Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system

Between 1985 and 1990, 50 patients with unresectable liver metastases from colorectal cancer and 34 subjects with metastases from gastric cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable prot system. A catheter was inserted into the hepatic artery via the left subclavian artery and was connected to the implantable injection port in each patient. 5-Fluorouracil (5-FU) at 330 mg/m2 per week (167 mg/m2 daily given continuously over the initial 3 months for colorectal cancer), Adriamycin (ADR) at 20 mg/m2 every 4 weeks and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to all 34 patients with gastric cancer and to 31 of the colorectal cancer patients. The remaining 19 patients with colorectal cancer received 5-FU at 1,000 mg/m2 every week. As a rule the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (23%), hepatic arterial occlusion (21%), and gastroduodenal mucositis (12%), although no major toxicity was encountered. The response rate (CR+PR) among the evaluated patients as determined using CT scans was 67% for colorectal cancer and 73% for gastric cancer. The overall median survival was 12 months and 15 months, respectively. Good local control of liver metastases from the colorectal and gastric cancers was achieved by repeated hepatic arterial infusion chemotherapy employing an implantable port system without the need for hospitalization and without producing major toxicity. Thus, the implantable port system is very useful for the management of patients with unresectable liver metastases.

Gallium-67 citrate scintigraphy in the pre-operative evaluation of soft tissue tumors of the extremities

We conducted a study of 90 patients with soft tissue tumor in their arms or legs, in order to determine the usefulness of scintigraphy with gallium-67 citrate as a diagnostic means. All patients had adequate scan images, and tumor tissues had been histologically confirmed by surgical resection. The subjects consisted of 19 patients with malignant tumors, 55 patients with benign tumors, and 16 patients with other disorders in which soft tissue tumor-like lesions occurred. When the activity of the tumor was more than the activity of the normal region of the contralateral extremity, it was estimated to be positive. The positive rate was found in 78% (15/19) of patients with malignant tumors, in 25% (14/55) of patients with benign tumors and in 31% (5/16) of patients with other disorders. Classified by diseases, high positive rates were observed in liposarcoma, leiomyosarcoma, malignant lymphoma, neurinoma, extra-abdominal desmoid and sarcoidosis. Out of 7 patients in which the activity of the tumor was equal to, or higher than that of the liver, 6 patients had malignant tumors and one patient was diagnosed as having an abscess. It seemed possible to distinguish between liposarcoma and lipoma by means of a gallium-67 scan. Furthermore, the gallium-67 scan was useful in detecting lesions of sarcoidosis as well as in evaluating the response to treatment.

[Five-hour hepatic arterial infusion of high-dose 5-FU on weekly schedule for liver metastases from colorectal cancer]

The study of 5-hour hepatic arterial infusion of high-dose 5-FU on a weekly schedule (weekly high-dose 5-FU HAI: WHF) was conducted to reveal a new pump-free regimen to avoid the reduction of QOL due to continuous infusion pumps. By the phase I study, the recommended dose was determined to be 1.000 mg/m2/5 hrs qw. Thus far, 20 cases entered the phase II study of this regimen, and 1 CR and 10 PRs were observed in 15 evaluated cases without major toxicity. This regimen is highly effective for liver metastases from colorectal cancer without reduction of QOL in patients by pumps. A study of this regimen involving a large number of cases is required.

[Hepatic arterial infusion of high dose 5-FU in weekly schedule for liver metastases from colorectal cancer employing a newly developed pump "Koken Infusor"]

Seventeen patients with unresectable liver metastases from colorectal cancer were treated with 5 hour infusion of 1,000 mg/m2 of 5-FU in weekly schedule, employing a newly developed portable pump "Koken-Infusor". This pump is operated by batteries. It is small, light and easy to use. And five hundred cycles of treatments were performed, but the pump induced no major complications. The response evaluated by a CT-scan was 73% (11/15) without major toxicities. In conclusion "Koken-Infusor" is very useful for this treatment, especially for out patients. It appears that this therapy is one of the effective treatments for liver metastases from colorectal cancer.

Liver hypertrophy and portal hypertension in association with tumor thrombus in the portal vein: CT findings

The growth rate of tumor thrombus in the portal vein and the concomitant enlargement of the volumes of the left lateral segment of the liver and the spleen were retrospectively investigated in 11 patients with hepatocellular carcinoma (HCC). In 7 of the 11 patients the left lateral segment of the liver enlarged as the tumor thrombus extended to the right second order branches and the more proximal order branches to the porta hepatis and eventually obstructed these branches. The volume of the left lateral segment was 1.3 to 2.7 times larger, compared with its original volume at the time of HCC detection. An increase in splenic volume was also found in 8 of the 11 patients. The increasing ratios of the splenic volume amounted to 1.3 to 2.1 times the volume found at the time of HCC detection. The growth of tumor thrombus in the right first order branch and portal trunk and the ensuing obstruction of these branches by the tumor thrombus resulted in the development of intractable ascites in 5 of the 11 patients and the development of hepatofugal collateral vessels in all 11 patients. These findings were not demonstrated prior to obstruction of these branches.

