Successful 24-hour preservation of ischemically damaged canine small intestine by the cavitary two-layer method

BACKGROUND

The purpose of this study is to examine the possibility of a long-term preservation of the ischemically damaged intestine by the cavitary two-layer method (TLM) in canine small intestinal transplantation.

METHODS

The grafts were allotransplanted without preservation immediately (group 1) or after 30 minutes of warm ischemia (group 2). The ischemically damaged grafts were also allotransplanted after cold preservation for 24 hours in University of Wisconsin (UW) solution (group 3) or the cavitary TLM (group 4). Seven-day survivals, tissue adenosine triphosphate (ATP) concentrations, absorption tests, and histopathology were examined.

RESULTS

seven-day survivals in groups 1, 2, 3, and 4 were 8 of 8, 6 of 8, 0 of 8, and 6 of 8, respectively. In group 4, significant recovery of ATP tissue level was seen after preservation compared with group 3, and absorption function and regeneration of the graft mucosa recovered at day 14.

CONCLUSIONS

Ischemically damaged canine small intestine could be preserved for 24 hours by the cavitary TLM.

[Harvesting of autologous peripheral blood stem cells following percutaneous isolated hepatic perfusion for patients with advanced hepatocellular carcinoma]

Percutaneous isolated hepatic perfusion (PIHP) using high-dose chemotherapeutic agents is highly effective for advanced hepatocellular carcinoma in comparison with conventional regional and systemic chemotherapies. However, bone marrow toxicities resulting from the first PIHP preclude additional second/third PIHP in some cases. In an attempt to increase safety of repeated PIHP, autologous peripheral blood stem cells (PBSC) were harvested after the first PIHP in nine patients with multiple hepatocellular carcinoma with administration of G-CSF. PBSCs were successfully harvested in only three patients with relatively well-preserved liver function, whereas PBSC harvests were unsatisfactory in the remaining six patients with highly impaired liver function. The possible reasons for this phenomenon may include hypofunction of bone marrow in cirrhotic patients, and an insufficient use of G-CSF in the present study. Alfa-fetoprotein-mRNA, determined by nested RT-PCR, was detected in six PBSCs, indicating frequent contamination of tumor cells. More precise studies are needed before clinical application of autologous stem cell infusion for patients with malignant hepatic tumors and impaired liver function.

Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery

BACKGROUND

Compromised patients subjected to major digestive surgery frequently develop infective complications caused by methicillin-resistant Staphylococcus aureus (MRSA), which may have dangerous consequences. This was a prospective randomized study to determine whether intranasal mupirocin could reduce postoperative infective complications in patients having digestive surgery.

METHODS

A total of 395 patients who underwent abdominal digestive surgery were assigned randomly into two groups: a treated group (193 patients) and controls (202). Patients in the treated group were given 30 mg mupirocin calcium hydrate ointment topically to each nostril three times a day on each of the 3 days before operation. The untreated group received no mupirocin treatment.

RESULTS

Most infections were due to Gram-negative bacteria in both groups. There were 21 Gram-positive infections detected at the surgical site, ten in the treated group and 11 in control patients. The incidence of pneumonia was significantly different between the groups (none in the treated group and five in control patients; P = 0.028). Four of five patients with pneumonia had a sputum culture containing MRSA.

CONCLUSION

Intranasal mupirocin treatment had no significant impact on surgical-site infection after digestive surgery.

Comparison of intestinal transit recovery between laparoscopic and open surgery using a rat model

BACKGROUND

After laparoscopic surgery (LS), patients show faster recovery of intestinal transit than after conventional open surgery (OS). To prove the mechanism of this advantage, we compared the recovery of intestinal transit using steel carbon balls.

METHODS

Rats underwent either open laparotomy or were insufflated with carbon dioxide followed by the administration of steel balls (0.6 mm). An abdominal radiograph was taken 12 h after the operation. Compliance of the intestinal walls was analyzed with a computer-driven barostat device.

