[Functions and the regulation of cytokines and growth factors in the thrombotic event of arteries and veins]

Recent progress of molecular biology has elicited the pathogenesis of arterial and venous thrombosis at the cellular level. The pathogenesis, as well as the etiology of the sequelae, has become clear to be closely relevant to inflammatory cytokines and growth factors such as tumor recrosis factor (TNF) alpha, interleukin-1 beta, or vascular endothelial growth factor (VEGF). From this point of view, the anti-cytokine or the anti-growth factor therapy including the use of some proteins, antibodies, drugs, and gene delivery systems has every possibility of improving the therapeutic outcome for the thrombosis.

Surgical strategy for abdominal aortic aneurysm with concurrent symptomatic malignancy

In an attempt to improve the guidelines for concurrent management of concomitant abdominal aortic aneurysm (AAA) and symptomatic malignancy, a retrospective study was undertaken. A total of 186 AAA repairs were performed electively, and 25 patients (13.4%) had concurrent symptomatic malignancy from April 1986 to March 1997. Fourteen patients underwent a one-stage operation, including five abdominoperineal rectal resections, four subtotal gastrectomies, three total gastrectomies, and two right hemicolectomies. Eleven others underwent a two-stage operation, including four with total gastrectomy and left hemicolectomy followed by AAA repair, as well as two with right hemicolectomy and one with left hemicolectomy prior to AAA repair. There were no operative deaths or severe postoperative complications. Of the 25 patients, 22 (88.0%) are still alive during follow-up ranging from 8 months to 11 years. Our surgical approach to both lesions is as follows: (1) Using the transperitoneal approach alone, subtotal gastrectomy and abdominoperineal rectal resection can be safely done simultaneously. (2) Although total gastrectomy can also be performed concurrently, the approach used for each lesion is separate. (3) Colorectal resection is generally done separately. However, a one-stage operation can be performed using the thromboexclusion procedure for AAA repair in patients with right-sided colonic cancer or a temporary transverse colostomy for left-sided colorectal cancer.

[Urachal cyst with stone: a case report]

A 52-year-old woman complained of persistent discharge from an umbilicus which she had for 18 years. Abdominal X-ray showed a stone-like shadow measuring 5 x 3 cm at the 5th lumbar spine. Cystoscopic examination revealed a hole at the dome of the bladder and a ureteral catheter was inserted approximately 3 cm through the hole. Computerized tomography scan and magnetic resonance imaging demonstrated a cyst communicating to the umbilicus and bladder. The preoperative diagnosis was a patient urachus associated with stone. Urachal cyst containing a stone was removed and partial cystectomy was performed. The stone was a mixture of magnesium ammonium phosphate and calcium phosphate. Pathological examination showed no evidence of malignancy. More than 210 cases of urachal cyst have been reported in Japan. About 10% of the cases were associated with stones.

[Studies on the efficacy and safety of panipenem/betamipron in infections in surgical domain and the safety when mixed with lactate containing infusion]

Studies were done on the effectiveness and safety of panipenem/betamipron, a new carbapenem antibiotic, in infections in the surgical domain and its safety when dissolved in infusions containing lactate. The obtained results are summarized as follows. The preparation, 0.5 g/0.5 g or 1.0 g/1.0 g, was administered by intravenous drip infusion 2 to 3 times a day to 31 cases of patients with infections in the surgical domain. A physiological saline solution was used as the solvent in 21 cases (group A) of them and Solita T3, an infusion containing lactate, was used as the solvent in the 10 remaining cases (group B). As for its clinical effects, results were rated as "excellent" in 20, "good" in 7, "fair" in 3 and "no response" in 1 out of the 31 cases, and the efficacy rate was 87.1%. Regarding its bacteriological effects, results were rated as "disappeared" in 22, "decreased" in 2, "unchanged" in 1 and "unknown" in 1 out of 26 cases from which bacteria were isolated, hence the bacteria-clearance rate was 88.0%. As for side effects, skin rash was seen in 1 case and slight increases of GOT and GPT were noted as abnormal changes in laboratory data in 2 cases. These side effects were all observed among the cases in group A but not at all in group B where a lactate containing infusion was used as the solvent.

[Basic and clinical studies on AMPC (amoxicillin) in the field of surgery (author's transl)]

In the present study, amoxicillin was compared with other antibiotics with respect to sensitivity, levels achieved in the blood and various organs and clinical results. We would like to make further studies accumulated number of cases.