Clinical features of hepatocellular carcinoma supplied by the left internal mammary artery

Purpose

To evaluate the clinical features of hepatocellular carcinoma (HCC) supplied by the left internal mammary artery (LIMA).

Materials and methods

This cohort included 12 HCCs of 12 patients supplied by the LIMA. The clinical features of these tumors were analyzed.

Results

The tumor diameters were 4.2 ± 4.4 cm (mean ± SD) located at the surface of segments 4 (n = 6), 3 (n = 3), 2 (n = 2), and 4–8 (n = 1), respectively. The tumor was supplied by the phrenic branch (n = 8) or musclophrenic artery (n = 4) entirely (n = 7) or partially (n = 5). Two patients with large tumors 10 and 16 cm in diameter, respectively, received no previous treatment. Ten patients had previously undergone 5.8 ± 3.7 TACE sessions including through extrahepatic collaterals. Selective TACE could not be completed in one. No TACE-related complications developed. Of 11 embolized tumors, six did not recur at 8.8 ± 4.6 months and five recurred 4.4 ± 2.6 months later.

Conclusion

The clinical features of HCC supplied by the LIMA can be divided into two categories, untreated large tumors and small tumors receiving multiple TACE sessions at the subcapsular area of the left hepatic lobe.     

Probiotics promote rapid-turnover protein production by restoring gut flora in patients with alcoholic liver cirrhosis

Background and aims

Accumulating evidence suggests that deterioration of the gut flora contributes to the pathogenesis of alcoholic liver cirrhosis (ALC). However, the ALC flora profile and its response to probiotic treatment have not been fully examined. This double-blind placebo-controlled study aimed to evaluate whether the probiotic beverage Yakult 400 (Y400), which contains Lactobacillus casei strain Shirota, improves liver function in ALC patients, and to analyze the precise gut flora profile by real-time quantitative PCR (qPCR).

Methods

A total of 37 hospitalized ALC patients were randomly allocated to Y400 (n = 18) and placebo (n = 19) groups. Y400 or placebo was served twice a day during the first half of the four-week study. Serum concentrations of rapid-turnover proteins (i.e., transthyretin and transferrin), hypersensitive C-reactive protein, and interleukin-6 were measured weekly. qPCR analysis of fecal bacteria was performed biweekly; stocked fecal samples from 46 healthy subjects were used as references.

Results

Serum transthyretin levels significantly increased in the Y400 group in week 3; similar—although statistically insignificant—increases were seen for transferrin and albumin. Levels of hypersensitive C-reactive protein, but not interleukin-6, significantly decreased in week 4. Before treatment, populations of obligate anerobic bacteria were significantly smaller and those of Enterobacteriaceae were larger in patients than in healthy subjects examined in a previous study. Y400 corrected this imbalance.

Conclusions

This is the first report describing the unique gut flora of ALC patients. Y400 treatment normalized the gut flora and improved liver function. These promising findings warrant further investigation in larger, multicenter studies.     

Occlusion of the abdominal aorta caused by enlargement of the false lumen after graft replacement for a DeBakey type IIIb dissecting aneurysm: Report of a case

(Received for publication on July 10, 1997; accepted on Mar. 10, 1998)     

A case of graft replacement of the ascending aorta to the aortic arch and the partial descending aorta in a single stage for thrombosed aortic dissection (debakey type II + IIIB)

We report here a case of graft replacement of the ascending aorta to the aortic arch and the middle portion of the descending aorta in a single stage for thrombosed aortic dissection. The patient was a 53-year-old male who was transfered to our hospital with a diagnosis of thrombosed aortic dissection. Conservative therapy was continued but three weeks after the onset, chest enhanced CT scan and digital subtraction angiography revealed an opacified false lumen in the ascending aorta and a ulcer like projection in the middle portion of the descending aorta. He was therefore diagnosed as having redissection in DeBakey type II + IIIb thrombosed aortic dissec- tion. Graft replacement of the ascending aorta, the aortic arch, and a part of the descending aorta was performed in a single stage via median stenotomy with the aid of extracorporeal circulation and selective cerebral perfusion. Postoperative digital subtraction angiography showd satisfac- tory reconstruction of the thoracic aorta. The patient is still leading a normal life two years after the operation.     