RESULTS

An abdominal radiograph of 12 h after administration of the steel carbon balls showed the balls scattered in the small and large intestine of the LS patients, whereas they remained mostly in the stomach of the OS patients. Compliance of the intestinal walls was sustained at approximately 100 microl/mmHg in the LS patients, whereas it dropped to 94 microl/mmHg in the OS patients with the increase in balloon pressure. Histologically, the extent of serosal edema was more severe in the OS than in the LS patients. In terms of intestinal transit and irritation LS has advantage over OS.

CONCLUSIONS

Intestinal transit recovery, as measured by the migration of steel carbon balls, is faster in LS, and gastric emptying is slow in OS.

Protection against experimental small intestinal ischaemia-reperfusion injury with oxygenated perfluorochemical

BACKGROUND

Intestinal ischaemia-reperfusion (IR) injury frequently occurs in abdominal surgery. Perfluorochemical (PFC) can be used to oxygenate intestinal organs directly and allows adenosine 5'-triphosphate (ATP) production within the submerged organs during ischaemia. This study was designed to evaluate the protective effect of PFC in IR injury, focusing on cytokine production in rat small intestine.

METHODS

The superior mesenteric artery was occluded in rats for 60 min and the small bowel placed in an intestinal bag containing either normal saline (group 1), oxygenated saline (group 2) or oxygenated PFC (group 3). The arterial clip was subsequently removed, allowing reperfusion. The number of rats that survived for 7 days, tissue ATP levels, biochemical variables, tissue lipid peroxidation (LPO), bacterial cultures and histological changes were examined after reperfusion.

RESULTS

The use of oxygenated PFC in group 3 improved survival compared with the other groups. Serum creatine phosphokinase and lactate dehydrogenase levels in groups 1 and 2 reflected small intestinal damage, and plasma levels of tumour necrosis factor alpha and interleukin 6 were raised. In contrast, oxygenated PFC decreased these levels, and reduced LPO, bacterial translocation and augmented apoptosis of the small intestine after reperfusion.

CONCLUSION

An intestinal bag containing oxygenated PFC showed protective effects during bowel ischaemia.

Isolated Gastric Varices Resulting from Iatrogenic Splenic Vein Occlusion: Report of a Case

Iatrogenic splenic vein occlusion is known to be a rare cause of left-sided portal hypertension. We herein describe the clinical course of a 43-year-old woman with isolated gastric varices, which proved to be attributable to a segmental splenic vein resection during an operation for a benign pancreatic tumor 11 years previously. Seven years after the initial operation, prominent gastric varices due to left-sided portal hypertension were first noted. During the follow-up period of 4 years, she had no episodes of gastrointestinal hemorrhaging. Although the size of the gastric varices did not change, she decided to have a splenectomy considering the potential risk of variceal hemorrhaging. It may be reasonable to perform a splenectomy concomitantly when the splenic vein is to be resected or ligated during pancreatic surgery to avoid the future development of left-sided portal hypertension. However, the role of prophylactic surgery in asymptomatic patients with iatrogenic splenic vein occlusion remains to be determined.

Identification of hepatitis C virus (HCV) subtype 1b strains that are highly, or only weakly, associated with hepatocellular carcinoma on the basis of the secondary structure of an amino-terminal portion of the HCV NS3 protein

The NS3 protein of hepatitis C virus subtype 1b (HCV-1b) isolates obtained from 89 patients with hepatocellular carcinoma (HCC) and 78 patients without HCC were analyzed. On the basis of the secondary structure of the amino-terminal 120 residues of NS3, HCV-1b isolates were classified into group A, group B, and an indeterminate group, each of which was further divided into a number of subgroups, such as A1-1, A1-2, A2-1, A2-2, B1-1, B1-2, B2-1, B2-2, C-1, C-2, and C-3. HCV-1b isolates of subgroup B1-1 were found in 53 (59.6%) of 89 patients with HCC and 19 (24.4%) of 78 patients without HCC, with the difference between the two patient groups being statistically significant (P < 0.00001). Although the number of isolates was small, subgroup B2-1 was also highly associated with HCC, with all five isolates in that subgroup being found in patients with HCC (P < 0.05). On the other hand, HCV-1b isolates of subgroup A1-1 were associated only weakly with HCC; they were found in 6 (6.7%) of 89 patients with HCC and in 25 (32.1%) of 78 patients without HCC, with the difference between the two patient groups being statistically significant (P < 0.0001). The other subgroups, such as A1-2, A2-1, B1-2, C-1, C-2, and C-3, were moderately associated with HCC; their distribution patterns among patients with HCC did not differ significantly from those among patients without HCC. Taken together, our results suggest that HCV-1b isolates of subgroups B1-1 and B2-1 are highly associated with HCC and that this secondary structure analysis may be useful for predicting the relative risk of developing HCC.

