Biomedical subjects
Publications and source records attributed to A Maki.
A case of rhabdomyosarcoma in the retroperitoneal space is reported. The patient, a 71-year-old man, visited us with a complaint of left flank pain. The tumor measuring 13 x 10 x 7 cm and weighing 700 g, was removed operatively. The patient had no evidence of recurrence in 12 months following surgery.
To determine the tolerance limit of the liver in the critically suppressed mitochondrial oxidation-reduction state, the arterial ketone body ratio (acetoacetate/3-hydroxybutyrate), which reflects hepatic mitochondrial oxidation-reduction potential, was measured 1319 times in 161 patients during the postoperative critical period. Because patients who showed arterial ketone body ratios between 0.40 and 0.25 had a higher incidence of postoperative complications than had those who showed ratios above 0.40, this was designated as the critical zone of the arterial ketone body ratio. When duration in the critical zone was less than 2 days, 90% of the patients were able to tolerate the condition and survive. By contrast, when an arterial ketone body ratio below 0.40 was prolonged for more than 5 days, there was a high incidence of multiple organ failure and a 100% mortality rate, with the average survival period after a 5-day suppression being estimated as 5.7 +/- 2.4 days. It is suggested that the arterial ketone body ratio in the critical zone must be returned to normal values within 2 days to obtain a good prognosis.
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We are investigating the antigenic changes on the cell surface of human hepatocytes that distinguish the normal from the transformed phenotype using monoclonal antibodies. In vivo expression of antigens has been directly assessed by in situ radioimmunohistology. This technique allows one to determine the distribution and density of antigen expression at the individual cellular level on fresh hepatoma and adjacent uninvolved liver tissue. We have found two antigens recognized by monoclonal antibodies XF-8 and AF-20 that are uniformly present on 15/15 hepatocellular carcinomas tested thus far. Most if not all tumor cells highly express these antigens. Such antigens were not evident on adjacent normal liver and the XF-8 epitope was not found on other normal human tissues. AF-20 antigen distribution revealed low-level expression on a subpopulation of cells in the zona glomerulosa of the adrenal gland and on crypt cells of the small intestinal tract. We have studied the capability of radiolabeled XF-8 and AF-20 monoclonal antibodies when administered either alone or in combination to localize a hepatitis B virus-related hepatocellular carcinoma cell line (FOCUS) grown as subcutaneous tumors in nude mice. Biodistribution experiments demonstrated an excellent localization to tumor of 15 to 22% of the injected dose of 125I-labeled antibodies. Indeed, it was possible to enhance the delivery of 125I to the tumor cell surface by the use of XF-8 and AF-20 in combination. Nuclear imaging studies showed sharp visualization of tumor and demonstrate that these monoclonal antibodies have sufficient specificity and sensitivity to be strongly considered as immunotargeting agents.
Hepatic tolerance to hypotension was assessed by changes in arterial ketone body ratio (KBR) and hepatic energy charge levels in experimental brain death induced by epidural ballooning in dogs, and compared with the hemorrhagic shock model. Systolic arterial blood pressure was significantly decreased from 182 mmHg to 67 mmHg after completion of brain death (P less than 0.01), but KBR was maintained at near the control value of 1.098 +/- 0.051 in spite of marked hypotension. Hepatic energy charge was 0.846 +/- 0.016 and remained at normal level. No significant changes were observed in lactate level, total bilirubin, SGPT, and LDH. SGOT was slightly elevated but was still within normal limits (P less than 0.05). Light microscopic examination revealed no apparent ischemic change in the centrilobular region under hematoxylin and eosin staining. By contrast, KBR decreased from 0.975 +/- 0.054 to 0.273 +/- 0.060 following hypotension in the Wiggers' shock model (P less than 0.01). Lactate levels were gradually elevated significantly (P less than 0.05), but no significant increases were observed in total bilirubin, SGOT, SGPT, and LDH. It is suggested that the hepatic energy status is well maintained in the state of brain death, in which state the liver has high tolerance to marked hypotension until shortly before stoppage of the heart.
To investigate the feasibility of obtaining grafts from living, genetically related adult donors without any complicated harvesting techniques, orthotopic partial liver transplantation (PLT) without cold perfusion of the donor graft was evaluated in beagles by assessing the graft viability using ketone body ratio (KBR). Ten PLT were performed under venovenous bypass. The left half of the donor liver was transected in situ followed by systemic heparinization, and immediately implanted with care taken to leave the recipient's inferior vena cava intact, and to maintain the normothermic state without cold perfusion. Four of ten dogs survived for 5 days or longer (longest survival was 9 days) and died of other causes than graft dysfunction. Four others died of thromboembolitic episode, accidental bleeding or technical failure. Two dogs died of graft dysfunction. The changes in KBR in 5 dogs without fatal complications after transplantation were maintained within normal range thereafter. These results suggest that the PLT without cold perfusion of donor graft is possible from the viewpoint of energy metabolism.
Changes in the composition of serum bile acids were investigated after orthotopic liver transplantation in piglets. Serum levels of all bile acid components rapidly increased during the anhepatic phase and then quickly decreased, returning to the preoperative state within 6 h of revascularization of the allograft. In the animals in which extrahepatic biliary stenosis was a complication, serum total bile acids (TBA) increased remarkably. A marked increase of hyocholic acid and marked decrease of hyodeoxycholic acid were noted; as percentages of TBA, the average levels per day were 91.3 +/- 1.3 and 5.0 +/- 1.3%, respectively. No change in chenodeoxycholic acid (CDCA) was observed. In the animals suffering acute rejection without extrahepatic biliary stenosis, serum TBA increased slightly and the percentage of CDCA rose, the average level being 29.6 +/- 1.5%. These results suggest that the measurement of the composition of serum bile acids may serve as a useful means of assessing allograft function after liver transplantation.
Between May, 1985 and September, 1987, percutaneous nephrolithotripsy (PNL) and transurethral ureterolithotripsy (TUL) have been performed at our hospital and five affiliated hospitals. We report on the therapeutic results of 216 cases treated during this period. PNL and TUL were performed 168 times on 120 patients (119 males and 41 females) and 57 times on 56 patients (35 males and 21 females), respectively. Rate of success with PNL was 80.7% (103/130) for renal calculus, 85.7% (18/21) for upper ureteral calculus, and 47.1% (8/17) for middle-lower ureteral calculus. Rate of success with TUL was 57.9% (33/57). Of these, cases of ureteral lower edge calculus showed the lowest rate of success, being 33.3% (2/6). Complications of the cases undergoing PNL and TUL were: ureteral damage in 13; hemorrhage in 6; renal pelvic damage in 4; ureteral lower edge stenosis in 3; pyrexia in 3; cardiac insufficiency in 2 and retention of perfusate in posterior peritoneal cavity, pneumonia and renal insufficiency in 1 case each.
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