Prevention of intimal hyperplasia employing the cavitary two-layer method in allogeneic rat heart transplantation.

BACKGROUND: The development of graft arteriosclerosis is a significant contributor to chronic rejection in organ transplant recipients. The purpose of the present study was to establish whether or not the cavitary two-layer method can prevent graft arteriosclerosis after rat heart transplantation. METHODS: F-344 rats served as donors to Lewis recipients. Grafts in the control group (group C) were immediately allotransplanted without preservation. Grafts were also transplanted after cold preservation for 3 h in University of Wisconsin solution (group UW), or employing the cavitary two-layer (CTL) method (group TL). In another group (group W), grafts were subjected to 15-min warm ischemia and then transplanted. Grafts damaged by ischemia were also transplanted after preservation for 3 h using CTL (group WTL). We measured intimal thickening (IT) before transplantation and at 30 and 60 d post-transplant and also assessed the expression of heat shock proteins (HSPs). RESULTS: At 60 d post-transplant, IT in group WTL was significantly lower than in group W (0.30 ± 0.03 versus 0.45 ± 0.04, respectively). In contrast, no significant changes were observed in the cold storage groups. Expression of HSPs 60 and 70 at 60 d in group WTL (25.40% ± 1.64% and 35.96% ± 2.65%, respectively) was reduced compared with group W (46.07% ± 5.84% and 55.11% ± 1.54%, respectively). CONCLUSIONS: CTL reduces IT induced by warm ischemia in rat heart transplantation, and allows the maintenance of low HSP 60 and 70 expression.

[Risk factors for recurrence of stage II colon cancer].

PURPOSES: This study was designed to clarify risk factors for the recurrence of stage II colon cancer in patients and to determine possible treatment options for postoperative adjuvant chemotherapy. SUBJECTS AND METHODS: The subjects were 132 patients with stage II colon cancer who underwent surgery in this department from January 1998 to December 2007. Various high risk factors for recurrence and factors indicative of poor prognosis were examined (age, gender, site of tumor, maximum tumor diameter, invasion depth, histopathological classification, D number, ly, v, number of biopsied lymph nodes, preoperative tumor marker values and presence of postoperative adjuvant therapy). RESULTS: The group with postoperative adjuvant therapy had a better prognosis than the others (p=0. 0168). Groups with an absence of postoperative adjuvant therapy (p=0. 041), presence of vessel involvement (p=0. 0127), and poorly-differentiated types (p=0. 027)were extracted in a multivariate analysis of risk factors for recurrence. CONCLUSIONS: Postoperative adjuvant therapy was effective for stage II colon cancer. Vessel involvement and poorly-differentiated types were risk factors for recurrence of stage II colon cancer.

[A case of AFP-producing gastric carcinoma, in which liver metastases were eliminated successfully underwent total gastrectomy after chemotherapy].

A 64-year-old man was admitted to our hospital for severe anemia, and a thorough examination revealed an AFP-producing gastric cancer with multiple liver metastases. He was treated with S-1, and liver metastases were reduced. However, the originalgastric tumor did not disappeare. We administered paclitaxelas second-line treatment, and CDDP/CPT-11 as thirdline treatment, intravenously. In August 2006, liver metastases were not detected, so he underwent total gastrectomy and lymph node dissection. The final stage was StageIB(mp, n0). He has had no recurrence as of 36 months postoperatively.

Usefulness of performing a pancreaticojejunostomy with an internal stent after a pancreatoduodenectomy.

PURPOSE: In pancreaticojejunostomy (PJ), the occurrence of an injury during the removal of a stented tube is sometimes related to pancreatitis or late-onset stenosis of the pancreatic duct. In this study, we compare the outcomes of a PJ with an external stent versus an internal stent in a randomized study. METHODS: We compared the complications including pancreatic fistula, mortality, and postoperative hospital stay of 43 patients who had PJ with an external stent (group E) or PJ with an internal stent (group I) after a pancreaticoduodenectomy (PD). RESULTS: Pancreatic fistula occurred in 8 patients (36.4%) in group E, while it only was seen in 7 patients (33.3%) in group I. Pancreatitis was recognized in 3 patients in group E, while there was no patient in whom an obstruction due to an internal stent was suspected. CONCLUSION: Pancreaticojejunostomy with an internal stent is therefore considered to be an effective treatment alternative after PD, with an acceptable morbidity and no mortality.

