Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases.

BACKGROUND: Despite the gradual diffusion of laparoscopic liver resection, the feasibility and results of laparoscopic two-stage hepatectomy (TSH) for bilobar colorectal liver metastases (CRLM) have not been described frequently. This study aimed to evaluate the feasibility, safety and oncological outcomes of laparoscopic TSH for bilobar CRLM. METHODS: All patients eligible for laparoscopic TSH among those treated for bilobar CRLM from 2000 to 2013 were included. Demographics, tumour characteristics, surgical procedures, and short- and long-term outcomes were analysed. RESULTS: Laparoscopic TSH was planned in 34 patients with bilobar CRLM, representing 17·2 per cent of all 198 patients treated for bilobar CRLM. Thirty patients received preoperative chemotherapy, and 20 had portal vein occlusion to increase the volume of the remnant liver. Laparoscopic resection of the primary colorectal tumour was integrated within the first-stage hepatectomy in 11 patients. After a median interval of 3·1 months, 26 patients subsequently had a successful laparoscopic second-stage hepatectomy, including 18 laparoscopic right or extended right hepatectomies. The mortality rate for both stages was 3 per cent (1 of 34), and the overall morbidity rate for the first and second stages was 50 per cent (17 of 34) and 54 per cent (14 of 26) respectively. Mean length of hospital stay was 6·1 and 9·0 days respectively. With a median follow-up of 37·8 (range 6-129) months, 3- and 5-year overall survival rates in patients who completed TSH were 78 and 41 per cent respectively. The 3- and 5-year disease-free survival rates were 26 and 13 per cent respectively. CONCLUSION: Laparoscopic TSH for bilobar CRLM is safe and does not jeopardize long-term outcomes in selected patients.

The role of polyamines in liver regeneration after hepatectomy with ischemic injury.

A total of 175 rats were divided into: (1) a sham operation group, in which the liver was slightly mobilized after laparotomy; (2) a control group in which 68% of the liver was resected without the blockade of blood flow; (3) an ischemia + hepatectomy group, in which the vessels entering the right and caudate lobes were clamped for 30 min, and the nonischemic lobes were resected; (4) a DFMO + ischemia + hepatectomy group, in which the same procedure as for the ischemia + hepatectomy group was performed, but the animals received alpha-difluoromethylornithine (DFMO); (5) a DFMO + Put + ischemia + hepatectomy group, in which the animals underwent the same procedure, but were given putrescine (Put) in addition to DFMO. There were 6 to 7 rats in each of the five groups. The putrescine level and ornithine decarboxylase (ODC) activity were significantly higher in the ischemia + hepatectomy group than in the control group, but were markedly decreased in the DFMO + ischemia + hepatectomy group. However, the lipid peroxide level was significantly higher in the DFMO + ischemia + hepatectomy group than in the ischemia + hepatectomy group. The incorporation of [3H]thymidine in the DFMO + ischemia + hepatectomy group was significantly lower than that in the control group. The increase in the lipid peroxide level and the decrease in [3H]thymidine found in the DFMO + ischemia + hepatectomy group tended to be reversed by the administration of putrescine. These results suggest that putrescine suppressed the production of lipid peroxides and promoted DNA synthesis in regenerating the liver after ischemia-reperfusion injury.

Changes in subcellular and zonal distribution of glucokinase in rat liver during postnatal development.

Subcellular and zonal distribution of glucokinase in rat liver during postnatal development was examined immunohistochemically. Before day 11 after birth, only some hepatocytes were immunostained, and a positive immunostaining was found in the cytoplasm but not in the nucleus. No zonal distribution of glucokinase was observed in livers of such pups. From day 15, at which time a dietary change from milk to laboratory chow begins to take place, glucokinase immunoreactivity increased; this increase was associated with increases in glucokinase activity and in glucokinase protein, and also the immunostaining was observed mainly in the nuclei. At day 21, the glucokinase immunoreactivity was found almost exclusively in the perivenous zone. At day 30, an intense immunostaining was seen both in the perivenous zone and in the periportal zone, being slightly predominant in the former. The present results indicate that dramatic changes in the distribution of glucokinase in developing rat liver may be related to dietary change.

Tissue and subcellular distribution of glucokinase in rat liver and their changes during fasting-refeeding.

