Kazuhiko Jingu

Effectiveness of Hydroxyethyl Starch (HES) on Purification of Pancreatic Islets

BACKGROUND The isolation of large-scale and high-quality islets from the pancreas is essential for a successful islet transplantation. We developed a hydroxyethyl starch (HES)-Collins solution as the purification medium and evaluated its usefulness on islet isolation from the pancreas of beagle dogs. MATERIALS AND METHODS The pancreas of beagle dog was digested using our original 2-step automated technique. Islets were purified by discontinuous purification method on HES-Collins solution (group 1, n = 10) or Euro-Ficoll solution (group 2, n = 16) with a COBE2991 cell processor. Islet yield and purity, changes in islet number during 3-day cultures, static incubation, perifusion study, and insulin content were examined. In addition, the islets were autotransplanted into the liver via the portal vein. RESULTS Although no significant differences were detected, yield and purity were higher in group 1. After 3 days of culture, the islet number decreased less in group 1. Both under static incubation and in the perifusion study, stimulation indices were 4.50 +/- 1.82 and 6.02 +/- 1.05, which were significantly higher than the 2.18 +/- 0.67 and 3.32 +/- 1.46 observed in group 2. Also, insulin content of the islets was significantly higher in group 1 than in group 2. Fasting blood glucose levels were maintained at values below 100 mg/dl for 100 days in group 1 and around 200 mg/dl in group 2. CONCLUSIONS The use of HES-Collins solution was associated with an improvement of islet yield and purity. Also, islet viability and function were preserved longer during culture. Accordingly, islet purification using HES-Collins solution might be recommended for clinical islet transplantation.

A Case of G-CSF-Producing Histiocytic Sarcoma of the Stomach

No reports have been published to date regarding primary gastric granulocyte colony-stimulating factor (G-CSF)-producing histiocytic sarcoma. We encountered a case of primary gastric histiocytic sarcoma that also fulfilled the criteria for a G-CSF-producing tumor. A 75-year-old man was diagnosed with gastric cancer with poorly differentiated adenocarcinoma. The patients white blood cell count was elevated to 20,700/μL, and the G-CSF level was elevated to 380 pg/mL. A computed tomography scan showed hepatic infiltration; therefore, a preoperative diagnosis of T4 (liver) N2H0M0 cStage IV gastric cancer was made, and surgery was performed. No. 11d lymphatic metastasis was noted, resulting in invasion of the pancreatic tail, and combined resection of the liver, pancreas, and spleen was conducted with complete gastrectomy. The results of hematoxylin-eosin and immunohistochemical staining were subsequently assessed. On discharge, the G-CSF level had fallen to 22.7 pg/mL. Currently, the patient is still alive and has experienced no recurrence approximately 4 years after the operation.

Reasonable Treatment for Pancreatic Cancer with Respect to Its Prognosis and Quality of Life of the Patients.

教室では, 膵癌に対し拡大りんぱ節郭清, isolation method+門脈合併切除を導入し, 拡大手術を推進してきた. 教室膵癌切除例99例を対象と予後, QOLからみた膵癌の至適治療につき検討した. 膵頭部癌切除例の検討ではD2郭清群はD1郭清群に比較し生存日数, 在宅生存日数の延長が得られた. 門脈合併切除により有意に局所再発率は低下した. しかしながら, stage IVb例では郭清度, 根治度に関わらず予後不良であった. 肝転移対策としてのisolation methodは肝転移抑制, 予後向上に寄与しなかった. 膵頭部癌に対する再建術式としては, 栄養状態, 膵機能の面でPDに比較しPpPDが優れていた. stage IVa以下の膵癌に対しては再建術式をPpPDとする積極的な拡大手術を, stage IVb症例では, QOLを考慮した治療法を選択すべきと考える.