Retrograde transgastric jejunostomy for nutritional management and aspiration prevention in cases with severe malignant esophageal strictures

Locally advanced esophageal cancer often presents with dysphagia and can be complicated by aspiration pneumonia. Therefore, nutritional management is important to prevent pneumonia. Enteral nutrition via gastrostomies is common in esophageal cancer patients. Here, we describe the efficacy of nutritional management using a gastrojejunostomy tube retrogradely inserted in the esophagus through gastrostomy to simultaneously drain accumulated fluid on the proximal side of a malignant stricture. We performed this procedure for two cases with severe malignant strictures using two types of endoscope insertion. A 57-year-old male patient (Case 1) underwent a retrograde insertion of a gastrojejunostomy tube for severe esophageal malignant stricture with severe nausea and salivary reflux. After a narrow endoscope was inserted through the gastrostomy fistula, a gastrojejunostomy tube was inserted alongside a guidewire allowing the patient to undergo definitive chemoradiotherapy without symptoms. An 82-year-old male patient (Case 2) was scheduled for a minimally invasive esophagectomy following neoadjuvant chemotherapy after gastrostomy. However, the patient developed aspiration pneumonia due to salivary reflux; before surgery, a narrow nasal endoscope was inserted and passed through the strictures. The percutaneous endoscopic transgastric jejunostomy catheter was retrogradely inserted alongside the guidewire. In patients with malignant strictures and salivary reflux, retrograde insertion of gastrojejunostomy tubes can simultaneously provide enteral nutrition and saliva drainage.

Butyricimonas is a key gut microbiome component for predicting postoperative recurrence of esophageal cancer

BACKGROUND

Recently, intestinal bacteria have attracted attention as factors affecting the prognosis of patients with cancer. However, the intestinal microbiome is composed of several hundred types of bacteria, necessitating the development of an analytical method that can allow the use of this information as a highly accurate biomarker. In this study, we investigated whether the preoperative intestinal bacterial profile in patients with esophageal cancer who underwent surgery after preoperative chemotherapy could be used as a biomarker of postoperative recurrence of esophageal cancer.

METHODS

We determined the gut microbiome of the patients using 16S rRNA metagenome sequencing, followed by statistical analysis. Simultaneously, we performed a machine learning analysis using a random forest model with hyperparameter tuning and compared the data obtained.

RESULTS

Statistical and machine learning analyses revealed two common bacterial genera, Butyricimonas and Actinomyces, which were abundant in cases with recurrent esophageal cancer. Butyricimonas primarily produces butyrate, whereas Actinomyces are oral bacteria whose function in the gut is unknown.

CONCLUSION

Our results indicate that Butyricimonas spp. may be a biomarker of postoperative recurrence of esophageal cancer. Although the extent of the involvement of these bacteria in immune regulation remains unknown, future research should investigate their presence in other pathological conditions. Such research could potentially lead to a better understanding of the immunological impact of these bacteria on patients with cancer and their application as biomarkers.

Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report

BACKGROUND

Esophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure depending on the case. Herein, we report a case in which we successfully performed thoracoscopic esophageal drainage as emergency airway management due to tracheal compression by a mucocele after esophagogastric bypass for unresectable esophageal cancer with esophagobronchial fistula.

CASE PRESENTATION

A 56-year-old man underwent esophageal bypass surgery for an unresectable esophageal carcinoma with an esophagobronchial fistula following chemotherapy and radiation therapy. Nine months after bypass surgery, he experienced severe dyspnea due to tracheal compression caused by mucus retention on the oral side of the esophageal tumor. We planned thoracoscopic surgery for mucus retention drainage through the right thoracic cavity to secure the airway as an emergency procedure under general anesthesia. Intubation can be performed safely by guiding bronchoscopy in the semi-supine position. Upper esophageal dilation was observed on the cranial side of the azygos arch. We dissected the mediastinal pleura of the upper thoracic esophagus and exposed its wall. A 12-Fr silicone drain was placed in the esophagus through the right chest wall and 120 ml of white fluid was aspirated. He was discharged 9 days after surgery without complications and resumed treatment with an immune checkpoint inhibitor 23 days after surgery. Thereafter, he continued chemotherapy for esophageal cancer, but died of tumor progression and lung metastasis 35 months after bypass surgery and 25 months after thoracoscopic surgery.

