Mamoru Hiraishi

Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy.

ObjectiveThe authors used prolamine (Ethibloc, Ethicon GmBH, Norderstedt, Germany) for segmental obstruction of the pancreatic duct to prevent pancreatic fistula development after distal pancreatectomy combined with total gastrectomy for gastric malignancies. Summary Background DataSummary Background Data the initial clinical application of prolamine was pancreatic duct obstruction for patients with pancreatitis and undergoing pancreatic transplantation and pancreaticoduodenectomy for pancreatic cancer, there are no reports on prevention of pancreatic fistula formation after distal pancreatectomy. MethodsProlamine (0.2 mL) was injected into the distal segment of the main duct in the remaining pancreata of 51 patients. Small pancreatic ducts on the cut surface, from which prolamine extravasates, were closed by ligation, the main duct was ligated doubly, and the transected pancreatic margin was closed 15 minutes after phenylpropanolamine hydrochloride injection. ResultsResults patient developed a pancreatic fistula or the complication of arterial bleeding due to prolonged infection. ConclusionConclusion obstruction of the pancreatic duct with prolamine is useful for preventing pancreatic fistula development after distal pancreatectomy.

The effect of oral adsorbent on surgically induced hepatic failure

The oral adsorbent AST-120 is one type of activated carbon for oral use. In the present study, AST-120 was administered, to clarify its effect, on surgically induced hepatic failure in dogs and rats. Portacaval shunts and varying extents of hepatectomies were performed on 44 dogs. Eleven dogs were given an ordinary diet (control group), and 33 dogs received the oral adsorbent with an ordinary diet after the operation (AST group). Plasma bile acids and ammonia increased, and body weight decreased in both groups. However, after the administration of AST-120, the plasma bile acids and ammonia decreased significantly, and the body weight tended to increase in the AST group. Portacaval shunts and about 70 per cent hepatectomy were performed on 59 Sprague-Dawley rats. These rats were divided into two groups, diet with the oral adsorbent (AST group, n=19) and an ordinary diet alone (control group, n=40). DNA synthesis and protein synthesis of the liver were measured on the 5th, 10th and 20th postoperative days using radioisotopes in these rats. Both DNA and protein synthesis of the liver were increased significantly in the AST group. Histological examination revealed many more glycogen granules in the cytoplasm of hepatocytes in the AST group compared to the control group on the 5th postoperative day. It was suggested that some metabolic toxin was adsorbed by AST-120 in the alimentary tract.

Influence of perioperative blood transfusion on the prognosis of patients with gastric cancer receiving anticancer chemotherapy.

AbstractBackground. The deleterious effect of blood transfusions on survival has been reported in patients with cancers of various organs. However, it remains unclear whether there is any adverse effect of blood transfusion when the patients are administered anticancer drugs after surgery for gastric cancers. Methods. Data from patients with gastric resection for advanced gastric cancer were retrospectively analyzed to determine the influence of perioperative blood transfusion on the survival rate. All patients were administered anticancer drugs (mitomycin C [MMC] and tegafur-uracil [UFT]). Sixty-nine (33%) of 208 patients received blood transfusion perioperatively, while 139 patients (67%) did not receive transfusion. Multivariate analysis of clinicopathologic prognostic factors, including blood transfusion, was performed. Lymphocyte subsets were measured to investigate the immunosuppressive effect of blood transfusion. Results. The 5-year survival rate was 48.8% in the 69 transfused patients and 66.9% in the 139 non-transfused patients (P < 0.01). Coxs multiple regression analysis showed that, when patients received anticancer drugs, perioperative blood transfusion was not a significant factor affecting survival after the gastric cancer surgery. However, the CD4/CD8 ratio at 3 months after the surgery was significantly lower in the transfused group than in the non-transfused group. Conclusion. Blood transfusion did not affect the survival of operated patients who received postoperative adjuvant chemotherapy. However, the finding that the ratio of CD4/CD8 after surgery was significantly higher in the non-transfused group than in the transfused group supports the notion that transfusion causes broad-spectrum immunosuppression.

A combination of laser therapy, radiation therapy, and stent placement for the palliation of complete malignant bronchial obstruction

Abstract. We treated a complete obstruction of the left mainstem bronchus due to nonresectable recurrent esophageal carcinoma with a combination of laser therapy, radiation therapy, and the placement of an expandable metallic stent. The patient survived 1 year after the first therapy, with good quality of life. We conclude that a combination of laser ablation, radiotherapy, and stent placement can improve survival and quality of life for the patients with complete malignant bronchial obstruction.

