Evaluation of the acetaminophen absorption test for early detection of orthotopic small bowel transplant rejection

We evaluated the efficiency of the acetaminophen (AC) absorption test as a marker of graft rejection in orthotopic small bowel transplantation (SBTX) in rats. Brown Norway (BN) rats were used as donors and Lewis (LEW) rats as recipients. Orthotopic allogenic SBTX was accomplished using a cuff technique for vessel anastomosis. Animals were divided into: group A (n = 9), untreated; group B (n = 15), extended small bowel resection; group C (n = 12), syngeneic SBTX without immunosuppressants; group D (n = 15), allogenic SBTX with tacrolimus (0.1 mg/kg per day); group E (n = 15), allogenic SBTX with tacrolimus (0.5 mg/kg per day). Serum AC was measured 15 min following the instillation of 0.15 g/kg AC into the stomach on postoperative days (POD) 1, 3, and 7. Grafts were examined histologically. The group D grafts showed progressive acute rejection histologically, from normal on POD 1, to moderate on POD 3, and severe on POD 7. Serum AC in group D decreased significantly from 53.1 ± 3.9 μg/ml on POD 1, to 35.0 ± 12.0 μg/ml on POD 3, and 10.9 ± 5.6 μg/ml on POD 7. No remarkable change was observed in the other groups. Serum AC correlated well with histological changes in rats subjected to SBTX, resulting in acute rejection. The AC absorption test could be useful for detection of progressive graft rejection in clinical SBTX. Received: August 17, 2000 / Accepted: March 6, 2001     

Effect of the extracellular matrix on pancreatic endocrine cell function and its biocompatibility in dogs

The effect of the synthetic extracellular matrix (ECM) in a diffusion chamber for a bioartificial endocrine pancreas (Bio-AEP) on pancreatic endocrine cells in vitro and its biocompatibility in dogs were investigated. Two different types of ECM were used: type I collagen treated with low antigen (type I LA), and reconstituted basement membrane matrix (Matrigel) derived from Englbreth-Holm-Swarm (EHS) mouse sarcoma. Matrigel contains growth and differentiation factors and cell adhesion molecules such as laminin, heparan sulfate proteoglycan, and entactin. Purified porcine pancreatic endocrine (PE) cells were suspended in type I LA or Matrigel and then placed into a 12-well culture plate (4 x 10(7) cells/ml gel/well). The insulin accumulation from PE cells in Matrigel was significantly greater than that in type I LA (9.3 +/- 3.6 mU/well vs. 2.3 +/- 1.3 mU/well). When Bio-AEP with Matrigel and PE cells was implanted into the abdominal cavity of a pancreatectomized diabetic dog, the exogenous insulin requirement for maintaining normoglycemia was reduced for the first 4 weeks. However, after 6 weeks of implantation, fasting blood glucose levels suddenly increased. Laparotomy revealed encapsulated Bio-AEP with thick fibrous tissue. Following removal of the Bio-AEP from the abdominal cavity, another Bio-AEP containing type I LA and PE cells was implanted into the same dog. The exogenous insulin requirement was gradually decreased to almost half that of preimplantation levels. Bio-AEPs containing type I LA or Matrigel, but not PE cells, were implanted into the abdominal cavities of four healthy dogs. After 4 weeks of implantation, the Bio-AEP with Matrigel was encapsulated with fibrous tissue similar to that in the diabetic dog, but the Bio-AEP with type I LA was not. These results indicate that Matrigel may be incompatible with dogs and that the type I LA is more suitable for Bio-AEP.     

In situ pedicle resection in left trisegmentectomy of the liver combined with reconstruction of the right hepatic vein to an inferior vena caval segment transpositioned from the infrahepatic portion

A combination of an in situ pedicle resection of the liver and a hepatic vein reconstruction using a cranially transpositioned segment of the IVC after implantation of an ePTFE graft at the missing IVC was useful in treating a patient who suffered from a huge liver tumor involving all of the hepatic venous confluence and the IVC. Although early tumor recurrence remains an unresolved problem for such patients, a surgical approach is feasible. This technique can be justified as a therapeutic modality, not only because it improves quality of life, but also because it provides patients with an opportunity for additional treatment.     

Magnitude of the regression to the mean within one-year intra-individual changes in serum lipid levels among Japanese male workers

To investigate the magnitude of the 'regression to the mean' effect for the changes in serum total cholesterol (TC), triglycerides (TG), and high density lipoprotein cholesterol (HDLC) levels during one-year interval between annual health check-ups in occupational settings, the relationships between the baseline level and subsequent one-year change in TC, TG or HDLC were analyzed using paired health check-up data in 1998 and 1999 of 547 Japanese male clerical workers. After adjustment for age, body mass index (BMI), yearly change in BMI, drinking score and smoking score by the multivariate analyses, the yearly changes in each serum lipid (deltaTC, deltaLn(TG) or deltaHDLC) were clearly inversely associated with the lipid levels in 1998. For example, in the multiple linear regression analyses setting delta value in each serum lipid as a dependent variable, the partial regression coefficients for the baseline lipid levels (beta1) were - 0.21 (p<0.001) for the TC, -0.39 (p<0.001) for the Ln(TG) and -0.15 (p<0.001) for the HDLC, respectively. These results suggest that the observed yearly change in each serum lipid level may largely reflect the 'regression to the mean' effect in addition to the real yearly biological change.     

Peritoneal carcinomatosis in lung cancer patients

Metastatic involvement of the peritoneum is not a very rare autopsy finding. Clinically, however, peritonitis carcinomatosis from a lung cancer is infrequently encountered and the pattern of the metastasis has not been studied. A total of 1041 patients with lung cancer who were admitted to our division over a 26-year period were retrospectively analyzed. Twelve (1.2%) of the 1041 patients with advanced lung cancer developed peritoneal carcinomatosis in their clinical courses. The incidence of peritoneal carcinomatosis was high in patients with large cell carcinoma and adenocarcinoma. Six and 9 of the 12 patients had metastases in intra-abdominal sites and pleural seeding, respectively. The median survival time from the diagnosis of peritoneal carcinomatosis was 2 months. Ascites accompanying metastasis to abdominal organs and pleural seeding in a patient with a known lung cancer would be regarded as a metastasis.     

Isolated splenic metastasis of sigmoid colon cancer: a case report

We report the case of a 62-year-old man who developed isolated splenic metastasis of sigmoid colon cancer. The patient underwent left hemicolectomy for Dukes C sigmoid colon cancer in February 1997. In March 1999, an abdominal CT scan revealed a tumor 3 cm in size at the inferior pole of the spleen. The tumor was hyperechoic on ultrasonography. The serum carcinoembryonic antigen level was normal. Since no other site of recurrence was identified, a splenectomy was performed with a curative intent. At laparotomy, neither hepatic metastasis, peritoneal dissemination, lymph node metastasis nor local recurrence was detected. Histological findings of the splenic tumor were compatible with metastasis of the previously resected sigmoid colon adenocarcinoma. The patient has been disease-free for 19 postoperative months. Immunohistochemical staining for urokinase-type plasminogen activator was positive in primary sigmoid colon cancer and splenic metastasis, but negative in lymph node metastasis; results that possibly reflect the difference in progenitor cells between splenic metastasis and lymph node metastasis or the difference in the microenvironment of cancer cells between the spleen and lymph nodes. Based on the present case, we recommend that clinicians pay close attention to the spleen for the early diagnosis of isolated splenic metastasis when routinely evaluating abdominal CT scans and abdominal ultrasonography following curative resection of primary colorectal cancer.