CONCLUSIONS

Thoracoscopic esophageal drainage could be performed safely as emergency airway management, shorten the period of discontinuance, and allow cancer treatment to be resumed promptly. We believe that this thoracoscopic procedure is an effective and less invasive method if the percutaneous approach is difficult.

Clinical Treatment of Perioperative Disseminated Intravascular Coagulation in Patients Who Underwent Gastrointestinal and Hepato-Biliary-Pancreatic Surgery

BACKGROUND

It is unclear how effective recombinant thrombomodulin (rTM) treatment is in disseminated intravascular coagulation (DIC) during the perioperative period of gastrointestinal and hepato-biliary-pancreatic surgery. The current study aimed to evaluate the therapeutic outcomes of rTM for perioperative DIC.

METHODS

We enrolled 100 consecutive patients diagnosed with perioperative DIC after gastrointestinal surgery, and hepato-biliary-pancreatic including emergency procedures, between January 2012 and May 2021. Patients received routine rTM treatment immediately after DIC diagnosis. Then, the DIC, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated and used for evaluation. The outcomes of rTM treatment and the predictors of survival were evaluated.

RESULTS

The causative diseases of DIC were as follows: perforated peritonitis, n = 38; intestinal ischemia, n = 23; intra-abdominal abscess, n = 13; anastomotic leakage, n = 7; pneumonia, n = 7; cholangitis, n = 4; and others, n = 6. The 30-day mortality rate was 18.0%. There were significant differences in the platelet count (13.78 vs 10.41, P = .032) and the SOFA score (5.22 vs 9.89, P<.0001) at the start of DIC treatment between the survivor and non-survivor groups (day 0). The survivor group had a significantly lower DIC score (3.13 vs 4.93, P = .0006) and SOFA score (4.94 vs 12.14, P < .0001) and a higher platelet count (13.50 vs 4.34, P < .0001) than the non-survivor group on day 3.

CONCLUSIONS

Comprehensive and systemic treatment is fundamentally essential for DIC, in which rTM may play an important role in the treatment of perioperative DIC.

Indocyanine Green Fluorescence Image-guided Laparoscopic Hepatectomy Enabled Resection of a Tumor Invisible With Ultrasonography

BACKGROUND

Ultrasonography (US) is widely used for pre-operative detection of liver tumors. However, US does not have high resolution and very small tumors, tumors located near the liver surface, or those in cirrhotic livers are often not detected.

CASE REPORT

A 47-year-old woman with a previous surgery for sigmoid colon cancer (T3N1bM0 Stage3b) showed a liver tumor on the surface of segment 2 by contrast-enhanced computed tomography (CT) and gadoliniumethoxybenzyldiethlenetriaminepen-taacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI). However, preoperative US could not identify a tumor lesion at the same site. The most likely preoperative diagnosis was metastasis from her sigmoid colon cancer and laparoscopic liver resection was performed. Intraoperative ultrasonography (IOUS) did not identify the tumor, but it was visualized with indocyanine green (ICG) fluorescence at the surface of segment 2. Laparoscopic liver resection was performed under fluorescence guidance. Pathological examination showed a pseudotumor with negative margins.

CONCLUSION

ICG fluorescence imaging can allow visualization of liver tumors that are undetectable on US.

Experience of the pancreas duodenectomy for so-called carcinosarcoma of the common bile duct:a case report and review of literature

A 79-year-old man presented with malaise and jaundice at a local hospital. His blood tests showed severe inflammation, liver failure, and high expression of several tumour markers. Radiological findings revealed dilated common and intrahepatic bile ducts and a lower bile duct constricted by a soft tissue mass. Histological findings by endoscopy showed a suspected adenocarcinoma, which was determined as class IV by cytology. The patient was referred to our hospital for surgical treatment. He underwent pancreaticoduodenectomy and the final diagnosis was so-called carcinosarcoma of the bile duct. He had liver metastasis and died at 26 postoperative months.

Minimally invasive esophagectomy and radical lymph node dissection without recurrent laryngeal nerve paralysis

Background

We introduce a novel operative technique to dissect lymph nodes adjacent to the recurrent laryngeal nerve, referred to as the “native tissue preservation” technique. Using this technique, there was no damage to the recurrent laryngeal nerve, which is maintained in its anatomical position.