Xyloglucan antibodies inhibit auxin-induced elongation and cell wall loosening of azuki bean epicotyls but not of oat coleoptiles

Polyclonal antibodies were raised in rabbits against isoprimeverose (Xyl(1)Glc(1)), xyloglucan heptasaccharides (Xyl(3)Glc(4)), and octasaccharides (Gal(1)Xyl(3)Glc(4)). Antibodies specific for hepta- and octasaccharides suppressed auxin-induced elongation of epicotyl segments of azuki bean (Vigna angularis Ohwi and Ohashi cv Takara). These antibodies also inhibited auxin-induced cell wall loosening (decrease in the minimum stress-relaxation time and the relaxation rate of the cell walls) of azuki segments. However, none of the antibodies influenced auxin-induced elongation or cell wall loosening of coleoptile segments of oat (Avena sativa L. cv Victory). Auxin caused a decrease in molecular mass of xyloglucans in the cell walls of azuki epicotyls and oat coleoptiles. The antibodies inhibited such a change in molecular mass of xyloglucans in both species. Preimmune serum exhibited little or no inhibitory effect on auxin-induced elongation, cell wall loosening, or breakdown of xyloglucans. The results support the view that the breakdown of xyloglucans is associated with the cell wall loosening responsible for auxin-induced elongation in dicotyledons. The view does not appear to be applicable to poaceae, because the inhibition of xyloglucan breakdown by the antibodies did not influence auxin-induced elongation or cell wall loosening of oat coleoptiles.

[Mechanical valve thrombosis in the tricuspid position--reoperative management of 2 cases]

Because valve thrombosis occurred after the tricuspid valve replacement with the mechanical valve, we performed replacement of the mechanical valve with the bovine pericardial valve in two cases. Case 1: The patient, at 13 years old, received open-heart surgery to correct infundibular stenosis. At 23 years of age, decortication and tricuspid valve replacement (TVR) with a phi 31 mm Björk-Shiley valve were performed due to constrictive pericarditis and tricuspid regurgitation developed after the initial operation. Thrombosis of the mechanical valve occurred after the TVR. Treatment with urokinase for the thrombolytic therapy failed to improve the valve opening. Finally 12 years after the TVR, replacement of the mechanical valve with a phi 27 mm Carpentier-Edwards bovine pericardial valve was performed. Case 2: The patient, at 21 years old, received open-heart surgery to close an atrial septal defect. At 40 years of age, mitral and tricuspid valve replacements were performed because regurgitation developed in both valves. The mitral and tricuspid valves were replaced with phi 27 mm and 31 mm St. Jude Medical valves, respectively. Thrombosis of the mechanical valve used for the TVR occurred 2 months after the replacement. The mechanical valve was replaced with a phi 27 mm Carpentier-Edwards bovine pericardial valve. In both cases, subjective symptoms improved and prosthetic valve complications did not occur after re-replacement with the bovine pericardial valve. These cases suggested that for TVR a bovine pericardial valve of sufficient size would be better to select than a mechanical valve.

Comparison of the multiple molecular forms of bovine adrenocortical P450scc with those of corpus luteum P450scc

1. Bovine adrenocortical P450scc was resolved into several fractions by chromatography on AH-Sepharose 4B followed by gel filtration on Toyopearl HW55S. All fractions contained P450scc of the same molecular size and the P450scc could be resolved into 3-4 major and more than 10 minor isoelectric point forms by isoelectric focusing on polyacrylamide gel in the presence of Emulgen 913. 2. Both the AH-Sepharose chromatography profile and the isoelectric focusing pattern of the adrenocortical P450scc were more complex than those of the corpus luteum P450scc. The corpus luteum P450scc was practically devoid of the neutral to acidic isoelectric point forms. 3. Three to four P450scc subfractions with different isoelectric focusing pattern were obtained from a purified preparation of adrenocortical P450scc by ion-exchange chromatography on DEAE-Toyopearl 650S or DEAE-Sephadex A25. These P450scc subfractions showed essentially the same spectral properties, catalytic activity, molecular weight and N-terminal amino acid sequence. 4. The most acidic (the latest eluting) subfraction was composed mostly of the neutral to acidic isoelectric point forms. The sedimentation characteristics of this subfraction was also studied. 5. The structural basis of the multiple molecular forms was discussed.

