Kengo Fukuzawa

Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: a pilot study

BackgroundMany clinical studies have demonstrated that early postoperative enteral nutrition (EN) improved the postroperative course. Post-pancreaticoduodenectomy (PD), patients tend to suffer from postoperative nausea, abdominal distention, and diarrhoea, causing difficulty in the introduction of EN. In this pilot study, we investigated the appropriate nutritional mode post-pancreatic surgery.MethodsBetween October 2006 and March 2007 2 postoperative nutritional methods were implemented in 17 patients in a prospective single-centere study. Eight patients received only enteral nutrition (EN group) and 9 patients received enteral nutrition combined with parenteral nutrition (EN + PN group).ResultsThere were no differences in the patient characteristics and postoperative morbidity between the 2 groups. The rate of discontinuance of enteral feeding was significantly high in the EN group, and the duration of enteral feeding was significantly longer in the EN + PN group. The central venous line was retained for a significantly longer period in the EN + PN group, but there was no difference in the frequency of catheter-related infection between the 2 groups.ConclusionEN combined with PN is more adequate for patients after pancreatic surgery.

Restoration of ATP Contents in the Transplanted Liver Closely Relates to Graft Viability in Dogs

Searching for a marker of graft viability, adenosine triphosphate (ATP) content in the graft tissue was measured sequentially during orthotopic liver transplantation (OLT) in 24 adult mongrel dogs. According to the survival period, 12 recipients were divided into two groups: group I - early-death group (n = 6), death within 3 days after OLT and group II - survival group (n = 6), survived more than 7 days after OLT (average 12 days). Serum biochemical findings showed no differences between the two groups except that the prothrombin time on the first postoperative day in group I was significantly longer (p less than 0.05). The ATP content ratio (% of initial value) was significantly higher in group II, compared to that of group I (p less than 0.05), 94 versus 53% at 10 min after perfusion, 31 versus 17% at just before recirculation, respectively. The ATP content ratio recovered significantly to more than 80% at 10 min after recirculation in group II but only to less than 50% in group I. These results suggest that restoration of ATP content in the liver after graft recirculation reflects the viability of the graft and can serve as an appropriate prognostic marker in cases of OLT.

Primary breast lymphoma in the right breast during treatment for left breast cancer

BackgroundPrimary breast lymphoma is a rare condition, and distinguishing it from breast cancer is important because their treatments differ radically. Moreover, a recent report showed that mastectomy offered no benefit in the treatment of primary breast lymphoma.Case presentationA 59-year-old woman was treated with adjuvant chemotherapy and local radiation after surgery for left breast cancer. She presented with a rapidly growing mass in the right breast at 20 months after surgery. Mammography and computed tomography revealed a massive tumour. She was diagnosed with primary breast lymphoma by aspiration cytology, and surgery was performed. Histopathological and immunohistochemical findings confirmed a diffuse large B-cell type primary breast lymphoma.ConclusionIn this case, the lymphoma exhibited rapid growth despite chemotherapy for a malignancy in the contralateral breast. The patient had developed bronchiolitis obliterans organizing pneumonia due to radiation. Therefore, surgical treatment of the lymphoma was selected.

Ammonia elimination as a rapid index of viability in liver grafts in dogs

We examined intraoperative changes in blood ammonia levels and the correlation with graft viability in orthotopic liver transplantation (OLTx) in 29 dogs. Blood ammonia levels following total hepatectomy were examined using five dogs. These levels immediately following hepatectomy (15 min) were significantly higher (212 +/- 29 micrograms/dl) over values noted before hepatectomy (93 +/- 11 micrograms/dl, P less than 0.05). OLTx was performed using the cuff technique. The animals were divided into two groups: Group A (n = 6 pairs), OLTx with a nonpreserved fresh graft; Group B (n = 6 pairs), OLTx with an 8-hr preserved graft with lactated Ringer (4 degrees C). In both groups, the blood ammonia levels before the surgery and at the anhepatic phase data did not differ; however, following reperfusion, the levels in Group B were significantly higher (211 +/- 26 at 15 min, 200 +/- 50 micrograms/dl at 30 min) than those in Group A (121 +/- 10 at 15 min; P less than 0.01, 109 +/- 9 micrograms/dl at 30 min; P less than 0.05). The blood ammonia level highly correlated with adenosine triphosphate contents in the liver tissue, blood level of lactic acid, and amount of bile output, all pertinent indicators of the graft viability. Thus, the potential to eliminate ammonia immediately after reperfusion can serve as an indicator of graft viability. The intraoperative monitoring of blood ammonia levels can be included in management guidelines in cases of liver transplantation.

Ex vivo perfusion for accurate assessment of liver graft viability in dogs.

A new type of ex vivo liver perfusion model (EVPM) was developed. The system includes a physiological porto-portal connection, using a centrifugal pump and an aorto-aortal connection, through a heparin-coated tube. Ten pairs of mongrel dogs, weighing 13-20 kg, were used. Grafts of the liver procured from donors were perfused on the EVPM for 3 h. These grafts were divided into two groups: group A (n = 5), nonpreserved graft; group B (n = 5), 8-h graft preserved with lactated Ringers solution (4 degrees C). The orthotopic liver transplantation (OLTx) series with the nonpreserved graft was reviewed, and dogs surviving for over 7 days following OLTx, group C (n = 5), were selected for liver grafts in the actual OLTx. In comparison with groups A and C, no difference was noted among enzyme levels (sGOT, sGPT, LDH) or in the recovery rate of ATP content in the graft liver tissue after revascularization. There were significant differences between group A and group B after revascularization. This simple and physiological EVPM accurately reflects graft function and hemodynamics in the actual OLTx. Graft viability, as a substitute for OLTx, in large animals can be reliably assessed. This EVPM is expected to contribute to research on events related to liver transplantation.

Pulmonary Resection for a Residual Tumor after Definitive Radiation in Locally Advanced Non-Small Cell Lung Cancer

Objective and Methods To clarify the benefits of surgery for a persistent tumor following definitive radiation in locally advanced non‐small cell lung cancer, five patients were retrospectively reviewed. Results All patients received definitive radiation, and three received concurrent chemotherapy followed by anatomical lung resection for a residual local tumor. The median time from the radiation to surgery was 8.2 weeks. There were no postoperative mortalities. Four patients developed distant metastasis with a mean recurrence‐free interval of 7.5 months. Conclusions Distant metastasis frequently occurred within a relatively short period after surgery. Further studies with a larger sample size are needed.