Methods

From September 2016 to December 2018, minimally invasive esophagectomy was performed in the left lateral decubitus position in 87 patients with esophageal cancer. The native tissue preservation technique for lymphadenectomy around the recurrent laryngeal nerve was used, and all patients were evaluated for recurrent laryngeal nerve paralysis.

Results

Minimally invasive esophagectomy was completed in all patients without conversion to thoracotomy. Although an extended lymphadenectomy was performed in all patients, there were no grade II or higher complications (Clavien–Dindo classification) and no incidence of recurrent laryngeal nerve paralysis.

Conclusion

The native tissue preservation technique may reduce the incidence of recurrent laryngeal nerve paralysis after minimally invasive esophagectomy with radical lymph node dissection.

Electronic supplementary material

The online version of this article (10.1007/s00464-020-07372-3) contains supplementary material, which is available to authorized users.

Thoracoscopic and hand assisted laparoscopic esophagectomy with radical lymph node dissection for esophageal squamous cell carcinoma in the left lateral decubitus position: a single center retrospective analysis of 654 patients

Background

The rates of thoracoscopic esophagectomy performed in the prone and left lateral decubitus positions are similar in Japan. We retrospectively reviewed short- and long-term outcomes of thoracoscopic esophagectomy for esophageal cancer performed in the left lateral decubitus position.

Methods

Between 1996 and 2015, 654 patients with esophageal cancer underwent thoracoscopic esophagectomy in the left lateral decubitus position. Patients were divided into early (1996–2008) and late groups (2009–2015, with standardization of the procedure and formalized training), and their clinical outcomes reviewed.

Results

The completion rate of thoracoscopic esophagectomy was 99.5%, and the procedure was converted to thoracotomy in three patients, due to hemorrhage. The mean intrathoracic operative time, intrathoracic blood loss, and number of dissected mediastinal lymph nodes were 205.0 min, 127.3 mL, and 24.7, respectively. Postoperative complications included pneumonia (8.5%), anastomotic leakage (7.5%), and recurrent nerve paralysis (3.5%). Postoperative (30d) mortality was 4/654 (0.61%) due to anastomotic leak and pneumonia. The five year overall survival rate was 70%. A comparison of the 289 early- and 365 late-study period cases revealed significant differences in mean intrathoracic blood loss (174.0 vs. 94.2 mL), number of mediastinal lymph nodes dissected (20.0 vs. 28.4), hospital length of stay (33.4 vs. 20.0 days, p < 0.001), and postoperative anastomotic leakage (14% vs. 1.6%, p < 0.0001).

Conclusions

Standardization of the procedure for thoracoscopic esophagectomy in the left lateral decubitus position, with a standardized clinical pathway for perioperative care led to significant improvements in surgical outcomes.

A long-term survival case after surgical resection of skeletal muscle metastasis following esophagectomy for squamous cell carcinoma of the esophagus

Cases of skeletal muscle metastasis of esophageal carcinoma are very rare, with few reports of long-term survival. We report a case of long-term survival after surgical resection of skeletal muscle metastasis. A 56-year-old man with advanced esophageal cancer and early gastric cancer underwent thoracoscopic esophagectomy, 2-field lymph node dissection, partial gastrectomy and gastric tube reconstruction. Six months later, cervical lymph node metastasis and mediastinal lymph node recurrence were found. Therefore, the patient underwent cervical lymph node dissection and adjuvant chemoradiotherapy. Two years and 3 months after the esophagectomy, a muscle metastasis was found in the left shoulder, and he underwent tumor dissection, followed by adjuvant chemotherapy for a year. There has been no sign of recurrence since, even 13 years after the esophagectomy. We believe our aggressive surgical treatment might have led to long-term survival.

Endoscopic clipping of spontaneous esophageal rupture: Case reports of three patients

INTRODUCTION

Spontaneous esophageal rupture is a life-threatening condition which is difficult to diagnose early, and is usually treated surgically. Prolonged hospitalization is common. Non-operative treatment of esophageal rupture localized to the mediastinum has been reported. We report three patients with spontaneous esophageal rupture successfully managed with endoscopic clipping.

