Akihiko Mizoe

Utility of technetium-99m-labeled-galactosyl human serum albumin scintigraphy for estimating the hepatic functional reserve.

Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (Tc-GSA) is a receptor binding agent, specific for asialoglycoprotein receptor, that resides exclusively on the plasma membrane of mammalian hepatocytes. The usefulness of Tc-GSA for estimating the hepatic functional reserve was retrospectively evaluated in patients undergoing a hepatic resection. Tc-GSA scintigraphy was performed in 35 patients before hepatectomy, and the hepatic uptake ratio (LHL15) was calculated. The LHL15 was then compared with the findings of conventional liver function tests, the indocyanine green retention rate in 15 minutes (ICG R15), and histologic activity index (HAI) score. Significant correlations were observed between the LHL15 and values of ICG R15, prothrombin time activity, serum levels of total bilirubin, hyaluronic acid, and values of HAI score. Ratios of LHL15 to preoperative liver volume (LHL-V) correlated well with the regenerative rates of the residual liver after major hepatectomy. In addition, patients with more than 0.76 of LHL-V value had no complications in postoperative course, whereas those with less than 0.73 had several complications due to hepatic dysfunction. Tc-GSA scintigraphy thus appears to be a useful diagnostic tool for evaluating functioning mass of the liver and the values of LHL-V seems to be able to demonstrate regenerative activity in the residual liver after hepatectomy.

Successful treatment of bleeding due to ileal varices in a patient with hepatocellular carcinoma.

This case report concerns a 62-year-old female who was known to have cirrhosis. An endoscopic examination showed no evidence of haemorrhaging due to either oesophageal or gastric varices. Angiographic studies demonstrated extravasation from the ileal varices. There was a prominent arterio-portal shunt in the liver, and the shunt was considered to be a contributing factor to induce portal hypertension and variceal bleeding in the ileum. Therefore, transcatheter arterial embolization was performed, but was unsuccessful. As a result, the patient underwent a laparotomy, and a dilatating ileocaecal vein and a communicating ovarian vein were selectively ligated. Following the procedure, the haemorrhaging stopped and she then recovered. The patient is doing well 21 months after surgery at the time of writing.

Primary leiomyosarcoma of the jejunal mesentery: Report of a case

The occurrence of a primary leiomyosarcoma of the mesentery is rare. A 61-year-old man was admitted to the hospital complaining of an abdominal mass. The findings of both abdominal ultrasonography and a computed tomography (CT) scan revealed an irregular and heterogeneous mass located in the mesentery. A laparotomy was performed and a 7.0-6.5cm tumor was thus found within the jejunal mesentery. The tumor was successfully resected by a combined resection of 40 cm of the jejunum and end-to-end anastomosis of the jejunum. Pathological examination of the resected specimen revealed leiomyosarcoma. The patient had an uneventful postoperative course, but multiple liver metastases were discovered 1 year and 5 months after the initial operation. A second operation was performed, but the patient died due to hepatic failure and unexpected bleeding from the cut surface of the remnant liver. Preoperative imaging examinations, including abdominal ultrasonography and CT scan, were thus found to be useful tools for both identifying and diagnosing the origin and extension of a mesenteric mass. However, even using such diagnostic techniques an accurate diagnosis of intraabdominal leiomyosarcoma remains difficult.

Efficacy of endothelin-1 receptor antagonist for protecting the function of grafted livers from preservation-reperfusion injury in pigs

P RESERVATION-REPERFUSION INJURY is one of the most serious problems in liver transplantation. Endothelin-1 (ET-l) is a 21-residue peptide that has various chemical and mechanical factors.’ Recently, various studies have focused on the hepatic microcirculatory disturbance induced by ET-l. 2,3 We reported that ET-l was harmful to the grafted liver, and that levels of ET-l correlated closely with the activity of sinusoidal endothelial cells and with graft survival after reperfusion in porcine orthotopic liver transplants.4 These results suggest that inhibition of endothelin activity might be able to prevent preservation-reperfusion injury in liver transplantation. TAK-044, which is a novel nonselective receptor (ETAIB) antagonist,” has been reported to have a hepatoprotective effect against ischemia-reperfusion injury in warm ischemic models of canine liversh,’ Little is known, however, about the efficacy of this agent on preservation-reperfusion injury in liver transplantation. The aim of the present study is to evaluate the efficacy of TAK-044 in protecting the grafted liver from preservationreperfusion injury during orthotopic liver transplantation in pigs.

Alanyl‐glutamine provides beneficial nutritional support after orthotopic transplantation of the liver in pigs

We evaluated the nutritional status of pigs that received glutamine after orthotopic liver transplantation. After transplantation, one group of pigs received an oral diet (group I,n=5), one group received conventional total parenteral nutrition (group II,n=4), and one group received alanylglutamine supplemented parenteral nutrition (group III,n=7). We compared nutritional status, graft liver function, and ileal mucosal thickness in the three groups. There were no significant differences in nutritional parameters or serum chemistries among the groups. In terms of ileal integrity, mucosal thickness was reduced after liver transplantation in group II, whereas it was relatively well preserved in group III. The level of endotoxin in the portal venous blood was significantly lower in group III, than in group II on the 7th day after liver transplantation. Parenteral alanyl-glutamine appears to have beneficial effects in preserving the integrity of the ileal mucosa when oral intake of nutrients may not be feasible. This could prevent bacterial translocation in the portal vein.

Effect of Superoxide Dismutase Derivatives Modified with Monosaccharides on Reperfusion Injury of Orthotopic Liver Transplantation in Rats. Evaluaiton by Liver Na+, K+-ATPase Activity.

Superoxide dismutase (SOD) 誘導体のmannosylated SODは肝非実質細胞に, galactosylatedSODは肝実質細胞に取り込まれ, 肝由来の活性酸素の効果的な消去を期待しうる.そこで, ラット肝移植実験でこれらの単糖類で修飾したSODを使用し再灌流障害に対する効果を検討した.通常のSODと修飾型SODを肝移植再灌流直前に投与し再灌流30分後に犠牲死させ, 血液および肝組織を採取して血液一般肝機能, 肝組織Na+, K+-ATPase活性, 組織過酸化脂質 (LPO), 組織SOD活性を測定した.移植再灌流によって血中逸脱酵素の上昇と肝組織Na+, K+-ATPase活性の有意の低下, LPOの増加とSOD活性の低下を認めた.これらの障害は通常のSODでは抑制されず, 単糖類で修飾したSOD, ことにgalactosylated SODによりNa+, K+-ATPase活性低下は抑制され, 組織LPO, SOD活性の改善が認められ, 再灌流時に発生する組織障害の防止に有効と考えられた.