Off-pump coronary artery bypass grafting: comparison between standard CABG and off-pump CABG

We have performed 321 cases of coronary artery bypass grafting (CABG), between October 15 1995 and November 20 2000. We have evaluated the operative results of 142 cases (44.2%) of conventional CABG and 179 cases (55.8%) of off-pump CABG performed during this period. The average numbers of bypassed grafts was 3.53 for conventional CABG, and 1.62 for off-pump CABG. The total number of 369 grafts were anastomosed to 501 coronary arteries for conventional CABG, and 283 grafts were anastomosed to 290 coronary arteries for off-pump CABG. RESULTS: Although two saphenous veins were occluded, the early postoperative patency rate was 100% for conventional CABG using RITA, LITA, GEA and RA. Three site of stenosis in 18 LITAs and 2 in 16 RITAs were recognized in off-pump CABG without the use of stabilizers. One site of stenosis in 130 LITAs and 3 string signs in 44 GEA were recognized in off-pump CABG with the use of stabilizers. Postoperative angiography in 52 off-pump CABG cases at one year later showed no new lesion. CONCLUSION: The use of stabilizers and LIMA suture enables adaptation of the MIDCAB procedure to a wider range of coronary artery bypass procedures, and a higher graft patency can be expected.     

The influence of thermal history on water associated with polyelectrolytes and cellulose

The formation of freezing water as a function of temperature and time has been studied in polyelectrolytes and in cellulose. In such systems, a portion of the sorbed water is not crystallizable under normal conditions. However, it was observed that in rapidly cooled systems the ratio between freezing and non-freezing water is variable and depends on the annealing temperature. The difference between the saturated concentration of freezable water and the concentration of freezing water which is formed immediately after the rise of the sample's temperature is dependent on the materials geometry. It is assumed that the rise of the annealing temperature above room temperature increases the amount of mobile water which can crystallize. By comparing the measured concentration of freezing water with desorption analysis, the average distance of transportation of mobile water for sodium carboxymethylcellulose was calculated as 8–10 μm.     

Successful treatment of gallbladder carcinoma producing alpha-fetoprotein with segmental adenomyomatosis

The successful treatment of hepatoid adenocarcinoma of the gallbladder with elevated serum alpha-fetoprotein (1243 ng/ml) and segmental adenomyomatosis in a 58-year-old woman is described. The woman had alpha-fetoprotein (AFP)-producing carcinoma of the gallbladder with regional lymph node metastasis and was treated by extended radical resection and postoperative adjuvant chemotherapy. She is alive, showing normal serum AFP concentration and no recurrence, 57 months after surgery. The tumor cells were stained immunohistochemically for AFP by the peroxidase anti-peroxidase method. Serum AFP reactivity to concanavalin A and lentil lectin was similar to the pattern shown in hepatocellular carcinoma. Only a few cases of AFP-producing gallbladder carcinoma have been reported and there have been no reports of long-term survivors. The combination of aggressive radical resection and chemotherapy seems to have been effective for achieving long-term survival without liver metastasis.     

The effects of cadmium-accumulated chlorella on the reproduction of Moina macrocopa (cladocera)

Chlorella cultured for 6 days in a medium containing cadmium at 0.02, 0.1, and 0.5 ppm accumulated approximately 14, 70, and 340 μg/g (in dry wt) of cadmium, respectively. These chlorella were supplied as food to Moina macrocopa everyday after washing with artificial soft water. Reproductive impairment was not observed in M. macrocopa fed chlorella containing 14 μg/g of cadmium. Slight reproductive impairment was observed in M. macrocopa fed chlorella containing 70 gmg/g of cadmium at initial and late stages of the experiment. However, survival rate, growth rate, and reproductive rate were significantly affected in M. macrocopa fed chlorella containing 340 μg/g of cadmium. The accumulation level of cadmium in chlorella which causes 50% reproductive impairment of M. macrocopa was estimated to be 280 μg/g (in dry wt). The cadmium accumulation level in M. macrocopa fed these chlorella was measured throughout the 8-day experiment. The rate of accumulation of cadmium by Moina through chlorella was considerably lower than that through the water containing dissolved cadmium.     

Evaluation of a combination chemotherapy with docetaxel and nedaplatin for patients with oral squamous cell carcinomas

The purpose of this study was to evaluate the effectiveness and safety of combination chemotherapy with docetaxel (TXT) and nedaplatin (CDGP) for patients with oral squamous cell carcinomas. Eight patients were enrolled in this study (4 men and 4 women, with a mean age of 61.7 years). TXT and CDGP were administered at a dose of 60 mg/m(2) and 70 mg/m(2) by drip infusion for 120 minutes, respectively. Three patients received one more administration 4 weeks after the first one. The locoregional response was evaluated 4 weeks after the final administration of TXT and CDGP. As a result, the locoregional response rate after 1 course was 62.5% including 25.0% of complete response (CR). The response rate after 2 courses was 100.0% with 66.7% of CR. According to Oboshi and Shimosato's classification, histological evaluation of surgical specimens revealed that four cases were Grade IIa, two cases Grade IIb, and two cases Grade IV. The severe adverse events were neutropenia and leukopenia, which were effectively managed with granulocyte colony-stimulating factor (G-CSF). No other severe side effects were recognized. The present study suggested that the combination chemotherapy with TXT and CDGP would be an effective and safe regimen in neo-adjuvant chemotherapy for oral squamous cell carcinomas.     

