Stimulation of liver regeneration and function after partial hepatectomy in cirrhotic rats by continuous infusion of recombinant human hepatocyte growth factor

BACKGROUND/AIMS

Radical resection is accepted as one of the most curative treatments for hepatocellular carcinoma. However, most patients have coexisting cirrhosis and their liver function is usually impaired. It is therefore important to stimulate the regeneration and function of the remnant cirrhotic liver after hepatectomy. Hepatocyte growth factor is a potent mitogen that has been suggested to play a crucial role in liver regeneration.

METHODS

In this study, we performed 45% hepatectomy in rats with cirrhosis induced by thioacetamide, and administered recombinant human hepatocyte growth factor (rhHGF) with dextran sulfate by continuous infusion into the jugular vein with an infusion pump.

RESULTS

rhHGF stimulated an increase in the wet weight of the remnant liver compared with untreated control rats. The proliferating cell nuclear antigen labeling index showed that this increase resulted from the stimulation of DNA synthesis. Serum levels of liver enzymes increased after hepatectomy, but returned to the prehepatectomy level more rapidly in rhHGF-treated rats than in controls. rhHGF increased hepatic protein synthesis above prehepatectomy levels and also markedly increased the serum levels of hepatic lipid metabolites.

CONCLUSIONS

These results demonstrate that continuous intravenous infusion of rhHGF enhances the growth and function of the remnant liver in rats with cirrhosis after partial hepatectomy. Therefore, rhHGF may be useful after hepatic resection in patients with cirrhosis.

[Combination use of second generation cephem and isepamicin for the treatment of post-surgical infection of the lower digestive tract]

Effects of combination use of a second generation cephem and an aminoglycoside antibiotic isepamicin (ISP), for the treatment of post-surgical infections of the lower digestive tract were examined from a laboratory and clinical perspective. Thirty-three out of total 35 cases were included in the analysis of the test, while the other 2 cases did not meet the criteria for analysis. ISP was administered in combination with one of the second generation cephems among cefotiam (CTM), cefmetazole (CMZ), or cefuroxime (CXM) for 26 cases of wound infection and 7 cases of peritonitis. The overall efficacy rate was 88%; 92% in wound infection and 71% in peritonitis individually. There was no significant difference in efficacy among different groups. Bacteriological study showed the combination use of any one of the second generation cephems and ISP was very effective in all 14 cases of infections with a single species of bacterium, the efficacy rate was 100%. It was also effective in 9 out of 10 cases with mixed infections of 2 species of bacteria (90%), but effectiveness was diminished in only 6 out of 9 cases with mixed infections of 3 species (67%). Sixty-nine strains were isolated from the 35 cases, more than half of which (44 strains) were Gram-negative; 14 strains of E. coli (20%), 13 strains of E. faecalis (13%) and 6 strains of P. aeruginosa (9%). The MIC50 and MIC90 were, respectively, 1.56 micrograms/ml and 100 micrograms/ml for ISP, 6.25 micrograms/ml and 100 micrograms/ml for CTM, 12.5 micrograms/ml and 100 micrograms/ml for CMZ, and 25 micrograms/ml and 100 micrograms/ml for CXM. The MICs in any combination uses decreased synergistically according to ISP concentration. Adverse events were observed in 3 out of 35 cases, but they were not severe. The results indicated that the combination use of a second generation cephem and ISP was useful and should be one of the choices for the treatment of post-operative infections of the lower digestive tract.

A prospective trial of steroid cessation after renal transplantation in pediatric patients treated with cyclosporine and mizoribine

We conducted a multi-center prospective study to evaluate the safety and efficacy of steroid withdrawal after renal transplantation in children. In 52 children (51 living-related donor transplants and 1 cadaver donor transplant), immunosuppressive therapy was started with cyclosporine (CyA), mizoribine (MZ), methylprednisolone (MPL) and anti-lymphocyte globulin. Administration of MPL was reduced to alternate days more than 6 months after transplantation, and attempts were made to withdraw it. Acute rejection was noted in 19 patients (36.5%) by 1 month after transplantation. The whole-blood CyA trough level using monoclonal antibody was 175.0+/-17.0 ng/ml in patients who developed acute rejection and 282.0+/-25.3 ng/ml in those who did not show acute rejection (p<0.01). During the 37 attempts at alternate-day MPL administration, clinical acute rejection was observed in only 1 patient and chronic rejection in 3. During 10 attempts to withdraw MPL, acute rejection was noted in 3 patients, but graft function recovered to the pre-rejection level after treatment of the acute rejection. At the last observation, graft function was lost in 3 patients, 22 were receiving MPL on alternate days, and MPL had been withdrawn from 7 for a mean period of 16.7 months. The survival rate of the patients and the grafts was 100% and 94% after an average follow-up period of 4 years. Evaluation of growth showed catch-up growth in all patients during the withdrawal period.

