[Increased incidence of senile dementia in the Hansen's disease sanatoriums of Japan]

In 1973, Narita reported that the rate of demented patients above 65 years was about 2% at the sanatorium--Tama Zenshoen, which was much lower than that of the average aged people (4-5%). The reason for that was thought to be due to the acquirement of strong mind under loneliness and difficulties faced by the patients through social enforcement to live in isolation. From that report on the low percentage of dementia among the Japanese Hansen patients reemed to be widely accepted. Fifteen years later in 1988, Narita reported that the rate of demented patients above 65 years was 3.2% in males and 3.6% in females indicating still a low rate at Tama Zenshoen. In 1994, however, Narita found unexpectedly that the percentage of dementia among patients above 80 at Tama Zenshoen was higher than the average aged population. Therefore in this report, we tried to analyze the reason for this difference. In addition to Tama Zenshoen patients, we also investigated those of another Hansen disease sanatorium namely Nagashima Aiseien which has similar structural organization as Tama Zenshoen. A comparison of dementia between these two was carried out, taking patients above 65 years as the study group (Used GBS scale based on Karasawa's method). In Tama Zenshoen, the rate of patients with dementia was 18.6% in males and 31% in females. Above 80 years those were 54.4% in males and 75.9% in females. The reason for the above high rate of dementia may be probably due to the passage of long years (40 to 50 years) after the enforcement to live in isolation causing the weakening of the spirit. The patients might have got some mental support if they had offspring, but they had no way to have any under the forced contraception. On the contrary, in Nagashima Aiseisen, the percentage of patients with dementia was low, namely 3.6% in males and 9.1% in females. In those patients above 80 years, it was 2.7% in males and 6.8% in females, those were almost similar to the average normal population (6%). Such a big difference was quite surprising. The reason behind this difference, may be due to the construction of the houses for the disabled persons. Both Nagashima Aiseien and Tama Zenshoen, have small individual rooms. In Tama Zenshoen, patients are able to visit their close neighbor, only after changing their shoes or with the aid of wheel chairs, but in Nagashima Aiseien, the corridors connecting quarters allow the patients to move easily to his neighbors with bare feet or even with crawl. Therefore, in Nagashima Aiseien, the number of patients who have social contacts with their neighbors is much greater in number which make them mentally active, thus eliminating the major factors affecting dementia. We can conclude that such communication between friends and co-mates make them alert and keep the spirit in the aged.

Minute nodular intrahepatic cholangiocarcinoma

BACKGROUND

This study describes the clinicopathologic features of minute intrahepatic cholangiocarcinoma (ICC) and clarifies the relation between minute nodular ICC and hepatitis viral infection.

METHODS

The presence of hepatitis C virus antibody (anti-HCV) and hepatitis B surface antigen (HBsAg) was examined in the serum of 50 patients with ICC who underwent hepatectomy from 1990-1996. The ICCs included 12 minute tumors (<3 cm in greatest dimension), 6 of which were nodular type and 6 others were nonnodular type (5 of periductal spreading or infiltrating type and 1 of intraductal type).

RESULTS

Of these 50 patients with ICC, 16 (32%) were positive for anti-HCV, 5 (10%) were positive for HBsAg, and 1 (2%) was positive for both. The prevalence of hepatitis viral infection in cases of minute nodular-type tumor (83%; 5 patients positive for anti-HCV) was significantly higher than that in cases of minute nonnodular-type tumor (0%; P < 0.05). These minute nodular-type tumors were detected during follow-up of patients with chronic hepatitis or cirrhosis. All patients were treated with hepatectomy alone. At last follow-up, 3 patients had been free of disease for >5 years after surgery. However, 1 patient died 2 years after surgery because of remnant liver and lymph node recurrence.

CONCLUSIONS

Minute nodular ICC appears to be related to hepatitis viral infection and could be detected at an early stage, similar to hepatocellular carcinoma, by following up cases of chronic hepatitis or cirrhosis.