Gastroesophageal Reflux After Gastric Surgery

Esophageal and gastric pH monitoring and endoscopic examination of the esophagus were performed in patients after gastric surgery. The duration time and frequency of gastroesophageal reflux were studied using an ambulatory 24-h pH monitoring system. The subjects consisted of 43 patients with distal gastrectomy, 3 patients with proximal gastrectomy, 19 patients with total gastrectomy, 9 patients with reflux esophagitis without previous gastric surgery, and 53 preoperative patients. Esophageal and gastric pH were measured 5 cm above and 5 cm or 10 cm below the esophagogastric junction (EGJ). The duration, ratio and frequency of acid (pH 7.4) reflux, acid and alkaline clearance time, and mean and median pH were measured. From the pattern of the esophageal pH curve, patients were divided into four groups: normal, acid reflux, alkaline reflux, and mixed type. In patients who received distal gastrectomy, acid reflux time (pH 7.4) and alkaline clearance time were longer than in preoperative patients. There were a few patients who showed small changes in esophageal pH in spite of esophagitis; the esophagitis in these patients was considered to be due to pancreatic enzymes.

Leucovorin, Cisplatin, and 5-Fluorouracil for Advanced Esophageal Cancer

Biochemical modulation involves the use of one drug (modulating agent; modulator) to change the pharmacokinetics and/or pharmacodynamics of a cytotoxic agent (effector), in a way that the therapeutic index of the effector is enhanced [1]. The modulator is often also a cytotoxic agent, but a non-cytotoxic agent like leucovorin is sometimes used as well. The modulating agent improves selectivity or sensitivity of an effector and decreases its toxicity to normal cells via a biochemical or metabolical mechanism. Currently, several biochemical modulations such as the sequential methotrexate (MTX)/5-fluorouracil (5-FU), leucovorin (LV)/5-FU, and cisplatin (CDDP)/5-FU have been evaluated clinically in terms of their efficacy for alimentary tract malignancies.

Hepatic Arterial Infusion Therapy with Leucovorin 5-Fluorouracil for Liver Metastasis of Gastric Colorectal Cancer

We conducted a biochemical modulation with leucovorin (LV) and 5-fluorouracil (5-FU) through hepatic arterial infusion (HAI) for metastatic liver tumors. Eight patients of hepatic metastasis of adenocarcinoma from the gastrointestinal tracts (3 from gastric cancer and 5 from colorectal cancer) received HAI treatment of LV 20mg/m2 and 5-FU 425mg/m2 for the consecutive 5 days, repeated every 4 weeks. Tolerable leukocytopenia, nausea and vomiting, diarrhea, anorexia, and stomatitis were seen. Response rate of 50% (2 CR and 2 PR) without severe adverse effect indicates the high efficacy of this biochemical modulation via HAI against liver metastatic tumors.

Endoscopic Treatment for the Cancer and Submucosal Tumor of the Upper Gastrointestinal Tract

Endoscopic treatment was performed for 38 patients of gastric cancer and 6 patients of esophageal cancer and 3 patients of submucosal tumor of the upper gastrointestinal tract. Thirty-four patients of gastric cancer were treated by laser irradiation. In these patients, 26 were considered as early cancer, and 8 were considered as advanced cancer. Four patients of gastric cancer and one patient of esophageal cancer were treated by strip biopsy. All these patients were considered as intolerable for surgical operation or refused for operation. In the laser therapy, Nd:YAG laser irradiation of 40–90 watts with 1–0.5 second duration was repeated for the lesions. The prognosis of early gastric cancer was good in case of protruded type or small ulcerative type which was less than 2cm in diameter. Three patients of subumcosal tumor of the upper GI tract were treated by laser and electro-surgery. The lesion was in the esophagus, stomach and duodenum. KTP laser with bare quartz fiber of 0.3 mm in diameter was used. The surface of mucosal layer was cut with laser at the base of the tumor. Then the tumor was grasped by forceps and resected by electro-surgery. The resected specimens revealed myoma of the esophagus, fibrosis with calcified tissue of the stomach, and lipoma of the duodenum.