[A survival case of intraoperative pulmonary embolism diagnosed early by transesophageal echocardiography]

An otherwise healthy 36-year-old housewife was diagnosed with advanced cancer of the stomach 5 months after her third parturition. Surgery was performed with the patient under total intravenous anesthesia combined with continuous epidural anesthesia. The course of anesthesia and the operative course were uneventful until the abdominal skin was sutured, when unexplained severe circulatory collapse developed. A widely dissociated PETCO2- PaCO2 suggested pulmonary embolism, and the findings of transesophageal echocardiography corroborated the diagnosis. Infusion of 480,000 units of urokinase in 30 minutes was immediately started via a Swan-Ganz catheter, and intravenous heparin 10,000 units in 24 hours, was administrated continuously. The pulmonary circulation was restored 30 minutes after the start of therapy, resulting in rapid recovery of the patient's systemic circulatory and acid-base status. The patient was safely extubated 19 hours postoperatively.

Extracellular glutamate and dopamine measured by microdialysis in the rat striatum during blockade of synaptic transmission in anesthetized and awake rats

We investigated the effect of high dose tetrodotoxin (TTX) on microdialysis measurements of extracellular striatal glutamate and dopamine in normal female rats. Both halothane-anesthetized rats with acutely implanted microdialysis probes and awake rats with microdialysis probes implanted for 24 h were tested. Glutamate levels in awake rats were 45% higher than those of anesthetized rats. Extracellular glutamate remained TTX-insensitive regardless of TTX concentration, anesthesia, or time lapsed after probe implantation. In contrast, TTX reduced dialysate dopamine in all TTX concentrations tested. We speculate that the lower glutamate levels in anesthetized rats reflect the effect of anesthesia. Because glutamate is involved, either as a reactant or a product in a variety of reactions critical to intermediary metabolism in the brain, basal dialysate glutamate levels might indirectly reflect brain metabolism. Further, we conclude that extracellular glutamate collected during non-stimulated conditions is TTX-insensitive. The fact that glutamate levels are TTX-independent does not rule out that glutamate is synaptic in origin but rather demonstrates that it is not nerve impulse-dependent. However, the brain interstitial glutamate pool accessible to the microdialysis probe during control conditions is most likely isolated from the synapse, and therefore does not impose a neurotoxic potential.

Prophylactic laparoscopic ovarian ablation for premenopausal breast cancer: medical and economic efficacy

Worldwide analysis showed a highly significant reduction in the annual rates both of recurrence and of death produced by ovarian ablation. We examined the safety, efficacy, and cost-effectiveness of prophylactic laparoscopic oophorectomy for premenopausal breast cancer. Prophylactic laparoscopic oophorectomy was attempted in 15 selected premenopausal patients with breast cancer. After mastectomy, these patients had laparoscopic ovarian ablation as treatment for breast carcinoma with positive estrogen receptors. To evaluate the economic impact of laparoscopic oophorectomy, comparisons were made between patients treated laparoscopically and those treated with conventional surgery, chemotherapy, and hormonal therapy. The average time required for laparoscopic bilateral oophorectomy was 44 min. Oral intake was resumed the next morning, and the patients were discharged 3 days after surgery. No limitation on physical activity and no complications were required during postoperative days. There was no reduction in the overall costs of laparoscopic surgery and conventional surgery in Japan. The cost of one year's supply of tamoxifen was equivalent to the overall cost of surgical oophorectomy. From medical and economic viewpoints, we conclude that laparoscopic ovarian ablation should be considered an alternative to adjuvant chemotherapy in premenopausal women.

