Masazumi Zaima

Survival in Nonocclusive Mesenteric Ischemia: Early Diagnosis by Multidetector Row Computed Tomography and Early Treatment With Continuous Intravenous High-dose Prostaglandin E1

Objectives:The aim of the study was to establish a procedure for early diagnosis and treatment of nonocclusive mesenteric ischemia (NOMI). Background:NOMI has a high mortality rate, and early diagnosis and treatment are important for improving survival in patients with this condition. Methods:The subjects were 22 patients treated at our hospital over 13 years. Diagnostic criteria for NOMI were established based on the first 13 cases. In the 9 more recent cases, we performed abdominal contrast multidetector row computed tomography (MDCT) upon suspicion of NOMI based on these criteria. Imaging allowed definite diagnosis of NOMI, and continuous intravenous high-dose PGE1 administration was initiated immediately after diagnosis (dose, 0.01–0.03 μg/kg per min; mean administration period, 4.8 days). Results:Nine of the first 13 patients died of multiple organ failure associated with multiple intestinal necrosis. These cases suggested that NOMI may develop when 3 of the following 4 criteria are met after cardiovascular surgery or maintenance dialysis in elderly patients: symptoms of the ileus develop slowly from abdominal symptoms, such as an unpleasant abdominal feeling or pain; a requirement for catecholamine treatment; an episode of hypotension; and slow elevation of the serum transaminase level. In the 9 recent cases, definite diagnosis was made from spasm of the principal arteries in arterial volume rendering and curved planar reformation MDCT images. Early treatment with PGE1 prevented acute-stage NOMI in 8 of the 9 cases. Conclusions:Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI.

Effect of Gabexate Mesilate on Thrombin and Plasmin Generation after Hepatic Resection in Cirrhotic Patients

The effect of the gabexate mesilate (Gab) on thrombin and plasmin generation following liver resection in cirrhotic patients was studied. Six cirrhotic patients received an infusion of Gab after liver resection (Gab group), and another 6 patients did not receive such treatment (Con group). The parameters measured were thrombin-antithrombin complex (TAT), plasmin-antiplasmin complex (PAP) and D-dimer. The real increases of D-dimer and PAP were significantly higher in Con group after surgery while no significant difference was observed in the increase of TAT. These results show that Gab suppresses plasmin generation and following D-dimer production more effectively than thrombin generation after hepatic resection.

Fibrin Sealant of the Cut Surface of Partial Liver Grafts from Living Donors

Complete hemostasis and proof against bile leakage on the cut surface of the partial liver graft and the remnant liver of the donor are basic desiderata for a successful outcome in living related liver transplantation (LRLT). This study evaluated the efficacy of fibrin glue sealant on the cut surface of a graft in human living related liver transplantation and canine partial liver transplantation in terms of postoperative complications. From June 1990 to August 1993, a series of 70 LRLTs were performed on children with end-stage liver disease. In harvesting the graft from living donor, hepatic parenchyma was transected by ultrasonic aspirator. Clearly exposed vessels were either ligated or suture ligated. Fibrous connecting tissues of the glissonian branches and tiny vessels were coagulated by a newly devised bipolar electric cautery equipped with saline dripping system. Fibrin sealant was sprayed on the cut surface of the liver graft and the remnant liver of the donor. All donors were discharged from hospital at 10 to 17 (mean = 11.6) days after surgery without any complications that required surgical intervention, and were able to return to normal life. At reperfusion of the graft in the recipients, no blood loss from the cut surface was observed. However, bile oozing on the cut surface was observed in 3 of the 70 cases. No infection or foreign body reactions were observed in the fibrin-sealed cut surface of the graft. Actuarial recipient survival rate was 89% (48/54) in elective cases and 69% (11/16) in emergency cases. In canine transplantation, 16 out of 23 beagles survived for 4 days or longer (longest 20 days).(ABSTRACT TRUNCATED AT 250 WORDS)

A new strategy for management of retroperitoneal tumors with supradiaphragmatic vena caval thrombi

A new surgical technique to treat retroperitoneal tumors with supradiaphragmatic vena caval invasion is described. In this technique, hepatic warm ischemia can be avoided with reversed hepatic outflow through the portal vein and neither hypothermic circulatory arrest nor cardiopulmonary bypass is necessary using centrifugal blood pump-driven bypass.

