Toshitake Takahashi

Randomized, controlled study on adjuvant immunochemotherapy with PSK® in curatively resected colorectal cancer

A randomized, controlled trial of adjuvant immunochemotherapy with PSK®(Kureha Chemical Industry Co., Tokyo, Japan) in curatively resected colorectal cancer was studied in 35 institutions in the Kanagawa prefecture. From March 1985 to February 1987, 462 patients were registered. Four hundred forty-eight of those patients (97.0 percent) satisfied the eligibility criteria. The control group received mitomycin C intravenously on the day of and the day after surgery, followed by oral 5-fluorouracil (5-FU) administration for over six months. The PSK®group received PSK®orally for over three years, in addition to mitomycin C and 5-FU as in the control group. At the end of February 1990, the median follow-up time for this study was four years (range, three to five years). The disease-free survival curve and the survival curve of the PSK®group were better than those of the control group, and differences between the two groups were statistically significant (disease-free survival,P=0.013; survival,P=0.013). These results indicate that adjuvant immunochemotherapy with PSK®was beneficial for curatively resected colorectal cancer.

Thoracoscopic splanchnicectomy for the relief of intractable abdominal pain

Video-thoracoscopic transthoracic splanchnicectomy has been applied to patients in the end stage of pancreas cancer who had intractable pain mediated through the splanchnic nerve in the left upper quadrant. The procedure is performed under general anesthesia in a right hemilateral position. Following the establishment of access to the thoracic cavity, the left splanchnic nerve is cut off at the level immediately above the aortic hiatus, through a small opening made in the pleura between the descending aorta and the vertebrae. All patients had immediate and complete relief of pain postoperatively. Only a transient drop in the mean arterial pressure was observed immediately after cutting off the nerve. No other detrimental effect of the procedure on the general condition was observed. No patients developed postoperative complications. The present method may, thus, be a treatment of choice directed toward the relief of intractable abdominal pain in selected patients with pancreatic cancer.

Intestinal Behçet's disease--pathognomonic changes in intramucosal lymphoid tissues and effect of a "rest cure" on intestinal lesions.

To clarify the pathognomonic changes of intestinal lesions of Behçet’s disease and to determine effective therapeutic measures, we recruited 13 patients with the intestinal form of this disease for study. We performed pathology studies on the resected specimens of 7 patients and treated 5 of the other 6 patients with a low-residue diet. Pathology examination revealed that 6 of the 7 had inflammatory ulcerations in the ileocecal region. The ileal ulcers were mainly on the antimesenteric side. We observed remnants of Peyer’s patches at the margins of the major ulcerative lesions in 2 of 2 patients examined. There were aggregations of lymphocytes resembling destroyed lymph follicles in the superficial layer at the mouths of small fissuring lesions, and ulcer scars were also noted in Peyer’s patches in 4 of 5 other patients. X-ray and endoscopic examinations revealed the disappearance of intestinal lesions in 5 patients within 1 month during, or following the low-residue diet treatment. We found the intestinal lesions of Behçet’s disease at sites coinciding with intramucosal lymphoid tissue. The “rest cure” for the affected bowel was effective, i.e., there was significant alleviation of gastrointestinal symptomas and the intestinal lesions disappeared. We speculated that acute exudative inflammation, abscess formation, and consequent ulceration may occur in these tissues by the same mechanisms as those that operate in the positive needle-prick reactions seen in patients with Behçet’s disease.

The concepts, procedures, and problems related in endoscopic laser therapy of early gastric cancer

SummaryWe report 34 cases of early gastric cancer in which endoscopic laser therapy was performed at the Kitasato University Hospital. The problems encountered were the size and location of the tumor, the presence of lymphatic metastasis or concomitant disorders, and technical problems associated with the irradiation procedure. Of the 34 cases, 22 cases were considered as completely cured (no malignancy was detected after laser therapy), 11 cases were incompletely cured (malignant cells were detected after laser therapy), and 1 case was undetermined.

Protective Effects of Urinary Trypsin Inhibitor (UTI) on Hepatic Microvasculature in Hypotensive Brain-Dead Rats

Background/Aims: We examined the protective effects of a protease inhibitor, urinary trypsin inhibitor (UTI), on livers of brain dead rats associated with systemic hemodynamic instability. Methods: Brain death was induced by inflating a balloon catheter placed in the epidural space in rats followed by intravenous administration of UTI for 6 h. The hemodynamic, functional and morphological changes in the liver were examined. Results: The induction of brain death resulted in a significant decrease in both mean arterial pressure (MAP) and hepatic tissue flow (HTF), and an increase in serum AST and cytokines such as tumor necrosis factor (TNF)-α and cytokine-induced neutrophil chemoattractant (CINC). An increase in the number of sequestered neutrophils and enhanced expressions of intercellular adhesion molecules (ICAM)-1 and CINC were also noted in the liver. The treatment with UTI significantly restored HTF to basal level without affecting MAP, and decreased the number of sequestered neutrophils in the hepatic sinusoids, suppressed the expression of ICAM-1 and CINC in the sinusoids, inhibited the production of serum TNF-α and CINC, and inactivated Kupffer cells. Conclusion: Intravenous administration of UTI is likely to ease unfavorable effects on the hepatic microvasculature evoked by brain death.

Functional integrity of the rat liver after subzero preservation under high pressure.

IT WAS REPORTED in 1986 that the liver could be preserved for a longer period at 24°C compared with 4°C when assessed in a rat transplantation model. To date, however, several attempts at preserving the liver at subzero temperature have failed, predominantly due to problems related to the freezing and thawing of grafts or the toxicity of antifreezing agents. Thus, it has not been verified fully whether subzero-temperature hypothermia actually contributes to prolongation of preservation time of liver grafts. In this regard, it is known that we can maintain preservation solutions unfrozen even at subzero temperature (supercooling) by applying a certain pressure to such solutions. Similarly, we may also be able to preserve the liver without freezing for a long period at temperatures below zero, thus avoiding hepatic injury from freezing and thawing. However, we do not fully understand the levels of pressure that the liver can tolerate while continuing to function and sustain life after transplantation. In an attempt to answer this question, we conducted the present study.

The response of neoplastic intestinal vessels to prostaglandin F2α: Angiographic observations with emphasis on therapeutic applications

The effects of prostaglandin (PG) F2α in 16 patients with vascular malignant intestinal tumors were analyzed by angiography. It was found that PGF2α reduced tumor vascular flow selectively in all but one patient, a rectal carcinoma case. Among the remaining group, a case of intestinal choriocarcinoma complicated by massive gastrointestinal hemorrhage was successfully controlled with intraarterial infusion of PGF2α into the superior mesenteric artery. Owing to the reduced blood flow in tumors, PGF2α is expected to be used extensively as a vasoconstrictor to control bleeding from tumors of the alimentary tract.

Clinical studies on emergency operation for duodenal ulcer.

十二指腸潰瘍緊急手術例111例 (穿孔101例, 出血10例) の手術術式を中心に検討を行った. 術式の内訳は広範囲胃切除術 (以下広範胃切) が75例と多く, 選択的迷走神経切離術兼幽門洞切除術 (selective vagotomy+antrectomy以下SV+A) を主体とする迷切付加手術は32例であった. 術式の年次別推移をみると, 1980年までは広範胃切が大部分でSV+Aの症例はなかったが, 1980年までに広範胃切を行った56例中2例 (3.6%) に吻合部潰瘍の発生をみたことから, 1981年以降は緊急手術においても迷切付加手術が望ましいと考えてSV+Aを基本術式とし, SV+Aが55%と過半数を占めるようになった.