Portal vein thrombosis in liver cirrhosis

Portal vein thrombosis(PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to:(1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis;(2) describe the principal factors most frequently involved in PVT development; and(3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.     

Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort

Limited data exists on ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) managed by a well-organized cardiac care network in a metropolitan area. We analyzed the Tokyo CCU network database in 2009–2010. Of 4329 acute myocardial infarction (AMI) patients including STEMI (n = 3202) and NSTEMI (n = 1127), percutaneous coronary intervention (PCI) was performed in 88.8 % of STEMI and 70.4 % of NSTEMI patients. Mean onset-to-door and door-to-balloon times in STEMI patients were shorter than those in NSTEMI patients (167 vs 233 and 60 vs 145 min, respectively, p < 0.001). Coronary artery bypass graft surgery was performed in 4.2 % of STEMI and 11.4 % of NSTEMI patients. In-hospital mortality was significantly higher in STEMI patients than NSTEMI patients (7.7 vs 5.1 %, p < 0.007). Independent correlates of in-hospital mortality were advanced age, low blood pressure, and high Killip classification, statin-treated dyslipidemia and PCI within 24 h were favorable predictors for STEMI. High Killip classification, high heart rate, and hemodialysis were significant predictors of in-hospital mortality, whereas statin-treated dyslipidemia was the only favorable predictor for NSTEMI. In conclusion, patients with MI received PCI frequently (83.5 %) and promptly (door-to-balloon time; 66 min), and had favorable in-hospital prognosis (in-hospital mortality; 7.0 %). In addition to traditional predictors of in-hospital death, statin-treated dyslipidemia was a favorable predictor of in-hospital mortality for STEMI and NSTEMI patients, whereas hemodialysis was the strongest predictor for NSTEMI patients.     

Establishment of a Human Small Cell Lung Carcinoma Cell Line Carrying Amplification of c-myc Gene and Chromosomal Translocation of t(3p;6p) and t(12q;17p)

A transplantable tumor and an in vitro culture cell line (GK-T3) were established from metastatic liver tissue of human small cell lung carcinoma (SCLC). Southern blot analysis revealed about 30-fold amplification of c- myc gene in the tumor cells in liver, xenografts, and in vitro cell line. The degree of c- myc amplification was essentially conserved through serial passages in nude mice and cultivation in vitro. The level of c- myc mRNA was significantly increased in these cells. Cytogenetically, numerical and complex structural abnormalities were observed in GK-T3 cells, including t(3p;6p), t(12q;17p), two homogeneously staining regions (hsrs) and several double minutes (dmins). These results suggest that activation of c- myc gene and alteration of gene(s) round these chromosomal breakpoints may play a role in tumorigenesis of GK-T3 SCLC.     

5-fluorouracil sensitivity and dihydropyrimidine dehydrogenase activity in advanced gastric cancer

BACKGROUND: Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme of 5-fluorouracil (5-FU) catabolism. Several studies have demonstrated the clinical importance of DPD in cancer patients, suggesting that the efficacy of 5-FU may be related to DPD activity in tumor tissue. In the present study, DPD activity and chemosensitivity to 5-FU were evaluated in advanced gastric cancer. Materials and METHODS: Thirty-four gastric cancers from 32 patients were studied and chemosensitivity to 5-FU was evaluated by histoculture drug response assay. RESULTS AND CONCLUSION: DPD activity and tumor inhibition of 5-FU among all cases showed no significant correlation, but among 14 histologically differentiated cases significant correlation was observed. DPD activity may be useful in determining the 5-FU sensitivity of differentiated gastric cancer.     

A prospective randomized trial comparing pneumoperitoneum and U-shaped retractor elevation for laparoscopic cholecystectomy

Summary Between April and August 1991, 83 Japanese patients with symptomatic gallstones underwent laparoscopic cholecystectomy in our clinics. A prospective randomized trial was carried out to examine the safety, efficacy, and complications of the two techniques, pneumoperitoneum vs an elevating method using a U-shaped retractor. Forty-two patients were randomly allocated to the pneumoperitoneum (P) group and 41 to the U-shaped retractor (U) group. These two groups were well matched with respect to age, sex, etiology, and the severity of the chronic cholecystitis.Laparoscopic resection was successful for 88.1% (37/42) in the P group and 100% (41/41) in the U group. In patients with a severe fibrotic gallbladder, the rate of success was significantly higher (P<0.05) in the U group (100%, 6/6) than in the P group (11.8%, 1/6). In the moderately inflamed group, the operation time (mean±SD) was significantly (P<0.01) less in the U group (58.7±22.7) than in theP group (87.3±18.3). With the U-shaped retractor the usual surgical instruments can be used, and a rapid and safer laparoscopic cholecystectomy can be carried out. We prefer this approach to a pneumoperitoneum for patients with an inflamed gallbladder as hospital stay and pain are minimal.     

Studies on intimal smooth muscle cells in rabbits: decreased growth response to the tumor promoter

The growth behavior of intimal smooth muscle cells (SMC) prepared from atheromatous plaques of the thoracic aorta in hyperlipidemic rabbits was studied in a culture system. Specimens of intimal and normal medial SMC were examined in terms of their proliferative response to various growth factors, polypeptide hormones or 12-O-teradecanoylphorbol-13-acetate (TPA). Intimal SMC showed lower rates of growth and DNA synthesis when the cells were exposed to TPA, but there was no difference in growth response between intimal and medial SMC to the other growth-promoting stimuli such as fibroblast growth factor (FGF), epidermal growth factor (EGF), insulin or serotonin. 3H-phorbol-12,13-dibutyrate (3H-PDBu) binding assays showed the number of binding sites to phorbol esters in intimal SMC to be decreased by 65% as compared with that in medial SMC. These results suggested that intimal SMC have different growing characteristics, which seemed to be acquired during the process of intimal thickening.     

Specific induction of 68 KD protein synthesis in rabbit smooth muscle cells by growth stimuli in platelets: comparison of intimal and medial SMC

We examined the influence of growth stimuli in heat-treated platelet extract on specific protein synthesis in the early phase of the cell cycle prior to the initiation of DNA synthesis in cultured rabbit aortic smooth muscle cells (SMC). The extract preferentially stimulated the synthesis of a cytoplasmic protein with a molecular weight of 68000 (p68) and an isoelectric point of around 6.3. Stimulation of p68 synthesis occurred within 1 h after the addition of heat-treated platelet extract to growth-arrested and quiescent SMC, continued until 4 h after stimulation, and then returned to the baseline level. Actinomycin D preferentially inhibited p68 synthesis. In SMC prepared from atheromatous plaques from the aorta of hyperlipidemic rabbits (I-SMC), the amount of DNA synthesis and of p68 synthesis by heat-treated platelet extract were less than those of SMC prepared from normal media (M-SMC), suggesting that the decreased capacity for cell proliferation of I-SMC in response to heat-treated platelet extract was due to the down-regulation of signal transduction in the early G0/G1 phase of the cell cycle.