Cytokine patterns and the effects of a preoperative steroid treatment in the patients with abdominal aortic aneurysms.

BACKGROUND: The aim of this study was to investigate the cytokine patterns of patients with abdominal aortic aneurysms and the effects of preoperative steroid administration on surgical stress. METHODS: From January 1996 to August 1996, 20 consecutive patients underwent an elective reconstruction of infrarenal abdominal aortic aneurysms. The patients were randomly divided into two groups consisting of a control group (n=10) and a steroid group (n=10), in whom 1 g of methylprednisolone was intravenously administered two hours before the operation. MEASURES: Interleukin-6 was serially measured and the perioperative parameters including C-reactive protein were compared between both the control and the steroid groups. RESULTS: The interleukin-6 values in the steroid group immediately after declamping, as well as at one and three postoperative days were significantly lower than those in the control group. C-reactive protein values at one postoperative day in the steroid group were also significantly lower than those in the control group. In one patient with a ruptured abdominal aortic aneurysm, the interleukin-6 values were higher than those in the patients undergoing elective surgery throughout the study. CONCLUSIONS: These results thus suggest that preoperative steroid administration using methylprednisolone in patients with abdominal aortic aneurysms appears to reduce surgical stress by decreasing cytokine release.     

Transnodal cancer chemotherapy for metastatic lymph nodes in rats

The antitumor effects of transnodal cancer chemotherapy were studied using rat models. After inoculation of AH-66 tumor cells into the iliac lymph nodes (target lymph node), emulsionized bleomycin (BLM emulsion) or BLM water solution was injected into an intact popliteal lymph node and chronological changes in BLM levels in the target lymph node were measured. In the target lymph node of the iliac lymph node, the level of BLM emulsion continuously was greater than 2 micrograms/g for 9 hours after the injection, while the level of BLM water solution decreased rapidly. The antitumor effects were quantitatively estimated in the tumor of the target lymph node. The ratio of necrotic area in the BLM-emulsion-treated group was significantly greater than that in the emulsion- or saline-treated groups. Survival rate in rats treated with BLM emulsion was significantly higher than that in control groups and was slightly higher than that in the group given BLM water solution iv. The concentration of BLM in the serum and lung in case of transnodal administration of BLM was much lower than that in rats given an iv administration of BLM water solution. These findings suggest that transnodal administration of BLM emulsion is an effective and safe treatment for metastatic lymph nodes, at least in rats.     

Endothelium-derived relaxing factor and vein grafts.

Platelet thrombosis, intimal hyperplasia and progression of atherosclerosis are the most important factors determining the patency of vein grafts for arterial occlusive disease. Interactions between aggregating platelets and the vessel wall play an important role in all of these processes. Recently, it has become evident that the endothelium modulates the underlying vascular smooth muscle by releasing an endothelium-derived relaxing factor, a potent vasodilator and anti-aggregating substance. Little information is available, however, on such endothelial functions of autogenous vein grafts. This review focuses on vascular modulation by endothelium-derived relaxing factor in vein grafts.     

Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: analysis based on tumor hemodynamics.

HYPOTHESIS: Surgical margin, i.e., the area of possible local intrahepatic metastasis, is controversial in hepatectomy for hepatocellular carcinoma. DESIGN: The blood drainage area of tumor was identified preoperatively by abdominal helical computed tomographic scan under hepatic arteriography and excised as surgical margin. The specimens were pathologically examined on the basis of the corresponding computed tomographic images. SETTING: University hospital. PATIENTS: From June 2, 1997, to April 24, 2000, 67 patients with hepatocellular carcinoma who underwent curative hepatic resection. MAIN OUTCOME MEASURE: Intrahepatic recurrence. RESULTS: Blood drainage area of tumor could be classified into the following types. The marginal type (drainage into the peritumorous area) was frequent (50 cases) and excised mostly by nonanatomic, limited resection. Portal vein type (drainage into the portal branches) was less common (12 cases) and resected mostly by anatomically systematic hepatectomy. The remaining 5 cases were of the hypovascular type and underwent limited resection. Multiple nodules were frequently found inside the drainage area (4 of 8 cases) and were moderate or poorly differentiated hepatocellular carcinoma, consistent with intrahepatic metastasis. Solitary nodules were mostly outside the drainage area (11 of 12 cases) and contained well-differentiated hepatocellular carcinoma (7 of 10 cases), suggesting multicentric carcinogenesis. Intrahepatic recurrences were commonly found in bilateral or contralateral lobes (17 of 19 cases) and divided into 2 groups with a few (< or =4) and multiple (> or =8) recurrent nodules. CONCLUSIONS: Surgical margin varied according to tumor hemodynamics. Tumor recurrences may result not only from multicentric carcinogenesis but also from intrahepatic metastasis via systemic circulation.     

Proposed distal margin for resection of rectal cancer

To determine the adequate distal margin, particularly from the point of extent of lymph node metastasis, 2,333 lymph nodes from 44 patients with rectal carcinoma were evaluated, using a clearing method. The tumors were divided into two growth patterns; infiltrative and localized. Lymph node metastasis was histo-pathologically examined with special attention focused on nodes on the distal side of the tumor. The intramural spread was also given attention. The proximal pararectal lymph nodes often contained malignant cells, whereas the distal ones were rarely involved, and if involved, they were present within 1 cm from the tumor. Pararectal lymph node metastasis and intramural spread were seen with a range of 1 cm and 0.5 cm, respectively, in the localized type and 1 cm and 2.1 cm, respectively in the infiltrative type. Based on these findings, the distal margin for surgical resection of rectal carcinoma is considered to be 2 cm for the localized type and 3 cm for the infiltrative type.     