A case of intermittent bleeding Meckel's diverticulum

The initial technetium-99m pertechnetate abdominal scintigraphy revealed equivocal or normal results. However, a second scintigraphy without pentagastrin demonstrated a focal area of persistently increasing radioactivity in the right lower quadrant of the abdomen. At surgery, Meckel's diverticulum was confirmed, and histological examination of the excised specimen revealed that it was lined with ectopic gastric mucosa. It has not been satisfactorily explained why the initial imaging failed to demonstrate the ectopic gastric mucosa. The necessity to perform repeated scintigraphy must be emphasized because 50 to 91 percent of bleeding Meckel's diverticula in the pediatric age group are said to contain gastric mucosa.

[Frozen blood from one closely related donor reduced complications of blood transfusion without adverse effects in the open-heart surgery]

We used frozen blood from one closely related donor in 24 patients (group I) who underwent open heart surgery for congenital heart disease, in order to reduce of complications from a large quantity of blood transfusion. Blood of 600-2200 ml was collected from the single donor and was kept frozen until the operation. Two conditions of the patients were instituted, (1) body weight less than or equal to 40 kg (2) the single donor is father or mother or a close relative. The group of these patients was compared with patients using frozen autologous blood (group II) and patients using banked blood (group III). In group I patients two times of decline of red blood cell counts (RBC), hematocrit (Ht), hemoglobin (Hb) and total protein (TP) were noticed. The first was the period during the cardio-pulmonary bypass. The second was the time about one week after the transfusion of frozen red cells. But degree of the decline was uneventful clinically. The increment of complications induced from the use of frozen red cells was not noticed, and there was no case of serum hepatitis in group I patients. We concluded that the open-heart surgery using frozen blood cells (single donor), if the application was appropriate, could be undergone safely and would be effective on reducing infection and reaction induced from blood transfusion.

[A case of gastric lipoma diagnosed preoperatively]

A case of gastric lipoma seen in a 57-year-old-woman was reported. UGI, endoscope, CT, MRI and EUS revealed a tumor, which showed typical findings of this disease. Above all, EUS findings correlated well with the cut surface of the operative specimen.

[Post-operative evaluation of a 17 mm diameter Björk-Shiley Monostrut prosthesis for aortic valve replacement--pressure gradient and effective valve area]

A 17 mm diameter Björk-Shiley Monostrut prosthesis was implanted in a 64-year-old female for aortic valve replacement in a semi-emergency. This valve was one of the smallest valves which were available in Japan. The patient was admitted because of severe hemolytic anemia and heart failure. Echocardiography showed regurgitation and calcification of Ionescu-Shiley tissue valve which was implanted 5 years ago. The patient's body surface area was 1.2 m2. Because of narrow aortic annulus, we could barely implant a 17 mm diameter Björk-Shiley Monostrut prosthesis. The valve function was examined by Brockenbrough method. During catheterization, the heart rate was 85 b/min and cardiac index was 3.00 l/min/m2. In these hemodynamic conditions, simultaneous measurements of aortic and left ventricular pressures revealed only 9 mmHg mean systolic pressure gradient. Similarly, 20 mmHg of pressure gradient across the implanted valve was obtained by Gorlin's formula. We could calculate that the effective orifice area of a 17 mm diameter Björk-Shiley Monostrut prosthesis was 1.0 cm2. Postoperative echocardiography demonstrated 42 mmHg systolic pressure gradient across this prosthesis by Doppler techniques, and left ventricular wall thickness was not decreased. To best our knowledges, this was the first case in which post-operative evaluation such a small prosthesis was measured.

[A case of modified Fontan operation for complete atrioventricular canal of right dominance with double-outlet right ventricle, common atrioventricular valve regurgitation]

A 6-year-old boy was diagnosed to have complete atrioventricular canal (CAVC) with double-outlet right ventricle (DORV), common atrium and common atrioventricular valve regurgitation. The atrioventricular junction predominantly connected to the right ventricle (right dominance) and the left ventricle was hypoplastic (LVEDV = 64% of normal). The combination of DORV with right dominant CAVC makes more difficult to make intra-ventricular rerouting. A modified Fontan procedure, atrial partition and DeVega's annuloplasty were successfully performed. It is concluded that Fontan procedure might be preferable rather than intra-ventricular rerouting in this case.

