Influence of warm ischemia on isolation and primary culture of hepatocytes from rat liver for a hybrid artificial liver

To assess the possibility of using hepatocytes from ischemic liver, as a bioreactor of a hybrid artificial liver, we investigated the influence of warm ischemia on the isolation and culture of hepatocytes in rats. Warm ischemia was induced by clamping the liver hilus and the animals were divided into 3 groups according to the duration of ischemia: group A (no ischemia), group B (10 minutes) and group C (20 minutes). Hepatocytes were isolated by the collagenase perfusion method and cultured for 5 days. The yield and viability of the isolated hepatocytes were lower in group C. Rate of attachment was decreased as the duration of ischemia increased. There was no significant difference observed in functions in culture. Sufficient hepatocytes, as a bioreactor, can be isolated and cultured from warm ischemic liver within 10 minutes. Though the number of available hepatocytes were diminished, hepatocytes procured from longer warm ischemic liver could be utilized as a bioreactor.

[Effect of continuous infusion of 5-fluorouracil and daily low-dose cisplatin for inoperable recurrent cancer of the stomach and colon]

With the use of cisplatin to enhance the effect of 5-FU, a combined approach was designed to treat patients with inoperable recurrent cancer of the stomach (15) and colon (6). This CDDP-5-FU therapy consisted of intermittent infusion of CDDP at a dose of 6 mg/m2 every day and continuous infusion of 5-FU at a daily dose of 200 mg/m2 for 2 weeks with a 2-week interval in between. There were 1CR and 6PR, and the overall response rate was 40.0%. Toxicity was manifested in slight nausea or vomiting in two patients (10.0%), but there was no nephrotoxity. Thrombocytopenia of Grade 4 was found in 1 patient and leucopenia of Grade 3 in another. The efficiency of performance status was in 14 patients (66.7%). Combination of daily low-dose cisplatin and 5-FU is a tolerable treatment for patients with inoperable recurrent stomach and colon cancer. It is suggested that CDDP plays a role as not only an effector but also a modulator in biochemical modulation of 5-FU in this therapy. The infusion schedule is also suitable for chemotherapy of outpatients. Further studies on the appropriate infusion of CDDP and 5-FU are needed.

Allopurinol effects in rat liver transplantation on recovery of energy metabolism and free radical-induced damage

Rat livers were orthotopically transplanted after 90-min cold ischemia (group 1) or after 20-min warm and 70-min cold ischemia without (group 2) or with (group 3) allopurinol treatment (AT) (50 mg/kg i.v. 10 min prior to warm ischemia into the donor, flush perfusates with 1 mmol/l). Recovery processes were followed up for 60 min of reperfusion. Liver tissue levels of ATP and total adenine nucleotides were restored in group 1 to almost preischemic ranges within 15-30 min, remained significantly reduced by 30 and 20%, respectively, in group 2, and recovered with AT within 60 min in group 3 to almost the same extent as in group 1. A massive increase in the tissue malondialdehyde concentration, indicative of lipid peroxidation, occurred in the beginning of reperfusion of warm-ischemically damaged donor livers, which in group 3 with AT tended to be less pronounced than in group 2 without AT. The GSSG/GSH ratio reflecting intracellular oxidant stress averaged 3.3 x 10(-3) in group 1 between 15 and 60 min reperfusion. In group 3 AT resulted in comparably low values averaging 3.8 x 10(-3), while in warm-ischemically damaged livers without AT of group 2 this ratio was significantly and continuously elevated averaging 5.8 x 10(-3).(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of Warm Ischemia on Isolation and Primary Culture of Hepatocytes from Rat Liver for a Hybrid Artificial Liver

To assess the possibility of using hepatocytes from ischemic liver, as a bioreactor of a hybrid artificial liver, we investigated the influence of warm ischemia on the isolation and culture of hepatocytes in rats. Warm ischemia was induced by clamping the liver hilus and the animals were divided into 3 groups according to the duration of ischemia: group A (no ischemia), group B (10 minutes) and group C (20 minutes). Hepatocytes were isolated by the collagenase perfusion method and cultured for 5 days. The yield and viability of the isolated hepatocytes were lower in group C. Rate of attachment was decreased as the duration of ischemia increased. There was no significant difference observed in functions in culture. Sufficient hepatocytes, as a bioreactor, can be isolated and cultured from warm ischemic liver within 10 minutes. Though the number of available hepatocytes were diminished, hepatocytes procured from longer warm ischemic liver could be utilized as a bioreactor.

