Naoki Nagashima

Autologous blood transfusion in patients with hepatocellular carcinoma undergoing hepatectomy

BACKGROUND Homologous blood transfusion (HBT) has the risk of an immunosuppressive effect and may adversely affect the prognosis of patients with carcinomas. Autologous blood transfusion (ABT) has not yet become a standard procedure in gastroenteric cancer surgery. We investigated the usefulness and problems of ABT combined with the use of recombinant human erythropoietin (rh-EPO). METHODS An evaluation of autologous blood transfusion (ABT) combined with recombinant human erythropoietin (rh-EPO) treatment was conducted in 46 patients with hepatocellular carcinoma undergoing hepatectomy. Preoperative autologous blood donation (ABD) was accomplished for 25 of the 46 patients. The preoperative changes in hemoglobin and hematocrit in relation to route of administration of erythropoietin were studied. In addition, intraoperative blood requirements and the postoperative complications for patients who predonated were compared with those of patients who underwent surgery without autologous predonation. RESULTS The proportion of patients not requiring additional homologous blood transfusions (HBT) during operation was significantly higher in the ABD group than in the non-ABD group (88% versus 38%). The incidence of postoperative complications was significantly higher in patients receiving HBT than in nontransfused patients and in those receiving ABT. CONCLUSIONS Preoperative autologous blood donation in combination with rh-EPO therapy markedly reduced the requirement for homologous blood transfusion during surgery in patients with hepatocellular carcinoma having hepatectomy.

Measurement of mycophenolate mofetil effect in transplant recipients

Background. Immunosuppression involves the nature of the immunosuppressive agents and individual differences in patient factors. We investigated whether the effect of mycophenolate mofetil (MMF) is measurable using an in vitro measure of immunocompetence and related its effects to cyclosporine (CsA) in vitro. Methods. Liver or kidney transplant recipients receiving prednisone; CsA or tacrolimus; and MMF, azathioprine (AZA), or neither, were studied. Immunocompetence was assessed by one-way mixed lymphocyte culture using patients’ peripheral blood leukocytes (PBL) and three validated stimulators. The effect of immunosuppressive agents added in vitro on normal PBL stimulation by Staphylococcus enterotoxin B was determined by the carboxyfluorescein diacetate succinimidyl ester measurement of division. Results. Patients receiving MMF had an average immunocompetence level of 12±23, compared with 39.7±65 and 25.5±42 for those receiving AZA or neither AZA nor MMF, respectively. Thus, there was an approximately 80% suppression of the response in the MMF group. Assessment of normal cell division revealed that CsA allowed multiple cell generations but suppressed the numbers of cells in each, whereas MMF blocked proliferation into subsequent generations. Addition of clinically relevant levels of mycophenolic acid, the active agent for MMF, added to more moderate levels of CsA, was required to achieve greater than 80% suppression, consistent with the degree of immunocompetence depression measured in patients. Conclusions. These data provide the novel finding that the effect of MMF treatment on patients is measurable in their PBL as decreased immunocompetence in vitro. The effect of MMF on normal PBL approximates the 80% inhibition that we found in patients. Moreover, the effect of MMF on cell division provides a rationale for the superior effectiveness of regimens including MMF.

Surgical Management of Coincidental Gastric or Colorectal Carcinoma and Abdominal Aortic Aneurysm.

消化器悪性疾患に腹部大動脈瘤 (AAA) を伴った6例を経験したので報告する.1991年1月～1994年12月までに経験した非破裂性AAAは57例で, その内消化器癌を合併した6例を対象とした.男5例, 女1例で胃癌4例, S状結腸癌1例, 直腸癌1例であった.AAAの手術適応は径5cm以上とし, 無症状の場合はまず癌に対して手術し, 2期的に人工血管置換術を施行.合併疾患, AAA最大径, 癌の進行度, 術後合併症, 予後について検討した.6例すべて経過良好で退院したが, 冠動脈病変のほか貧血, 腎機能, 呼吸機能障害を認めた胃癌の1例は術後6か月後急性心不全で死亡.胃癌のみ手術を施行した2例中1例は7か月後癌性腹膜炎, 他の1例は2年2か月後再発で死亡.その他の3例は生存中である.以上より, 2期的な手術は安全だが, 進行癌および冠動脈病変など合併疾患を有する症例に対しては術後厳重なフォローが必要であると思われた.