Preoperative determination of the surgical procedure for hepatectomy using technetium-99m-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy

Technetium-99m-diethylenetriaminepentaacetic acidgalactosyl human serum albumin (Tc-GSA) is a new liver scintigraphy agent which binds to the asialoglycoprotein receptors. We evaluated the preoperative assessment for hepatectomy using Tc-GSA liver scintigraphy. Ninety patients with hepatocellular carcinoma were admitted for elective hepatectomy. Tc-GSA scintigraphy was conducted after the intravenous injection of Tc-GSA, and maximal removal rate of Tc-GSA (GSA-Rmax) was calculated using a radiopharmacokinetic model. Measurement of GSA-Rmax, conventional liver function, and 15-minute retention rate of indocyanine green (ICGR15) was carried out preoperatively. The relationships between liver functions, histological activity index (HAI), ICGR15, and GSA-Rmax values were estimated. A significant correlation was obtained between GSA-Rmax and ICGR15 (r = .534, P < .0001). Preoperative discrepancies between GSA-Rmax and ICGR15 values were seen in 15 patients. In these cases, the GSA-Rmax values correlated well with the total HAI scores (r = .595, P < .02), but no significant correlation was seen between the ICGR15 and HAI scores. Two patients died of postoperative liver failure within 2 months of the operation. These two patients were found to have severe discrepancies between their preoperative GSA-Rmax and ICGR15 values. We concluded that GSA-Rmax might be useful for selecting candidates for hepatectomy and that extended hepatectomies (di- and tri-segmentectomy) are high-risk surgical procedures in the case of low GSA-Rmax scores (below 0.35).

The anti-inflammatory drug sodium salicylate inhibits nitric oxide formation induced by interleukin-1beta at a translational step, but not at a transcriptional step, in hepatocytes

Recent evidence suggests that nitric oxide (NO) mediates cellular injury under the pathological conditions such as endotoxemia in the liver of rats. Regulation of NO production is crucial for improving the hepatic dysfunction. We have previously reported that, in cultured rat hepatocytes, a single cytokine interleukin-1beta (IL-1beta) stimulated a release of nitrite, an oxidation product of NO, into culture medium dose- and time-dependently. The objective of this study was to investigate an ability of the anti-inflammatory drug NaSA to affect the production of NO in hepatocytes. IL-1beta increased levels of inducible NO synthase (iNOS) messenger RNA (mRNA) with a maximal effect at 8 hours in primary cultures of rat hepatocytes. Nuclear factor-kappaB (NF-kappaB), that is an important nuclear factor protein in iNOS gene transcription in response to inflammatory mediators, also appeared in the nuclear fraction of hepatocytes 1 hour after addition of IL-1beta. Sodium salicylate markedly inhibited the NO formation induced by IL-1beta, but did not affect NF-kappaB activation and iNOS mRNA induction. Western blot analysis revealed that sodium salicylate (NaSA) blocked a step of iNOS protein synthesis. These findings indicate that NaSA may reduce hepatic injury by preventing the induction of NO formation in response to IL-1beta at the posttranscriptional step.

Assessing the eligibility for liver transplantation of patients with fulminant hepatitis

The spleen to liver volume (S/L) ratio of 13 patients with fulminant hepatitis was determined using X-ray computed tomography (CT), and the correlation between S/L ratio and prognosis was evaluated. The S/L ratio of 6 patients who died was greater than 0.16, whereas that of the remaining 7 patients who survived was less than 0.15. These findings suggest that determining the S/L ratio using CT may be useful for assessing the eligibility of patients with fulminant hepatitis for liver transplantation.

[Epidural anesthesia for herniorrhaphy in a patient with severe dilated cardiomyopathy (DCM) under pimobendan control]

A 60-year-old man with severe DCM was scheduled for a herniorrhaphy under epidural anesthesia using fentanyl. Three months prior to operation, the patient suffered heart failure associated with life-threatening ventricular arrhythmia. The former was successfully treated with pimobendan as the main constituent of medication, but the latter was not responsive to various antiarrhythmic drugs with the exception of aprindine. On the day of operation and for two days postoperatively, pimobendan was administered daily. A sudden drop in systemic blood pressure and central venous pressure (CVP) during anesthesia, as well as the tendency to hypotensive status in the postoperative period were well regulated with continuous infusion of dopamine and dobutamine via CVP catheter probably due to the effect of up-regulation of pimobendan, together with adjustment of the volume of intravenous fluids. No dangerous ventricular arrhythmia were observed. Thereafter the patient made uneventful progress and was discharged on the 8th postoperative day.

