When S-carbamido(14C)methyl glutathione, a model compound of glutathione S-conjugate, was administered i.v. to mice, radioactivity accumulated in the kidney within 1 to 2 min and then decreased gradually during the following 10 to 15 min with concomitant increase in hepatic radioactivity. Most hepatic radioactivity was accounted for by S-carbamidomethyl cysteine and its N-acetyl derivative, a mercapturic acid. The i.v. administration of S-carbamido(14C)methyl cysteine resulted in rapid and predominant accumulation of radioactivity in the liver. In both cases, the radioactive urinary metabolites were fully accounted for by N-acetyl-S-carbamidomethyl cysteine. N-Acetyl-S-carbamido(14C)methyl cysteine administered to mice were accumulated preferentially in the kidney and was excreted into urine very rapidly. These results suggest the following series of events: glutathione S-conjugate accumulated mainly in the kidney and is hydrolyzed into its component amino acids, presumably by gamma-glutamyl transferase and some peptidase(s) on the renal brush border membranes. The cysteine S-conjugate which is formed in the tubular lumen is reabsorbed and transferred to the liver, acetylated to form N-acetylcysteine S-conjugate, and excreted in the urine. Thus, renal hydrolysis of glutathione S-conjugates seems to be coordinated with acetylation in liver and with mercapturic acid biosynthesis in vivo.

Acetylation↗

PubMedDate not supplied

Pancreas-preserving total gastrectomy for proximal gastric cancer.

Lymph node (LN) dissection along the upper border of the pancreas is one of the essential parts of curative surgery for gastric cancer, and the distal portion of the pancreas was frequently resected for complete removal of LNs along the splenic artery. However, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreatic resection. To avoid these problems a new surgical procedure, the pancreas-preserving operation, was developed by Maruyama in 1979. We found that lymphatic channels from the stomach did not flow into the pancreas parenchyma, and that the spleen, splenic artery, and fatty connective tissue including nodes could be removed completely without dissection of the pancreas parenchyma and splenic vein. The preserved pancreas receives its arterial blood supply through the transverse pancreatic artery, and its preservation prevents postoperative diabetes. A total of 299 patients were treated by this procedure. The operative mortality rate was 0.3%, the hospital death rate 1.6%, and the surgical complications rate 19.6%. The cumulative 5-year survival rate for those with stage II was 70.5% and for those with stage III 54.1%. These results were superior to those of the pancreas resection group.

Gastrectomy↗

PubMedDate not supplied

Splenectomy for treatment of gastric cancer: Japanese experience.

Surgery for gastric cancer in Japan has frequently been combined with resection of the spleen (splenectomy) or of the pancreatic body and tail and spleen (pancreatosplenectomy, PS). Splenectomy in patients with gastric cancer has been performed with two major purposes in mind: (1) curability of the cancer and (2) immunologic reasons. Direct cancerous invasion to the pancreas requires PS, although examination of these cases revealed that in 34.3% of such macroscopic invasions only fibrous adhesion to pancreas existed. Metastases to lymph nodes at the splenic hilus (no. 10) or along the splenic artery (no. 11) also required splenectomy. The incidences of no. 10 or no. 11 lymph node metastasis were as high as 26.7% and 22.2% respectively, for cancers of whole stomach, and 15.5% and 12.1% for cancers of the upper portion of stomach. Concerning the immunologic aspect of splenectomy for gastric cancer, the reports of fundamental research and clinical studies suggest that the spleen plays sometimes acts as a suppressor and at other times as a helper to the tumor activity, according to the number of tumor cells. From these data, we concluded that the spleen should be preserved in stage I, II, and III patients with curative operation; for stage IV patients the spleen should be resected. The immunologic significance of splenectomy should be clarified precisely in the near future.

Humans↗

PubMedDate not supplied

Bilio-enteric anastomosis as a risk factor for postembolic hepatic abscesses.

In 2 patients who had undergone pancreatoduodenectomy with choledochojejunostomy, a subsequently detected metastatic tumor of the liver was treated with transcatheter arterial embolization. Weeks later intrahepatic abscesses developed. Pathophysiologic processes that may lead to this complication of hepatic embolization are discussed.

Adult↗

PubMedDate not supplied

Transcatheter arterial infusion therapy combined with radical hysterectomy in the treatment of advanced cervical cancer.

Two or three sessions of transcatheter arterial infusion (TAI) therapy were performed preoperatively in 13 patients with advanced cervical cancer (stage 3 or more). The efficacy of TAI was evaluated by tumor markers, magnetic resonance imaging (MRI), and postoperative histopathological examination. In all cases, tumor marker levels decreased after TAI therapy, and MRI also showed a decrease in the tumor size in 11/12 patients. The tumor tissue resected at radical hysterectomy showed no viable cancer cells in 6 patients, and no viable extrauterine cancer was detected in 5 more patients. Thus, TAI performed via both internal iliac arteries reduced both tumor size and extension to the parametrium, and it appears to have the potential to be an effective treatment modality for advanced cervical cancer.

Adenocarcinoma↗