CASE PRESENTATIONS

Two patients had ruptures localized to the mediastinum, and were discharged within one week of undergoing closure. The third patient presented with Boerhaave's syndrome with a leak into the pleural space and needed prolonged hospitalization (34days), but she did not need surgery and began oral intake two days after endoscopic clipping. The patient had an uneventful recovery.

Intrathoracic Hernia after Total Gastrectomy

Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

Diagnostic validity of computed tomography for mediastinitis after cardiac surgery

BACKGROUND

Optimal treatment based on appropriate early diagnosis is essential in managing mediastinitis after cardiac surgery. We evaluated the accuracy of thoracic computerised tomography (CT) in the diagnosis of mediastinitis.

METHODS

Forty-one patients in whom we performed CT after cardiac surgery were classified into two groups as follows; Six cases had mediastinitis requiring a redo surgical intervention (Group M). Thirty-five cases recovered without mediastinitis (Group C). Comparisons of CT findings in both groups were made retrospectively.

RESULTS

In group M, CT and re-operations were performed 6.3+/-2.5 days and 8.0+/-5.2 days after previous operation, respectively. All but one of redo surgical procedures were mediastinal lavage and omental transplantation. Two patients died due to septic shock and multiple organ failure. CT in group M showed a soft tissue mass with contrast enhancement in 4 patients, bilateral pleural effusion in 5, free gas appearance in 4, and sternal dehiscence or destruction in 2 patients. Consequently, we regarded 4 of the 6 patients in this group as showing postoperative mediastinitis radiographically. In group C, CT performed 16.6+/-7.1 days after operations revealed findings suggestive of mediastinitis in 6 patients. Therefore, in terms of the validity of CT for the diagnosis of mediastinitis, the sensitivity was 67% and the specificity was 83%.

CONCLUSION

The sensitivity of CT for diagnosis of mediastinitis after cardiac operations is unsatisfactory. Diagnosis by seeking infective changes in a multidisciplinary way is important in dealing with mediastinitis.

Surgical repair of coronary artery aneurysm after percutaneous coronary intervention

Two cases of coronary artery aneurysm after percutaneous coronary intervention are presented. In both cases, follow-up coronary angiography revealed an expanding saccular aneurysmal formation and restenosis or a new lesion. Consequently, surgical repair and revascularization were indicated. The intraoperative angioscope was used to identify the aneurysm, which had not been visible on the heart surface in one case. Its optic fiber light was a useful guide, but little information was obtained from direct vision because of the small caliber of the angioscope. Plication of the aneurysm and bypass grafting distal to the aneurysm were performed. A whitish and thick-walled aneurysm was easily found in one case, in which ligation of the aneurysm was attempted with added distal bypass. The postoperative course was uneventful in both cases, and follow-up angiography showed disappearance of the aneurysm with patent grafts. There was a fragile thrombus inside both the aneurysmal sacs, which might have caused myocardial infarction and, therefore, justified the surgical repair of the aneurysm with concomitant revascularization.

Quality of life in patients over 70 years of age after heart valve replacement

BACKGROUND

Previous studies on valve replacement in patients over 70 years of age have been concerned with early and long-term outcome. Little is known, however, of the quality of life (QOL) of survivors following surgery.

METHODS

Thirty-one consecutive patients, mean age 74.0+/-3.1 years, who underwent heart valve replacement were reviewed and questioned as to their physical and social activities before and after surgery and compared with 75 patients aged less than 70 years old who underwent similar procedures during the same time interval. QOL was measured by using the Rosser distress and disability scores.

RESULTS

Hospital mortality in the elderly group was the same as in the younger group (9.7% vs 2.7%, p = 0.121). Median 5-year survival was 79% in the elderly group and 92% in the younger group (p = 0.068). Overall morbidity due to valve-related complications was 3.55%/patient-year in the elderly group and 2. 35%/patient-year in the younger group, and freedom from all valve-related complications at 5 years was 76%, and 83%, respectively (p = 0.202). There were significant improvements in the distress and disability scores postoperatively (mean interval: 32. 4+/-20.4 months). The QOL value rose from 0.960 to 0.981 in the elderly group (p = 0.0004), and from 0.975 to 0.984 in the younger group (p = 0.07), suggesting that the magnitude of improvement in the elderly group was superior to that in the younger group.

