Shozo Mori

Erythropoietin and its derivative protect the intestine from severe ischemia/reperfusion injury in the rat

OBJECTIVE To investigate the protective effect of erythropoietin (EPO) and its nonhematopoietic derivative (asialoEPO) against intestinal ischemia/reperfusion (I/R) injury in a rat model. METHODS The superior mesenteric artery of Wistar rats was clamped for 60 minutes and then released. The rats were divided into 4 groups (n = 15 in each group): sham operation (Sham), vehicle treatment (Vehicle), EPO treatment (EPO), and asialoEPO treatment (AsialoEPO). EPO and asialoEPO were administered subcutaneously at 1000 units/kg for 10 minutes before clamping, 30 minutes after the start of clamping, and just before declamping. This treatment was followed by determination of 72-hour survival rates, serum TNF-alpha and IL-6 levels, histologic evaluation of the small intestine, quantification of the number of apoptotic cells, and analysis of the antiapoptotic molecules Bcl-xL and XIAP by Western blotting. RESULTS The survival rates at 72 hours after I/R injury in the Sham, Vehicle, EPO, and AsialoEPO groups were 100%, 33%, 75%, and 83%, respectively (P < .05). Blood TNF-alpha and IL-6 were significantly more suppressed in the EPO and AsialoEPO groups than in the Vehicle group at 6 hours after I/R injury. Histologically, injury to villi in the EPO and AsialoEPO groups was significantly less than in the Vehicle group. The number of apoptotic cells in the EPO and AsialoEPO groups was significantly less than in the Vehicle group. Western blotting revealed that EPO and asialoEPO constitutively increased the expression of Bcl-xL. CONCLUSIONS EPO and asialoEPO exert a strong protective effect against intestinal I/R injury, possibly by inhibiting release of TNF-alpha and IL-6 and decreasing apoptosis.

Asialoerythropoietin Is a Strong Modulator of Angiogenesis by Bone-Marrow Cells

The angiogenetic effect of asialoerythropoietin (asialoEPO) was investigated in a murine (BALB/c) ischemic hind limb model created by ligating the right femoral artery, and severe ischemia was created by ligating two points on the femoral artery. The mice were allocated to six groups: 1, Control (n = 15), no treatment; 2, BMC (n = 15), Injected with 1 × 106 bone marrow cells (BMC); 3, EPO (n = 15), EPO(500 U/kg for 2 weeks); 4, BMC + EPO (n = 15), BMC + erythropoietin (EPO); 5, asialoEPO (n = 15), asialoEPO (500 U/kg for 2 weeks); 6, BMC + asialoEPO (n = 15); BMC + asialoEPO. Blood flow in the ischemic and normal limbs was measured using a Doppler flowmeter on days 7 and 14. Vessel density was evaluated by immunohistochemical staining for Von Willebrand Factor (vWF). In the severe ischemia model, limb survival was investigated. Blood flow was significantly higher in the BMC + asialoEPO group than in the Control, BMC, EPO, BMC + EPO, or asialoEPO group on day 7 (p =. 007) and on day 14 (p =. 002). Vascular density was also significantly higher in the BMC + asialoEPO (0.067 ± 0.022) group than in the Control (0.026 ± 0.007), BMC (0.027 ± 0.012) EPO (0.029 ± 0.002), BMC + EPO (0.048 ± 0.015), and asialoEPO (0.031 ± 0.001) groups (p =. 006). Finally, limb survival at day 14 in the severe ischemia model was significantly better in the BMC + asialoEPO group (83.3%) than in the Control (40.0%), BMC (52.9%), EPO (44.4%), BMC + EPO (64.7%), or asialoEPO (36.4%) group (p =. 02). This provides the conclusions that asialoEPO promotes angiogenesis by BMC and that its action is significantly more potent than that of EPO.

A case of obstructive jaundice due to early carcinoma of the cystic duct protruding into the common bile duct

Highlights • An extremely rare early cystic duct carcinoma.• The protruding part was the cause of jaundice.• There is a significant interesting macro findings in the removed sample.• The only small part of the invasive part which reach fibro-muscular layer is revealed by the pathological findings.

A Novel Approach for Hepatic Arterial Reconstruction after Total Pancreatectomy with Common Hepatic Artery Resection Using Inferior Phrenic Artery

Background/Aims: Because of the anatomical characteristics, pancreatic cancers (PC) can easily invade to visceral vessels such as celiac artery, superior mesenteric artery, common hepatic artery (CHA) and portal vein, which makes curative resection difficult. In this study, we report an R0 resection for locally advanced PC by total pancreatectomy, combined resection of CHA, and reconstruction of hepatic artery using autologous left inferior phrenic artery (IPA). Methods: A 47-year-old woman with complaints of low back pain was referred to our department. Contrast-enhanced computed tomography revealed a hypo-attenuation tumor of the pancreatic body measuring 70 mm, which completely encased the CHA. When unresectable locally advanced PC was diagnosed, systematic chemotherapy was administrated. After downstaging, she underwent surgery with curative intent. The tumor completely infiltrated the peripheral part of the CHA and gastroduodenal artery. As the tumor also extended to the head of the pancreas, total pancreatectomy and combined resection of CHA were performed. Then the exposed left IPA and proper hepatic artery were anastomosed with a microvascular technique. Results: R0 resection was performed for restoring hepatic arterial flow and the postoperative course was uneventful without any postoperative morbidity. Conclusion: Hepatic artery reconstruction using IPA is a simple and safe procedure in selected patients.

Traumatic pancreatic injury during playing sports

The patient was a 33-year-old man. He had severe upper abdominal pain after a rugby game and he was diagnosed with traumatic pancreatic injury. Since intra-abdominal bleeding became severe, laparotomy was performed for haemostasis. On operation, venous bleeding from the upper edge of the head of the pancreas was found and the haemorrhage was stopped. The whole pancreas had severe inflammation with oedematous tissue spreading into the meso-colon and meso-jejunum. On the same day, the patient was transferred to our hospital for further treatment of acute pancreatitis. On admission, the amylase level in the drainage fluid was high and, thus, we started continuous arterial infusion treatment via the superior mesenteric artery, in addition to subcutaneous administration of octreotide. Enteral nutrition was started on postoperative day 6, oral intake was started on postoperative day 15. The patient recovered successfully and was discharged on postoperative day 30.