Minute nodular intrahepatic cholangiocarcinoma

BACKGROUND

This study describes the clinicopathologic features of minute intrahepatic cholangiocarcinoma (ICC) and clarifies the relation between minute nodular ICC and hepatitis viral infection.

METHODS

The presence of hepatitis C virus antibody (anti-HCV) and hepatitis B surface antigen (HBsAg) was examined in the serum of 50 patients with ICC who underwent hepatectomy from 1990-1996. The ICCs included 12 minute tumors (<3 cm in greatest dimension), 6 of which were nodular type and 6 others were nonnodular type (5 of periductal spreading or infiltrating type and 1 of intraductal type).

RESULTS

Of these 50 patients with ICC, 16 (32%) were positive for anti-HCV, 5 (10%) were positive for HBsAg, and 1 (2%) was positive for both. The prevalence of hepatitis viral infection in cases of minute nodular-type tumor (83%; 5 patients positive for anti-HCV) was significantly higher than that in cases of minute nonnodular-type tumor (0%; P < 0.05). These minute nodular-type tumors were detected during follow-up of patients with chronic hepatitis or cirrhosis. All patients were treated with hepatectomy alone. At last follow-up, 3 patients had been free of disease for >5 years after surgery. However, 1 patient died 2 years after surgery because of remnant liver and lymph node recurrence.

CONCLUSIONS

Minute nodular ICC appears to be related to hepatitis viral infection and could be detected at an early stage, similar to hepatocellular carcinoma, by following up cases of chronic hepatitis or cirrhosis.

[Hepatic resection using glissonean pedicle transection]

The basics of hepatic resection using the glissonean pedicle transection method are presented. The portal triad continues from the hepatoduodenal ligament to the intrahepatic portion in the from of the glissonean pedicle, i.e., the artery, portal vein, and bile duct are Combined with connective tissue and sheathed by the peritoneum in the form of a fibroid bundle. The full length of the primary branches and the origin of secondary branches are located extrahepatically, and the trunk of the secondary and more peripheral branches have an intrahepatic course. The ramification pattern of the tertiary branches of each secondary branch varies by individual. The liver is nourished by the 3 secondary branches of the glissonean pedicle. Each secondary branch supplies one segment, and therefore the liver can be divided into 3 segments and the additional caudate area. The area supplied by each of the tertiary branches is cone shaped ("cone unit"). Each segment is composed of from 6 to 8 cone units. The standard method for hepatic resection is the segmental resection method, in which one secondary branch is transected. In cases of limited resection, the number of cone units to be resected is adjusted, and the tertiary branches which supply them must also be transected selectively through the hilar or parenchymal approach. The author has performed hepatic resection using the glissonean pedicle transection method in 834 consecutive patients with hepatocellular carcinoma with no trouble.

Bisubsegmental liver resection for gallbladder cancer

BACKGROUNDS/AIMS

The ultimate goal was to determine the therapeutic value and indications of resection of segment IV inferior and segment V in patients with advanced gallbladder cancer.

METHODOLOGY

Indications for systematic resection of the liver, particularly segment IV inferior and segment V as defined by Couinaud (1) or Healey (2), in patients with advanced gallbladder cancer, were examined in a total of 201 patients with advanced gallbladder cancer who underwent surgical resection were studied.

RESULTS

All primary tumors invaded the subserosa of the gallbladder wall or deeper. Liver invasion and liver metastasis were studied clinicopathologically, and the long-term outcome was analyzed according to the procedure used for liver resection.

CONCLUSION

The clinicopathological result suggests that resection of segment IV inferior and segment V of the liver may be beneficial in patients with liver bed type invasion less than 20 mm in depth.

