative irradiation, and 70 Gy in irradiation alone. When "number of indications," including, for example, partial pharyngectomy, positive or close (< or = 5 mm) margin, and extracapsular extension, was used for multivariate analysis in patients who underwent surgery, it proved to be the only significant prognostic factor for gross survival. Six of seven patients with a positive surgical margin or close margin who received postoperative irradiation had local recurrence. A tumor dose of 50 Gy (25 fractions/5 weeks) in postoperative irradiation is not enough. It is difficult to cure by irradiation metastases to the parapharyngeal lymph nodes large enough to be detected with CT. It is necessary to irradiate parapharyngeal lymph nodes prophylactically, but 50 Gy in postoperative irradiation may not be enough from our results. The same may be true for metastases to the paratracheal nodes, which lie close to the lower poles of the thyroid gland or within the superior mediastinum and are difficult to access through surgery. In the patients who were operated on, N stage and the number of lymph node metastases were significant for gross survival. When "number of indications" was used for analysis, "number of indications" proved to be the most significant prognostic factor for gross survival.

Improvement of image quality in megavoltage computed tomography with second generation scanning mode

Megavoltage computed tomographic (CT) scanning is a topic of interest in precision radiation therapy. It is useful in verifying and improving the accuracy of the patient's positioning. For this purpose, we developed a third generation mode megavoltage CT scanner. However, insufficient spatial resolution limits its clinical usefulness. A second generation mode megavoltage scanner using a turntable has been newly developed to investigate whether improvements in spatial sampling could result in image quality high enough for clinical use. Scanning is composed of 11 rotations and 12 translations of the table. The scanning beam is a 3 MV X-ray, and the detector consists of 75 elements of cadmium tungstate crystals combined with photodiodes. A spatial resolution of 0.5 mm and contrast resolution of approximately 5% were obtained. The image quality is inferior to that of conventional diagnostic CT scanners, but is estimated to be adequate for some clinical applications of radiation therapy. Based on the satisfactory results, a new third generation megavoltage CT scanner is under investigation.

All-optical subtracted joint transform correlator with a holographic interferometer

A new, to our knowledge, subtracted joint transform correlator (SJTC) is proposed that has no digital processing in a computer. All processing for obtaining correlation signals between an object and multiple reference patterns were treated optically by use of a joint transform correlator with a holographic interferometer similar to the Mach-Zehnder one. The joint power spectrum of the reference patterns was subtracted from that of the input image (the object pattern plus the reference patterns), and the spurious correlation signals between the different reference patterns were removed. Because of the optical parallel computations of the Fourier spectra and the subtraction, the real-time SJTC is possible to achieve by use of only an optical system. An experimental arrangement of the system and system performances of the shift-invariant characteristics and discriminability are described. The results show the good performance of this system.

Dose-dependent incorporation of tea catechins, (-)-epigallocatechin-3-gallate and (-)-epigallocatechin, into human plasma

Tea catechins, (-)-epigallocatechin-3-gallate (EGCg) and (-)-epigallocatechin (EGC), have been reported to suppress oxidation of plasma low density lipoprotein (LDL) in vitro. If dietary catechins can be efficiently incorporated into human blood plasma, anti-atherosclerotic effects in preventing oxidative modification of LDL would be expected. In this study, a newly developed chemiluminescence detection-high pressure liquid chromatography (CL-HPLC) method for measuring plasma catechins was used and the incorporation of EGCg and EGC into human plasma was investigated. Healthy subjects orally ingested 3, 5, or 7 capsules of green tea extract (corresponding to 225, 375, and 525 mg EGCg and 7.5, 12.5, and 17.5 mg EGC, respectively). The plasma EGCg and EGC concentrations before the administration were all below the detection limit (< 2 pmol/ml), but 90 min after, significantly and dose-dependently increased to 657, 4300, and 4410 pmol EGCg/ml, and 35, 144, and 255 pmol EGC/ml, in the subjects who received 3, 5, and 7 capsules, respectively. Both EGCg and EGC levels detected in plasma corresponded to 0.2-2.0% of the ingested amount. Catechin intake had no effect on the basal level of endogenous antioxidants (alpha-tocopherol, beta-carotene, and lycopene) or of lipids in plasma. These results suggested that drinking green tea daily would contribute to maintain plasma catechin levels sufficient to exert antioxidant activity against oxidative modification of lipoproteins in blood circulation systems.

