Multi-modal optimization of bismuth vanadate photoanodes via combinatorial alloying and hydrogen processing

Exploration of alloying and thermal processing of BiVO₄ reveals the ability to combine strategies for improving carrier transport, and the common role of rare earths in co-alloying.

Quadrics and Scherk towers

We investigate the relation between quadrics and their Christoffel duals on the one hand, and certain zero mean curvature surfaces and their Gauss maps on the other hand. To study the relation between timelike minimal surfaces and the Christoffel duals of 1-sheeted hyperboloids we introduce para-holomorphic elliptic functions. The curves of type change for real isothermic surfaces of mixed causal type turn out to be aligned with the real curvature line net.

Hepatic artery reconstruction with the jejunal artery of the Roux-en-Y limb in pediatric living donor liver re-transplantation

When re-anastomosis and re-transplantation becomes necessary after LDLT, arterial reconstruction can be extremely difficult because of severe inflammation and lack of an adequate artery for reconstruction. Frequently, the recipient's HA is not in good condition, necessitating an alternative to the HA. In such cases, the recipient's splenic artery, right gastroepiploic artery or another vessel can be safely used for arterial reconstruction. There have, however, been few reports on using the jejunal artery. Herein, we report our experience with arterial reconstruction using the jejunal artery of the Roux-en-Y limb as an alternative to the HA. A three-yr-old girl who had developed graft failure due to early HA thrombosis after LDLT required re-transplantation. At re-transplantation, an adequate artery for reconstruction was lacking. We reconstructed the artery by using the jejunal artery of the Roux-en-Y limb, as we judged it to be the most appropriate alternative. After surgery, stent was deployed because hepatic blood flow had reduced due to kinking of the anastomosed site, and a favorable outcome was obtained. In conclusion, when an alternative to the HA is required, using the jejunal artery is a feasible alternative.

Pediatric liver retransplantation from living donors can be considered as a therapeutic option for patients with irreversible living donor graft failure

Liver retransplantation (re-LT) is required in patients with irreversible graft failure, but it is a significant issue that remains medically, ethically, and economically controversial, especially in living donor liver transplantation (LDLT). The aim of this study was to evaluate the outcome, morbidity, mortality, safety and prognostic factors to improve the outcome of pediatric living donor liver retransplantation (re-LDLT). Six of 172 children that underwent LDLT between January 2001 and March 2010 received a re-LDLT and one received a second re-LDLT. The overall re-LDLT rate was 3.5%. All candidates had re-LDLT after the initial LDLT. The overall actuarial survival of these patients was 83.3% and 83.3% at one and five yr, respectively. These rates are significantly worse than the rates of pediatric first LDLT. Vascular complications occurred in four patients and were successfully treated by interventional radiologic therapy. There were no post-operative biliary complications. One case expired because of hemophagocytic syndrome after re-LDLT. Although pediatric re-LDLT is medically, ethically, and economically controversial, it is a feasible option and should be offered to children with irreversible graft failure. Further investigations, including multicenter studies, are therefore essential to identify any prognostic factors that may improve the present poor outcome after re-LDLT.

Living donor liver transplantation for ornithine transcarbamylase deficiency

Ornithine transcarbamylase deficiency, the most common urea cycle disorder, causes hyperammonemic encephalopathy and has a poor prognosis. Recently, LT was introduced as a radical OTCD treatment, yielding favorable outcomes. We retrospectively analyzed LT results for OTCD at our facility. Twelve children with OTCD (six boys and six girls) accounted for 7.1% of the 170 children who underwent LDLT at our department between May 2001 and April 2010. Ages at LT ranged from nine months to 11 yr seven months. Post-operative follow-up period was 3-97 months. The post-operative survival rate was 91.7%. One patient died. Two patients who had neurological impairment preoperatively showed no alleviation after LT. All patients other than those who died or failed to show recovery from impairment achieved satisfactory quality-of-life improvement after LT. The outcomes of LDLT as a radical OTCD treatment have been satisfactory. However, neurological impairment associated with hyperammonemia is unlikely to subside even after LT. It is desirable henceforth that more objective and concrete guidelines for OTCD management be established to facilitate LDLT with optimal timing while avoiding the risk of hyperammonemic episodes.