[A case of metastatic breast cancer successfully treated with weekly low-dose epirubicin (EPI), cyclophosphamide (CPA), 5-fluorouracil (5-FU) and medroxyprogesterone (MPA)]

We reported a case of successful treatment of disseminated breast cancer with epirubicin (EPI), 5-fluorouracil (5-FU), and medroxyprogesterone (MPA). The patient was a 49-year-old female with bone and liver metastasis developed 5 years after surgery. The primary tumor was ER-positive, and she had been treated previously with adjuvant therapy using UFT and tamoxifen. The treatment consisted of 3 cycles of thrice-weekly EPI (40mg), 5-FU (500mg) and CPA (500mg). The patient was then treated with a weekly schedule of EPI (10mg), 5-FU (50mg/day), CPA (50mg/day) and MPA (400mg/day). After 2 years, her bone and liver metastasis showed remarkable remission (PR). No side effects of this chemotherapy were observed. In the search for palliative treatments which have a minimal impact on normal lifestyle, low toxicity is important. PR was continued for 2 years, and the patient enjoyed a favorable quality of life. This low dose-weekly approach was very well tolerated, yet was effective.

[Efficacy of transarterial embolization combined with percutaneous ethanol injection therapy for recurrent hepatocellular carcinoma]

One hundred and eighty-nine patients with hepatocellular carcinoma (HCC) underwent hepatectomy since 1987 to 1992 in our institute. Recurrences were detected on residual liver in 84 patients up to December 1993. Sixty-seven of 84 patients were treated with re-resection (group-O, n = 11), transarterial embolization (TAE) combined with percutaneous ethanol injection therapy (PEIT) (group-TP, n = 13), TAE alone (group-T, n = 34) and intraarterial chemotherapy (group-IA, n = 9). Among these 67 cases, the efficacy of treatment for recurrences was investigated. There was no significant difference in age, positive ratio of hepatitis B virus, ICG R15 and percentage of underlying liver cirrhosis among the 4 groups. However, the frequency of patients with 2 nodules or less, was significantly higher in group-O than in other groups. Cumulative 1-, 2- and 3-year survival rates (%) were 88.9, 64.8 and 51.9 in group-O, 92.1, 55.4 and 55.4 in group-TP, 70.9, 49.6 and 31.0 in group-T, and 16.9, 0 and 0 in group-IA, respectively. The survival rate after recurrences in group-TP was higher than in group-IA and group-T, and almost equivalent to that of group-O. Either re-resection or TAE combined with PEIT might assure- a favorable prognosis in patients with recurrent HCC.

The inhibitory effects of cephalosporin and dipeptide on ceftibuten uptake by human and rat intestinal brush-border membrane vesicles

The types of inhibitory effects caused by compound V (an analogue of ceftibuten) and alanylproline (dipeptide) on the uptake of ceftibuten by brush-border membrane vesicles (BBMV) prepared from human and rat small intestine were analysed. In the presence of an inward H(+)-gradient, the initial uptake rate of ceftibuten by both human and rat intestinal BBMV was concentration-dependent with apparent Km and Vmax values of 0.35 mM and 2.052 nmol (mg protein)-1 min-1 for human BBMV, and 0.50 mM and 3.056 nmol (mg protein)-1 min-1 for rat BBMV, respectively. For both human and rat BBMV, kinetic analysis by Dixon and Lineweaver-Burk plots demonstrated that the uptake of ceftibuten was competitively inhibited by compound V, whereas inhibition by alanylproline was noncompetitive or partially competitive. These results suggest that there is a stereospecific transport system which is common to ceftibuten and compound V, and that this system is not identical to the carrier system for the dipeptide, alanylproline.

