Importance of luxury flow for critically ill patients receiving a left ventricular assist system

The presence of a significant organ dysfunction does not immediately exclude patients from consideration for treatment with a left ventricular assist system (LVAS). However, in treating morbid circulatory shock patients with multiple organ failure, it is important to know the preoperative and postoperative factor or factors related to the recovery of the damaged organ function. In this study, we retrospectively analyzed patients receiving a LVAS at our institution and tried to determine the important factors related to the survival of patients with multisystem failure. Twenty-seven patients who underwent LVAS placement at Saitama Medical School Hospital between 1993 and 2003 were included in this study. The preoperative risk factors analyzed were renal dysfunction, respiratory dysfunction, hepatic dysfunction, the existence of active infection, and the combination of all four factors. As a postoperative factor, the pump flow index (mean LVAS pump flow during the first 2 weeks after LVAS surgery divided by the body surface area) was analyzed. None of the analyzed preoperative factors could predict survival after LVAS surgery, but a pump flow index of less than 2.5 l/min/m² had a significant relationship with death after LVAS surgery. Further analysis revealed that all the patients with a pump flow index of 3.0 l/min/m² or more could overcome preoperative organ dysfunction. Congestive heart failure patients with multisystem failure need luxury pump flow for successful LVAS surgery; this factor could be especially important in device selection and postoperative management.     

The role of γδ T cells in priming macrophages to produce tumor necrosis factor-α

The secretion of tumor necrosis factor (TNF)-α from macrophages is regulated by both priming and triggering signals. We found that macrophages from mice lacking γδ T cells [T cell receptor (TCR) δ^?/- mice], which lack the gene encoding the δ chain, produced only small amounts of TNF-α in response to lipopolysaccharide (LPS) and showed a reduced level of expression of CD14. Pre-incubation of macrophages from TCR δ-/- mice with γδ T cells from their TCR δ^+/- littermates restored their capacity to produce TNF-α in response to LPS. The priming activity of γδ T cells was in part inhibited by neutralizing anti-interferon (IFN)-γ monoclonal antibodies. Collectively, these results suggest that γδ T cells play a role in priming macrophages to a steady state of activation via IFN-γ secretion, which allows them to produce TNF-α when exposed to LPS.     

A case of prostatic malignant lymphoma

A 65-year-old man was admitted for dysuria. He had been irradiated 60Co for malignant lymphoma of tonsils 2 years earlier. The findings of palpation of prostate, retrograde urethrogram and urethroscopy strongly suggested benign prostatic hypertrophy. Retropubic prostatectomy was performed and 18 g of "adenoma" was resected. By histological observation, the "adenoma" proved to be malignant lymphoma. This tumor belonged to follicular lymphoma, medium-sized cell type of LSG non-Hodgkin's lymphoma classification. After the operation, he left our hospital for a personal reason and received systemic chemotherapy at another hospital.     

Experience with microsurgical epididymovasostomy (specific tubule technic: end-to-end anastomosis by the Silber method)

Here, we report 2 cases of epididymovasostomy operation in which good results were obtained. These operations were done for patients whose complaints were male sterility due to obstructive azospermia after bilateral epididymitis. The method of this operation was reported by Silber in 1978 as "specific tubule technique", and excellent results have been reported. Herein, we introduce this technique perhaps for the first time in Japan, and the characteristics of this method are considered. The important factors and characteristics of this method are that it is very reasonable with a high success rate, it is more difficult than microsurgical vasovasostomy, it is a time-consuming operation. Epididymovasography should not be done preoperatively but intraoperatively, if possible and chronic epididymitis should be ruled out by serological study and culture study.     

Diagnostic impact of monitoring transcranial motor-evoked potentials to prevent ischemic complications during endovascular treatment for intracranial aneurysms

Neurosurgical Review - The present study aimed to determine the incidence of intraprocedural motor-evoked potential (MEP) changes and to correlate them with intraprocedural ischemic complications...     

Does the washout phenomenon of Tc-99m HM-PAO correlate to the “Filling-in” phenomenon of I-123 IMP with brain SPECT?

Summary Using SPECT, the time course of brain uptake was compared between N-isopropyl-p-[I-123]-iodoamphetamine (I-123 IMP) and Tc-99m d,l hexamethyl-propyleneamine oxime (Tc-99m HM-PAO). Of 14 patients with cerebrovascular disease showing areas of the filling-in phenomenon (i.e. delayed uptake) with I-123 IMP brain SPECT, 7 exhibited persistent defects with Tc-99m HM-PAO (Group I), and 7 showed early washout after the initial uptake (Group II). The filling-in of I-123 IMP did not always correlate to the washout region of Tc-99m HM-PAO. The temporal changes were also confirmed by semiquantitative analysis. While the filling-in of I-123 IMP was affected by many factors, the washout of Tc-99m HM-PAO was attributed to significant reduction of Tc-99m HM-PAO in the plasma. Delayed imaging of the brain with Tc-99m HM-PAO using SPECT may give a more accurate estimate of regional cerebral blood flow in cerebrovascular disease, because it should be lees effected by cerebral blood volume.     

Enhancement by hyperthermia of the in vivo antitumour effect of doxorubicin hydrochloride (DOX) and buthionine sulfoximine (BSO)-hydroxyapatite (HAP) complex

We have developed a new type of drug delivery system (DDS) comprising a complex of porous hydroxyapatite (HAP) with the anticancer drug doxorubicin hydrochloride (DOX) and the glutathione inhibitor buthionine sulfoximine (BSO) (DOX and BSO-HAP complex). We then studied the antitumour effect of DOX and BSO-HAP combined with 44 degrees C hyperthermia for 40 min. It was found that in mice this combined treatment suppressed the growth of sarcoma 180 in terms of tumour volume to 36% in comparison viith mice given plain HAP, and was more effective than HAP + hyperthermia or DOX- and BSO-HAP. These results were also confirmed by histological observation.