An experimental study on the pharmacokinetics of 5-fluorouracil regional chemotherapy for pancreatic cancer

BACKGROUND

Recently a few centers reported promising results of regional intra-arterial chemotherapy for pancreatic cancer. However, the detailed pharmacokinetics and the side effects of anticancer agents remain unclear.

METHODS

Catheters were introduced into the gastroduodenal artery and the splenic artery of dogs. In group I, arterial infusion of 5-fluorouracil (5-FU) was performed over 10 minutes. In group II, 5-FU was infused systemically. In group III, an intra-arterial infusion was repeated weekly three times. Blood samples and liver and pancreas tissue samples were obtained to determine 5-FU levels. In a subset of each group, the pancreas, duodenum, and liver were excised for histological analyses.

RESULTS

Immediately after the infusion of 5-FU, the portal level in group I was higher than that in group II. However, the mean systemic level in group I was lower than in group II. The mean tissue concentration in the pancreas in group I was significantly higher than that of group II. Histological examination revealed no microscopic alterations after treatment in all groups, including group III.

CONCLUSIONS

This fundamental study suggested that intra-arterial chemotherapy of 5-FU for pancreatic cancer allows higher regional drug delivery without adverse effects on normal regions of the pancreas, the duodenum, and the liver.

Dynamic behavior of ozonation with pollutant in a countercurrent bubble column with oxygen mass transfer

The dynamic behavior of ozonation with pollutants in a countercurrent bubble column is studied for the model establishment. Bubble columns have been widely used for an ozonation system in the plants and laboratories. In addition, a countercurrent bubble column has been commonly recommended than a cocurrent one because it has a higher ozone transfer efficiency. Therefore, the investigation of this paper focuses on the countercurrent bubble column. As an ozonation process starts, the gas mixture of ozone and oxygen is introduced into the bottom of a column, and then transferred into the liquid. The pollutants in the wastewater are eliminated subsequently via oxidation by the dissolved ozone. There certainly exists a temporary and unsteady period before the ozonation system reaches steady state. However, available ozonation models employed to describe ozone and pollutant profiles have commonly been developed for steady state. The treating qualities of wastewater in the early stage of ozonation are usually not predicted, and the time required for the steady-state establishment remains to be determined. Moreover, oxygen mass transfer is usually neglected in previous ozonation models so that the increase of dissolved oxygen is uncertain. These information is desirable for the proper design and operation of ozonation system in a bubble column. Thus, the aim of this study is to model and investigate the dynamic processes of ozonation with pollutants including oxygen mass transfer. The dynamic axial dispersion model proposed is employed to predict the variation of the ozone, pollutant, and oxygen concentrations profiles. The validity of the model was demonstrated by comparing the predicted results with the experimental data. The o-cresol was chosen as the model pollutant. The temporal concentration variations of the residual o-cresol and dissolved oxygen in the effluent liquid, and the off-gas ozone in the free volume were measured accordingly. Furthermore, the variation of the enhancement factor of ozone and the amount of off-gas were predicted. Note that it usually needs 2-5 hydraulic retention times to approach steady state under the conditions of this study. Further, the effects of dimensionless system parameters on the performance of the ozonation processes are examined. As a result, the proposed dynamic model of ozonation with pollutants is useful for proper prediction of the variables of an ozonation system in a countercurrent bubble column.

Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors

For adult patients with end-stage liver disease, living-donor liver transplantation (LDLT) of right-lobe grafts with or without the middle hepatic vein (MHV) has been increasingly used in recent years. We investigated the role of the MHV in donor remnant liver regeneration after right-lobe LDLT, which has not been described in previous studies. A total of eight living donors were included in this study of right-lobe LDLT. Four donors underwent right lobectomy (without MHV), and the remaining four underwent extended right lobectomy (with MHV). Regeneration of the donor remnant liver was assessed by volumetric computed tomography studies before and 90 days after LDLT. Comparison between the right-lobe and extended right-lobe donors did not show a clear-cut difference in the net increase of remnant liver volume at 3 months. However, the mean volume increase of the medial segment at the 90th postoperative day was 7% in the extended right-lobe donors and 61% in the right-lobe donors, showing a lower value in the remnant livers without MHV. The MHV plays a specific role in remnant liver regeneration of right-lobe living donors. We expect that this knowledge will contribute to securing a margin of safety in right-lobe LDLT.

Genetic analysis of cancer occurring in the ileocecal valve

The ileocecal valve consists of an upper and lower segment formed by a duplication of the wall of the small and large bowels. The origin of tumor that occurs in the ileocecal valve is often difficult to prove. The tumor in the ileocecal valve was found with endoscopic examination in a 74-year-old man. The resected specimen of the tumor was genetically studied by using PCR-SSCP (polymerase chain reaction amplification, single strand conformational polymorphism) analysis to determine the origin and direction of the tumor. PCR-SSCP analysis of p53 showed a mutation of exon 8 only in the ileum side of the tumor. This suggests that the tumor has grown towards the ileum. The cancer in the ileocecal valve is derived from the colonic part of the valve which acquired the additional genetic change of p53 mutation.

Carcinosarcoma of the gallbladder with chondroid differentiation

Carcinosarcoma of the gallbladder is an uncommon neoplasm. We herein report the case of a patient with carcinosarcoma of the gallbladder with chondroid differentiation, treated by cholecystectomy with liver segmentectomy and lymph node dissection for a tumor which occupied the entire gallbladder and spread to the liver. Histologically, the tumor contained two distinct components: a mixture of both well and poorly differentiated tubular adenocarcinoma and sarcomatoid tissue with chondroid differentiation. From a review of the literature, it was seen that carcinosarcomas of the gallbladder could be divided into two groups: one group with apparent sarcomatous differentiation, such as chondroid, osteoid, and rhabdomyosarcomatous differentiation, and the other group, of carcinosarcomas with a sarcomatous portion composed of anaplastic spindle cells. Each group had a poor prognosis in spite of surgical resection of tumors. Our patient died of peritoneal dissemination 7 months after surgery.

Correlation between secondary structure of an amino-terminal portion of the nonstructural protein 3 (NS3) of hepatitis C virus and development of hepatocellular carcinoma

Correlation between sequence variation of hepatitis C virus (HCV) and development of hepatocellular carcinoma (HCC) has not yet been demonstrated. In the present study, we analyzed sequence diversity of the NS3 protein of HCV and its possible correlation with HCC. On the basis of secondary structure of an amino-terminal portion of NS3, HCV subtype lb (HCV-1b) isolates were classified into two groups, A and B. Group A isolates were found in 4 (11%) of 36 patients with HCC, and 22 (63%) of 35 patients without HCC. On the other hand, group B isolates were found in 32 (89%) of 36 patients with HCC, and 12 (34%) of 35 patients without HCC. The distribution patterns of those groups were significantly different between patients with and without HCC (P< 0.001). HCV isolates of group B were found in both tumor and adjacent non-tumor tissues obtained from patients with HCC, suggesting that the emergence of group B isolates was not a result of, but rather a possible causative factor for development of HCC. Taken together, our present results suggest that HCV-lb strains of group B are highly associated with HCC and that the secondary structure analysis of NS3 would be useful to predict high risk for development of HCC in HCV-lb-infected patients.

Predicting factors for survival of patients with unresectable pancreatic cancer: a management guideline

BACKGROUND/AIMS

When pancreatic cancer cannot be resected, palliative procedures including gastroenteric bypass and biliary bypass may be selected. However, since predicting survival is difficult, indication of these procedures remains unclear. This study was designed to elucidate the prognostic factors of patients with unresectable pancreatic cancer in order to improve their quality of life.