Purification of an antitumor-active, branched (1----3)-beta-D-glucan from Volvariella volvacea, and elucidation of its fine structure

A (1--3)-beta-D-glucan branched by O-6 substitution (FCAP), obtained from the cold-alkali extract of the fruiting body of V. volvacea, exhibited potent growth-inhibitory activity against implanted tumors in mice. It contained protein and appeared to be heterogeneous. Fractionation by DEAE-Toyopearl column chromatography yielded an unbound, protein-free glucan fraction ([alpha]D - 30 degrees in M NaOH, mol. wt. 1.5-2 x 10(6)), which showed the highest antitumor activity. The polysaccharide had a moderately branched structure, consisting of a backbone chain of beta-(1--3)-linked-D-glucose residues, one out of five or six being substituted at O-6 with single glucosyl of beta-(1--6)-linked diglucosyl groups. Digestion of the glucan with exo-(1--3)-beta-D-glucanase yielded glucose and ++gentiobiose (molar ratio, 8:2:1.0), and a highly branched (d.b. 1/3), degraded glucan. Digestion with endo-(1--3)-beta-D-glucanase gave D-glucose, laminarabiose, a trisaccharide beta-D-Glcp-(1--6)-beta-D-Glcp-(1--3)-D-Glc, a tetrasaccharide beta-D-Glcp-(1--3)-beta-D-Glcp-(1--3)-[beta-D-Glcp-(1--6)]-D-Glc, and a highly branched (d.b. 1/2), enzyme-resistant glucan. The results suggest that the Volvariella glucan is structurally heterogeneous with regard to the distribution of branches, having less branched, moderately branched, and highly branched segments.

[Surgical repair and late problem for Ebstein's anomaly--surgical cases with severe tricuspid stenosis or regurgitation]

In this report, we described our surgical experiences of Ebstein's anomaly with severe tricuspid stenosis (TS) or regurgitation (TR). Long-term clinical assessments and late problems of the treatment were also mentioned. From 1953 to 1988, a total of 2850 patients with congenital heart malformation underwent surgery in our hospital. During this period, 32 patients with Ebstein's anomaly were admitted, and surgical treatment was performed in 10 of these patients. Thus, the surgical treatment of Ebstein's anomaly took only 0.35% of total surgeries of congenital heart diseases. According to Takayasu's classification of Ebstein's anomaly, 6 of our these patients were classified into TS, and 4 into TR type. The operative methods were shunt operation in 3 patients, plication in 2 patients and tricuspid valve replacement (TVR) in 5 patients. One patient was died during the operative course of Glenn's procedure. Other 9 patients are alive and the longest follow-up period is 18 years at this moment. In the remaining two patients with shunt operation, Blalock-Taussig's procedure completely diminished their polycythemia. In the cases of TVR, the replaced valve was sutured to the right atrium in 2 patients with TS, true annulus in 2 patients with TR, valve remnant in one patient with TR type. Delayed cardiac tamponade occurred in 2 patients and calcification of Xenograft valve was observed at 8 years after the surgery in one patient with TVR. Although the hemodynamics did not improve immediately just after open heart surgery, cardio-thoracic ratio reduced and clinical symptoms were improved remarkably throughout the long-term follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Preparation and characterization of antibodies against 6-O-alpha-D-xylopyranosyl-beta-D-glucopyranose (beta-isoprimeverose), the disaccharide unit of xyloglucan in plant cell-walls

The p-aminophenyl beta-glycoside of 6-O-alpha-D-xylopyranosyl-D-glucopyranose (isoprimeverose), the disaccharide unit of plant xyloglucan, was coupled to bovine serum albumin, and the resulting glycoconjugate was used as an immunogen for the immunization of a rabbit. The immunochemical specificities of the rabbit antiserum raised against the glycoconjugate were characterized by immunodiffusion, quantitative precipitation, and hapten inhibition. After removal of anti-bovine serum albumin antibodies, the antiserum exhibited a specificity for the introduced disaccharide unit of the artificial antigen. The antibody-combining site was also shown to recognize the aglycon portion of the introduced hapten. The antiserum interacted with some xyloglucans, such as those from tamarind seed and the cell wall of pea stem. beta-Isoprimeverose and alpha-D-xylopyranosides were good inhibitors of the xyloglucan-antibody precipitation system, indicating that the antibodies recognize the beta-isoprimeverose unit of the xyloglucan.

[A case of hepatocellular carcinoma with a duodenal invasion from metastatic lymph node]

A 64-year-old male, who had been diagnosed as having hepatocellular carcinoma, was admitted to hospital and underwent transcatheter arterial infusion therapy. CT and US examinations revealed a large tumor with air in its center. Barium meal examination of the duodenum showed a large filling defect with a central excavation. At endoscopic examination, a dark reddish tumor was seen protruding into the duodenal lumen. A biopsy specimen from this tumor revealed a hepatocellular carcinoma. The patient subsequently died of hepatic coma following gastrointestinal bleeding. An autopsy revealed that metastatic lymph nodes had infiltrated into the adjacent duodenum. Nine previous cases of duodenal metastasis from a hepatocellular carcinoma have been reported in the Japanese literature.