Living-donor liver transplantation in 126 patients with biliary atresia: single-center experience

OBJECTIVES

To describe our experience with 126 consecutive living-donor liver transplantation (LDLT) procedures performed because of biliary atresia and to evaluate the optimal timing of the operation.

PATIENTS AND METHODS

Between May 2001 and January 2010,126 patients with biliary atresia underwent 130 LDLT procedures. Mean (SD) patient age was 3.3 (4.2) years, and body weight was 13.8 (10.7) kg. Donors included 64 fathers, 63 mothers, and 3 other individuals. The left lateral segment was the most commonly used graft (75%). Patients were divided into 3 groups according to body weight: group 1, less than 8 kg (n = 40); group 2,8 to 20 kg (n = 63); and group 3, more than 20 kg (n = 23). Medical records were reviewed retrospectively. Follow up was 4.5 (2.7) years.

RESULTS

All group 3 donors underwent left lobectomy, and all group 1 donors underwent left lateral segmentectomy. No donors required a second operation or died. Comparison of the 3 groups demonstrated that recipient Pediatric End-Stage Liver Disease score in group 1 was highest, operative blood loss in group 2 was lowest (78 mL/kg), and operative time in group 3 was longest (1201 minutes). Hepatic artery complications occurred more frequently in group 1 (17.9%), and biliary stenosis (43.5%) and gastrointestinal perforation (8.7%) occurred more frequently in group 3. The overall patient survival rates at 1, 5, and 9 years was 98%, 97%, and 97%, respectively. Five-year patient survival rate in groups 1,2, and 3 were 92.5%, 100%, and 95.7%, respectively. Gastrointestinal perforation (n = 2) was the primary cause of death.

CONCLUSIONS

Living-donor liver transplantation is an effective treatment of biliary atresia, with good long-term outcome. It seems that the most suitable time to perform LDLT to treat biliary atresia is when the patient weighs 8 to 20 kg.

Management of intra-abdominal drain after living donor liver transplantation

BACKGROUND

There have been few reports on the management of intra-abdominal drains after living donor liver transplantation (LDLT). We retrospectively investigated changes in ascitic data related to management of an intra-abdominal drain.

PATIENTS AND METHODS

Between March 2008 and June 2009, we performed 28 LDLT. On the first and the fifth postoperative day (POD) after LDLT, we examined the number of ascites cells and cell fractions as well as performed biochemical examination and cultures.

RESULTS

The day of removal of the drain for massive ascites (10 mL/kg/d or more) was 14.2 ± 5.4 POD; for less than 10 mL/kg/d it was 8.7 ± 1.9 POD (P < .001). Nine patients were ascites culture positive; long-term placement of the drain caused an infection in two patients.

CONCLUSIONS

When the amount of ascitic fluid on the fifth POD after LDLT was small, it was important to assess the properties of the ascitic fluid because of the possibility of a drain infection or of poor drainage. If the ascitic neutrophil count is less than 250/mm(3) or the examined ascites is normal, intra-abdominal drains should be removed.

Living donor liver transplantation for neonates using segment 2 monosubsegment graft

The prognosis of liver transplantation for neonates with fulminant hepatic failure (FHF) continues to be extremely poor, especially in patients whose body weight is less than 3 kg. To address this problem, we have developed a safe living donor liver transplantation (LDLT) modality for neonates. We performed LDLTs with segment 2 monosubsegment (S2) grafts for three neonatal FHF. The recipient age and body weight at LDLT were 13-27 days, 2.59-2.84 kg, respectively. S2 or reduced S2 grafts (93-98 g) obtained from their fathers were implanted using temporary portacaval shunt. The recipient portal vein was reconstructed at a more distal site, such as the umbilical portion, to have the graft liver move freely during hepatic artery (HA) reconstruction. The recipient operation time and bleeding were 11 h 58 min-15 h 27 min and 200-395 mL, respectively. The graft-to-recipient weight ratio was 3.3-3.8% and primary abdominal wall closure was possible in all cases. Although hepatic artery thrombosis occurred in one case, all cases survived with normal growth. Emergency LDLT with S2 grafts weighing less than 100 g can save neonates with FHF whose body weight is less than 3 kg. This LDLT modality using S2 grafts could become a new option for neonates and very small infants requiring LT.