METHODOLOGY

We treated 187 consecutive patients with unresectable pancreatic cancer at the Kobe University Hospital. Fifteen prognostic variables for survival were analyzed (sex, age, the degree of pain, diet, presence of jaundice, main site of the tumor, tumor size, major vessel invasion, liver metastasis, peritoneal dissemination, distal metastasis and operative procedures) in surgically treated patients (n = 125). All patients were followed until death. Cox's proportional hazard model and logistic regression models were used to determine the factors influencing the survival of patients with unresectable pancreatic cancer.

RESULTS

Cox's proportional hazard model revealed that duodenal invasion (p = 0.001) and liver metastasis (p < 0.0001) significantly influenced the survival of the patients with unresectable pancreatic cancer. In multivariate logistic regression analysis, liver metastasis (p = 0.009) and peritoneal dissemination (p = 0.004) were significant factors on the six-month survival after palliative operation.

CONCLUSIONS

Liver metastasis and peritoneal dissemination were negative predictive factors for the six-month survival of patients with unresectable pancreatic cancer. Palliative bypass surgery is recommended for patients expected to survive long-term (more than six-months).

Factors influencing hepaticojejunostomy leak following pancreaticoduodenal resection; importance of anastomotic leak test

BACKGROUND/AIMS

Pancreatic fistula is a common complication after pancreaticoduodenostomy. Prevention of a concomitant bile leak from hepaticojejunostomy is important because it could lead to more serious complications including intraperitoneal abscess, subsequent sepsis and massive hemorrhage by activating pancreatic fistula. This study was designed to determine perioperative risk factors of the hepaticojejunostomy leak for the purpose of decreasing this morbidity.

METHODOLOGY

Clinical records of 107 consecutive pancreaticoduodenal resections were reviewed. hepaticojejunostomy anastomoses were performed using absorbable sutures in an end-to-side, single-layer and interrupted fashion. A total of 8 presumed perioperative risk factors were analyzed. They included advanced age, low serum albumin, low serum total cholesterol, impaired glucose tolerance and placement of a biliary drainage catheter as preoperative factors, and dilated common hepatic duct and undone anastomotic leak test as intraoperative factors. In addition, transanastomotic stenting techniques including retrograde transhepatic bile drainage, T-tube and transjejunal drainage were compared with respect to hepaticojejunostomy leak rates.

RESULTS

Hepaticojejunostomy leak was demonstrated in 9 patients (8%). Anastomotic leak testing only achieved statistical significance (p = 0.04). It is noteworthy that no hepaticojejunostomy leak developed among 28 patients who underwent this test through a retrograde transhepatic bile drainage catheter. In addition, the frequency of bile leaks (14/107) associated with the transanastomotic stenting techniques urged the necessity of appropriate intraperitoneal drain placement.

CONCLUSIONS

Careful anastomotic procedures with a subsequent anastomotic leak test most effectively prevent hepaticojejunostomy leak after pancreaticoduodenal resection.

Effect of portal vein embolization on function of the nonembolized lobes of the liver: Evaluation by first-pass hepatic lidocaine extraction in dogs

BACKGROUND

Portal vein embolization (PVE) of hepatic lobes planned for resection is known to increase the margin of safety in extended hepatic resection. We examined whether volume gain could directly translate into functional gain in the nonembolized hepatic lobes after PVE, using a unique pharmacologic model of hepatic venous isolation and charcoal hemoperfusion.

METHODS

Lidocaine hydrochloride (8 mg/kg) was infused over 10 minutes in the portal vein of beagles with hepatic venous isolation and charcoal hemoperfusion, which prevented hepatic recirculation of the drug, and the lidocaine first-pass hepatic extraction ratio (Lid-HER) was determined to assess the selective lobar function of the liver. First, the correlation between Lid-HER and hepatic parenchymal weight of the lidocaine perfusion area was studied. Second, PVE was performed of the left portal branch, and Lid-HER of the nonembolized lobes was determined 1 hour or 2 weeks after PVE.

RESULTS

Hepatic venous isolation and charcoal hemoperfusion reduced (>95%) the postfilter and systemic lidocaine concentrations compared with prefilter concentrations. In the first study, a significant correlation was demonstrated between Lid-HER and hepatic parenchymal weight (P =.0023, r(2) = 0.992). In the second study, both weight ratio of the nonembolized lobes relative to the whole liver and Lid-HER of the nonembolized lobes showed significant increases 2 weeks after PVE of 1.7- and 1.9-fold, respectively.