CYFRA 21-1 as a tumor marker for squamous cell carcinoma of the esophagus

This study assessed the clinical value of CYFRA 21-1 in comparison with squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) in patients with esophageal squamous cell carcinoma. In 112 primary cancer patients, the diagnostic sensitivity of CYFRA 21-1 (33.9%) was superior to SCC-Ag (28.6%), CEA (12.5%), and CA19-9 (6.3%). Levels of CYFRA 21-1 were closely correlated with TNM stage and wee below the cutoff value in all 21 patients with stage I disease. All 38 patients with a CYFRA 21-1 level over the cutoff value among the 80 patients who underwent esophagectomy had lymph node metastases (pN1). A correlation was found between CYFRA 21-1 levels and clinical response in serial measurements of 21 patients who received chemotherapy or chemo radiotherapy. Our findings suggest that CYFRA 21-1 is not useful for diagnosis, but that it is valuable for monitoring the efficacy of therapy.

Changes in sequestered leukocytes and platelets in the pulmonary microvasculature of rats with monocrotaline-induced pulmonary hypertension

The role of leukocytes (WBCs) and platelets (PLTs) in the pulmonary circulation may be important in the development of monocrotaline (MCT)-induced pulmonary hypertension in rats. We investigated the changes in WBCs and PLTs in the pulmonary microvasculature during the development of chronic pulmonary hypertension in MCT rats by real-time confocal scanning laser microscopy. The number of WBCs sequestered in the pulmonary microvasculature increased significantly from day 7 after MCT injection, but no further increase occurred from days 14-28. The number of PLTs sequestered in the pulmonary microvasculature increased significantly from day 7 after MCT injection, and reached a peak on day 14. However, the number of PLTs sequestered on days 21 and 28 after MCT injection was significantly lower than on day 14. These findings suggest that PLTs mainly contribute to the initial and middle stages of the development of MCT-induced pulmonary hypertension in rats, while WBCs mainly contribute to the middle and late stages.

Apoptosis with FasL+ cell infiltration in the periphery and thymus of corrected autoimmune mice

Fas (CD95) ligand (L) is a death factor that binds to its receptor, Fas, and induces apoptotic cell death, a crucial process in immunological tolerance. gld (generalized lymphoproliferative disorder) mice, which have a point mutation in the FasL gene, develop spontaneous systemic autoimmune syndromes characterized by hypergammaglobulinaemia and lymphoid hyperplasia owing to accumulation of abnormal B220+ CD3+ cells. Transplantation of wild-type (wt) bone marrow cells into old gld mice on the same strain background results in normalization of autoimmune syndromes. We characterized the cellular mechanisms (functionally and histologically) of the above phenomena in gld mice after bone marrow transplantation (BMT) to determine the role of apoptosis via Fas/FasL interactions in inducing and maintaining self-tolerance in vivo. Activated splenocytes from wt and BMT (wt to gld) mice showed significant cytotoxic activity against Fas transfectant cells while those from BMT (gld to gld) mice did not. Cells in the thymus, spleen and lymph nodes of gld mice uniformly upregulated Fas expression and were sensitive to Fas-mediated apoptosis compared with those in wt mice. Cells sensitive to Fas-mediated apoptosis in gld mice resided not only among abnormal B220+ CD3+ cells but also among conventional lymphocytes. More importantly, histological analysis revealed that cells in the spleen, lymph nodes and thymus frequently underwent apoptosis with infiltration of FasL+ cells in BMT (wt to gld) mice compared with BMT (gld to gld) mice. Our results indicated that apoptosis via Fas/FasL interactions can directly eliminate pathogenic cells responsible for autoimmunity in the periphery and possibly in the thymus in vivo.

[Diagnosis of tumor extension of ductal adenocarcinoma of the pancreas based on histological findings]