Efficacy of double-filtration plasmapheretic cross-circulation with a high-permeability membrane using canine harvested liver in porcine fulminant hepatic failure model

INTRODUCTION

The use of bioartificial liver devices requires. A sufficient liver cell mass to provide adequate metabolic support, reduction of xenogeneic immune reactions, and avoidance of viral transmission. We have developed a plasmapheresis system using a semipermeable membrane combined with canine whole liver perfusion (PMCWLP). In this study, we investigated the efficacy of our system in a porcine fulminant hepatic failure (FHF) model.

METHODS

The porcine FHF model was established by intraportal administration of alpha-amanitin (0.1 mg/kg) and lipopolysaccharide (1 microg/kg). Nine hours after drug injection, xenogenic perfusion treatment was performed twice within 6 hours (n = 5). As the plasmapheresis device, we used a hollow-fiber module with cellulose diacetate porous fibers (pore size, 0.05 microm, surface area, 2 m2). The canine whole liver was perfused with modified Krebs solution, which is commonly used in many laboratories, containing albumin (2 g/dL) and glucose (300 mg/dL). Control pigs (n = 10), had the circuit not connected to the whole canine liver.

RESULTS

The survival of FHF pigs was significantly increased by the treatment (58.9 +/- 21.8 hour) compared with the controls (22.3 +/- 8.1 hour). Mean blood ammonia levels and intracranial pressure during treatment were significantly lower compared with control groups.

CONCLUSION

Treatment of FHF pigs with the system significantly increased survival time, suggesting that this method may have applications as a clinical liver assist device.

Intraoperative blood lactate level as an early predictor of initial graft function in human living donor liver transplantation

This study was performed to investigate whether intraoperative changes in blood lactate levels after hepatic allograft reperfusion reflect initial graft function in living donor liver transplantation (LDLT).

PATIENTS AND METHODS

From 1994 to 2003, 15 of LDLT cases were divided into two groups based on the intraoperative blood lactate levels. Group A consisted of seven recipients whose new liver grafts started to consume lactate immediately after portal perfusion. Group B consisted of the remaining eight recipients whose intraoperative blood lactate values showed no change or an elevation for 2 hours after graft revascularization.

RESULTS

All Group A patients survived, whereas three out of eight patients in Group B died of infection and portal vein thrombosis within 3 months after LDLT. There was no significant difference in preoperative donor and recipient laboratory data. The recipient age and body size in Group B were significantly higher than those in Group A, indicating that Group B consisted of small-for-size liver transplant cases. Serum total bilirubin concentrations in Group B were significantly higher than Group A from postoperative day 5 to 23, whereas postoperative liver enzyme levels and prothrombin time were similar between the two groups.

CONCLUSION

The change in intraoperative blood lactate after hepatic allograft reperfusion served as an accurate predictor of initial graft function which was associated with graft size in human LDLT.

Attenuation of canine warm ischemic small bowel injury by novel combination of nitric oxide donor, FK409, and cytokine suppressive anti-inflammatory agent FR167653

Organ ischemia-reperfusion injury is caused by two consecutive steps, microcirculatory disturbance and neutrophil-endothelial cell interactions, which are caused by inflammatory cytokines. We examined the hypothesis that combination therapy with a donor (FK409) of nitric oxide, one of the potent mediators with diverse roles as a vosodilator and a platelet inhibitor, together with the cytokine suppressor agent (FR167653) attenuates warm ischemic injury in canine small bowel. Small bowel ischemia was initiated by clamping the superior mesenteric artery and vein. Animals were divided into two groups: a control group (n = 5) subjected to 2-hour small bowel ischemia only, and a combination therapy group (FK/FR group, n = 5) that received FK409 (300 mcg/kg/h) plus FR167653 (1 mg/kg/h) intravenously before and after the ischemic event. We evaluated animal survival, small bowel tissue blood flow, and enzyme release from the small bowel. All controls died from severe acidosis within 2 days and all the FK/FR animals survived 7 days (P < .05). The FK/FR group recovered more than 70% of blood flow immediately after the revascularization, while the flow was less than 40% among the controls. Serum creatine phosphokinase values in the control group after reperfusion were significantly higher than those in the FK/FR group. In conclusion improvement of the microcirculation by FK409 and inhibition of cytokine release by FR167653 together attenuated warm ischemic small bowel injury.

