The Japanese journal of surgery最新文献

P-glycoprotein is a transmembrane protein with increased drug efflux from resistant cells, which is encoded by the MDR1 gene. An overexpression of P-glycoprotein has been reported to correlate with the degree of resistance to anticancer agents, especially to adriamycin. In this study, the expression of P-glycoprotein was analyzed immunohistochemically by using a monoclonal antibody, MRK16 against P-glycoprotein in 18 fresh human tumors. The expression of P-glycoprotein was detected in eight (44 per cent) tumor specimens out of 18 patients. Although six (75.0 per cent) of the 8 P-glycoprotein positive tumors were resistant to adriamycin, the other two tumors showed clinical responses. Furthermore, five (50.0 per cent) of the 10 P-glycoprotein negative tumors exhibited positive clinical responses. These results suggest that P-glycoprotein expression may not be a useful marker to predict intrinsic resistance to adriamycin in fresh human tumors.

A rare case of valvular pneumoperitoneum is reported. A 49-year-old Japanese man underwent an emergency laparotomy under a tentative diagnosis of perforating panperitonitis on the 19th post-open heart surgery day. A large volume of free intraperitoneal gas was revealed, but no identification of gastrointestinal perforation. On the 17th postlaparotomy day, pneumoperitoneum recurred. On the 41st postlaparotomy day, a tiny gastric perforation was detected with an oral contrast medium. The patient died of liver failure due to serum hepatitis. The autopsy revealed a minute gastric ulcer scar 2 mm in diameter in the mucosa of the fornix, which was thought to have caused the valvular pneumoperitoneum. A literature review was made of 8 reports on 11 cases. In two cases of valvular pneumoperitoneum, the perforating site could not be found even during laparotomy. It is suggested that either gastrointestinal series or endoscopy must be carefully repeated in order to identify the perforating site.

For reconstruction of the pharynx and cervical esophagus following pharyngolaryngoesophagectomy, free gut transfer revascularized to such cervical vessels as the cervical transverse artery and external jugular vein is commonly performed. However, for reconstruction of the esophagus in the cervicothoracic junction or anterior to the chest wall, using the cervical vessels has more disadvantages than using the vessels in the chest wall. Thus, we developed a method of using the throracoacromial artery and cephalic vein for vascular anastomoses of a free jejunal graft and report herein our results in six cases. Three of these cases underwent reconstruction for an esophageal defect anterior to the chest wall, while the other three underwent reconstruction of the thoracic esophagus using a colonic pedicle graft. Satisfactory results were obtained in five of the six cases. Therefore, we recommend the use of the thoracoacromial artery and cephalic vein in vascular anastomoses during a free gut transfer or colonic pedicle graft for reconstruction of the esophagus anterior to the chest wall.

Polyepoxy compounds (PC) have been introduced as new cross-linking agents to overcome some of the disadvantages of glutaraldehyde (GA). In this study, we investigated the relationship of the reaction time to the immunogenicity and mechanical properties of canine and bovine common carotid arteries cross-linked with one of PC, namely, glycerol polyglycidyl ether (GPE). To evaluate mechanical properties, we made use of the finite deformation theory. Arteries cross-linked with GPE for 48 hours proved to be about 3 times as flexible as those cross-linked with GA for 48 hours. In the immunogenicity experiments, GPE was observed to reduce the immunogenicity of the arteries according to the reaction time, and the arteries, which were cross-linked with GPE for 48 hours, showed little immunogenicity. It was concluded that GPE is a more suitable cross-linking agent than GA, and its optimum reaction time seems to be 48 hours.

The effects of the anticoagulants, heparin and low molecular weight heparin (LMWH), and the antiplatelet agents, prostaglandin E1 (PGE1) and aspirin, on endotoxin-induced renal insufficiency not induced by prerenal factors, were investigated using rabbits to evaluate the clinical usefulness of these drugs and their possible involvement in the activation of hemostasis in renal insufficiency. The intravenous administration of PEG1, at 0.4 microgram/kg/min, or aspirin, at 5 mg/kg, significantly restored all the parameters of renal function measured in the present study, namely, effective renal plasma flow, glomerular filtration rate and urine N-acetyl-beta-D-glucosaminidase, as well as histological renal ischemic changes. On the other hand, neither heparin nor LMWH, even at a high dose, improved any parameter. As the antiplatelet effect is the common property of PGE1 and aspirin, it is suggested that the activation of platelets may be prerequisite to the occurrence of renal insufficiency induced by endotoxin. The results of this study thus show that PGE1 or aspirin may be applied in clinical use for renal insufficiency complicated by sepsis or endotoxemia.

