Clinical Application of a Self-Sealing Poly(ether-urethane) Graft Applicable to Blood Access for Hemodialysis

A poly(ether-urethane) graft (PEU) has been developed by our group and examined clinically. From July 1986, four straight and 11 loop grafts were implanted in 15 patients on maintenance hemodialysis. One straight and three loop grafts thrombosed between 1-6 months after the operation. One loop graft was ligated to remedy edema caused by a preexisting subclavian vein thrombosis. Angiographic findings of the grafts revealed a smooth positioning of the graft in most of the cases with minimal to moderate stenosis at anastomotic sites. Punctured sites were identified as tiny filling defects on the wall. However, neither stenosis nor aneurysmal dilatation were observed. Specimens of the graft were obtained from three patients to examine histological findings. Neointimal coverage was observed near the anastomotic site in a specimen obtained 6 months after the operation. The bare luminal surface still remained at the center of the graft. No clinical sign of peripheral thrombi was found. In addition to the clinical experience, this study is supplemented with the preliminary result of an animal experiment using a newly modified PEU graft with an open structure on the luminal surface.     

Bronchoplasty for bronchogenic carcinoma

This report details our experience in 34 patients with primary bronchogenic carcinoma who underwent broncho-plastic lobectomy between 1969 and 1981. Twenty-four had squamous cell carcinoma, 6 had adenocarcinonia, 2 large-cell carcinoma, 1 small-cell carcinoma, and 1 combined type. Twelve patients had no lymph node involvement, while 10 had hilar node metastasis and 12 had mediastinal node metastasis. Sleeve lobectomy was accomplished in 19 patients and wedge lobectomy in the remaining 15. Bronchoplasty was performed for direct tumorous invasion in 26 patients, whereas in 8 patients this procedure was done when metastatic cancer had involved the main bronchus. There were 3 operative deaths (8.8%). One was ascribed to tension pneumothorax, one to postoperative bleeding, and the other to myocardial infarction. One patient developed a bronchopleural fistula and died 44 days after completion pneumonectomy. Another died of massive hemorrhage from a bronchopulmonary artery fistula in the fourth postoperative month. Bronchial stenosis was observed in 4 patients: 3 granulation formation and 1 local recurrence. The 5-year survival rate was 17%, which was higher than that of pneumonectomy. Early postoperative pulmonary function studies revealed good function of the reconstructed lung. Bronchoplasty for bronchogenic carcinoma is an effective procedure for preserving pulmonary parenchyma and controlling the disease.

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Résumé Cet article rapporte notre expérience concernant 34 malades qui ont subi une lobectomie pulmonaire pour cancer bronchogénique primitif de 1969 à 1981. La série se compose de 24 cancers squamieux, de 6 adéno-carcinomes, de 2 cancers à larges cellules, de 1 cancer à petites cellules, de 1 cancer à cellules mixtes. 12 malades ne présentaient pas de métastase ganglionnaire, 10 avaient des métastases hilaires et 12 des métastases médiastinales.19 opérés subirent une lobectomie dite en manche et 15 une lobectomie cunéiforme. La bronchoplastie fut pratiquée chez 26 malades qui présentaient un envahissement tumoral direct alors qu'elle fut effectuée chez 8 malades dont la bronche principale était envahi par des métastases.Nous eûmes 3 morts à déplorer: l'une due à un pneumothorax suffocant, l'autre à une hémorragie post-opératoire, la troisième à un infarctus du myocarde.Un opéré présenta une fistule broncho-pulmonaire et mourut le 44ème jour après une tentative de pneumectomie, un autre fut emporté par une hémorragie massive au cours du 4ème mois qui suivit l'intervention, hémorragie due à une fistule artérielle bronchopulmonaire. Nous observames 4 cas de sténose bronchique, 3 formations granulomateuses et une récidive locale.Le taux de survie à 5 ans fut de 17 pour cent. Il est meilleur que celui de la pneumectomie.L'étude précoce des fonctions pulmonaires postopératoire montra qu'elles étaient bonnes.La bronchoplastie représente une méthode efficace de traitement du cancer bronchogénique. Elle respecte le parenchyme pulmonaire et permet de maîtriser la maladie.

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Presented at the XXIXth Congress of the Société Internationale de Chirurgie, Montreux, Switzerland, September, 1981.     

A controlled study of maintenance chemoimmunotherapy vs immunotherapy alone immediately following palliative gastrectomy and induction chemoimmunotherapy for advanced gastric cancer

Summary A randomized trial of surgical adjuvant chemoimmunotherapy was conducted in patients who had undergone palliative gastrectomy for previously untreated advanced stomach cancer. First, all patients received the same induction chemoimmunotherapy with MFC (mitomycin C, 5-fluorouracil, and cytosine arabinoside) plus OK-432 for 6 weeks after surgery. The patients were then randomized to receive either chemoimmunotherapy with MFC plus OK-432 (group A) or immunotherapy with OK-432 alone (group B) for maintenance. The survival rate of patients was significantly higher in group B (44 cases) than in group A (39 cases) during the first 9 months after the start of induction therapy (P<0.05). A further division of patients in terms of carcinoma histology revealed a difference in survival rate only in patients with an undifferentiated histology (poorly differentiated adenocarcinoma and signet-ring cell carcinoma), and not in those with a differentiated histology (papillary, tubular, and mucinous adenocarcinomas). These results indicate that simple immunotherapy with OK-432 is better for maintenance than chemoimmunotherapy involving MFC, particularly in patients with undifferentiated gastric carcinomas.Chairman of the Study Group: K. Ota