Clinical evaluation of closed suction drainage following hepatectomy

A prospective randomized study on 186 patients was conducted to determine the influence of closed suction drainage (n = 102) versus open drainage (n = 84) on the incidence of postoperative complications after elective hepatic resection. The patients were randomly allocated between the two groups. A total of 60 complications occurred in 31 of the 84 patients (36.9%) given open drainage, while 24 complications occurred in 15 of the 102 patients (14.7%) given closed suction drainage. The incidence of pleural effusion, postoperative ascites, and infected subphrenic collections was significantly lower in the closed suction drainage group than in the open drainage group, at 31% vs 16% (P < 0.05), 19% vs 3% (P < 0.01), and 17% vs 5% (P < 0.05) respectively. However, both groups showed similar rates of subphrenic hematoma and bile collection. These findings indicate that closed suction drainage significantly reduces the incidence of postoperative complications after elective hepatic resection.

Histologic features and clinical significance of venous invasion in colorectal carcinoma with hepatic metastasis

BACKGROUND

In colorectal carcinoma, venous invasion has been related to patient survival. Liver metastasis develops more frequently when venous invasion is present. However, the histologic features and clinical significance of venous invasion are not well understood.

METHODS

A histologic study of venous invasion in colorectal carcinoma was performed on 19 patients with synchronous hepatic metastasis (Group A), 16 patients with metacaronous hepatic metastasis (Group B), and 26 patients with Dukes Stage C tumors who survived for 5 years without recurrence (Group C). The histologic features of venous invasion were classified into three types: tumor cells that were distant from the vein walls were categorized as floating type, those filling the lumen of a vein as filling type, and those surrounded by a vein obliterated with inflammatory reaction as occlusive type.

RESULTS

Venous invasion was present in 89.5% of Group A patients and 75% of Group B patients, which was significantly higher than the 15.4% observed in Group C patients (P < 0.001). A slight to extensive degree of venous invasion was found in Groups A and B, but no extensive venous invasion was found in Group C. All patients in Groups A and B (except one patient) had floating, filling, or a combination of floating and filling types of venous invasion, whereas all patients in Group C had the occlusive type of venous invasion. A majority of the patients in all three groups showed invasion of extramural veins.

CONCLUSIONS

There is a close relationship between venous invasion and the development of liver metastasis in patients with colorectal carcinoma. Patients with no sign of metastasis had a lower incidence and lower extent of venous invasion, and inflammatory damage to the vein walls around the intravenous tumor appeared to reduce the likelihood of distant metastasis.

Ionic current model of the vertebrate rod photoreceptor

We describe voltage- and calcium-dependent ionic currents in the photoreceptor inner segments similar to the Hodgkin and Huxley (Journal of Physiology, 117, 500-544, 1952) equations. The model is used to describe both rods and cones by adjusting parameters. To simulate the light response, the inner segment model was connected with the phototransduction model proposed by Torre et al. (Cold Spring Harbor Symposia on Quantitative Biology, 55, 563-573, 1990). The role of individual ionic currents in the inner segment in shaping the light response was analyzed through computer simulations. The results suggest that: (1) the transient hyperpolarization to a bright flash is generated by Ih; (2) the oscillation after prolonged hyperpolarization in rods results from the interaction among Ica, IK(Ca), and ICI(Ca). Since the present model describes the biophysical processes from phototransduction to voltage response, the model can be used for analyzing the light response properties of the photoreceptors quantitatively.

Gallbladder cancer with a low junction of the cystic duct or an anomalous pancreaticobiliary junction

OBJECTIVE

To evaluate conditions similar to those of carcinogenesis of the gallbladder between the gallbladder with a low junction of the cystic duct (LJCD) and an anomalous pancreaticobiliary junction (APBJ).

DESIGN

Retrospective and clinicopathological analysis of patients with gallbladder carcinoma.

SETTING

First Department of Surgery, Kansai Medical University.

PATIENTS

Examination of 47 patients (7 men and 40 women; average age: 67.8 years) with gallbladder carcinoma revealed 7 patients (14.9%; 1 man and 6 women; average age: 67.8 years) with LJCD and 6 patients (12.8%; 6 women; average age: 60.3 years) with APBJ.

METHODS

Clinical findings in both groups were compared with those of the 34 patients who remained after exclusion of the data of the above 7 patients with LJCD and 6 patients with APBJ. The data of the three groups were examined by the chi 2 test at the 5% level of significance.