In vitro evaluation of cross-circulation system using semipermeable membrane combined with whole liver perfusion

INTRODUCTION

Many types of isolated hepatocytes-based bioartificial liver have been developed. However, to maintain hepatocyte-specific functions for a long period is still a significant challenge. The possibilities of rejection or viral transmission still remain as untackled obstacles. We developed a cross-circulation system, using a semipermeable membrane combined with whole liver perfusion. Detoxifying functions of the extracorporeal porcine liver and molecular movements across the membrane were evaluated in vitro.

METHODS

The hollow-fiber module has a molecular cutoff of 100 kD. A spiked solution containing 500 mL low molecular dextran solution spiked with 12 mg ammonium chloride, 500 mg D-galactose, and 300 mg lidocaine, which mimicked a patient, was recirculated through the inner fiber space. The extracorporeal liver perfusion circuit consisted of an extra-fiber spaces. A reservoir containing 1000 mL healthy pig plasma, a membrane oxygenator, and a porcine whole liver. Both circuits circulated in the opposite direction for 6 hours.

RESULT

In 6 hours, 47.3% +/- 10.2% of ammonia, 89.5% +/- 1.7% of D-galactose, and 95.5% +/- 1.0% of lidocaine were eliminated from the circuits; 66.5 +/- 11.1 mg of urea were produced at the same time. Oxygen consumption was maintained between 0.248 and 0.259 mL/100 g liver/min for 6 hours. Movement of IgM was completely blocked by the 100-kD membrane, whereas albumin was freely transferred from the reservoir to the intrafiber space.

CONCLUSION

The perfusion experiments showed the possibility of using a whole liver with oxygenated plasma perfusion in a bioartificial liver system in vitro.

G-CSF producing malignant fibrous histiocytoma in the jejunum: a case report

Malignant fibrous histiocytoma arising from the alimentary tract is extremely rare. We experienced a young patient with an inflammatory type of malignant fibrous histiocytoma in the jejunum which produced granulocyte-colony stimulating factor. A 16-year-old male was admitted to Umehara Hospital with abdominal pain, frequent vomiting of 2 days' duration, high fever and leukocytosis. Serum level of granulocyte-colony stimulating factor was 61.2 pg/mL. Plain abdominal X-ray, ultrasonography and computed tomography led to the diagnosis of intussusception with small intestinal tumor. On the 2nd hospital day, the patient underwent exploratory laparotomy. The jejunum showed intussusception with a hen's egg-sized tumor. After manual reduction, a 20-cm segment of the jejunum was removed. The patient was alive and doing well 29 months after the operation. Microscopic examination of the resected tumor disclosed an inflammatory type of malignant fibrous histiocytoma in the jejunum, and immunohistochemistry was positive for granulocyte-colony stimulating factor. This is the 5th case of malignant fibrous histiocytoma arising from the small intestine that has been described in the English literature.

Hepatocellular carcinoma responding to chemotherapy with 5-FU

A 69-year-old man with unresectable hepatocellular carcinoma and portal vein tumor thrombus was treated by chemotherapy with 5-fluorouracil. A dose of 500 mg/day of 5-fluorouracil was continuously administered via a central venous catheter. After 4 months, the alpha-fetoprotein level was decreased from 50,000 ng/mL to 4,760 ng/mL. Computed tomography revealed disappearance of the low-density area in the liver parenchyma, but the portal vein tumor thrombus was not changed. After 6 months, pancytopenia appeared and continuous infusion of 5-fluorouracil was stopped. After 8 months, the patient died of pneumonia, at which time the alpha-fetoprotein level was 12,000 ng/mL. Continuous intravenous infusion of 5-Fluorouracil was effective against unresectable primary hepatocellular carcinoma, but had little influence on portal vein tumor thrombus.

Long-term results of modified distal splenorenal shunts for the treatment of esophageal varices

BACKGROUND/AIMS

Long-term results were compared for 3 types of distal splenorenal shunt for the treatment of esophageal varices.

METHODOLOGY

Between July 1983 and December 1997, 45 patients with esophageal varices underwent distal splenorenal shunt. Group 1 underwent standard distal splenorenal shunt (n = 11). Group 2 underwent distal splenorenal shunt with splenopancreatic disconnection (n = 11). Group 3 underwent distal splenorenal shunt with splenopancreatic disconnection and gastric transection (n = 23).