Ischemically damaged heart after preservation by the cavitary two-layer method as a possible donor in rat heart transplantation.

BACKGROUND: The purpose of this study was to examine the possibility of using an ischemically damaged heart, after preservation by the cavitary two-layer (CTL) method, as a donor in heart transplantation. METHODS: Each donor heart was heterotopically transplanted to the recipient aorta. The grafts in Group 1 were immediately transplanted. In Group 2, the grafts with (a) 15- or (b) 30-minute warm ischemia were transplanted. The ischemically damaged grafts were transplanted after preservation for 3 hours in University of Wisconsin (UW) solution (Group 3) or CTL (Group 4). Five-day animal survival, tissue adenine triphosphate (ATP) concentration, biochemical assay and histopathologic data were obtained. RESULTS: Five-day survival in Group 4a was 7 of 8, with significant recovery of the ATP tissue level (9.31 +/- 0.80 micromol/dry weight). Biochemical and pathologic examinations demonstrated that ischemia-reperfusion injury was prevented in Group 4a compared with Group 2a. CONCLUSIONS: An ischemically damaged rat heart preserved for 3 hours by CTL was found to be a potential donor in rat heart transplantation.

Impact of gemcitabine on the survival of patients with stage IV pancreatic cancer.

OBJECTIVES: The prognosis of patients with advanced pancreatic cancer remains very poor. This study was designed to elucidate the prognostic factors of patients with pancreatic cancer to evaluate appropriate treatment with gemcitabine. METHODS: Ninety-nine consecutive patients with stage IV pancreatic cancer were treated in the gemcitabine era at the Kobe University Hospital. Prognostic variables for survival were analyzed (sex, age, performance status, main site of the tumor, tumor size, major vessel invasion, distal metastasis, resection, gemcitabine, radiation, and pathological factors). The Cox proportional hazards model was used to determine the factors influencing the survival of patients with stage IV pancreatic cancer. RESULTS: Multivariate analysis revealed that pancreatic resection, gemcitabine, and distant metastasis significantly influenced the survival of all patients with stage IV pancreatic cancer. Pancreatic resection and gemcitabine were significant factors influencing the survival of patients with stage IVa pancreatic cancer, whereas gemcitabine was the strongest factor influencing stage IVb pancreatic cancer. CONCLUSIONS: Gemcitabine has a possible role for stage IV pancreatic cancer.

Application of the two-layer method on pancreas digestion results in improved islet yield and maintained viability of isolated islets.

BACKGROUND: Oxygenation of the pancreas during preservation by the two-layer method (TLM) has shown beneficial effects in islet transplantation. Here, we apply this concept (oxygenation) to the isolation process. METHODS: Rat pancreases were digested using four different methods. Pancreases were digested with preoxygenated perfluorocarbon (PFC) in group 2 and without it in group 1. Additionally, adenosine was included in the collagenase solution in subgroups B but not in subgroups A. Islet yields and viability were compared between groups. RESULTS: Tissue oxygen tension in group 1 was essentially zero during digestion, but rapidly reached around 300 mm Hg and was maintained in group 2. The tissue adenosine triphosphate (ATP) level in rat pancreas just after laparotomy (control) was 4.2+/-0.7 micromol/g dry weight; after digestion, it was 0.12+/-0.03 micromol/g, 0.70+/-0.10 micromol/g, 0.30+/-0.18 micromol/g, and 2.90+/-0.80 micromol/g in groups 1A, 1B, 2A, and 2B, respectively. No significant differences were observed between group 2B and control (P=0.19). Islet yields (IEQ/pancreas) were 1600+/-400, 1400+/-400, 1300+/-400, and 2400+/-100 in groups 1A, 1B, 2A, and 2B, respectively. The islet yield of group 2B was significantly higher than other groups (P<0.05). The cure rate after transplanting 200 islets into athymic nude mice did not differ (80% in all groups). The stimulation indices in the four groups were also the same. CONCLUSIONS: Tissue ATP levels after digestion were well maintained using TLM with adenosine digestion method. Consequently, greater numbers of islets could be retrieved. The new method was at least equivalent to islet function isolated by conventional method. Clinical study is therefore warranted.