CONCLUSIONS

Hepatic-weight increase paralleled functional increase, as determined by Lid-HER, in the nonembolized hepatic lobes 2 weeks after PVE. Thus, volume change directly translated into functional change in future remnant noncirrhotic liver after PVE.

Comparative sequence analysis of the core protein and its frameshift product, the F protein, of hepatitis C virus subtype 1b strains obtained from patients with and without hepatocellular carcinoma

The core protein of hepatitis C virus (HCV) has been implicated in hepatocarcinogenesis. In order to determine whether there is a correlation between mutations of the core protein and the development of hepatocellular carcinoma (HCC), the core protein-coding sequence of the viral genome of HCV subtype 1b (HCV-1b) obtained from patients with and without HCC was analyzed. We found that 12 (40.0%) of 30 HCV-1b isolates from patients with HCC but none of 29 isolates from patients without HCC had a point mutation(s) in an N-terminal region of 20 residues. Similarly, 10 (33.3%) of 30 isolates from patients with HCC had mutations in a limited region between residues 141 and 160, whereas only 2 (6.9%) of 29 isolates from patients without HCC did. The differences between the two groups were statistically significant. The mutations were found in isolates from both cancerous and adjacent noncancerous tissues of patients with HCC, suggesting that the mutations were present before the development of HCC. The other regions of the core protein of some isolates also had mutations, but no significant difference was observed between isolates from patients with HCC and those from patients without HCC. The F protein, a frameshift product that is still hypothetical for HCV-1b strains, showed more sequence diversity than the core protein among the isolates analyzed, but there were no significant differences in the mutation rates or positions between isolates from patients with HCC and isolates from patients without HCC, except for a short N-terminal sequence of approximately 11 residues that is shared with the core protein.

Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size

HYPOTHESIS

Selection of proper pancreaticojejunostomy techniques according to pancreatic texture and the main duct size reduces the pancreatic fistula rate.

DESIGN AND PATIENTS

Data from 50 consecutive patients undergoing pancreatoduodenectomy with 3 different anastomotic techniques prospectively used according to pancreatic texture and the main duct size were analyzed. Duct-invagination anastomosis was selected for pancreata with a small duct (n = 34 [29 with a soft texture and 5 with a hard texture]). Stitches between the stump parenchyma and the jejunal seromuscular layer were added to this anastomosis procedure only for the hard pancreata. Pancreata with a large duct were reconstructed with a conventional duct-to-mucosa anastomosis (n = 16).

SETTING

A university hospital department of digestive surgery.

RESULTS

The morbidity was 40% (20 of 50 patients) in this series. Four patients (8%) with a soft pancreas and a small duct developed a pancreatic stump leak after duct-invagination anastomosis, but all of them were removed without sequelae. No pancreatic anastomotic leak was seen in this series, which resulted in no mortality, no remnant pancreatectomy, and only 1 relaparotomy in the consecutive 50 patients.

CONCLUSION

The proper selection of pancreatic reconstruction techniques according to our criteria may reduce the pancreatic fistula rate, eliminate risky pancreatic anastomotic leaks, and result in excellent outcomes for those undergoing pancreatoduodenectomy.

Decomposition of 2-naphthalenesulfonate in aqueous solution by ozonation with UV radiation

This study investigates the ozonation of 2-naphthalenesulfonate (2-NS) combined with ultraviolet (UV) radiation. Naphthalenesulfonic acids are of importance as dye intermediates for the dye and textile auxiliary industries. Its derivatives, such as 2-NS, have been found in rivers and tannery effluents causing pollution problems. Thus, the 2-NS is of concern for the aquatic pollution control especially in the surface and waste waters. Ozonation combined with UV radiation is employed for the removal of 2-NS in the aqueous solution. Semibatch ozonation experiments were proceeded under different reaction conditions to study the effects of ozone dosage and UV radiation on the oxidation of 2-NS. The concentrations of 2-NS and sulfate are analyzed at specified time intervals to elucidate the decomposition of 2-NS. In addition, values of pH and oxidation reduction potential are continuously measured in the course of experiments. Total organic carbon is chosen as a mineralization index of the ozonation of 2-NS. The mineralization of 2-NS via the ozonation is remarkably enhanced by the UV radiation. These results can provide useful information for the proper removal of 2-NS in the aqueous solution by the ozonation with UV radiation.