This study was undertaken to evaluate the diagnosis for tumor extension of ductal adenocarcinoma of the head of the pancreas based on histological investigation. From 1968 to 1995, 316 patients underwent radical resection and histological tumor extension was quite as follows; the rate of invasion to the anterior pancreatic capsule was 49%, invasion to the retroperitoneal tissue was 77%, invasion to the portal vein system was 38%, invasion to the extrapancreatic nerve plexus was 53% and lymph node metastases were 79%. 249 patients was performed extended radical operation consisted of regional lymphadenectomy, retroperitoneal dissection and resection of portal vein system, however non-curative resection was 52% with tumor invasion to dissected pancreatic surface in 88% of non-curative patients. And there was no 5-year survivor with non-curative resection. The extended radical operation should be indicated for patients who will have curative resection. Then, we set up clinical stage (CS; CSI approximately IV) by three factors related to resectability mostly; invasion to retroperitoneal tissue (RP), invasion to portal vein system (PV), invasion to major arterial system (A). It was also set up preoperative diagnostic criteria for RP, PV and A factor by computed tomography (CT) or abdominal angiography. From 1989 to 1995, 101 patients who had extended radical operation were investigated prospectively. The rate of accuracy of preoperative diagnosis of tumor extension were about 80% in each factor. Curability was 94% in CS I, 67% in CS II, 43% in CS III, respectively, and 3-year survival rate was 53% in CS I, 35% in CS II, 2-year survival rate was 8% in CS III. However, in CS IV the rate of non-curative resection was 77% and there was no 2-year survivor. It was concluded that extended radical operation of ductal adenocarcinoma of the head of the pancreas should be indicated for patients in less than CS III diagnosed by CT or angiography preoperatively.

[Immunohistological study of the nasal mucosa with reference to gamma delta-T cells]

The distribution of gamma delta-T cells (gamma delta-TCR positive cells) in nasal mucosa and polyps was studied in patients with nasal allergy and non-allergic patients. The biopsy specimens from the inferior turbinate and resected polyps were frozen at -70 degrees C and sliced at a thickness of 4 microns with a cryostat. Monoclonal antibodies (CD3 and TCR-gamma delta-1) and the Labelled Streptavidin Biotin method were used to detect T lymphocytes and gamma delta-T cells. The results were as follows: 1) The rate of gamma delta-T cells in the epithelium is higher than that in the lamina propria in patients with nasal allergy. 2) In non-allergic patients, on the other hand, the rate of gamma delta-T cells was almost the same in these layers. 3) The distribution of gamma delta-T cells in nasal polyps was uniform and their rate was relatively high. It has been reported that gamma delta-T cells can recognize a stress antigen such as heat shock protein. These cells are thought to play an important role in non-specific immunoreactions. This study suggests that gamma delta-T cells in the nasal mucosa play an important role also in specific immunoreactions.

[The study for the surgical treatment on distal bile duct carcinoma]

The surgical result in 74 patients with resected distal bile duct carcinoma was reviewed to clarify the surgical strategy of distal bile duct carcinoma. The clinicopathological record was according to the General rules for surgical and pathological studies on cancer of biliary tract(the 3rd edition, edited by the Japanese society of biliary surgery). 58 patients underwent standard pancreatoduodenectomy and 16 patients had pylorus-preserving pancreatoduodenectomy. The curative resection was performed in 38 patients (51.3%). The overall 5-year survival rate (operated death included) was 35.8%. The 5-year survival rate in curative resection was 56.6%. The survival rate of patients with curative resection was significantly better than that of the patients with relative non-curative (p < 0.05) or absolute non-curative resection (p < 0.01). We concluded that the Long-term survival after surgical resection was mostly correlated with curability. To obtain curative resection, the free surgical margin of hw and ew was essential. As for free "hw", intraoperative frozen dissection was indispensable. For free "ew", the dissection of the soft tissues in retroperitoneum at the back of pancreas head was necessary. On the lymph node dissection, the lymph nodes of No 8, 12, 13, 14 should be removed.