CONCLUSIONS

Heart valve replacement in patients over the age of 70 years was associated with reasonable early and mid-term morbidity. We believe that significant improvements in the symptoms, functional status, and QOL of the patients can be expected.

Natural Hybridization between Diploid Crucian Carp Species and Genetic Independence of Triploid Crucian Carp Elucidated by DNA Markers

The population structure of genus Carassius in Lake Koyama, southeast Japan, was analyzed by genetic markers as microsatellite DNA, mtDNA RFLP and isozymes. Based on the ploidy level and morphological analysis, four Carassius groups were detected. The triploid group was identified as Ginbuna (C. langsdorfii). In the diploid group, Nagabuna (C. burugeri sp) and Gengoroubuna, (C. cuvieri) were identified. Remaining diploid individuals had morphological traits that were intermediate between Nagabuna and Gengoroubuna. These were considered as hybrids and their descendants. From the results of mtDNA RFLP and isozyme patterns, the triploid population was considered to be independent from the gene pools of diploid. The hybrids had the mtDNA haplotypes which were common to Gengoroubuna and Nagabuna populations. Based on the three microsatellite loci, Ginbuna was classified into six clonal lines. In the diploid population, substitution of the major alleles of Nagabuna and Gengoroubuna were found. The hybrids had alleles that were common in Nagabuna and Gengoroubuna. The values of the hybrid index (IH) which are ranged from 0.771 to 0.964 in Nagabuna, from 0.102 to 0.806 in the hybrids and from 0.068 to 0.157 in Gengoroubuna. The hybrid population was verified to be derived from crossbreeding between the Gengoroubuna and Nagabuna populations. Evidence of backcrossing in nature by microsatellite DNA markers was also obtained in the diploid populations.

Effect of linoleic acid-albumin on post-thaw survival of in vitro-produced bovine embryos at the 16-cell stage

The effect of addition of linoleic acid-albumin (LAA) to culture medium before freezing on the survival rate of bovine 16-cell embryos after freezing-thawing was investigated. Embryos were incubated in CR1aa containing LAA (0.25 mg/ml) for 4 days after insemination. A conventional slow cooling method was used, in which embryos were cooled at a rate of 0.3 degrees C/min to -30 degrees C in medium supplemented with 1.5 M ethylene glycol and 0.2 M trehalose. The developmental rate to the blastocyst stage of thawed embryos that had been cultured with LAA-containing medium before freezing was higher than that of these cultured without LAA (P<0.05). However, with fresh, non-frozen, embryos that were incubated under the same culture conditions (with and without LAA), no such difference was found.

Pericardio-peritoneal drainage using a subcostal approach

A 56-year-old man admitted to our hospital for cardiac tamponade due to dilated cardiomyopathy did not respond to treatment by usual medical means or surgery. Pericardio-peritoneal drainage was conducted using a subcostal approach. Seven months later, the patient remains well and free of signs of pericardial tamponade. This method has proved to be safe and effective in patients with persistent massive pericardial effusion.

Clinical and angiographic assessments and treatment of patients with recurrent varices after transabdominal transection of the esophagus

BACKGROUND/AIMS

Risk factors regarding the recurrence of esophageal varices and were researched preoperative clinical and angiographic findings in patients with variceal recurrence and/or rebleeding after transabdominal esophageal transection were analyzed.

MATERIALS AND METHODS

Clinical and angiographic assessments of recurrence of varices after transabdominal esophageal transection were made on 55 patients with portal hypertension. In all these patients, postoperative endoscopy was performed at 3-6 monthly intervals.

RESULTS

Varices recurred in 13 patients and 4 patients re-bled during the 5-106 month follow up. There was a significant increase in the rate of recurrence in patients with a history of hematemesis, and in those with a higher grade of development of cephalad collateral vessels in the lesser splanchnic area, as seen on the preoperative portography. Eight of the 13 patients were then effectively treated by endoscopic injection sclerotherapy.

CONCLUSIONS

Despite transabdominal transection of the esophagus, varices may well recur if the patient has had a history of hematemesis and a higher grade of development of cephalad collateral vessels. In such cases endoscopic injection sclerotherapy should be done.