[Preoperative and postoperative variations of human hepatocyte growth factor (hHGF) in hepatectomized patients]

We clinically analyzed significance of serum human hepatocyte growth factor (hHGF) concentrations (ng/ml) before and after hepatectomies. We examined 39 hepatectomized patients (Group H) and 8 non-hepatectomized patients as control (Group C). In group H, hHGF levels elevated significantly on postoperative 1st, 3rd, 5th, and 7th days (0.59 +/- 0.24, 0.47 +/- 0.23, 0.38 +/- 0.16, 0.38-0.14, respectively) compared with the preoperative value (0.27 +/- 0.11). On the 3rd day hHGF levels in Group H (0.45 +/- 0.22) were significantly higher than those in Group C (0.30 +/- 0.06). Nineteen cases of 2-segmentectomy and 8 cases of partial resection showed significantly higher hHGF levels on the 3rd day than those in Group C. In 12 patients with liver cirrhosis, hHGF levels were significantly higher on the 5th and 21st days than those in 27 patients without cirrhosis. Three patients with hepatic failure showed significantly higher hHGF levels correlated conversely with preoperative serum albumin and hHGF levels on the 1st day after operation significantly correlated with operative time, blood loss during the operation. It was suggested that serum hHGF level correlated with hepatic functional reserve. We concluded that serial measurement of hHGF was useful for evaluation of postoperative damage of hepatic functions, and prolonged high hHGF levels might suggest hepatic failure.

[Efficacy of benzimidazole-type drugs on alveolar echinococcosis (AE)]

AE patients can be cured only by complete excision of the lesions. In Europe and the United States, however, benzimidazole-type drugs have been reported to be effective. We treated 37 patients (20 males and 17 females, mean age of 45.9 years) with mebendazole (MBZ) (n = 17) or albendazole (ABZ) (n = 20) according to the WHO chemotherapy protocol, and compared adverse reactions, drug concentrations, serological parameters, and measurable lesions by CT scan and/or X-ray examination. In the MBZ group, serological parameters were unaffected. One patient each had hepatic disorder and alopecia (12%), and 5 lesions in the liver and 3 in the lung gradually increased in size (105% in 1 year, 112% in 2 years), and showed NC (no response) in 6, PD (progressive disease) in 2. One case of released biliary obstruction were judged as PR (partial response) (Response rate: 11.1%). In the ABZ group, no adverse reactions were found and ELISA level decreased significantly in 10 out of 12 patients. One lesion in the liver, 3 in the lung, 1 in the chest wall and 1 in the retropancreatic region reduced in size significantly (Mean: 56%) (PR 3, NC 3; Response rate: 50.0%). ABZ was safer and more effective than MBZ.

Eyelid metastasis originated from gastric-cancer

The incidence of cutaneous metastasis from neoplasms of internal organs is uncommon, and in particular eyelid metastasis from gastric cancer is extremely rare. We report on such a case together with a review of a total of 6 cases. Of the 6 cases, 5 were males and 4 were pathologically low-grade differentiated adenocarcinoma. The presentation of eyelid mass was 3 nodular, 2 diffuse and one ulcerative without characteristics of its location. All the cases involved systemic disease and the effective treatment was not performed. We consider that the number of cases with eyelid metastasis from gastric cancer is actually much higher and that gastroenterologists should pay more attention to such cases in order to adequately grasp the pathogenesis.

Treatment of lymph node recurrence in patients with hepatocellular carcinoma

The clinicopathological features and results of lymph node dissection were investigated in four patients with hepatocellular carcinoma (HCC) who developed lymph node recurrence following hepatectomy. One patient was found to have metastasis in the periportal lymph nodes at the time of a second laparotomy, while the other three developed posterior pancreaticoduodenal lymph node metastasis. All four patients had concomitant cirrhosis of the liver and were negative for hepatitis B surface antigen. No relationship between the site of the primary lesion and the location of lymph node metastasis was found. Two of the four patients are alive and in good health 4 years and 3 months, and 7 years and 3 months after their first operation, respectively. Thus, we conclude that the posterior pancreaticoduodenal lymph nodes are the most common site of lymph node recurrence of HCC, and that dissection of the affected lymph nodes offers the best chance of long-term survival.