Graft transection and warm perfusion in situ in canine partial orthotopic liver transplantation

Abstract. Liver transplantation is now proven therapy for various forms of end‐stage liver disease in children; however, the problem of donor liver shortage remains. To investigate the feasibility of graft procurement from living, genetically related adult donors without injury to either donor or recipient, partial orthotopic liver transplantation (PLT) using a graft transected and warm perfused in situ was evaluated in beagles; the viability of the graft was assessed in terms of energy metabolism, including blood ketone body ratio (KBR), as well as of recipient survival. PLT was performed in two groups with venovenous bypass. The left half of the donor liver was transected in situ, flush perfused with 2 1 lactated Ringers solution (4°C in group A, 20°C in group B), and immediately implanted into the recipient, who was totally hepatectomized, care having been taken to leave the inferior vena cava intact. Four of seven dogs survived for 5 days or longer (longest, 8 days) in group A and six of eight dogs (longest, 20 days) in group B. Causes of death were gastrointestinal bleeding, intussusception, or infection but not graft dysfunction. In both groups the KBR decreased significantly during the anhepatic period, recovered rapidly to the pre‐anhepatic level after revascularization, and was maintained within a normal range thereafter. No significant differences in the time course of changes in KBR were seen between the two groups. These results suggest that a warm‐perfused graft does not have a poorer viability than a cold‐perfused one, that the concept of PLT with a graft transected and warm perfused in situ is feasible, and that it may be the solution to the problem of donor liver shortage.

A phase II study of neoadjuvant chemotherapy with S‐1 and cisplatin for stage III gastric cancer: KUGC03

A multi‐center phase II study was conducted to evaluate the safety and efficacy of neoadjuvant chemotherapy (NAC) with S‐1 plus cisplatin for advanced gastric cancer.

Conversion to complete resection with mFOLFOX6 with bevacizumab or cetuximab based on K‐ras status for unresectable colorectal liver metastasis (BECK study)

Patients with colorectal liver metastasis (CRLM) might be down‐staged by chemotherapy from an initially unresectable stage to a resectable stage. Because the tumor response to preoperative chemotherapy has been correlated with resection rate, the improved efficacy from the concept that only the patients without K‐ras mutations receive an anti‐EGFR antibody might be expected to increase the conversion rate. The purpose of this study is to evaluate the conversion rate from unresectable CRLM to complete resection.

Outcomes of Neoadjuvant Chemotherapy without Radiation for Rectal Cancer

Aim: The efficacy of neoadjuvant chemotherapy without radiation (NAC) in the treatment of rectal cancer remains unclear. This retrospective study was aimed at determining the pathological complete response rate and short-term outcomes of NAC in patients with locally advanced rectal cancer. Patients and Methods: We collected data on 159 consecutive patients treated for rectal cancer (cT3/cT4a, cN+, and cM0 status) at five tertiary referral hospitals between 2005 and 2010. Pathological complete response (pCR) and safety were assessed as the main outcomes in 124 eligible patients comprising 15 who received NAC (NAC group) and 109 who received no neoadjuvant chemotherapy (non-NAC group). Results: In the NAC group, 2 patients (13.3%) achieved a pCR (95% confidence interval: 1.7-40.5%) and 3 patients (20%) experienced grade 3/4 adverse events. No significant differences were found between the NAC and non-NAC groups in terms of short-term outcomes, including R0 proportion (100 vs. 96.3%, p = 0.45) and postoperative grade 3/4 complications (13.3 vs. 18.4%, p = 0.63). Conclusions: Neoadjuvant systemic chemotherapy without radiation appears to be safe, without worsening short-term outcomes, in patients with locally advanced rectal cancer. A further study is needed to verify these findings in larger samples.

Indication for neoadjuvant chemotherapy in patients with colorectal liver metastases based on a nomogram that predicts disease-free survival

The purpose of this study was to validate the Beppu nomogram, which predicts disease‐free survival (DFS) after resection of colorectal liver metastases, and to investigate the efficacy of neoadjuvant chemotherapy based on the nomogram‐predicted recurrence risk.

Sequential decrease in platelet energy charge after hepatic resection in cirrhotics

The adenylate energy charge of human platelets was measured in the early postoperative period after hepatic resection in cirrhotic and noncirrhotic patients to evaluate the metabolic status of platelets in this period. The adenylate energy charge of platelets decreased on the first, second, and third postoperative days in the cirrhotic group, whereas no significant decrease was found in the noncirrhotic group. A decrease in the percentage of adenosine triphosphate and an increase in that of hypoxanthine also occurred concomitant with a decrease in the adenylate energy charge, which was considered to be the result of an increased utilization of adenosine triphosphate. These findings indicate that in cirrhotic patients, the intravascular activation of platelets takes place and platelet function is damaged during the period immediately after hepatic resection, even when there is no clinical evidence of intravascular coagulation.