Biliary excretion of exogenous cadmium, and endogenous copper and zinc in the Eisai hyperbilirubinuric (EHB) rat with a near absence of biliary glutathione

Mutant Eisai hyperbilirubinuric (EHB) rats derived from an inbred strain of Sprague-Dawley (SD) rats are characterized by a near absence of biliary excretion of glutathione (GSH) due to inherently impaired ATP-driven organic anion transport. Cd (0.1 mg/kg bw from CdCl2) was injected intravenously into EHB rats and control SD rats. Output of biliary excretion of Cd was followed over 15-min intervals up to 60 min. Cd was excreted rapidly and reached the maximum level (73.2 ng/15 min) in the period from 15 to 30 min in SD rats. Its excretion in EHB rats, however was one-fortieth (only 1.8 ng/15 min) of that in SD rats. Biliary concentrations of two endogenous metals, Cu and Zn were also measured. The output of Cu in EHB rat bile (50 ng/15 min before Cd injection) was about one-fifth of that in SD rat bile (270 ng/15 min). The output was not influenced by the Cd injection in the two groups. There was a slight difference of Zn output between the two groups. The biliary excretion of GSH was 500 to 700 micrograms/15 min and only 1 to 2 micrograms/15 min in SD and EHB rats, respectively. Sixty min after Cd injection, the Cd concentrations in the serum, liver and kidney were slightly higher in EHB rats than in SD rats. There was no difference in the hepatic metallothionein (MT-I and-II) concentration between SD (34 micrograms/g liver) and EHB (33 micrograms/g liver) rats. The renal Cu concentration was about four times in the higher in the EHB rat than in the SD rat. These results suggest that reduced biliary excretion of Cd is mainly, but that of Cu is only partly, based in reduced canalicular transport of GSH due to lack of an ATP-driven organic anion transport system, not MT induction in EHB rats. It seems likely that biliary excretion of Cd is regulated mainly by the canalicular anion transport in rats.

[Adaptation and protection systems against chemical substances in living body]

Author's work on the adaptation and protection systems against chemical substances, such as drugs, food additives, heavy metals, pesticides and environmental pollutants, in the living body during the past thirty five years was reviewed. Using the induction of heme and drug metabolizing enzymes (especially heme oxygenase) and of metallothionein in the liver of animals as a biological index, the adaptation and protection of these substances to the body were discussed. This is because that heme oxygenase is a heat shock protein which is induced by various environmental factor, and that metallothionein also has a wide variety of biological functions, and was identified as an acute phase protein in the first phase defense system against environmental stresses. The research under mRNA levels as more sensitive index will advance in the near future.

Nitric oxide mediated metallothionein induction by lipopolysaccharide

The roles of calcium and/or of the other cellular transduction pathways, and of nitric oxide (NO) on the induction of metallothionein (MT) mRNA by lipopolysaccharide (LPS) has been studied in rat primary cell culture, using inhibitors of protein kinase pathways (H-7, W-7 and TMB-8) and NO production inhibitors (L-NAME, PTIO). LPS exposure led to a rapid increase of MT-mRNA and a peak level revealed 2.5-fold induction as compared to control for 6h incubation at a dose of 3.0 mg/L. A dose of 5.0 and 10.0 mg/L of LPS also provided the same level of MT-mRNA induction. The inhibition of MT induction by LPS was observed with L-NAME, PTIO, but not H-7, W-7. These findings indicate that the alteration of cellular calcium concentration and distribution does not relate to the induction of MT-mRNA by LPS in hepatocytes and that protein kinase C and calmodulin dependent protein kinase pathways have not contributed to MT-mRNA induction by LPS. Finally, the present results show that NO plays an important role in MT induction by LPS.

Protective effects of the nucleic acid components on CCL4-induced liver injury in rats

In our previous studies, uracil was identified as the active principle from Trionyx carapax. The protective effects of other nucleic acid components, and of xanthine are further investigated.

Effect of pretreatment of rats with uracil on liver injuries induced by D-galactosamine and allyl alcohol

Uracil was previously shown by us to be the active principle of Trionyx carapax. In this study, we show that pretreatment with uracil protects rats against hepatic injury induced by allyl alcohol and by D-galactosamine.

