Yasuaki Kashu

Sequential Percutaneous Microwave Coagulation Therapy for Liver Tumor

BACKGROUND Percutaneous microwave coagulation therapy (PMCT) is effective for small liver tumors. To enhance the radicality of PMCT, we developed a sequential coagulation technique. METHODS After inserting the first guide-needle under sonography, multiple needles were placed through a disk-type introducer that was devised to guide needle puncture at regular intervals, and microwaves were irradiated. Six patients, including 4 with hepatocellular carcinoma and 2 with liver metastasis, underwent this technique for tumors of 15 to 80 mm in diameter. RESULTS This technique can coagulate an area up to 60 mm in diameter in one session. Insertion of multiple needles, ranging from 2 to 11, was successful without complications. Three patients undergoing curative PMCT developed no tumor recurrence. The other 3 received incomplete PMCT due to the large size and location of the tumor. CONCLUSIONS This preliminary study indicates the efficacy of this technique to facilitate and secure PMCT in selected patients with liver tumors.

Enteric absorption of FK 506 : Estimation by a block liver perfusion technique in rats

This perfusion model enables a pharmacokinetic study of enteral absorption and hepatic metabolic rate simultaneously. FK 506 is absorbed mainly via the proximal small intestine and metabolized rapidly by the liver during single passage. These results may lead to further analyses of absorption and metabolism of FK 506 under various conditions.

Results from coronary artery bypass surgery combined abdominal aortic aneurysm repair

OBJECTIVE Complication from coronary artery disease is a major cause of mortality and morbidity in patients undergoing abdominal aortic aneurysm repair. We report our results from coronary artery bypass surgery performed in combination with abdominal aortic aneurysm repair in patients with coronary artery disease and abdominal aortic aneurysm, each being an indication for an emergency operation. METHODS Seventeen patients underwent combined coronary artery bypass surgery and abdominal aortic aneurysm repair. The mean age of the patients was 67.6 +/- 5.2 years. Four had left main disease, 8 patients had triple-vessel disease, and 12 had a prior myocardial infarction. The average left ventricular ejection fraction was 0.49 +/- 0.13. The average abdominal aortic aneurysm diameter was 6.2 +/- 1.0 cm (range 4.5-8.0 cm). Thirteen patients underwent coronary artery bypass surgery followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. In the remaining four patients, including one patient with severe left ventricular dysfunction, cardiopulmonary bypass was continued as a circulatory assist until the abdominal aortic aneurysm repair was completed. The left internal thoracic artery was used in 14 patients, and the right internal thoracic artery in one patient. RESULTS Postoperative surgical complications occurred in three patients (bleeding in one patient requiring reoperation, abdominal subcutaneous wound infection in another and transient neural disorder in the others). There were no surgical or in-hospital death. There was no late cardiac complication and no late cardiac death after a mean of 29 months follow-up. CONCLUSIONS We concluded that combined surgery was reasonable for selected patients with combined coronary artery disease and abdominal aortic aneurysm, each of which is an indication for an urgent operation. The aortic aneurysm repair during cardiopulmonary bypass for patients with severe left ventricular dysfunction was safe and effective.

The effect of combination splenectomy and low-dose FK506 therapy on graft survival after liver allograft transplantation in rats

The effect of splenectomy on allograft survival was investigated using orthotopic liver transplantation in a rat experimental model (ACI rat liver grafted to LEW rat). Control rats without any immunosuppressive treatment died, on average, 10.4 +/- 1.4 days after operation. Splenectomy alone somewhat prolonged the survival (13.4 +/- 2.0 days), and low-dose FK506 therapy moderately prolonged it (22.7 +/- 7 days). The graft survival period was significantly prolonged (39.7 +/- 6.3 days) when them two treatments were combined. The elevation of cytotoxic antiallograft antibodies was suppressed by splenectomy but not by low-dose FK506 therapy. The development of jaundice was moderately suppressed by FK506 but not by splenectomy. There was no difference between the pattern of body weight decline in either of them two groups and that in control rats. When these two treatments were combined at the same time, the elevation of cytotoxic antibodies, development of jaundice and decline of body weight were suppressed. These data indicate that B cells play an important role in the acute rejection of the rat liver allograft at least partially via production of cytotoxic antiallograft antibody. Splenectomy or other immunosuppressive methods affecting B cells can be a supplement for immunosuppression when using reduced-dose FK506.

Simultaneous off-pump coronary artery bypass grafting and in vivo heterogenous renal transplantation. Considering results and indications.

Complications of arterial sclerosis lesions are found in patients in dialysis for end-stage chronic renal failure. We present a case of simultaneous coronary artery bypass grafting (CABG) and renal transplantation. A 64-year-old man was to undergo in vivo heterogenous renal transplantation for chronic renal failure. Angiography was undertaken for preoperative abnormal electrocardiography, which showed severe long segmental stenosis of the left anterior descending coronary artery. We discussed the possibility of simultaneous surgery, conducting off-pump CABG and renal transplantation at the same time. Postoperative management of the implanted kidney was easy despite high infusion. His postoperative course went well, without cardiac events. Simultaneous off-pump CABG and in vivo heterogenous thus provide a viable option for patients with comorbid disease.

Combined Coronary Artery Bypass Surgery and Abdominal Aortic Aneurysm Repair during Cardiopulmonary Bypass for Patients with Severe Left Ventricular Dysfunction.

低左室機能を呈した虚血性心疾患と腹部大動脈瘤 (AAA) を合併した2例に対して冠状動脈バイパス術 (CABG) に続いて体外循環中にAAA手術も施行した. 症例は76歳と74歳の男性で, 左室駆出分画 (EF) は0.20と0.33, 冠状動脈は2枝と3枝病変を示していた. AAAは腎動脈下で1例は総腸骨動脈の閉塞を示し, 大きさは8cmと4.5cmであった. 低左室機能例では, CABGに続いて体外循環中にAAA手術を行う手技は有用な方法であると思われ報告した.

Identification and biochemical characterization of human plasma neutrophil inhibitor in vitro

In this study, assessment by a flow cytometric method using dichlorohydroxy fluorescin diacetate (DCFADH) in vitro revealed that human peripheral blood inhibits the production of active oxygen species by human peripheral neutrophis. It was also revealed that among the blood components, the plasma fraction inhibits active oxygen production most strongly. This plasma inhibitory activity was dose-dependent. Human serum also exerted an inhibitory activity; however, its activity was only one-third that of plasma. Moreover, when HL-60 human promyelocytic leukemic cells, with or without differentiation into the neutrophils by culturing with dimethyl sulfoxide (DMSO), active oxygen, which was also inhibited by plasma, was produced. Heat inactivation of the plasma did not alter the inhibitory activity, and gel filtration analysis showed that the peak activity was associated with a molecular mass of 70,000. The results of this study indicate that human plasma contains one or more substances that inhibit the active oxygen production of neutrophils, which may play an important role in inhibiting unneeded neutrophil activation in the bloodstream.