[Effect of percutaneous transluminal mitral commissurotomy on pulmonary function and on the pulmonary vasculature]

We evaluated the therapeutic effect of percutaneous transluminal mitral commissurotomy (PTMC) on pulmonary function, and the damage caused to pulmonary vasculature by transient occlusion of the mitral valve during PTMC in patients with mild mitral stenosis. Pulmonary function tests were done and serum thrombomodulin was measured in 6 patients before and after PTMC. The mean pulmonary arterial pressure and mean pulmonary arterial wedge pressure decreased significantly from the control values, and the decreases were proportional to the increase in the area of the mitral valve. VC, %VC, and DLco were in the normal range before and after PTMC but PEFR, FEV1%, FEV1, V50, V25, and V50/V25 were significantly higher after PTMC. Change in the area of the mitral valve correlated with the changes in FEV1% (r = 0.841), in V50 (r = 0.624), and in V25 (r = 0.697). The serum thrombomodulin levels before and after PTMC did not differ. We conclude that pulmonary dysfunction in patients with mild mitral stenosis MS is mainly due to an obstructive ventilatory defect, and that PTMC can correct this dysfunction without damaging the pulmonary vasculature.

Prenatal determination of human platelet antigen type 4 by DNA amplification of amniotic fluid cells

To predict a fetus at risk for neonatal alloimmune thrombocytopenia (NATP) caused by human platelet antigen (HPA)-4 incompatibility, we applied a sequence-specific polymerase chain reaction (PCR-SSP). We were able to determine the HPA-4 genotype of three infants at risk using amniotic fluid cells without the need for fetal blood sampling. The HPA-4 genotypes of amniotic fluid cells determined in this way were completely concordant with the genotype and phenotype of infants' venous blood samples obtained after delivery. Therefore, this technique is also convenient to a fetus at risk in the antenatal management of NATP induced by HPA-4 incompatibility.

Difference in gene expression for matrix metalloproteinase-1 between early and advanced hepatocellular carcinomas

The histological observation that well-differentiated cancer cells in early hepatocellular carcinoma (HCC) invade portal tracts and/or fibrous bands and that these fibrous tissues then disappear suggests the participation of matrix metalloproteinase-1 (MMP-1) in the degradation of fibrous tissue. To confirm this hypothesis, the authors investigated the localization of both the MMP-1 protein and its messenger RNA (mRNA) in early HCC immunohistochemically and by in situ hybridization using complementary DNA (cDNA) and synthetic antisense probe of MMP-1; they then compared the results with those in advanced HCC. MMP-1 gene transcripts and protein were observed in well-differentiated cancer cells of early HCC but not in moderately or poorly differentiated cancer cells. Thus, cancer cells producing MMP-1 in early HCC may destroy the portal tract tissue adjacent to the cancer lesion and/or the fibrous band of cirrhosis. These results seem to have demonstrated a difference in the mechanism of cancer growth and invasion between early and advanced HCCs.

Stromal and blood vessel wall invasion in well-differentiated hepatocellular carcinoma

We examined hepatocellular carcinomas (HCCs) that were smaller than 2 cm in diameter. Ninety-nine nodules from 65 patients were removed for treatment. The nodules were divided into four types (A, B, C and D) according to the following criteria: first, the appearance of the margin of nodules, distinct or indistinct; and second, cellular atypia, uniform or multiple as "nodules in nodule". In 45 indistinct margin nodules, 28 showed uniform atypia (type A) and 17 were of "nodules in nodule" (type B). As for 54 distinct margin nodules, 23 were "nodules in nodule" (type C) and 31 showed uniform atypia (type D). Cancer cell invasion was divided into three types: (1) stromal invasion into fibrotic tissue and/or portal tracts, (2) blood vessel wall invasion of portal veins or hepatic veins, and (3) tumor thrombus. The stromal and vessel wall invasion occurred almost at the same rate regardless of degree of atypia. This study shows that well-differentiated HCCs in which the cancer cells show only very slight atypia have the potential for metastasis to intrahepatic and other sites.

