Complications of hepatectomy for hilar cholangiocarcinoma

We retrospectively reviewed postoperative complications in 105 patients with hilar cholangiocarcinoma who underwent hepatectomy at Nagoya University Hospital from January 1990 through March 1999. Of the 105 subjects, 97 (92.4%) underwent resection of two or more Healey's segments of the liver. Combined portal vein resection was performed in 33 (31.4%) patients and pancreatoduodenectomy in 10 (9.5%). Twenty (19.0%) patients had no postoperative complications, another 39 (37.1%) patients had minor complication(s) only, and the remaining 46 (43.8%) developed major complication(s). The morbidity rate reached as high as 81.0%. Major complications required relaparotomy in 11 (10.5%) patients. Of the 46 patients with major complication(s) 36 recovered; the remaining 10 patients died of liver failure with other organ failure(s) or of intraabdominal bleeding 12, 14, 18, 21, 57, 75, 75, 87, 93, or 134 days after surgery. Thus the 30-day mortality was 3.8% and the overall mortality 9.5%. Pleural effusion was the most frequent complication found in 66 (62.9%) patients, followed by wound sepsis in 39 (37.1%), and then liver failure in 29 (27.6%). Liver failure developed in 16.7% of 48 patients with less than 50% liver resection and in 36.8% of 57 patients with 50% or more resection (P < 0.05). Other organ failures, including renal, respiratory, gastrointestinal, and hematologic failures, developed as a sign of multiple organ failure following liver failure in most patients or preceding liver failure in a few patients. None of the six patients with four or more organ failures survived. Hepatectomy for hilar cholangiocarcinoma is risky owing to impaired hepatic functional reserve in jaundiced patients and the technical difficulty associated with hepatobiliary resection. Our goal is to reduce mortality to less than 5% while keeping a high resectability rate (above 80%).     

Five-year survivors after aggressive surgery for stage IV gallbladder cancer

Abstract. Purpose: To describe 5-year survivors after radical surgery for stage IV gallbladder cancer and to determine the characteristics leading to potential long-term survival. Methods: Of 59 patients undergoing radical resection for stage IV disease between 1979 and 1994, 6 patients who have survived for more than 5 years were followed up. Results: Three patients had developed obstuctive jaundice due to involvement of the hepatic hilum, but the other three had not. The jaundiced patients had remarkable tumor spread over the bile duct and right hepatic artery within the hepatoduodenal ligament. However, the proper and left hepatic arteries and the portal trunk and its left branch were free from tumor involvement. The nonjaundiced patients had N1 or N2 lymph node metastasis. However, none underwent bile duct resection or pancreatoduodenectomy to establish radical lymphadenectomy. Conclusions: Selected patients with stage IV gallbladder cancer may be candidates for 5-year survival when the primary tumor is fairly localized even if it forms a large mass and involves neighboring organs including the hepatic duct, lymph node metastasis is limited to N1 and N2 except for the celiac and superior mesenteric nodes and is less infiltrative, and distant metastasis including that in the paraaortic area is absent. Received: January 9, 2001 / Accepted: June 18, 2001     

High fat diet enhances colonic cell proliferation and carcinogenesis in rats by elevating serum leptin

We postulated that high fat diet enhances colon cell proliferation and carcinogenesis by elevating serum leptin. To examine this possibility, the present study was conducted to investigate the effect of leptin on the growth of human colon cancer cells (HT29) and the relationship between serum leptin and colon cell proliferation and aberrant crypt foci (ACF) in the 1,2-dimethylhydrazine-treated rats fed graded levels of dietary fat for 28 days. In cell culture experiments, leptin stimulated the growth and proliferation (BrdU incorporation) of colon cancer cells and the expression of c-fos protein. In the in vivo experiments, an elevation of dietary fat caused higher serum leptin and adipose-tissue weight. Colonic cell proliferation (BrdU incorporation), c-fos protein expression and ACF were elevated with increasing dietary fat. There was a significant correlation between serum concentration of leptin and colon cell proliferation and ACF. The results suggest that the enhancement of colon cell proliferation and carcinogenesis by high fat diet is mediated through elevating serum leptin.     

Lymphadenopathic type of Kaposi's sarcoma in a Ugandan child seropositive for LAV/HTLV-III antibodies

The authors report a case of a lymphadenopathic type of Kaposi's sarcoma in a Ugandan boy aged 2 years and 1 month who was seropositive for antibodies to lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III).     

Characterization of an antigen defined by monoclonal antibody KMO1.

We have isolated an antigen defined by the monoclonal antibody KMO1 from tissue culture supernatant as a glycoprotein and from cancer cells as a glycolipid. The antigenic determinant was a carbohydrate. Antibody KMO1 inhibited the binding activity of 19-9 to CA19-9, but 19-9 antibody did not inhibited the binding activity of KMO1 to KMO1 antigen. The glycolipid antigen of KMO1 was a monosialoganglioside and was separated into 3 components on thin layer chromatography. The 19-9 antibody reacted with one of the components. These results suggest that the KMO1 antigen is similar to but not identical to CA19-9.     

Β-Lactam resistance in Streptococcus mitis isolated from saliva of healthy subjects

The purpose of this study was to examine the percentage of -lactam-resistant streptococcal carriers in healthy adults, and to investigate the relationships among minimum inhibitory concentrations (MICs) of -lactams, alterations in the penicillin-binding protein genes (pbp genes), and the affinity of penicillin-binding proteins (PBPs) for ampicillin (ABPC) in Streptococcus mitis. We also compared numbers of surviving bacteria at various ABPC concentrations in both ABPC-susceptible and -resistant S. mitis strains. The percentages of subjects carrying ABPC- and cefaclor (CCL)-resistant streptococci were 52% (27 of 52 subjects) and 100%, respectively. S. mitis, including both antibiotic-susceptible and -resistant strains, were classified into five groups according to the pbp gene mutations that resulted in alterations of the deduced amino-acid sequence in the homology boxes of PBPs. All ABPC-resistant strains showed alterations in PBP1A, 2X, and 2B, while no or only PBP2X alterations were detected in the susceptible strains. These results suggest that the accumulation of pbp gene mutations is strongly related to the MIC of ABPC for S. mitis. In the resistant strains, the affinity of PBPs for ABPC was reduced in comparison with that in the susceptible strains, and the bactericidal effect of ABPC was also reduced. Therefore, we should be aware of conditions such as infective endocarditis that are caused by -lactam-nonsusceptible streptococci in the normal oral flora.