Detection and analyses of ascorbyl radical in cerebrospinal fluid and serum of acute lymphoblastic leukemia

We have detected and analyzed a free radical in human cerebrospinal fluid (CSF) of acute lymphoblastic leukemia (ALL) for the first time using electron paramagnetic resonance (EPR) at ambient temperature. We have also introduced an alternative capillary method to measure the radical. EPR spectra of the radical show a characteristic doublet with hyperfine coupling value of 1.8 G and g = 2.005. Based on EPR measurements, computer simulation, and literature values, we have determined that the species is ascorbyl radical (AsR). The radical has been investigated in CSF samples from ALL patients having no therapy, undergoing chemotherapy, and following therapy. Determination of the ascorbyl radical concentrations in CSF and serum was attempted using known concentrations of a nitroxyl radical. In addition, comparison in CSF and serum for ALL has been made along with statistical analyses of the data obtained. We found that AsR in CSF and serum has a strong correlation in patients undergoing chemotherapy (n = 57, r = 0.57, P < 0.0001). Ascorbate in CSF and serum show good correlation in patients having therapy but not for patients after therapy.

[Clinical effect of high-flow pulsatile cardiopulmonary bypass in coronary artery bypass grafting]

The effect of high-flow pulsatile cardiopulmonary bypass was evaluated in 36 patients undergoing coronary artery bypass grafting in our unit. The patients were divided into two groups, based on cardiopulmonary bypass (CPB) flow; high (3.0 +/- 0.2 l/min/m2), or moderate (2.4 +/- 0.2 l/min/m2). Multidose cold crystalloid cardioplegia was administered for myocardial protection. Pulsatile flow during CPB was used and systemic perfusion pressure was maintained between 50 and 80 mmHg. Preoperatively, there were no differences between groups in left ventricular ejection fraction or extent of coronary artery disease. The times required for CPB and weaning from CPB were significantly shorter in high-flow group than moderate-flow group. The urinary output during CPB was significantly higher in high-flow group than moderate-flow group. Postoperatively, there were no significant differences in the incidence of myocardial infarction, stroke, or 30-day mortality between groups. In conclusion, high-flow pulsatile CPB shortens the length of CPB and does not differ significantly from moderate-flow with respect to mortality and morbidity.

Absorption and distribution of tea catechin, (-)-epigallocatechin-3-gallate, in the rat

To investigate the absorption and metabolism of an anticarcinogenic tea catechin, (-)-epigallocatechin-3-gallate (EGCg), in rats, a newly developed chemiluminescence-detection high-performance liquid chromatography (CL-HPLC) method was employed and the EGCg concentrations in blood plasma, liver, brain, small intestinal mucosa and colon mucosa were determined before and after EGCg administration. The recovery of EGCg, extracted consecutively with ethyl acetate and methanol, was 86.1% from plasma and 64.5-74.2% from the tissue samples. The EGCg concentrations of plasma and tissue samples from the control rat (before EGCg administration) were all below the detection limit (< 0.002 nmol/mL, 0.002 nmol/g), but 60 min after a single oral administration of EGCg (500 mg/kg body weight), the levels increased, reaching 12.3 nmol/mL in plasma, 48.4 nmol/g in liver, 0.5 nmol/g in brain, 565 nmol/g in small intestinal mucosa and 68.6 nmol/g in colon mucosa. The EGCg levels found in the tissues corresponded to 0.0003-0.45% of ingested EGCg. The results indicate that tea catechin, EGCg, is absorbed from the digestive tract, with the intestinal mucosa the most enriched of the organelles. This may explain the potent antioxidant function of EGCg in inhibiting colon mucosal phospholipid hydroperoxidation in the prevention of rat colonic carcinogenesis.