The maize gamma-zein sequesters alpha-zein and stabilizes its accumulation in protein bodies of transgenic tobacco endosperm

Zeins are seed storage proteins that form accretions called protein bodies in the rough endoplasmic reticulum of maize endosperm cells. Four types of zeins, alpha, beta, gamma, and delta, aggregate in a distinctive spatial pattern within the protein body. We created transgenic tobacco plants expressing alpha-zein, gamma-zein, or both to examine the interactions between these proteins leading to the formation of protein bodies in the endosperm. Whereas gamma-zein accumulated in seeds of these plants, stable accumulation of alpha-zein required simultaneous synthesis of gamma-zein. The zein proteins formed accretions in the endoplasmic reticulum similar to those in maize endosperm. Protein bodies were also found in protein storage vacuoles. The accumulation of both types of zeins peaked early in development and declined during maturation. Even in the presence of gamma-zein, there was a turnover of alpha-zein, suggesting that the interaction between the two proteins might be transitory. We suggest that gamma-zein plays an important role in protein body formation and demonstrate the utility of tobacco for studying interactions between different zeins.

[Histological and immunohistochemical study of nasal polyps]

Nasal polyps, in general, have been histologically classified as edematous, adenocystic and fibrous types. It has recently been pointed out that eosinophilic infiltration in nasal polyps has increased along with an increase in nasal allergy. The purpose of this study was to classify the nasal polyps histologically and to examine the mode of infiltration and activation of eosinophils by means of immunohistochemistry. The subjects were 101 patients who underwent surgery for nasal polyps. There were 66 males and 35 females ranging in age from 12 to 76 years. Resected polyps were fixed in formalin, embedded in paraffin, and sliced at a thickness of 4 microns. Hematoxylin-eosin staining and streptavidin- biotinyl peroxidase complex staining were used to detect eosinophils. The results were as follows: 1) The nasal polyps were, histologically, edematous in 88.1%, adenocystic in 47.5%, and fibrous in 19.8%. 2) The number and distribution of EG1-positive cells and EG2-positive cells were almost the same in the superficial layer of the lamina propria. This study suggests that eosinophilic infiltration into nasal polyps occurs mainly in edematous polyps and that the majority of the infiltrating eosinophils are activated.

Hepatic recurrence of cholangiolocellular carcinoma: report of a case

We present a rare case of hepatic recurrence of cholangiolocellular carcinoma in a 61-year-old woman. The patient's past history included a right hepatic lobectomy and a hepatic hilar resection with hepaticojejunostomy for cholangiolocelluar carcinoma in 1990. After the diagnosis of hepatic recurrence in 1993, a partial hepatic resection was performed. The gross specimen showed an irregularly shaped white nodular tumor 2.5 cm in size without liver cirrhosis. The histopathological findings revealed small cuboidal cells resembling cholangiole forming acinar structures with fibrotic stroma, these findings were the same as those in the previously resected tumor. An immunohistochemical examination showed a positive reaction to carcinoembryonic antigen and keratin. The ultrastructural features revealed small round nuclei, flat contact of the cell membranes without interdigitation resembling that of hepatocytes, relatively numerous intracytoplasmic filaments, few organelae and a basement membrane resembling those of the bile duct epithelium. No recurrence has been observed during a one-year follow up. On the basis of the characteristic clinical and histopathological features of this case, we therefore consider that cholangiolocellular carcinoma should be recognized as an intermediate type somewhere between hepatocellular and cholangiocellular carcinoma.

Analytical study of the clinical response to two distinct adoptive immunotherapies for advanced hepatocellular carcinoma: comparison between LAK cell and CTL therapy

To evaluate the effect of two distinct adoptive immunotherapies, tumor-specific cytotoxic T-cell (CTL) therapy and lymphokine-activated killer (LAK) cell therapy, the clinical responses of patients with stage IV primary hepatocellular carcinoma (HCC) treated with these therapies were studied. Of 18 patients treated with CTL, 3 had complete regression (CR), 2 had partial regression, and 3 had minor regression (MR). Their median survival was 21 months after the end of therapy, and 1 CR patient survived for > 6 years. On the other hand, in the LAK-cell-treated group of eight patients, four had MR and their median survival was only 2 months. No survival was observed 27 months after the end of LAK cell therapy. These results indicate that tumor-specific CTL therapy is more effective than LAK cell therapy and that it might be a promising therapeutic tool for advanced HCC patients.