Ultrastructural analyses of pancreatic grafts preserved by the two-layer cold-storage method and by simple cold storage in University of Wisconsin solution

The two-layer cold storage method (TLM) using University of Wisconsin (UW) solution supplies sufficient oxygen to pancreatic grafts during preservation and extends pancreas preservation time to up to 96 h in the canine model. Simple cold storage in UW (UWM) on the other hand, preserves canine pancreas grafts for up to 72 h by preventing cell swelling, mainly because of its high osmotic pressure. The aim of this study is to analyze morphologically dog pancreatic grafts preserved by these two methods with their different mechanisms. Immediately after preservation of canine pancreata by TLM for 72 h and 96 h (group 1 and group 3, respectively), and by UWM for 72 h and 96 h (group 2 and group 4, respectively), tissue ATP levels were determined using high-performance liquid chromatography (HPLC), and detailed morphological analyses of intragraft components were performed using light- and electron microscopy. The mean areas of one mitochondrion and rough endoplasmic reticulum (RER) vacuolization were calculated by computer-graphic analyses using NIH image 1.62 f soft. The tissue ATP levels were significantly higher in groups 1 and 3 than groups 2 and 4 ( P < 0.05). Light microscopy demonstrated no marked difference among the 4 groups. By electron microscopy however, mitochondrial swelling and RER vacuolization were observed in acinar cells to various extents in the 4 groups. They were significantly more evident in group 2 than group 1 ( P < 0.05), and in group 4 than group 3 ( P < 0.05). In conclusion, TLM demonstrated excellent protection of intracellular organelles, mitochondria, and RER, up to 72-96 h. Well-maintained graft ATP levels in TLM groups may result in maintaining the integrity of intracellular organelle membranes as well as cellular membranes.

Effect of portal vein embolization on function of the nonembolized lobes of the liver: Evaluation by first-pass hepatic lidocaine extraction in dogs

BACKGROUND

Portal vein embolization (PVE) of hepatic lobes planned for resection is known to increase the margin of safety in extended hepatic resection. We examined whether volume gain could directly translate into functional gain in the nonembolized hepatic lobes after PVE, using a unique pharmacologic model of hepatic venous isolation and charcoal hemoperfusion.

METHODS

Lidocaine hydrochloride (8 mg/kg) was infused over 10 minutes in the portal vein of beagles with hepatic venous isolation and charcoal hemoperfusion, which prevented hepatic recirculation of the drug, and the lidocaine first-pass hepatic extraction ratio (Lid-HER) was determined to assess the selective lobar function of the liver. First, the correlation between Lid-HER and hepatic parenchymal weight of the lidocaine perfusion area was studied. Second, PVE was performed of the left portal branch, and Lid-HER of the nonembolized lobes was determined 1 hour or 2 weeks after PVE.

RESULTS

Hepatic venous isolation and charcoal hemoperfusion reduced (>95%) the postfilter and systemic lidocaine concentrations compared with prefilter concentrations. In the first study, a significant correlation was demonstrated between Lid-HER and hepatic parenchymal weight (P =.0023, r(2) = 0.992). In the second study, both weight ratio of the nonembolized lobes relative to the whole liver and Lid-HER of the nonembolized lobes showed significant increases 2 weeks after PVE of 1.7- and 1.9-fold, respectively.

CONCLUSIONS

Hepatic-weight increase paralleled functional increase, as determined by Lid-HER, in the nonembolized hepatic lobes 2 weeks after PVE. Thus, volume change directly translated into functional change in future remnant noncirrhotic liver after PVE.

