[A case of renal oncocytoma with synchronous contralateral renal cell carcinoma].

A case of bilateral, synchronous renal cell carcinoma and oncocytoma is reported. The patient was a 70-year-old woman. Computed tomographic scan revealed bilateral low density masses, which had a diameter of approximately 4 cm (right kidney), and 2.5 cm (left kidney). We suspected bilateral renal cell carcinomas, and performed, right nephrectomy and left enucleation of the tumor. Pathological diagnosis was right renal cell carcinoma and left oncocytoma. To our knowledge only 5 previous cases of renal cell carcinoma associated with oncocytoma have been reported in Japan. Two cases were metachronous and three cases were unilateral and synchronous. This is the first reported case of bilateral, synchronous renal cell carcinoma and oncocytoma.

[Bellini duct carcinoma of the kidney: a case report].

A case of Bellini duct carcinoma is reported. A 71-year-old woman visited our hospital with a chief complaint of lower abdominal pain. Computerized tomography, ultrasonography showed a mass lesion measuring about 5 cm in the right kidney. Angiography showed an avascular mass lesion in the right kidney. Right radical nephrectomy was performed under the diagnosis of renal cell carcinoma. Histological examinations showed Bellini duct carcinoma of the papillary type. We performed M-VAC (methotrexate, vinblastine, doxorubicin, icisplatin) therapy as is used for transitional cell carcinoma. She is alive with no evidence of disease 5 months after her surgical treatment. To our knowledge, only 32 cases of Bellini duct carcinoma have been reported in the Japanese literature.

Living related liver transplantation in Oklahoma.

Living related liver transplantation (LRLT) presents several advantages as compared to cadaveric liver transplantation, and it has become an increasingly popular option for children with end-stage liver diseases. Since 1995, five LRLT procedures have been performed at the authors' facility. Recipients were three boys and two girls, whose mean age was 2.6 years. Recipients' primary diagnoses were primary hyperoxaluria (PH) (n = 3), Alagille's syndrome (n = 1), and Byler's disease (n = 1). Left lateral segments harvested from their parents were used as the liver grafts on all patients. The donors included three mothers and two fathers, with a mean age of 29 years. Tacrolimus with steroids was used as immunosuppressive therapy. In all cases (mean follow-up time of 11 months), graft function was excellent and four children are doing very well. One boy died of post-transplant lymphoproliferative disorder (PTLD) 7 months after LRLT. All donors are doing very well with no postoperative complications. The authors believe that LRLT is a safe procedure for both the donor and the recipient, and provides, in children, an excellent alternative to cadaveric liver transplantation.

Measurement of portal venous flow velocity with an implantable miniature Doppler probe in pig liver transplantation.

Portal venous flow (PVF) was serially monitored after pig liver transplantation (LTX) with the use of an implantable, miniature Doppler probe developed in our laboratory. Throughout the study period, the mean PVF in pigs that underwent LTX was significantly greater than that in pigs that were sham operated. For three animals with early graft failure secondary to primary nonfunction and for six that survived longer than 7 days, the mean PVF on postoperative day (POD) 1 was 18.7 +/- 3.8 cm/s and 41.7 +/- 11.2 cm/s, respectively (P < 0.05). For animals with acute cellular rejection (ACR), the mean PVF was 61.3 +/- 9.9 cm/s on POD 7 and 54.3 +/- 6.38 cm/s on POD 14. These values were significantly higher than those for animals without ACR (P < 0.05). Moreover, the increase in PVF correlated well with the degree of ACR. The actual PVF volume was measured by ex vivo perfusion, which showed a clear correlation with the PVF velocity obtained with the implanted, miniature Doppler probe. We feel that the liver graft requires increased PVF volume after transplantation to facilitate functional recovery from damage to hepatocytes due to preservation-reperfusion injury, and that ACR is also associated with an increased PVF. We conclude that monitoring the PVF in the early postoperative period after LTX is useful in the evaluation of graft function, particularly for predicting primary nonfunction and severity of ACR.

Fas antigen expression of hepatocytes and its modification by immunosuppressants.

Active cell death induced by ligation of the Fas antigen (Fas-Ag) with its antibody, Fas ligand (Fas-L), has been known to play a major role in cell killing via apoptosis by cytotoxic T lymphocytes (CTL). Thus, in liver transplantation, Fas-Ag expression of hepatocytes and its modification by immunosuppressive agents such as FK 506 or CsA can theoretically influence allograft survival. Mouse hepatocytes (BALB/c) were isolated and cultured with or without FK 506 or CsA, and Fas-Ag expression was determined by flow cytometry. Fas-Ag expression in the control was 17.2 +/- 2.5% after 24 hr of culture. When FK 506 or CsA was added, Fas-Ag expression with FK 506 at a concentration of 0.01-0.1 microg/ml was significantly lower than that with CsA (P < 0.05). When the cells were incubated with apoptosis-inducing anti-Fas-Ag monoclonal antibody, agarose gel electrophoresis of the control cells yielded a typical pattern of DNA fragmentations. The cells with FK 506 at 0.01 microg/ml yielded the least DNA fragmentation. These findings suggested that in the in vivo setting, the hepatocytes of the allograft would have a lower chance of being attacked by CTL in the host treated with FK 506.