What is the benefit of aggressive chemotherapy for advanced neuroblastoma with N-myc amplification? A report from the Japanese Study Group for the Treatment of Advanced Neuroblastoma

In 1985, a nationwide single protocol (cyclophosphamide, vincristine, tetrahydropyranyl Adriamycin, and cisplatin) for the treatment of advanced neuroblastoma was begun in Japan and was found to significantly increase the 3-year survival rate--to 70% for stage III, and to 45% for stage IV. In this study, the authors investigated the efficacy of this protocol for advanced neuroblastoma with or without N-myc amplification. In 159 of the 233 patients with advanced neuroblastoma treated with this protocol (between January 1985 and March 1993), genomic amplification of N-myc was determined. These 159 patients were divided into two groups according to the number of N-myc copies, ie, those with fewer than 10 copies (105 patients) and those with 10 or more copies (54 patients). The survival curves for the two groups were significantly different. The 5-year survival rate for patients with 10 or more copies was 43.9%; this is surprisingly high in comparison to results of previous studies in which no survivors were expected in cases of advanced neuroblastoma with highly amplified N-myc. Persistent bone marrow suppression was common, but there were no deaths attributable to drug side effects. Five patients with fewer than copies of N-myc amplification died more than 3 years after initial treatment. Three of the five had tumors with an unfavorable Shimada classification, and two had diploid nuclear DNA content. The authors conclude that the protocol resulted in dramatic improvement in the patients with advanced neuroblastoma, even with high N-myc amplification.(ABSTRACT TRUNCATED AT 250 WORDS)

[The two cases of examination of chemotherapy in advanced gallbladder carcinoma]

Two cases of advanced carcinoma of gallbladder were treated by combination chemotherapy consisting of 5-FU, leucovorin and continuous administration of etoposide. One of the cases was a male 61 years old and another was a female 64 years old, both of whom were diagnosed as inoperable cases by imaging studies. When combination chemotherapy consisting of 5-FU (750mg/day or 1,000mg/day infusion) was given, leucovorin (30mg/day) and etoposide (25mg/day oral or 33mg/day continuous infusion), angiography or other imaging studies pointed out a reduction in their lesions of over 50%, and their QOL was markedly improved.

Liver resection in children, using a water-jet

The water-jet method has been used during hepatic resection in children. The instrument cuts the hepatic tissue by means of a high-pressure fine water-jet, while the exposed intrahepatic vessels are spared injury. Physiological saline was used for the jet water, and pressure of 12 to 15 kilograms of force per square centimeter (kgf/cm2) through a 0.15-mm-diameter nozzle was found to be optimal for cutting the liver parenchyma. The authors evaluated the usefulness of the water-jet dissector (n = 8) during bisegmentectomy or trisegmentectomy in comparison to the Cavitron Ultrasonic Surgical Aspirator (CUSA) (n = 5). The mean operation time was 4.08 +/- 0.87 hours for the water-jet group and 5.08 +/- 1.33 hours for the CUSA group. The mean blood loss was 602 +/- 659 mL for the water-jet group and 1,036 +/- 521 mL for the CUSA group. Although there were no significant differences with respect to operation time, blood loss, or postoperative complications, the liver parenchyma was dissected more easily using the water-jet. The authors believe that the mechanical simplicity and safety of the water-jet method will lead to its more widespread use in liver resection in children.