[Immunohistochemical study on subpopulations of B cells in the nasal mucosa]

The subpopulations of B-lymphocytes in the inferior turbinates of 12 patients with allergic rhinitis and 3 patients with nonallergic nasal disease were studied by immunohistochemical procedures. The specimens were frozen at -70 degrees C and sliced at 4 microns with a cryostat. The LSAB method with monoclonal antibodies (CD4, CD8, CD20, CD40) was used to detect subpopulations of T-lymphocytes and B-lymphocytes. In every subject the number of CD4 (+) cells dominated over that of CD8 (+) cells in the lamina propria. CD20 (+) cells were seen mainly in the border between the subepithelial layer and the nasal gland layer. CD40 (+) cells were found among the epithelial cells, the gland cells and the round mononuclear cells. In the serial sections CD20 (+) CD40 (+) cells were found in the inferior turbinates. We did not observe any difference in the distribution of CD20 (+) cells and expression of CD40 between allergic patients and nonallergic patients. Further study seems to be necessary to elucidate the relationship between CD20 (+) CD40 (+) cells and T-lymphocytes and some cytokines.

A prospective randomized trial of the preventive effect of pre-operative transcatheter arterial embolization against recurrence of hepatocellular carcinoma

To clarify whether pre-operative transcatheter arterial embolization (TAE) improves survival after hepatectomy, a prospective randomized comparative study was done. Of a total of 115 registered patients having solitary hepatocellular carcinoma (HCC) 2 to 5 cm in diameter, 18 (15.7%) were excluded after randomization. As a result, 97 patients were chosen as subjects and divided into two groups: hepatectomy with (group A: n=50) and without (group B: n=47) pre-operative TAE. The period of observation of the patients who survived the surgery was between 4.0 and 6.6 years. The randomization appeared to have provided well-balanced groups of patients and the clinico-pathological characteristics of the two groups were quite similar. The necrotic part of the cancerous lesions, as confirmed by operative specimens, amounted to 74.8+/-33.4% (mean +/-SD) in group A and 6.8+/-7.2% in group B (P<0.01). However, the cancer-free survival rates after hepatectomy in both groups showed little difference (39.1+/-7.0 (%+/-SE) and 31.1+/-0.1, respectively). We speculate that TAE is not effective against such HCC accessory lesions as minute intrahepatic metastasis and tumor thrombus and that pre-operative TAE does not improve post-operative survival.

Recovery of gastrointestinal motility from post-operative ileus in dogs: effects of Leu13-motilin (KW-5139) and prostaglandin F2 alpha

Cyclical motor activity of the gastrointestinal tract, normally occurring during the interdigestive period in several mammals, is disrupted in the post-operative ileus. We determined the recovery from the disappearance of cyclical motor activity, from the stomach to the colon, in dogs after laparotomy with the force transducers. Moreover, we examined the effects of Leu13-motilin (KW-5139) and prostaglandin F2 alpha (PGF2 alpha), administered in the early post-operative period, on the gastrointestinal motility. Following laparotomy, the cyclical motor activity reappeared firstly in the ileum and the colon, then in the jejunum and the duodenum, and finally in the stomach. The reappearance time of the phase III contractions in the stomach was 105.8 +/- 10.6 h (n = 4). In the early post-operative period, KW-5139 (0.5 microgram kg-1, i.v.) induced phase-III-like contractions, whereas PGF2 alpha (50 micrograms kg-1, i.v.) induced simultaneously occurring contractions over the whole gastrointestine. The treatment with KW-5139 (0.5 microgram kg-1, i.v.) four times (twice daily on the first and the second post-operative day) significantly (P < 0.05) shortened the time required to recover the phase III contractions in the stomach (64.2 +/- 2.2 h, n = 4), whereas that with PGF2 alpha (50 micrograms kg-1, i.v.) four times did not (111.3 +/- 17.2 h, n = 4). The present results indicate that, after laparotomy, the cyclical motor activity recovers faster in the distal intestine than in the proximal intestine and the stomach, and that KW-5139, but not PGF2 alpha, shortens the reappearance time of the phase III activity in the stomach.