Ultrastructural analyses of pancreatic grafts preserved by the two-layer cold-storage method and by simple cold storage in University of Wisconsin solution

The two-layer cold storage method (TLM) using University of Wisconsin (UW) solution supplies sufficient oxygen to pancreatic grafts during preservation and extends pancreas preservation time to up to 96 h in the canine model. Simple cold storage in UW (UWM) on the other hand, preserves canine pancreas grafts for up to 72 h by preventing cell swelling, mainly because of its high osmotic pressure. The aim of this study is to analyze morphologically dog pancreatic grafts preserved by these two methods with their different mechanisms. Immediately after preservation of canine pancreata by TLM for 72 h and 96 h (group 1 and group 3, respectively), and by UWM for 72 h and 96 h (group 2 and group 4, respectively), tissue ATP levels were determined using high-performance liquid chromatography (HPLC), and detailed morphological analyses of intragraft components were performed using light- and electron microscopy. The mean areas of one mitochondrion and rough endoplasmic reticulum (RER) vacuolization were calculated by computer-graphic analyses using NIH image 1.62 f soft. The tissue ATP levels were significantly higher in groups 1 and 3 than groups 2 and 4 ( P < 0.05). Light microscopy demonstrated no marked difference among the 4 groups. By electron microscopy however, mitochondrial swelling and RER vacuolization were observed in acinar cells to various extents in the 4 groups. They were significantly more evident in group 2 than group 1 ( P < 0.05), and in group 4 than group 3 ( P < 0.05). In conclusion, TLM demonstrated excellent protection of intracellular organelles, mitochondria, and RER, up to 72-96 h. Well-maintained graft ATP levels in TLM groups may result in maintaining the integrity of intracellular organelle membranes as well as cellular membranes.

Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital

BACKGROUND/AIMS

This study was designed to evaluate risk factors influencing pancreatic leakage and pancreatic leakage-related mortality in a medium-volume hospital.

METHODOLOGY

We retrospectively reviewed the clinical records of 107 patients who underwent pancreaticoduodenectomy at the Kobe University Hospital. Fourteen predictive factors for pancreatic leakage and the pancreatic leakage-related mortality were evaluated using univariate and multivariate logistic regression models.

RESULTS

In univariate analysis, the degree of pancreatic fibrosis, type of resection (PD/PPPD), anastomosis techniques (invagination or duct-to-mucosa anastomosis), anastomosis sites (jejunum/stomach), and the presence of congestion in anastomosis sites significantly influenced pancreatic leakage, and the degree of pancreatic fibrosis influenced pancreatic leakage-related mortality. Multivariate logistic regression analysis revealed that congestion in anastomosis sites was the strongest parameter for pancreatic leakage. Univariate analysis of the patients with normal/mild fibrosing pancreas revealed that pancreatic leakage was influenced by type of resection, anastomosis techniques, anastomosis sites, congestion in anastomosis sites and the management of pancreas parenchyma.

CONCLUSIONS

In a medium-volume hospital, reconstruction after pancreaticoduodenectomy should be performed with careful attention to pancreas and anastomosis sites. In the patients with normal/mild fibrosing pancreas, duct-to-mucosa anastomosis without suturing the pancreas parenchyma may be a useful technique for reconstruction.

Suppressive effects of tea polyphenol and conformational changes with receptor for advanced glycation end products (RAGE) expression in human hepatoma cells

BACKGROUND/AIMS

It is reported that polyphenol is associated with low risk of hepatoma and that RAGE (receptor for advanced glycation end products) is important for cancer invasion.

METHODOLOGY

Effects of teapolyphenol, EGCG (epigallocatechin-3-gallate) were studied. Proliferation of on human hepatoma cells, HLF, was measured with the use of WST-1 colorimetric assay. Cell invasion was analyzed by the Matrigel invasion assay. Morphology and immunohistological staining of expression of RAGE were also performed.

RESULTS

Proliferation was inhibited with the addition of EGCG in a dose-dependent manner. EGCG (200 mumol/L) produced a profound growth suppression of HLF cells (24.5%). Cell invasion was also inhibited with preincubation of 100 mumol/L of EGCG (10.2%). In addition to the antitumor effects, neurite-like conformational changes of HLF cells were observed. Addition of EGCG (100 mumol/L) showed the expression of RAGE on cell surface in accordance to the morphological changes.

CONCLUSIONS

The pathway associated to cell movement might be activated with RAGE expression. Although EGCG inhibits the growth and invasion, the cells which expressed RAGE seem to survive. Thus, the enrollment of RAGE should be analyzed to clarify the mechanisms of cancer resistance.