The distribution of glucokinase in rat liver under both normal feeding and fasting-refeeding conditions was investigated immunohistochemically. Under normal feeding conditions, glucokinase immunoreactivity was observed in both nuclei and cytoplasm of parenchymal cells. The nuclei were stained intensely and evenly, whereas the cytoplasm showed weak immunoreactivity of different degrees of staining intensity depending on the location of the cells. The cytoplasm of perivenous hepatocytes was stained more intensely, though not so much more, than that of periportal hepatocytes. The cytoplasm of hepatocytes surrounding the terminal hepatic venule (THV), of hepatocytes surrounding the portal triad, and of some other hepatocytes showed a stronger immunoreactivity than that of residual hepatocytes. The nuclear immunoreactivity in hepatocytes surrounding the portal triad and in some other hepatocytes was weak or absent, and positive immunoreactivity was detected at the plasma membrane of some of these cells. After 72 h of fasting, glucokinase immunoreactivity was markedly decreased in all hepatocytes. After the start of refeeding, the cytoplasmic immunoreactivity began to increase first in the parenchymal cells surrounding the THV and extended to those in the intermediate zone followed by those in the periportal zone. In contrast, the increase in nuclear immunoreactivity started in hepatocytes situated in the intermediate zone adjacent to the perivenous zone and then extended to those in the perivenous zone followed by those in the periportal zone. Hepatocytes surrounding either THV or portal triad showed a distinctive change in immunoreactivity during the refeeding period. After 10 h of refeeding, strong immunoreactivity was observed in both the cytoplasm and the nuclei of all hepatocytes, and appreciable glucokinase immunoreactivity was detected at the plasma membrane of some hepatocytes. These findings are discussed from the standpoint of a functional role of glucokinase in hepatic glucose metabolism.

Purification of rat liver glucokinase.

A new purification method for rat liver glucokinase was developed. Glucokinase was purified to homogeneity in a yield of 70% in 5 days. The procedure consists of DEAE-cellulose ion-exchange chromatography, QAE-Toyopearl ion-exchange chromatography, glucosamine-Sepharose affinity chromatography, and HiLoad Superdex 200 gel filtration. Purified glucokinase had a specific activity of 200 units/mg protein and was highly stable in the presence of 100 mM glucose, 300 mM KCl, and 20% glycerol. We found that some of the methionine residues of glucokinase were oxidized to methionine sulfoxide residues during dialysis in the presence of glucose. It would appear that this oxidation is caused by formation of hydroxyl radicals in the presence of glucose and contaminating transition metal(s).

Evidence for glucokinase translocation by glucose in rat hepatocytes.

By an immunohistochemical technique, we examined changes in the subcellular distribution of rat liver glucokinase in response to external stimuli. Glucokinase immunoreactivity was found predominantly in the nucleus of hepatocytes. In situ perfusion of the liver with 20 mM glucose for 10 min caused a marked decrease in nuclear immunoreactivity and an increase in cytoplasmic immunoreactivity. Insulin (10 nmol/l) potentiated this glucose effect. However, no change took place when 5 mM glucose was perfused. These results indicate that glucokinase is translocated from the nucleus to the cytoplasm in response to a high concentration of glucose.

Two interconvertible forms of glucose-6-phosphate isomerase in rat muscle.

Chromatography of crude rat muscle extracts on CM-cellulose resulted in separation of glucose-6-phosphate isomerase (GPI) into two active peaks (designated types I and II in order of elution). Incubation of type I and type II at pH 6.0, 7.0, or 8.0 in the presence and absence of KCI revealed that one type of GPI is converted to the other type under certain conditions and that the two types are interconvertible by changing the incubation conditions. The two types were similar in molecular weight, kinetic property, and optimum pH. A remarkable difference was observed in pH-activity profile: the activity of type I, but not type II, was detectable at pH 6-7. The present results suggest that rat muscle has two types of GPI which are interconvertible and that the two types may be conformational variants of the same enzyme. It is conceivable that the interconversion between the two types is related to the regulation of glycolysis at lower intracellular pHs.

[Primary malignant lymphoma of the esophagus--a case report].

We report a rare case of primary malignant lymphoma of the esophagus without extraesophageal involvement. A 69-year-old woman was referred to our hospital because of dysphagia. Esophagogram revealed an irregularly marginal ulceration with stenosis at the abdominal esophagus. Endoscopic study showed an ulcerative lesion at the level of 30 cm from the incisor teeth. Esophagocardiectomy was performed. Resected specimen showed a shallow depressed ulceration, 6.5 x 6.0 cm in size, at the lower esophagus. Microscopic examination revealed malignant lymphoma of diffuse, large cell type. No evidence of involvement was found in the dissected lymph nodes and the bone marrow biopsy specimens. She has been well for 4 years and 6 months postoperatively.

[Three cases of lung cancer with bulla].

We present three cases of lung cancer with bulla, which were preoperatively detected by TBLB or brushing cytology. Case 1:55 year-old man. Large-cell carcinoma of the right upper lobe. A giant bulla had been observed eight years earlier. The carcinoma protruded into the bulla just like a pedunculated polyp. Case 2: 67-year-old woman. Adenocarcinoma with severe fibrosis adjoined to the bulla of the right upper lobe. Case 3: 63-year-old man. Adenocarcinoma surrounding the central margin of the subpleural giant bula of the right lower lobe. We also discussed the clinical and pathological problems of lung cancer with bullous disease.