RESULTS

Additional treatment for recurrent varices was required in group 1, (n = 1, 9.1%), group 2 (n = 2, 18.2%), and group 3 (n = 1, 4.3%). All of the patients with recurrent varices developed a shunt stenosis within the 1st year after distal splenorenal shunt. The prevalence of hyperammonemia in group 1 was 40.0% at 1, 5, and 10 years. In group 2, the prevalence was 14.3% at 1 year, 31.4% at 5 years, and 54.3% at 10 years. In group 3, the prevalence was 0% at 1 year, and 9.1% at 5 and 10 years. The differences between group 3 and groups 1 and 2 were significant (P < 0.01). The cumulative survival rates at 1 year were 90.9%, 63.6%, and 95.7% for groups 1, 2, and 3, respectively. At 10 years, the cumulative survivals rates were 70.7%, 63.6%, and 69.4% for groups 1, 2, and 3, respectively. There were no significant differences in survival between the 3 groups.

CONCLUSIONS

Distal splenorenal shunt with splenopancreatic disconnection and gastric transection may reduce the incidence of postoperative hyperammonemia.

Bikunin prevents adhesion of calcium oxalate crystal to renal tubular cells in human urine

Crystal-renal tubular cell interactions are important factors in crystal retention and development of kidney stones. It has been reported that human urine, especially its macromolecular fraction, distinctively prevented calcium oxalate monohydrate (COM) crystal adhesion to tubular cells. This study was designed to find and isolate a specific substance in human urine with a strong inhibitory effect against crystal adhesion. A protein from the urine was purified by two anion exchange chromatography columns and one gel filtration column. The inhibition activity for COM crystal adhesion to Madin-Darby canine kidney cells was determined quantitatively. Amino acid sequence of the protein was analyzed and then subjected to homology search in the GenBank protein database. A specific human urine protein that inhibited the COM crystal adhesion to the cells was isolated and identified. Molecular mass of the protein was approximately 35 kD. The first 20-amino acid sequence from the N-terminal of the purified protein was structurally homologous with the light chain of inter-alpha-trypsin inhibitor, also called bikunin. The isolated bikunin inhibited crystal adhesion at a minimum concentration of 10 ng/ml, and blocked completely at 200 ng/ml. It is concluded that bikunin may contribute to the regulation of crystal adhesion and retention within tubules during kidney stone formation.

[Successful total laryngectomy in three cases with severe motor and intellectual disabilities syndrome for the management of repetitive lower respiratory tract infections]

Total laryngectomy was successfully performed for the management of repetitive lower respiratory tract infections in three cases with severe motor and intellectual disabilities syndrome. The patients were thirteen, ten and nine years of age and had cerebral palsy, mental retardation and epilepsy which resulted from neonatal asphyxia and seizures. To treat repetitive lower respiratory tract infections, the patients underwent the operation at the age of nine years and a month, seven years and six months, and six years and eleven months, respectively. Postoperatively, the respiratory tract infections were remarkably reduced for two to four years. Total laryngectomy is one of the best methods for the prevention of aspiration pneumonia, because it separates trachea and esophagus completely. The operation is indicated for children with influx of saliva into trachea and gastroesophageal reflux. The family should recognize that this operation causes permanent loss of voice and speech. The bronchoscopy, upper gastrointestinal tract barium studies and esophageal pH monitoring should be performed before the operation. Our cases fulfilled all of these indications. Laryngectomy should be considered as an effective method of respiratory management for cases of severe motor and intellectual disabilities syndrome, although its application should be carefully examined from the point of improvement of quality of life for patients.

The effects of human urine on the adhesion of calcium oxalate crystal to Madin-Darby canine kidney cells

OBJECTIVE

To determine the effect of human urine on the adhesion of calcium oxalate monohydrate (COM) crystals to Madin-Darby canine kidney (MDCK) cells in a model system in vitro.

MATERIALS AND METHODS

MDCK cells were exposed to COM crystals in the presence of various human urine samples. COM crystals adhering on MDCK cells were quantified by measuring the calcium concentration using atomic absorption analysis. The inhibitory activities were estimated individually for various urine samples from healthy subjects and recurrent stone formers.