The effects of cell surface sugar chains combined with certain gene amplifications of breast cancers on the prognosis of patients were studied and the relationships between the sugar chains of cancer cells and amplifications of the proto-oncogenes c-myc, int-2 and c-erb B-2, evaluated. One hundred and fifty three human breast carcinoma tissues were investigated by an immunohistochemical technique using the avidinbiotin-peroxidase method with 1 lectin (HPA; Helix Pomatia) and 4 monoclonal antibodies (B-72-3, St-439, anti-Tn and anti-T). The positive rates of HPA, St-439, B-72-3, anti-Tn and anti-T were 43 per cent (63/153), 52 per cent (80/153), 53 per cent (81/153), 64 per cent (98/153) and 89 per cent (136/153), respectively. Patients whose cancers had positive HPA staining were found to have a lower survival rate than those with negative HPA staining (p less than 0.05), whereas those whose cancers had positive St-439 staining showed a better prognosis than those with negative St-439 staining (p less than 0.01). The positive rate of HPA was related to the gene amplification of c-myc proto-oncogene (p less than 0.01), whereas the negative rate of St-439 was correlated with the gene amplification of c-erb B-2 (p less than 0.01). These data indicate the prognostic value of HPA and St-439 and also the relationships between the gene amplifications and carbohydrate structures in breast cancer cells.

Fifteen patients with nonparasitic hepatic cysts underwent surgery to relieve abdominal complaints, at the First Surgical Department, Tokyo University Hospital between 1966 and 1989. Total removal of the cyst was carried out in 14 of the patients, while puncture and aspiration only were performed in the other patient in whom a cyst had ruptured spontaneously, after which hemoperitoneum was observed at emergency laparotomy. The size of the cysts varied from 7-19 cm with a mean of 12.4 cm. Histological study revealed a congenital cyst in 14 patients and a cystadenoma in one. The epithelium lining of the internal surface of the congenital cysts was highly atrophic and desolated and often disappeared. Examination of the cyst fluid revealed the same concentration of electrolytes as in the serum. Hepatic enzyme levels were usually lower than in the serum, but lactic dehydrogenase and aminotransferase levels were elevated in a few cases. Tumor marker levels of the cyst fluid were higher than those in the serum in four of five patients examined.

One representative microsection from each lymph node was carefully surveyed for metastasis in a routine examination. To scrutinize the existence of occult metastasis, three additional sections were then made from half of the remaining lymph node. A total of 1,698 lymph nodes taken from 55 patients with carcinoma of the esophagus, stomach, colon, thyroid or breast were thus reexamined histologically. The initial examination was not able to prove any metastasis in these lymph nodes. Upon reexamination, however, involvement by cancer cells was detected in 10 nodes of 7 patients. The maximum diameter of the metastatic foci varied from 0.2 mm to 1.3 mm and was less than 0.5 mm in more than half of the nodes. The metastatic patterns in the nodes were classified into three types, i.e., marginal sinus type, medullary sinus type and mixed type. The marginal sinus type was the most frequent, with the mixed type being next and the medullary sinus type being found in only one node. Accordingly, surgeons should keep the possibility of occult metastasis in mind and the marginal sinus of the lymph node should be carefully examined in order to detect any small foci of metastasis.

To clarify the possibility of developing a rapid cooling rate for islet cryopreservation, we used a cooling rate of 25 degrees C/min for hamster pancreatic islet cryopreservation using 15 per cent dimethylsulfoxide as a cryoprotectant. After preservation, these islets were examined for their morphology and function by assaying the insulin release after glucose stimulation and the contents of the insulin and DNA in 10 islets. In addition, islet cell replicatory activity was investigated by an autoradiographic technique. The effects of transplantation of the islets upon isogeneic and xenogeneic transplantation were also examined. Freezing using a rapid cooling rate of 25 degrees C/min was found to be as effective as a slow cooling rate of 1 degree C/min for hamster islet cryopreservation. Morphologically, the cryopreserved islets appeared to be similar to the non-frozen cultured islets. The glucose-stimulated insulin release and cell replicatory activities in vitro also remained unchanged, whereas the number of cells per islet decreased slightly after cryopreservation. The grafting of cryopreserved islets normalized streptozotocin induced hyperglycemia following isogeneic transplantation. On the other hand, no prolongation of graft survivals in the case of the xenogeneic transplantation of hamster islets to rats was observed. The isogeneically transplanted islets exhibited the same cell replicatory activities in vivo, which was even higher compared that of normal hamster pancreatic islets in situ. In conclusion, the present findings indicate that hamster pancreatic islets can be successfully cryopreserved using a rapid cooling rate, however, it does not appear that this treatment reduces islet vulnerability to xenogeneic graft rejection.

The cellular levels of topoisomerase II expression were compared between 10 fresh human tumors and normal tissues to predict the selective anticancer effect of its inhibitors such as adriamycin and VP-16. Topoisomerase II expression was observed in 9 of the 10 tumor tissues (90.0 per cent), 3 of which showed extremely high levels, whereas only 5 of the normal tissues (50.0 per cent) expressed any cellular topoisomerase II and the levels were not higher than those seen in the cancer cells. Six of the 9 positive tumors showed a higher level of topoisomerase II expression than the normal tissues, while the other 3 showed the same level. It can be interpreted from these results that topoisomerase II inhibitors could be effective in cancer patients due to the greater level of this enzyme in tumor cells than in normal tissues. Thus, it is suggested that a comparative analysis of topoisomerase II expression between tumors and normal tissues may be useful for predicting the selective cytotoxicity of topoisomerase II inhibitors in clinical practice.