Effects of plasma from patients with fulminant hepatic failure on function of primary rat hepatocytes in three-dimensional culture.

BACKGROUND/AIM: As biotechnology continues to advance, a bioartificial liver is expected to be developed for the treatment of patients with fulminant hepatic failure (FHF) whose liver dysfunction is potentially reversible or for providing liver support as a bridge to liver transplantation. While monolayer-cultured hepatocytes rapidly lose their capacity to express many liver-specific functions over time when cultured, spherical-shaped hepatocytes in three-dimensional culture with the use of extracellular matrix components sustain long-term survival by maintaining differentiated hepatocyte functions. The aim of this study was to investigate whether sufficient functions of viable spherical-shaped hepatocytes could be maintained in plasma of patients with FHF in order to use these cells in an extracorporeal system. METHODS: Hepatocyte functions were evaluated under monolayer or three-dimensional culture in FHF plasma. RESULTS: Primary rat hepatocytes on poly-N-p-vinylbenzyl-D-lactonamide (PVLA) formed spheroids even in FHF plasma and maintained their spherical shapes in FHF plasma as long as in medium. Spherical-shaped hepatocytes on PVLA cultured in FHF plasma showed higher activity in albumin secretion, urea formation, and gluconeogenesis than those in normal human plasma or medium. As being cultured in medium, hepatocytes on PVLA cultured in plasma were also superior to cells on collagen in regard to albumin secretion, amino acid metabolism, and gluconeogenesis. CONCLUSIONS: These findings demonstrated that FHF plasma is not toxic to rat hepatocyte spheroids and that hepatocyte spheroids have potential use in the development of a bioartificial liver.

Metachronous colon tumors: risk factors and rationale for the surveillance colonoscopy after initial polypectomy.

PURPOSE: We analyzed the possible risk factors for metachronous colon tumors after endoscopic resection of initial tumors. METHODS: Three hundred and twenty-one patients entered the surveillance study after colonoscopic resection of initial tumors between 1985 and 1999. Histology of initial tumors was adenoma in 214 patients and carcinoma in 107 patients. Solitary tumor was observed in 196 patients and multiple tumors in 125 at initial endoscopy. The median surveillance period was 39 (range, 12-112) months, and the median frequency of surveillance colonoscopy was three (range, 2-10) times. RESULTS: Metachronous neoplasms were identified in 114 of 321 surveillance cases (36%). In the 114 cases, the number of patients with metachronous adenoma was 103 (90%) and that of carcinoma was 11 (10%). Clinical characteristics at entry - including age, gender, multiplicity of polyp, histology of polyp, and site of polyp - were not different between patients with metachronous tumors and those without metachronous tumors. Kaplan-Meier analysis revealed that patients with a histology of carcinoma and those with multiple polyps at entry developed metachronous tumors significantly earlier than did patients with initial adenomas and initial solitary polyp, respectively ( P<0.001, P<0.001). However, other characteristics at entry did not produce significant differences in the rate of the development of metachronous tumors using Kaplan-Meier analysis. Proportional hazards model analysis revealed that histology of the initial tumor as carcinoma (relative risk, 1.690, 95% confidence interval, 1.118-2.555) and multiplicity (1.472, 1011-2.143) were significant risk factors for metachronous colon tumors. The 75%, 50%, and 25% metachronous tumor-free periods after initial polypectomy were 14, 21, and 39 months, respectively. CONCLUSIONS: These results may help optimizing surveillance strategies for metachronous colon tumors and raising the economic benefit of colonoscopy.

[A new combination therapy with low-dose FP and daily oral administration of low-dose etoposide--a report of 2 cases].

We report 2 patients with advanced gastric cancer treated with a new combination chemotherapy of low-dose FP and daily oral administration of low-dose etoposide. Patient 1 was an 84-year-old man. He was diagnosed with cancer of the remnant stomach with multiple liver metastases. For eight months, he was treated as an outpatient and his performance status (PS) stayed at stage 1. Patient 2 was a 67-year-old man with lymph node metastasis of the lung. For the first 6 weeks, he was treated under hospitalization and for the following 10 months he was treated as an outpatient. His PS remained in stage 1 and blood CEA value fell from 2,420 ng/ml to 46.9 ng/ml. Upper gastrointestinal series showed a recovery of the extension of his lower gastric body. Both cases were so-called prolonged NC. From the viewpoint of patient QOL, this new combination is a possible candidate for a more effective chemotherapy.