RESULTS

Human urine inhibited the adhesion of COM crystals to MDCK cells, with some variations between individual samples. The most potent inhibition of crystal adhesion was expressed by the macromolecular fraction of the urine. Pretreatment of crystals with human urine before exposure to the cells significantly reduced crystal adhesion, suggesting that human urine altered the properties of the crystal surface but not the cell surface.

CONCLUSION

Coating of the crystals by some component(s) of human urine might be an important physiological event in preventing adhesion or retention of crystals in the renal tubules. Although the mechanisms by which crystal adhesion is prevented are unknown, a low potential for inhibiting adhesion may be a risk factor in stone formation because it permits crystal adhesion and retention in the tubules.

Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study

BACKGROUND

We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival.

METHODS

Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions.

RESULTS

Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) (p < 0.01). The survival rates and incidences of treatment-related complications have been similar among patients treated by both methods.

CONCLUSIONS

Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence.

Treatment of spontaneous ruptured hepatocellular carcinoma

BACKGROUND/AIMS

Spontaneous rupture with bleeding is a potentially life-threatening complication of hepatocellular carcinoma (HCC). We review our experience with treatments of ruptured HCC.

METHODOLOGY

Between January 1988 and December 1997, 18 patients with ruptured HCC were admitted. The patients were divided into 4 groups according to the treatment type of ruptured HCC. Group 1 consisted of 10 patients treated by transarterial embolization (TAE) followed by elective hepatectomy. Group 2 consisted of 2 patients treated by only TAE. Group 3 consisted of 3 patients treated by emergency operation. Group 4 consisted of 3 patients who could not be treated by TAE or surgery.

RESULTS

In Group 1, 4 of the 10 patients died; 3 from recurrent HCC and 1 from cerebral hemorrhage, and hospital mortality was absent. The 1-year survival rate was 87.5%. In Group 2, both patients recovered sufficiently well to be discharged. The 1-year survival rate was 50%. In Groups 3 and 4, hospital mortality rate was 100%.

CONCLUSIONS

TAE followed by elective hepatectomy was an effective treatment in patients with ruptured HCC.

[The effects of human urine on the adhesion of calcium oxalate crystal to renal tubular cells]

PURPOSE

We examined the effects of human urine on the adhesion of calcium oxalate monohydrate (COM) crystals to Madin-Darby canine kidney (MDCK) cells in vitro.

METHODS

Quantitative assay of COM crystal adhesion to MDCK cells: MDCK cells were exposed to COM crystal suspension for 5 minutes. Various urine samples were added in the COM crystal suspension. The adherent COM crystals on the MDCK cells were dissolved by 5 N hydrochloric acid. Calcium concentration of the solution was measured by atomic absorption analysis to quantify the volume of adherent COM crystals. This assay was applied for the experiments as follows. (1) Effect of human urine on COM crystal adhesion. (2) To investigate whether human urine inhibited COM crystal adhesion by acting on the crystal surface or on the cell surface. (3) Isolation of the substance from human urine that inhibits COM crystal adhesion. (4) Comparison of the inhibitory activities of the urine between from stone formers and healthy controls.

RESULTS AND CONCLUSION

(1) Human urine had a strong inhibitory effect on COM crystal adhesion to MDCK cells. (2) The capacity of human urine to inhibit adhesion of COM crystals to MDCK cells was shown to be mediated by their ability to act on the crystal surface. (3) We isolated a macromolecular fraction (MW 60,000) that had strong capacity to inhibit cellular adhesion of COM crystals through ion exchange and gel filtration chromatography. (4) Nine urine samples from stone formers demonstrated extreme low inhibitory activities, which supposed us that the inhibitory capacity of the urine against crystal adhesion might be one of the risk factors in kidney stone formation.

[Combined coronary artery bypass with right nephrectomy in a patient with left main lesion, calcified ascending aorta, pelvic carcinoma and liver cirrhosis]

A 66-year-old female had ischemic heart disease due to left main lesion complicated with calcified ascending aorta, right pelvic carcinoma and liver cirrhosis. The combined operations with coronary artery bypass by left internal thoracic artery under the hypothermic ventricular fibrillation with cardiopulmonary bypass and right nephrectomy were performed successfully. Postoperatively Treadmill exercise test and scintigram revealed no ischemihc change. She is doing well. The aortocoronary bypass to left anterior descending artery using a left internal thoracic artery under hypothermic ventricular fibrillation with cardiopulmonary bypass might be one of surgical options for high risk patient.