RESULTS

Most of the gallbladder cancer patients with LJCD or APBJ had gallstones. The biliary amylase levels determined in the gallbladder of patients with LJCD or APBJ were remarkably high.

CONCLUSION

The results indicate that patients with LJCD or APBJ are more likely to develop carcinoma of the gallbladder. The factors responsible for carcinogenesis may be alteration of the bile content due to reflux of pancreatic enzymes through the LJCD or APBJ, and mechanical irritation due to gallstones. Therefore, these pathological conditions in patients with LJCD are similar to those experienced in patients with APBJ.

Ionic current model of bipolar cells in the lower vertebrate retina

We propose an ionic current model of bipolar cells based on the published experimental data. Five types of ionic currents identified in bipolar cell bodies, Ih, IKv, IA, ICa and IK(Ca) were described by a mathematical formulation similar to the Hodgkin and Huxley (Journal of Physiology, 117, 500-544, 1952) equations. The model parameters were estimated from the voltage clamp data. In simulation, we demonstrate that the present model reproduces not only the voltage clamp responses but also the current clamp responses of the bipolar cells. As a result, the model provides a better understanding of the functional role of the ionic currents in bipolar cells in generating the electrical responses.

Histologic features and clinical significance of venous invasion in colorectal carcinoma with hepatic metastasis

BACKGROUND

In colorectal carcinoma, venous invasion has been related to patient survival. Liver metastasis develops more frequently when venous invasion is present. However, the histologic features and clinical significance of venous invasion are not well understood.

METHODS

A histologic study of venous invasion in colorectal carcinoma was performed on 19 patients with synchronous hepatic metastasis (Group A), 16 patients with metacaronous hepatic metastasis (Group B), and 26 patients with Dukes Stage C tumors who survived for 5 years without recurrence (Group C). The histologic features of venous invasion were classified into three types: tumor cells that were distant from the vein walls were categorized as floating type, those filling the lumen of a vein as filling type, and those surrounded by a vein obliterated with inflammatory reaction as occlusive type.

RESULTS

Venous invasion was present in 89.5% of Group A patients and 75% of Group B patients, which was significantly higher than the 15.4% observed in Group C patients (P < 0.001). A slight to extensive degree of venous invasion was found in Groups A and B, but no extensive venous invasion was found in Group C. All patients in Groups A and B (except one patient) had floating, filling, or a combination of floating and filling types of venous invasion, whereas all patients in Group C had the occlusive type of venous invasion. A majority of the patients in all three groups showed invasion of extramural veins.

CONCLUSIONS

There is a close relationship between venous invasion and the development of liver metastasis in patients with colorectal carcinoma. Patients with no sign of metastasis had a lower incidence and lower extent of venous invasion, and inflammatory damage to the vein walls around the intravenous tumor appeared to reduce the likelihood of distant metastasis.

[Selective thermocoagulation of unresectable malignant tumors using radiofrequency]

Based on our experimental findings on porcine liver, we have been conducting a clinical trial of selective hyperthermia by radiofrequency (RF) capacitive heating with laparotomy for patients with unresectable malignant tumors. In 10 patients with malignant tumors (8 carcinoma of the pancreas, 2 carcinoma of the gallbladder), laparotomy and RF heating were performed after informed consent. The local heat coagulation was produced by heating equipment using 13.56 MHz radiofrequency produced by Omron Corporation, Japan. Four 2-cm electrode needles were placed in the tumor in a square array at intervals of 2.0 cm. Hyperthermia was given for 30 min with a controlled temperature of 50 degrees C in the RF field (2 x 2 x 2 cm3). That of the surrounding area was maintained at less than 40 degrees C. The calculated volume treated by RF ranged between (2 x 2 x 2 cm3) x 1 and (2 x 2 x 2 cm3) x 6. We followed all patients by computed tomographic (CT) scan 2 weeks after coagulation. Tumor markers in the blood were assayed before and 14 days after heating. Follow-up CT scans demonstrated that after the tumor mass had been heterogeneously enhanced, it changed to a homogeneous low-density area in 6 of 10 patients. The levels of tumor markers decreased to lower than the pre-treatment values in 9 of 10 patients. In all patients, the changes in CT scans and/or decrease in the markers were confirmed. Complications such as bleeding or abscess formation were not observed. It was suggested that the selective hyperthermia was safely produced by this equipment. The encouraging results in these patients justify further clinical trials.