Repeated administration of alpha-galactosyl ceramide attenuates of natural killer T cells

alpha-Galactosyl ceramide (alpha-GalCer) is well known as a specific ligand which can activate natural killer T (NKT) cells. This drug potentially induces anti-tumor effect of NKT cells, and clinical trials for alpha-GalCer in cancer patients are ongoing in the world. The aim of this study is to investigate how repeated alpha-GalCer injection affects the activation of NKT cells in mice. The initial administration of alpha-GalCer triggered a rapid production of both IFN-gamma and IL-4 in NKT cells and induced subsequent apoptosis in the majority of those cells. Meanwhile, no increase in IFN-gamma production was observed after further injections, and NKT cells maintained the low level secretion of IL-4 since the first injection. After repeated alpha-GalCer administration, activation markers on NKT cells were down-regulated and autologous cytotoxicity against liver cells decreased, suggesting that repeated stimulation attenuates the response of NKT cells to the ligand. These data indicate that prudent discussion is required to determine the dosing interval of alpha-GalCer in clinical applications. A further study is needed for establishing effective methods of sustained NKT cell activation.     

Pharmacokinetic modulating chemotherapy for rectal carcinoma metastases to the liver and lung--a case report

Pharmacokinetic modulating chemotherapy (PMC) is a new therapeutic regimen for advanced colorectal carcinoma, in which high serum 5-FU concentrations are attained through the inhibition of 5-FU degradation by simultaneously administered uracil. A 67-year-old woman, presented with unresectable multiple hepatic and pulmonary metastases following abdominoperineal resection of rectal carcinoma, was successfully treated by the PMC. The patient was initially treated by 600 mg/m2/day of 5-FU infusion, once a week, and subsequently 5-FU doses were increased to 750 mg/m2/day and then to 1,200 mg/m2/day. Hepatic metastases responded at the dose of 750 mg/m2/day and pulmonary metastases responded at the dose of 1,200 mg/m2/day. The patient remains partial response (>21 months). 5-FU serum concentrations were higher at night time and the peak concentration of 5-FU was obtained at 3 a.m. 5-FU Cmax of 600 mg/m2/day, 750 mg/m2/day and 1,200 mg/m2/day were 254, 329, 531 ng/ml, respectively. The experience of this case, together with literature review, suggests that pulmonary metastases are more resistant to 5-FU than hepatic metastases in patients with colorectal carcinoma. The high serum 5-FU concentrations at night suggest the chronomodulating nature of PMC and are effective for metastatic colorectal carcinoma.     

Loss of carcinoembryonic antigen-related cell adhesion molecule 1 expression is an adverse prognostic factor in hepatocellular carcinoma

BACKGROUND: Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a negative regulator of tumor cell growth, and may function as a tumor suppressor. CEACAM1 expression is down-regulated with increasing histologic grade in a number of malignancies. The authors hypothesized that loss of CEACAM1 expression in hepatocellular carcinoma (HCC) cells may function as an adverse prognostic factor. METHODS: A retrospective analysis was conducted of 139 consecutive patients who underwent resection for HCC, with a median follow-up period of 83 months. Immunohistochemistry of the resected specimens was conducted using a monoclonal anti-CEACAM1 antibody. CEACAM1 expression in HCC was classified into two categories: diffuse expression, characterized by positive staining throughout the tumor specimen, or loss of expression, in which there were distinct areas of negative staining within the tumor specimen. RESULTS: Of the 139 patients, 113 were classified as having tumors with diffuse expression and 26 had loss-of-expression tumors. Loss of CEACAM1 expression was more frequent in tumor specimens with Edmondson-Steiner Grades III or IV (21 of 32 [66%]) than in tumor specimens with Grades I or II (5 of 107 [5%]; P < 0.001) and was always seen in areas with the highest histologic grade. Loss of CEACAM1 expression was significantly associated with large tumor size, multiplicity of the tumor, portal vein invasion, and satellite nodules and affected survival adversely, according to univariate (P < 0.0001) and multivariate analyses (relative risk, 5.737; P < 0.001). CONCLUSIONS: Loss of CEACAM1 expression reflects aggressive tumor biology and thus indicates a poor prognosis for patients with HCC.