Synthesis of novel poly(ethylene glycol) derivatives having pendant amino groups and aggregating behavior of its mixture with fatty acid in water

Novel poly(ethylene glycol) (PEG) derivatives having pendant amino groups were prepared by copolymerization of allyl glycidyl ether with ethylene oxide followed by chemical modification of the double bond side chains. Dropwise addition of the mixture of monomers to the anionic initiator gave an almost monodisperse (Mw/Mn = 1.05) random copolymer. 1H NMR spectra showed that addition of 2-aminoethanethiol to the pendant allyl groups of the copolymer was completely carried out in methanol without catalyst, and an aminated PEG derivative with a definite structure was obtained. Acetylation of the pendant amino groups was readily performed by acetic anhydride with triethylamine. A gel permeation chromatogram of the acetylated polymer showed a very narrow molecular weight distribution (Mw/Mn = 1.06) of the polyamine. These cationic PEG derivatives make amphiphilic polyion complexes with fatty acids, and then aggregate in water. A fluorescence study using pyrene as a microenvironment probe revealed that the aminated PEG-lauric acid ion complex could take up the hydrophobic fluorescence probe into the lipophilic field inside, and they also had a critical aggregation concentration at [lauric acid] = 0.7 mM. It is much lower than the critical micelle concentration of the corresponding fatty acid sodium salts, indicating high stability of the polymer-fatty acid aggregate.

[Interventional radiology for portal hypertension. PTO.TIO]

Percutaneous transhepatic obliteration (PTO) and transileocolic vein obliteration (TIO) are techniques of interventional radiology for embolization of collaterals due to portal hypertension 1) We can obtain good results from the precise selection of these techniques in accordance with the patient's hemodynamics and general condition. 2) Endoscopic injection sclerotherapy (EIS) combined with PTO or TIO for esophageal varices proves to be superior in reliability and durability to EIS alone, and the time before retreatment is much longer when this combination therapy is used. 3) In the intractable EIS only cases, a distinct improvement in results and prognosis appears in using PTO or TIO and also in adding more EIS thereafter. 4) After treatment with EIS and PTO or TIO for cardiac varices, we obtain better results in the disappearance rate as well as in the recurrence rate compared with EIS alone. 5) Gastric varices disappear and hepatic encephalopathy due to porto-systemic shunt is improved after PTO or TIO or using these with balloon occluded retrograde transvenous obliteration (BRTO). Thus PTO and TIO would be analogous to surgical devascularization or ligation. Therefore it is concluded that the best results would be obtained with PTO or TIO with other nonsurgical treatments.

[Clinical evaluation of endoscopic variceal ligation (EVL) using an intensive ligation method]

Endoscopic variceal ligation using an intensive ligation method, or intensive EVL, as we call it, was performed in 17 cases of esophageal varices, from August 1993 to November 1994. Intensive EVL involves making as many ligations as possible from just above the esophago-gastric junction at every session for the complete eradication of varices (F0 and negative Red color sign). Our success rate for the complete eradication of varices was 82.4% (14 out of 17 cases) with the mean number of sessions at 2.2 +/- 0.5 times. The total number of rubber bands used was 20.2 +/- 8.4, with 14.1 +/- 6.0 being used in the initial session alone. The rate of recurrence in complete eradicated cases was 50% (7 out of 14 cases) and the period to recurrence was 6.3 +/- 0.7 months. Although EVL using the intensive ligation method is useful for complete eradication of varices, a high incidence of recurrence in the short term is a concern. We conclude therefore that it is difficult to achieve long term complete eradication of varices with EVL alone, and that additional therapy is needed for long term control.

Adenoma accompanied by superficial squamous cell carcinoma of the esophagus

BACKGROUND

Adenoma of the esophagus is a rare type of esophageal submucosal tumor.

METHODS

An immunohistochemical and histopathologic study is reported of specimen from a patient with adenoma of the esophagus.

RESULTS

The eighth reported case of esophageal submucosal adenoma without Barrett epithelium is described. The patient was a 58-year-old man with an adenoma and carcinoma of the esophagus. The adenoma showed papillotubular structures lined with two layers of cuboidal cells within the submucosa and lamina muscularis mucosae, and the carcinoma was of the superficial squamous cell type confined to the submucosa.