Inflammatory pseudotumor of the liver: report of a case and review of the literature

Only 56 cases of inflammatory pseudotumor of the liver have been reported in the world literature since its first documentation in 1953. We report herein the case of a 68-year-old man incidentally found to have a lesion in the right lobe of the liver which closely resembled a neoplasm on imaging studies. Thus, partial hepatic resection was performed and histological examination of the resected specimen revealed a diagnosis of inflammatory pseudotumor. Surgical resection is the preferred treatment for inflammatory pseudotumor of the liver, especially in patients for whom a definite histologic diagnosis cannot be made preoperatively or by intraoperative frozen sections. In fact, most of the patients reported in the literature recovered uneventfully after local resection without any postoperative complications, as did our patient.

Hepatocyte volume as an indicator of hepatic functional reserve in cirrhotic patients with liver tumours

Using computed tomography (CT), measurements of whole liver volume have been used for the assessment of pre-operative functional reserve in cirrhotics. However, measurements of hepatocyte volume, which exclude stromal fibrous tissue, are considered to more directly reflect hepatic functional reserve. We investigated the relationship between total hepatocyte volume and each of the parameters of conventional liver function. Indocyanine green (ICG) tests and blood analyses for the assessment of liver function were performed prior to surgery in cirrhotic patients with liver tumours. Pre-operative liver volume was determined by integrating images of each liver area obtained by CT. Liver area was measured by an image processing program that traced the profile of the liver image while excluding the tumorous area. Sections of normal tissue stained by the haematoxylin-eosin method, were obtained from the resected liver. Using these sections, a hepatocyte area: whole tissue area ratio was calculated using the image processing program, by tracing the profiles of the hepatocyte nodules. The total volume of hepatocytes was then calculated by multiplying the liver volume by this ratio. The hepatocyte volume per unit bodyweight was significantly correlated with ICG tests and with many other parameters of normal liver function. However, the liver volume per unit bodyweight was correlated only with the plasma ICG disappearance rate and with the blood platelet count. These observations suggest that the functional reserve of the cirrhotic liver is assessed more precisely by hepatocyte volume than by liver volume.

Reconstruction of retinal horizontal cell responses by the ionic current model

An ionic current model of the retinal horizontal cell is constructed. The horizontal cell models are interconnected by gap junctions to form a horizontal cell layer. The light response properties of the L-type horizontal cell are analyzed using this model. We demonstrate the functional role of each ionic current and the role of the feedback loop between cones and horizontal cells. The present study provides insight into the dynamic relationships between characteristics on the cellular level and on the multi-cellular level for producing the light response in horizontal cells.

Interleukin 1 beta markedly stimulates nitric oxide formation in the absence of other cytokines or lipopolysaccharide in primary cultured rat hepatocytes but not in Kupffer cells

To investigate whether a single inflammatory cytokine could stimulate nitric oxide formation in the absence of other cytokines or lipopolysaccharide (LPS), NO was measured by the redox chemiluminescence method in primary cultured rat hepatocytes and in rat Kupffer cells. Interleukin (IL) 1 beta, but neither IL-6, tumor necrosis factor alpha (TNF-alpha), interferon gamma (IFN-gamma), nor LPS stimulated NO formation in a dose-dependent manner and induced half-maximal effects at 30 pmol/L. Maximal stimulation was achieved at 12 to 16 hours after the addition of 1I nmol/L of IL-1 beta, and was 50- to 60-fold above basal levels in rat hepatocytes. The combined effect of these cytokines with LPS or IFN-gamma on NO formation was also examined. Neither LPS nor IFN-gamma affected the IL-1 beta-induced NO formation. TNF-alpha, however, stimulated IL-1 beta-induced NO formation, while IL-6 inhibited it, although independently these cytokines had no effect on NO formation. None of the cytokines tested stimulated NO formation in cultured rat Kupffer cells. In hepatocytes, the NO formation induced by IL-l beta was blocked by both the NO synthase (NOS) inhibitor NG-monomethyl-L-arginine (L-NMMA) and by IL-1 receptor antagonist (IL-1ra). Furthermore, IL-1 beta markedly increased NOS activity, and this increase in activity was accompanied by the expression of inducible NOS (iNOS) messenger RNA (mRNA). This study clearly demonstrated that IL-1 beta markedly stimulates NO formation in hepatocytes, in the absence of other cytokines or LPS.