Induction of apoptosis during the early phase of reperfusion after rat liver ischemia

This study was designed to investigate the induction of apoptosis during the reperfusion phase following warm liver ischemia in vivo. We evaluated apoptotic bodies (ABs) in sections stained with hematoxylin and eosin (H. E.) and positive hepatocytes in sections stained by the in situ nick end labeling method (TUNEL method) during the reperfusion phase up to 48 h after a 70% liver ischemia for 30 or 60 min in duration (30 or 60 min group). The peak number of ABs in H. E.-stained sections was observed at 1 to 3 h in the 30 min group and 3 to 6 h in the 60 min group. The number of ABs gradually fell as the length of the perfusion period increased, and few ABs were observed at 24 and 48 h after reperfusion. A peak number of TUNEL-positive hepatocytes was recognized at 3 h after reperfusion in both groups, after which the numbers decreased gradually. DNA extracted from both groups was electrophoresed on a 1.5% agarose gel. In both groups, a ladder-like pattern over smear pattern was recognized at 3 h after reperfusion. These results show that hepatocyte apoptosis was induced during the early phase of reperfusion after rat liver ischemia morphologically and biochemically, which suggests that hepatocyte apoptosis may be associated with ischemia and reperfusion injury.

Juvenile xanthogranuloma occurring in the oral cavity: case report and histopathological findings

Juvenile xanthogranuloma is commonly seen in the dermis, and only very rarely develops in the oral mucosa. Here were report a case that occurred in the anterior palate of a 9-year-old boy. The lesion appeared as a dark red and well-defined nodule measuring 12 x 14 mm. Histologically, it consisted of a proliferation of histiocytes and fibroblastic stroma intermingled with foamy cells. Many lipid droplets without limiting membrane were observed in the cytoplasm under electron microscopy, but no Langerhans' cell granules were observed. The proliferative histiocytes were positive for lysozyme and macrophage HAM56 under immunohistochemical observation, but not for S-100 protein. From these findings, the lesion was diagnosed as juvenile xanthogranuloma. The post-operative course, now amounting to 7 years, has been uneventful.

Enhanced endothelial cell injury by activated neutrophils in patients with obstructive jaundice

BACKGROUND/AIMS

A high incidence of complications has been documented in patients with obstructive jaundice after operations. Recent reports have revealed that neutrophils are involved in the mechanism causing postoperative complications. However, there are few reports investigating the interaction between neutrophils and endothelial cells in obstructive jaundice. The aim of this study was to evaluate neutrophil-mediated endothelial cell injury in patients with obstructive jaundice.

METHODS

Patients were divided into three groups: those with normal liver, obstructive jaundice, and relief of obstructive jaundice. Neutrophils were isolated from patients individually. Human umbilical vein endothelial cells and neutrophils were co-cultured after addition of phorbol myristate acetate. The release of lactate dehydrogenase and thrombomodulin was measured in the medium.

RESULTS

Lactate dehydrogenase and thrombomodulin were released in the co-culture medium, and Eglin C, which is an elastase inhibitor, reduced the release of lactate dehydrogenase and thrombomodulin in a dose-dependent manner. The release of lactate dehydrogenase and thrombomodulin in the group with relief of obstructive jaundice was significantly higher than in the group with normal liver. There was no significant difference between the group with obstructive jaundice and the group with normal liver. The elastase activity in neutrophil suspension was similarly higher in the group with relief of obstructive jaundice than in the group with normal liver.

CONCLUSIONS

This study suggests that neutrophils in patients with obstructive jaundice are not activated before its relief. After relief of obstructive jaundice, neutrophils are strongly primed and have the potential to cause endothelial cell injury. The neutrophil "priming" in patients with obstructive jaundice may be associated with the frequent occurrence of postoperative complications.

Vascular reconstruction using left renal vein graft in advanced hepatobiliary malignancy

BACKGROUND/AIMS

In surgical resection for advanced hepatobiliary malignancies involving the portal vein and inferior vena cava, vascular reconstruction is usually required. We utilized left renal vein grafts for vascular reconstruction in cases of these malignancies, and their clinical significance is evaluated in this study.

METHODOLOGY

Left renal vein grafts were utilized for reconstruction of the portal vein in four patients and patch repair of the inferior vena cava was performed in two patients with advanced hepatobiliary malignancies. All six patients underwent hepatic resection with vascular resection and reconstruction. Postoperative renal function and graft patency were assessed.

RESULTS

Transient slight renal disturbances appeared in some patients, but there was no severe renal dysfunction requiring specific therapy. Graft patency was maintained during the follow-up period in all patients.

CONCLUSION

The use of left renal vein grafts as autovein grafts seems appropriate in cases involving reconstruction of the portal vein and in those involving patch repair of the inferior vena cava defect in surgical resection for advanced hepatobiliary malignancies.