Takao Ohyama

Significant influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy. Result of multivariate analysis.

OBJECTIVE The aim of this study was to evaluate the correlation between the histologic status of accompanying chronic hepatitis and the recurrence rate of hepatocellular carcinoma (HCC) after hepatectomy by multivariate analysis. SUMMARY BACKGROUND DATA Recent studies have suggested that a considerable number of intrahepatic recurrence of HCC after hepatectomy might be the results of metachronous multicentric hepatocarcinogenesis. The authors hypothesized that the incidence of recurrence due to metachronous multicentric hepatocarcinogenesis would depend on the histologic status of accompanying chronic viral liver disease, which is a main promoter of HCC. METHODS One hundred ten patients with HCC who underwent curative resection were studied. Histologic status of accompanying chronic hepatitis was classified into the three categories: 1) normal liver or chronic persistent hepatitis (CPH, n = 13), 2) chronic aggressive hepatitis (CAH, n = 50), and 3) liver cirrhosis (LC, n = 47). RESULTS The Cox multivariate proportional hazard model showed that the accompanying chronic viral hepatitis status (p = 0.0133), extent of hepatectomy (p = 0.0078), and number of tumors (p = 0.0475) were significantly predictive variables for recurrence-free survival. By the log-rank test, recurrence-free survival rate in patients with CPH was significantly higher than those in patients with CAH (p = 0.0005) and LC (p = 0.0075). Patients with CAH had the lowest recurrence-free survival rate (vs. LC, p = 0.028). CONCLUSIONS The results of this study indicated the significant influence of histologic activity of hepatitis on recurrence of HCC. This might support the concept of significant contribution of multicentric hepatocarcinogenesis to recurrence of HCC after hepatectomy.

Xenotransplantation of pig islets in diabetic dogs with use of a microcapsule composed of agarose and polystyrene sulfonic acid mixed gel

Introduction The authors have designed a microcapsule composed of agarose and polystyrene sulfonic acid (PSSa) mixed gel that provides a protective barrier against complement attack. Xenografts of islets, encapsulated in an agarose-PSSa microcapsule, have been shown to normalize blood glucose in rodents with chemically induced diabetes for extended periods of time without immunosuppression. Aim To investigate the efficacy of agarose-PSSa microencapsulated pig islets in reversing diabetes in a large animal model. Methodology Diabetes was induced in beagle recipients by total pancreatectomy. Each recipient received three to five intraperitoneal injections of either encapsulated (n = 5) or nonencapsulated pig islets (n = 2). Results In all dogs receiving microencapsulated islets, the graft function was achieved for 7.4 ± 3.1 weeks (mean ± standard error), as determined by elimination or reduction of exogenous insulin requirement. In three recipients, the fasting blood glucose levels were maintained at ≤200 mg/dL without any exogenous insulin for a period of 6, 50, and 119 days. Circulating porcine C-peptide was detected in the sera of all dogs after transplantation of encapsulated islets. Immunohistologic examination revealed the presence of insulin-positive cells in the microcapsules. In contrast, in two dogs receiving nonencapsulated islets there was no graft function. Conclusions This preliminary study demonstrates that agarose-PSSa microencapsulated pig islets can survive and function for weeks or months in totally pancreatectomized diabetic dogs without immunosuppression.

Solitary fibrous tumor of the abdominal wall

Solitary fibrous tumors (SFTs) are uncommon neoplasms of mesenchymal origin that usually arise from the pleura. SFTs of the abdominal wall are extremely rare, and only 12 cases have been reported in the Englishlanguage literature. This report presents a new case of SFT of the abdominal wall in a 74-year-old female. Positron emission tomography demonstrated the heterogeneous 18F-fluorodeoxyglucose uptake of the tumor (the maximum standardized uptake value was 2.8). Histologically, the mitotic count was 1 to 2/10 high-power fields. The patient is alive without recurrence at 10 months after undergoing a surgical excision. We discuss the clinicopathological features and differential diagnosis and present a review of the pertinent literature.

Agarose-microeneapsulated Islet Xenotransplantation.

Discordant異種膵ラ島移植におけるアガロースマイクロカプセル化 (MC (+)) と15-Deoxyspergualin (DSG) 投与の併用効果につき検討した.雑種成犬単離ラ島を5%アガロースハイドロゲルにて, マイクロカプセル化した.6,000個膵ラ島を糖尿病BALB/cマウス, またはNODマウスの腹腔内に異種移植した.Mc (+) ラ島の平均生着日数はそれぞれ37.8日, 30.6日であり, Mc (-) 群に対し有意の生着延長効果を認めた.Mc (+) に少量のDSG投与を加えることにより, 平均生着日数は76.3日, 75.3日とさらに著明に延長した.Mc (+) 群のマウス抗イヌ抗体価レベルは, DSG投与の有無にかかわらず, 移植後50%以上となる場合も認めたが, 正常血漿糖濃度が維持され, 抗体はMc (+) ラ島に傷害をあたえなかった.アガロースマイクロカプセル化とDSG投与の併用による著明な生着延長効果を認め, 将来の異種ラ島移植におけるバイオ人工膵の有用性を示した.