Regulation of energy metabolism by interleukin-1beta, but not by interleukin-6, is mediated by nitric oxide in primary cultured rat hepatocytes

The effects of inflammatory cytokines (interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha) on energy metabolism were studied in primary cultured rat hepatocytes. Adenine nucleotide (ATP, ADP, and AMP) content, lactate production, the ketone body ratio (acetoacetate/beta-hydroxybutyrate) reflecting the liver mitochondrial redox state (NAD+/NADH), and nitric oxide formation were measured. Insulin increased ATP content in hepatocytes and had a maximal effect after 8-12 h of culture. Both interleukin-1beta and interleukin-6, but not tumor necrosis factor-alpha, significantly inhibited the ATP increase time- and dose-dependently. Interleukin-1beta and interleukin-6 also stimulated lactate production. During the same period, interleukin-1beta but not interleukin-6 decreased the ketone body ratio. Furthermore, interleukin-1beta markedly stimulated nitric oxide formation in hepatocytes, and this increase was blocked by NG-monomethyl-L-arginine (a nitric oxide synthase inhibitor) and by interleukin-1 receptor antagonist. NG-monomethyl-L-arginine reversed inhibition of the ATP increase, decrease in the ketone body ratio, and increase in lactate production, which were induced by interleukin-1beta. Interleukin-1 receptor antagonist completely abolished all of the effects induced by interleukin-1beta. These results demonstrated that interleukin-1beta and interleukin-6 affect the insulin-induced energy metabolism in rat hepatocytes by different mechanisms. Specifically, interleukin-1beta inhibits ATP synthesis by causing the mitochondrial dysfunction, a process which may be mediated by nitric oxide.

[Combined chemotherapy with 5-FU and low dose CDDP for advanced or recurrent cancer of the digestive system and home anti-cancer chemotherapy]

We have performed combined chemotherapy with 5-FU, a biochemical modulator, and low dose CDDP for advanced or recurrent cancer of the digestive system. The therapy was effective in 37% of all cases and in 45.5% and 41.6% of esophageal and gastric cancer cases, respectively. In addition, few patients developed adverse side effects including renal disorders, one of the major side effects of CDDP. Therefore, we considered home anti-cancer chemotherapy feasible. For 27 outpatients with advanced cancer of the digestive system including 15 cases of esophageal cancer, 4 cases of gastric cancer, 3 cases of colon cancer, 4 cases of pancreatic cancer and 1 case of gall bladder cancer, 4 to 6 week home adjuvant chemotherapy was performed. The regimen comprised 1 week of oral administration of 300 mg/body/day of UFT-E granules and 5 days of continuous intravenous infusion of 25 mg/body/day of CDDP using an infusor pump. During the follow-up, 3 cases of catheter obstruction, 3 cases of catheter sepsis and 1 case of pneumothorax appeared. These complications all resulted from the catheter, and safe home anti-cancer chemotherapy could be continued because 5-FU and CDDP did not cause severe side effects.

Growth, development and nutritional status in Japanese children under 2 years on continuous ambulatory peritoneal dialysis

We examined the growth, development and nutritional status over a period of 10 years of 15 young children (< 2 years old) on continuous ambulatory peritoneal dialysis (CAPD). There were 6 males and 9 females with a mean age of 12.5 months, mean weight of 6.3 kg, mean height of 66.2 cm at the start of CAPD and a mean duration of therapy of 2.6 years. Height, weight, head circumference, development quotient (DQ), blood chemistry and dietary intake were assessed over a period of 10 years. The patients' mean height standard deviation score (SDS) did not change significantly (from -2.51 to -2.74) during CAPD therapy. The mean growth velocity index (GVI) during CAPD was 76.5% and correlated positively with energy intake but not with protein intake. The mean DQ was low (67.0%) at the start of CAPD and 69.3% at the end of CAPD. DQ did not correlate with energy intake, GVI, head circumference SDS or with the weight/height ratio; however, 2 patients with low DQ (< 60%) had a low energy intakes. Although most patients had a low DQ, the IQ at 5-6 years of age was normal in all patients except 1 without cerebral disease. Our study showed minimal growth (delta SDS) and mental developmental (IQ) delays during CAPD therapy, but an adequate nutritional intake must be assured to obtain the above results.