[Changes of arterial CO2 (PaCO2) and urine output by carbon dioxide insufflation of the peritoneal cavity during laparoscopic cholecystectomy]

We studied on the effects of carbon dioxide insufflation during laparoscopic cholecystectomy on the arterial blood gas analysis and urine output. Intra-abdominal pressure was increased up to either 10cmH2O or 15cmH2O, and we compared the PaCO2 values before and during insufflation. Both increase of PaCO2 and decrease in pH were larger in intra-abdominal pressure of 15cmH2O than 10cmH2O. In the intra-abdominal pressure 15cmH2O group, the increase of PaCO2 by CO2 peritoneal insufflation was significantly larger in operative time of more than 60 minutes group than in less than 60 minutes group, but no significant changes were observed in 10cmH2O group. In the group of obesity index of more than 120, elevation levels of PaCO2 by CO2 insufflation were significant, but in the group of less than 120 no significant elevation were observed. The tendency that the urine output during operation was decreased as increase of intra-abdominal pressure or operative time, but the obesity had no definite effects on urine output. Insufflation of the abdomen with CO2 caused large changes in PaCO2 or pH in the patients with a previous history of major cardiopulmonary disorder. It was shown that the low insufflation pressure and short operative time is good for the maintenance of normal physiological state.

[Progress in targeting therapy for hepatic cancer]

Targeting therapy for hepatic cancer is divided into a method using Lipiodol as drug carrier and a method employing immunological responses of monoclonal antibodies to the tumor antigens. For the latter method, immuno-conjugates of antibodies and cytotoxic agents have been studied. Because of the lower response rates of conventional chemotherapy. Lipiodol as drug carrier provides the most effective targeting therapy on hepatic cancer at the present time. Immunotherapy using cytotoxic cells, however, did not result in sufficient clinical efficacy on the liver cancer. The system for accumulation of the effective and sufficient number of cytotoxic cells or immunoconjugates in the targeting tumor tissues are expected to be investigated.

Positive effect of tamoxifen as part of adjuvant chemo-endocrine therapy for breast cancer. Hokkaido Adjuvant Chemo-Endocrine Therapy for Breast Cancer Study Group

A prospective randomised multicentre clinical study was undertaken for 2 years and 3 months from November 1982, with the aim of examining the significance of using a combination of ftorafur (FT) and tamoxifen (TAM) for post-operative adjuvant therapy of breast cancer. Patients had either stage II or stage IIIa disease, were age 75 or below and had undergone radical mastectomy. Patients were divided into two groups and received one of the following treatment protocols: treatment A, intravenous administration of doxorubicin (DOX), 20 mg on the day of surgery and 10 mg the next day, followed by oral FT 50 mg day-1 for 2 years from the 14th day; treatment B, the same pattern of DOX administration for the first 2 days, followed by a combined therapy of FT and TAM 20 mg day-1 for 2 years. The number of patients was 546 (treatment A 274 and treatment B 272), of whom 34 (6%) were ineligible. The remaining 512 patients (treatment A 254 and treatment B 258) were followed up for 5 years for analysis. Significantly higher 5 year disease-free rate and 5 year survival rates were observed with treatment B compared with treatment A. When seen in terms of background factors, node-positive patients appeared to derive more benefit from tamoxifen than node-negative patients, but the oestrogen receptor-negative and premenopausal subgroups appeared to derive about the same benefit as those who were oestrogen receptor positive and post-menopausal. Indeed, survival in the premenopausal group was significantly better with tamoxifen (P = 0.04). No increase in side-effects was seen by combining TAM with FT. The study results demonstrate that concomitant administration of FT and TAM is better than FT alone for post-operative adjuvant therapy for breast cancer.

Diagnostic-significance of liver-failure after newly-appeared serum fractions following liver surgery

We investigated a serum marker suggesting postoperative liver failure based on basic research. In diseased Long Evans Cinnamon rat with spontaneous development of hepatitis and hepatocellular carcinoma, the specific fractions, Fr 43 (peak-1) and Fr 58-60 (peak-2), newly appeared in the eluted serum following highperformance liquid chromatography. Peak-1 was associated with progressing Liver damage or failure. We applied this theory to five patients undergoing liver surgery and our expectations were realized. Peak-1 was probably a certain hepatic regenerating factor recognized in a previous study and we suspected that the exessive production of a liver regenerating factor signified an ongoing liver failure.