Protective effect of Trionyx carapax on CCl4-induced hepatic injury is mediated by uracil

Oral administration of crude extracts of Trionyx carapax into rats was found to protect the liver from its CCl4-induced injury as judged by morphological and biochemical observations. The active principle was purified from crude extracts of Trionyx carapax by Sephadex G-75, Sephadex G-25, DEAE-cellulose and silica gel column chromatographies. The results of elemental analysis, infrared and mass spectroscopy demonstrated the purified component to be identical to uracil. Upon administration, authentic uracil exhibited the protective effects on CCl4-induced hepatic injury, a pattern identical to or very similar to that observed with crude extracts of Trionyx carapax. Thus it is concluded that uracil is the active component responsible for protection from CCl4-induced hepatic injury.

Nature of heme metabolizing enzymes in a mutant rat with hyperbilirubinuria

Eisai hyperbilirubinuria rat (EHBR) is a mutant strain which is originated from Sprague Dawley rats. The activities of heme metabolizing enzymes in EHBR were compared with those of Sprague Dawley rats as the control. The activity of delta-aminolevulinic acid (delta-ALA) synthetase, the initial and rate-limiting enzyme in heme biosynthesis, was significantly higher in the liver of EHBR. However, no significant difference in the activity of heme oxygenase, the first and rate-limiting enzyme in heme degradation, was observed in EHBR as compared to control rats. DDC, a porphyrinogenic agent, caused marked and prolonged increase in the activity of delta-ALA synthetase in EHBR. However, the contents of microsomal total heme and cytochrome P-450 were significantly decreased in EHBR 24 hrs after DDC injection. The activity of heme oxygenase by CdCl2, a inducer of heme oxygenase, was considerably higher in EHBR than in control rats. These results indicate some specific hypersensitivity for heme metabolizing enzymes in EHBR.

A nine-month chronic toxicity study of tegafur-uracil mixture (UFT) in dogs

In order to evaluate the long-term-safety of UFT which contained tegafur [1-(2-tetrahydrofuryl)-5-fluorouracil, FT-207] and uracil in molar ratio of 1:4, a nine-month chronic toxicity study was performed in dogs. In doses of 9.7 (as FT-207: 3 mg/kg), 16.2 (as FT-207: 5 mg/kg) and 24.3 (as FT-207:7.5 mg/kg) mg/kg, UFT was administered orally in both sexes of dogs once a day for 9 months and withdrawn for 1 month. Three control drugs, FT-207, uracil and 5-FU, were also included in present experiment at doses of 7.5, 420.0 and 5.0 mg/kg, respectively. In this study, the two types of toxic behaviors and symptoms were observed in UFT, FT-207 and 5-FU. The first type was the acute and/or dynamic signs and the other type was the chronic and/or static signs. Slight decrease in food consumption was observed in males at the dose levels of 24.3 mg/kg of UFT group and in both sexes of 5-FU group. In the ECG test, high T-wave was observed in some males treated with UFT, FT-207 and 5-FU. Histopathologically, micro-vacuolizations were observed in various portions of the cerebrum in both survived and dead animals treated with UFT, FT-207 and 5-FU. After one month recovery period, significant changes were not observed in various examinations, but morphological changes in the cerebrum had been remained. In conclusion, it seemed that the maximum safety dose of UFT in dogs were the 9.7 mg/kg for males and less than 9.7 mg/kg for females.

Influences of maternal ethanol intake on maternal and perinatal hepatic heme and drug metabolizing enzymes in rats

The effect of ethanol on maternal and neonatal hepatic heme and drug metabolizing systems was determined. Ethanol (16%, w/v) was administered orally as drinking solution to pregnant or lactating rats at different pre- and post-natal stages. The dams and pups were sacrificed on days 7, 14 and 21 after parturition, respectively. Ethanol administration to lactating rats from just after birth caused an appreciable decrease in the maternal and neonatal body and liver weights. In addition, the activities of nicotinamide adenine dinucleotide phosphate-cytochrome c reductase, nicotinamide adenine dinucleotide-cytochrome b5 reductase and heme oxygenase were significantly enhanced in the livers of neonates whose mothers were exposed to the ethanol during only first week of lactation, but those activities were not altered in the maternal livers. However, no remarkable alterations were observed in the contents of cytochrome P-450 and b5, and the activities of aminopyrine demethylase, aniline hydroxylase and delta-aminolevulinic acid synthetase in the livers of neonates from mothers who had received ethanol during lactation period or last week of gestation, although the activities of aminopyrine demethylase and aniline hydroxylase were enhanced significantly in lactating dams by ethanol consumption for 14 d after parturition.