Role of tumor-associated macrophages in lung cancer

The percentage of tumor-associated macrophages recovered (TAMR) and antitumoral activity of tumor-associated macrophages (TAM) were examined in 77 patients with resectable primary lung cancer. TAM was obtained by plastic adherence following trypsinization. TAMR increased from Stage I to Stage II and decreased in Stage III. It also increased in N1 as compared with N0 and N2 but was unrelated to tumor size. However, the cytostatic activity of TAM declined with advance in stage of the disease and an increase of tumor size, but it was relatively unaffected by the presence of metastasis to regional lymph nodes. There was no correlation between TAMR and the recurrence rate; however, cytostatic activity of TAM was correlated significantly with the prognosis of totally resected cases. TAMR and cytostatic activity of TAM tended to be lower in palliatively resected cases. These results suggest that the assessment of the antitumor activity of TAM, but not merely TAMR, may give prognostic information for lung cancer patients.     

Successful treatment of Budd-Chiari syndrome with early gastric cancer.

In a patient with Budd-Chiari syndrome associated with early gastric cancer, the membranous obstruction of the inferior vena cava was removed by Percutaneus Transluminal Angioplasty (PTA) without any complication. Due to continuous poor clinical status and hepato-renal dysfunction, her early cancer stomach lesion was treated with Nd: YAG laser. In follow-up biopsies, malignant change became evident three months after laser therapy. By that time hepatorenal function gradually improved, and a partial gastrectomy was performed successfully. PTA is a safe and effective procedure for clinical management of Budd-Chiari syndrome, and when there is concomitant early stage malignancy, PTA followed by laser therapy paves the way for major surgery.     

Detection of DNA strand breaks in HeLa cells in vitro and in mouse sarcoma 180 cells in vivo induced by an alkylating agent, carboquone, using in situ nick translation

We determined the correlation between DNA strand breaks and the toxicity of carboquone (CQ) in HeLa cells in vitro and in mouse sarcoma 180 (S-180) cells in vivo, using in situ nick translation. The break sites in the DNA were translated artificially in the presence of Escherichia coli DNA polymerase I and [3-H]-labelled dTTP, and sites in the DNA were visualized by autoradiographic observation of grains in the nuclei. These breaks appeared as early as 5 min in the CQ-treated HeLa cells and increased in a dose- and time-dependent manner compared to findings in the control cells, i.e., 10.2-fold at 3 x 10(-6) M in 60 min. Strand breaks in the S-180 cells appeared in a dose- and time-dependent manner, i.e., 6.1-fold after the mice had been exposed to CQ (3.6 mg/kg) for 2 h. This level correlated with the increase in host life span. Our findings show that the survival response of cells decreases, while the level of DNA strand breaks increases following exposure to CQ. The nick translation method is a rapid in situ assay for determining drug-induced DNA damage of tumor cells, under in vitro and in vivo conditions and in a semiquantitative manner.     

Estrogen receptor status and effects of endocrine ablative surgery in ethyl methanesulphonate-induced rat mammary carcinoma

An experimental model of rat mammary carcinoma induced by oral administration of ethyl methanesulphonate (EMS) was characterized with reference to estrogen receptors (ER) and hormone dependency. After the administration of EMS, the mammary carcinomas developed more rapidly in the 4-week old rats than in the 16-week old rats. The developed mammary carcinomas were related to the ER status. Tumor development was prevented by ablative oophorectomy prior to EMS administration, but only partially, by adrenalectomy. These inhibitory effects on tumor development were more obvious when ablative surgery was performed on younger rats at age 4 weeks. In rats subjected to oophorectomy at after EMS administration at age 16 weeks, tumor induction was retarded but not completely prevented. Thus, it appears that mammary tumors induced by EMS are dependent on ovarian hormones and that mammary glands of the younger female rats are more sensitive to carcinogenic actions of EMS.     

Comparison of R1 and R2 gastrectomy for gastric cancer in patients over 80 years of age

To evaluate the benefit of R2 gastrectomy for gastric cancer in Japanese patients over 80 years of age, data on 93 patients who underwent gastrectomy between 1967 and 1989 were collected retrospectively from charts filed in the Kyushu University Hospital and two affiliated national hospitals. Of 93 patients, 62 had a localized tumor without evidence of metastatic spread. These 62 patients were classified into two groups according to the procedures performed: 35 underwent R1 gastrectomy and 27, R2 gastrectomy. The clinical and pathological characteristics of the patients in the two groups were comparable at the time of surgery, except that the group who underwent R1 gastrectomy was older. R2 gastrectomy involved a significantly longer operation time (P less than 0.01) and greater intraoperative blood loss (P less than 0.05) when compared to R1 gastrectomy, but no patient undergoing this extensive surgery died. The difference in the morbidity rate between the two groups was not statistically significant. The 5-year survival rate was 55.8% in the R1 group and 65.4% in the R2 group. When gastric cancer invaded the serosa and/or secondary nodes, a substantial increase in survival time was gained with R2 gastrectomy when compared to an R1 operation. These findings suggest that an R2 gastrectomy is feasible, even for patients over 80 years, but is indicated mainly when the carcinoma had invaded the serosa and/or secondary nodes and the patients are at good risk for major surgery.