CONCLUSIONS

Morphologic findings suggested that this adenoma had originated from the duct of the esophageal gland proper.

Adenoma accompanied by superficial squamous cell carcinoma of the esophagus

BACKGROUND

Adenoma of the esophagus is a rare type of esophageal submucosal tumor.

METHODS

An immunohistochemical and histopathologic study is reported of specimen from a patient with adenoma of the esophagus.

RESULTS

The eighth reported case of esophageal submucosal adenoma without Barrett epithelium is described. The patient was a 58-year-old man with an adenoma and carcinoma of the esophagus. The adenoma showed papillotubular structures lined with two layers of cuboidal cells within the submucosa and lamina muscularis mucosae, and the carcinoma was of the superficial squamous cell type confined to the submucosa.

CONCLUSIONS

Morphologic findings suggested that this adenoma had originated from the duct of the esophageal gland proper.

[Significance of embolization therapy for esophagogastric varices]

To evaluate the efficacy of the embolization therapy (Emb) for varices, we performed endoscopic injection sclerotherapy (EIS) alone and EIS combined with Emb. Various embolizations such as percutaneous transhepatic obliteration, splenic artery embolization and left gastric artery embolization have been employed. The efficacy rates were 76.5% of the patients in the EIS alone and 87.5% in the EIS with Emb group (EIS+Emb). The cumulative percentages of rebleeding at one year and 3 years were 23.1%, 34.6% in EIS alone, and 10.7%, 25.0% in EIS+Emb respectively. Especially in the patients with the Child C, there was significant difference in the efficacy rates: 60.0% (EIS alone) versus 88.9% (EIS+Emb), and recurrence rates within one year: 41.7% (EIS alone) versus 12.5% (EIS+Emb) (p < 0.05) and length of treatment free periods: 9.7 months versus 17.5 months (p < 0.01). After the treatments, improvement of Child's criteria was seen to be better in EIS+Emb than in EIS alone. The similar results have been obtained in the patients with hepatocellular carcinoma and with gastric varices. These results suggest that EIS should be combined with Emb to increase durability and to improve general condition.

Disposition of a new orally active dopamine prodrug, N-(N-acetyl-L-methionyl)-O,O-bis(ethoxycarbonyl) dopamine (TA-870) in humans

Dopamine (DA) levels in human plasma after oral administration of TA-870 and iv infusion of DA were measured by HPLC. The metabolites of TA-870 or DA in plasma and urine were also determined. The maximal concentrations (Cmax) of free DA in plasma after oral administration of 750 and 1500 mg of TA-870 to humans were 63 and 127 ng/ml, respectively, being higher than the concentrations of 8 and 31 ng/ml following the infusion of 1 and 3 micrograms/kg/min, the clinical doses of DA. These results demonstrated the clinical usefulness of TA-870. The plasma level of free deethoxycarbonylated TA-870 (DEC-TA-870) after oral administration of TA-870 was higher than that of DA. After oral administration of TA-870, the concentration of 3,4-dihydroxyphenylacetic acid (DOPAC) in plasma was higher than that after DA infusion, but the concentration of homovanillic acid (HVA) was about the same as that after DA infusion. The level of the total urinary metabolites (free and conjugated) after oral administration of TA-870 decreased as follows: DA greater than HVA greater than DOPAC greater than DEC-TA-870. The conjugated/free ratios of urinary metabolites after TA-870 dosing were 40-66 for DA, 0.5 for HVA, 0.6-0.9 for DOPAC, and 5.0-6.2 for DEC-TA-870. The composition of urinary metabolites after oral dosing of TA-870 was almost the same as that the DA metabolites. These results show that TA-870 is rapidly converted to DA in the human body.

[Combination therapy with etoposide, adriamycin and cisplatin in advanced primary and recurrent gastric cancer]

Fourteen patients with advanced gastric cancer consisting of seven primary cases and seven recurrent cases were treated with the combination of etoposide, adriamycin and cisplatin (EAP). One of the primary cases (14%) and three of the recurrent cases (43%) responded to the therapy, but a high incidence of toxicities including leukopenia, thrombocytopenia, alopecia, nausea and vomiting was observed. It is concluded that EAP therapy can be useful in the treatment of advanced gastric cancer if countermeasures to the toxicities of these drugs are considered.