Effects of maternal ethanol intake during pregnancy on fetal and maternal liver enzyme systems in Wistar rats

In the present study, the effects of maternal ethanol intake during pregnancy on microsomal cytochrome contents and on enzyme activities in the developing fetus were investigated. Ethanol intake to pregnant females did not affect the maternal body weight or number of fetuses, but tended to reduce the mean fetal body weight, especially the fetuses from a litter of mother who were treated with ethanol during day zero to 20 of gestation showed significant decreases in the body and liver weights. No significant changes were observed in the contents of cytochrome P-450 and b5 and the activities of NADPH-cytochrome c reductase and heme oxygenase in the livers of fetuses whose mothers were exposed to ethanol during pregnancy when compared with that of untreated pregnant rats. However, NADH-cytochrome b5 reductase activity in the fetal livers was found to significantly decrease by maternal ethanol intake during pregnancy.

Effects of age and sex on microsomal heme oxygenase and cytochrome P-450 content in liver of rats

Effects of age and sex on microsomal heme oxygenase activity and cytochrome P-450 content were investigated in Wister rats. Heme oxygenase activity declined with an increase in age, namely, its activity in 100 days old (young) rats was 58% in male and 72% in female rats as compared with respective 30 days old (immature) rats, and in 300 days old (old) rats it was 32% in male and 39% in female rats. In male rats, cytochrome P-450 content based on 100 g body weight decreased only in old rats as compared with immature rats, whereas a significant reduction was observed in female rats in the content based on mg microsomal protein as well as based on 100 g body weight in young and old animals. In littermate rats at the age of 56 days which obtained by in breeding in our laboratory, sex difference was apparent in heme oxygenase activity and cytochrome P-450 content, and further a good reciprocal correlation between that activity and content (r = 0.9730 in male, and r = -0.852 in female) was observed.

Acute effect of methamphetamine on heme oxygenase activity and on cytochrome P-450 content in the liver of female rats

After a single treatment with d-methamphetamine (philopon) at a dose of 8 mg/kg in 10 weeks old female Wistar rats, heme oxygenase activity was enhanced at 3 hr and reached it peak level at 12 hr, whereas cytochrome P-450 content showed the lowest level at 12 hr. However, activity of delta-aminolevulinic acid synthetase was not affected. Twenty-four hr later, all measured parameters returned to nearly initial levels at zero time. The pretreatment with cycloheximide blocked the increase of heme oxygenase activity in philopon-treated animals.

Effects of chlorinated benzenes of the activities of delta-aminolevulinic acid synthetase and heme oxygenase and on the content of hemoprotein in the liver of rats

Effects of chlorinated benzenes on the activities of delta-aminolevulinic acid (delta-ALA) synthetase and heme oxygenase, the rate-limiting enzyme in heme biosynthesis and degradation respectively, and on the incorporation of 3H-delta-ALA into hemoprotein in the liver of male rats were investigated. Monochlorobenzene (MCB) and 1,2,4-trichlorobenzene(TRCB) stimulated significantly the activities of above both hepatic enzymes. After a single injection of 200 mg/kg, heme oxygenase activity was enhanced rapidly and sustained markedly for at least 48 hr by MCB treatment, while that was also enhanced but restored nearly to control levels at 48 hr by TRCB. delta-ALA synthetase activity was once decreased at 6 hr and restored within 12 hr and then reached peak levels (about 2--3 times to control levels) at 24 hr by MCB or TRCB treatment. However, this activity was sustained for 48 hr by TRCB treatment, whereas returned again to nearly control levels by MCB at 48 hr. Cytochrome P-450 content at 48 hr was significantly decreased by MCB (63% to control), in contrast, increased by TRCB (200% to control). When MCB or TRCB injected once daily throughout the study, biphasic disappearance of radioactivity incorporated into CO-binding particles was shown in control and MCB- or TRCB-treated rats. The half-life of the fast phase was about 8 hr in control and about 6 or 13 hr in MCB- or TRCB-treated rats respectively.