Blunt liver trauma: a new concept for classification of liver trauma based on vessel injury

We reviewed a consecutive 143 cases of blunt liver trauma, 43 children and 100 adults, to clarify the pathosis of liver trauma and to reasonably select treatment, non-operative or operative management. The primary determinant in the prognosis of liver trauma was clearly hemorrhage due to vessel injuries and its main treatment method was hemostasis. We developed a new concept for the classification of blunt liver trauma based on vessel injuries: I = subcapsular Glissonian vessel injuries, II = transcapsular Glissonian vessel injuries and III = in-/out-flow vessel injuries and 3 basic types were divided into 2 subtypes, respectively. Distribution of liver trauma according to the present classification was as follows: type I = 23% in child cases and 22% in adult cases, type II = 65% and 64% and type III = 12% and 14%, respectively. The main management was non-operative for type I, minor or major surgery for type II, and extended surgery for type III. The analysis of dead cases showed the following: I = 0% in child cases and 6% in adult, II = 60% and 55%; III = 40% and 39%, respectively. The first direct cause was hemorrhage: 60% in child cases and 49% in adult. The present classification was applicable for both child and adult patients, and presented a selection of management for liver trauma, suggesting the prognosis.

Comparison of chemotherapy with or without medroxyprogesterone acetate for advanced or recurrent breast cancer

The usefulness of CAF [cyclophosphamide (CPA)/doxorubicin (ADR)/5-fluorouracil (5-FU)] + medroxyprogesterone acetate (MPA) therapy for advanced/recurrent breast cancer was studied in a randomised trial at 56 institutions. Patients received CAF therapy [CPA: 100 mg, orally, days 1-14; ADR: 30 mg/m2, intravenously (i.v.), days 1 and 8; 5-FU: 500 mg/m2, i.v., days 1 and 8) in arm I, or CAF + MPA therapy (CAF + MPA 1200 mg, daily) in arm II. The response rate was significantly higher (P = 0.041) in arm II (53.5%, 46/86) than arm I (36.6%, 30/82). The response rate by tumour site was significantly higher for lymph node and bone lesions in arm II. Partial response duration and overall response duration were significantly longer in arm II. Incidences of anorexia and nausea/vomiting were significantly higher in arm I but in arm II, moon face, oedema and vaginal bleeding were significantly higher. Many patients in arm II demonstrated improvement in performance status and weight loss, suggesting a beneficial effect of MPA. The chemoendocrine therapy with CAF + MPA appears to be more beneficial than CAF alone in the treatment of advanced/recurrent breast cancer.

Anomalous excretion of bile and pancreatic juice in a patient with choledochal cyst

The authors report the findings of endoscopic retrograde cholangiopancreatography in a 1-year-old girl with choledochal cyst; contrast dye injected through the common channel was excreted solely through the duct of Santorini. The obstruction to the bile and pancreatic juice caused by marked bending of the common channel was responsible for the abnormal drainage of bile and pancreatic juice.

[Study on the complete parathyroidectomy and parathyroid autoimplantation for secondary parathyroidism in chronic renal failure]

We studied on the operative indication and therapeutic effect of complete parathyroidectomy and autoimplantation for chronic hemodialysis. Twenty three surgical resections were performed on 21 patients who had been received long-term hemodialysis. Total resected glands from these patients were 83 and the mean total parathyroid's weight was 3.2 gram. The detection rate of hyperparathyroidism was 50.0% by scintigram, and 72.9% by computed tomography (CT). The mean diameter of resected glands proved to be 5 to 6mm larger than that estimated by CT. There was no statistical correlation between the durations of hemodialysis and the total parathyroid's weights. Our study revealed that the mean weight of 5 cases without 1,25(OH)2D3-plus therapy was 5.8 gram, which was significantly heavier than that with this therapy. Histopathologically, the larger glands often showed nodular growth, but the smaller glands tended to show diffuse hyperplasia. There was a positive correlation (r = 0.93, p < 0.01) between the weights of the resected glands and serum CPTH values only in those cases with the glands weighing equal or less than 4 gram.