Significance of the concentrated red cell and albumin priming method with particular reference to anaphylatoxin generation.

Anaphylatoxins generated by cardiopulmonary bypass were observed in basic and clinical studies (n = 120 in the latter). In vitro immunoglobulin fractions denatured by oxygen bubbling produced C4a, C3a, and C5a, but albumin identically treated did not. Therefore concentrated red cells with albumin were used to prime homologous blood for clinical application during cardiopulmonary bypass. Complement levels were compared with type of oxygenator (bubble or membrane) and the ratio of primed homologous blood to circulating autologous blood volume. With the bubble oxygenator at a low ratio of homologous to autologous blood (arbitrarily defined as less than 20%), C3a levels during cardiopulmonary bypass tended to be lower in the concentrated red cells plus albumin priming group than in the ordinary priming group (p less than 0.1, at 60 and 90 minutes of cardiopulmonary bypass). C4a and C3a levels increased less after protamine administration with concentrated red cells plus albumin priming (p less than 0.05, p less than 0.01, respectively, 90 minutes after protamine) than with ordinary priming. Such changes in the membrane oxygenator group were less remarkable. Thus C3a levels were approximately the same in both oxygenator groups primed with concentrated red cells plus albumin. The higher the homologous to autologous ratio, the steeper the C4a and C3a increase from the beginning of cardiopulmonary bypass with the bubble oxygenator. This tendency was less remarkable in the membrane oxygenator group. Early postoperative pulmonary function was improved by concentrated red cells plus albumin priming, especially in the bubble oxygenator group. In conclusion, (1) oxygenator systems primed with concentrated red cells plus albumin produced less anaphylatoxin than those with homologous blood, especially with the bubble oxygenator, and (2) our clinical results support the importance of immunoglobulin denatured by oxygen bubbling in anaphylatoxin generation (by means of the classical pathway), as shown by our in vitro study.     

Hyperthermia for brain tumors: improved delivery with a new cooling system

Hyperthermia has emerged as an adjunct to other forms of brain tumor therapy. Interstitial microwave irradiation is an effective method of inducing localized brain hyperthermia. One of the problems with this technique, however, is the overheating of tissue adjacent to the antenna. In this study, a cooling system for the interstitial microwave antenna was developed for the purpose of providing uniform and accurate heating by the elimination of overheating. The ability to generate more uniform hyperthermic fields was evaluated in normal monkey brains. Six monkeys under general anesthesia and controlled respiration underwent parietooccipital craniectomies 4 x 4 cm in size. The antenna cooling system was constructed of a silicone tube 5.0 mm in outer diameter. Silicone-coated interstitial microwave antennae 1.5 mm in diameter were used. A single antenna or a square array (1.6 cm on a side) of 4 antennae was inserted into the brain with the coupled system to a depth of 2 cm. The brain tissue was heated by 2450-MHz microwave irradiation. Temperature distributions were mapped using nonperturbing thermocouples. These thermal profiles were compared with those generated without the cooling system. In the experiments with the single antenna, the antenna cooling system eliminated the overheating and rapid radial falloff in temperature, without a reduction of the hyperthermic field. In the four-antennae experiments using the cooling system, the thermal field was dramatically flattened with minimal reduction in size; however, the area maintained at a therapeutic temperature range (42-45 degrees C) was significantly enlarged by the cooling system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of nucleotide and nucleoside mixture on rats given total parenteral nutrition after 70% hepatectomy

After partial hepatectomy rats were used as a model of patients with liver tumor after extensive hepatectomy. Supplementation of a nucleotide and nucleoside mixture to the total parenteral nutrition solution in rats after 70% hepatectomy resulted in earlier restoration of the nitrogen balance in the first 3 days than the solution without this supplementation. This supplementation had no unfavorable effects on the compositions of the blood and urine, and particularly the metabolites of nucleic acids such as uric acid, beta-alanine, and beta-aminoisobutyric acid. A suitable ratio of nucleotides plus nucleoside to amino acids was tentatively concluded to be 1:2 g N with a calorie supply of 400 kcal.