Preoperative and postoperative serum levels of carbohydrate antigen-(CA)19-9 in 148 patients with carcinoma of the pancreas were studied. All 18 patients with carcinoma of the pancreas of Stage I, II, and III were resectable, and their pre-operative serum levels of CA-19-9 were under 1,344 U/ml. Pre-operative serum levels of CA-19-9 in patients with Stage IV ranged widely between 5 and 32,240 U/ml. The postoperative survival rate was significantly superior in patients (n = 15) whose CA-19-9 pre-operative serum levels were less than 2,000 U/ml compare to those (n = 64) whose levels were over that level. Fifteen resectable patients who showed serum levels of CA-19-9 over 2,000 U/ml pre-operatively died within 2 years postoperatively due to recurrence, especially by liver metastasis in spite of aggressive surgery. Intraoperative quick immunostaining of CA-19-9 and carcinoembryonic antigen (CEA) was useful to diagnose intrapancreatic carcinoma development on frozen sections of cut margin of the pancreas and also useful in abdominal washing cytology combined with conventional staining.

Adenocarcinoma↗

PubMedDate not supplied

Clinical application of K-ras oncogene mutations in pancreatic carcinoma: detection of micrometastases.

Pancreatic adenocarcinomas are known to have a high incidence of K-ras gene mutation. We summarize our efforts to detect micrometastases through a search for mutated K-ras oncogene in liver tissues, peritoneal washings, para-aortic lymph nodes, and perioperative peripheral blood. Two-stage polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis were used to detect K-ras oncogene mutations at codon 12. Our results suggest that PCR/RFLP analysis is potentially highly sensitive for the detection of micrometastases in various tissues and might be of value in the diagnosis, treatment and follow-up of metastases in other organs with pancreatic adenocarcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Hepatic circulation during nonpulsatile cardiopulmonary bypass.

The arterial ketone body ratio, which reflects the hepatic mitochondrial redox potential (NAD+/NADH), decreases markedly during cardiopulmonary bypass (CPB). One of the reasons for arterial ketone body ratio reduction may be hepatic hypoperfusion during CPB. To evaluate the hepatic circulation under nonpulsatile CPB, the authors used color Doppler ultrasonography to measure the portal venous flow (PVF) in 24 adult patients before, during (aortic clamping and rewarming period), and after CPB. Nonpulsatile hypothermic CPB was performed at a flow rate of 2.4 L/min/m2. PVF was calculated from the product of mean flow velocity and cross-sectional area of the portal vein. PVF was maintained during CPB at 0.44 +/- 0.13 and at 0.54 +/- 0.18 L/min/m2. PVF (%) in relation to systemic blood flow was obtained by calculating PVF/CI or PVF/PI, where CI is the cardiac index and PI is the perfusion index. PVF (%) before, during, and after CPB was 18.3 +/- 9.3, 18.5 +/- 5.5, and 17.4 +/- 6.7%, respectively. In conclusion, PVF was maintained during nonpulsatile CPB at a flow rate of 2.4 L/min/m2 and depended upon systemic blood flow.

Adult↗

PubMedDate not supplied

Applicability of the latissimus dorsi muscle in situ as a biomechanical energy source.

The purpose of this study was to assess the applicability of the latissimus dorsi muscle in situ as an energy source for a circulatory assist device. A pneumatic chamber, devised by the authors, was inserted beneath the muscle and compressed by contractions of the muscle so that muscle contractile power was converted into pneumatic pressure. The optimal insertion position of the chamber beneath the latissimus dorsi muscle, and the influence of chamber size on generated pneumatic pressure, were investigated. The pneumatic chamber functioned better when it was placed in a proximal position (third intercostal space) than in a middle or distal position. Using a mock circuit, the performance of the pneumatic chamber as an energy source for a circulatory assist device was evaluated. The pneumatic chamber was able to generate power sufficient to drive a right ventricular assist device as far as stroke work was involved. When the pneumatic chamber was operated with a high afterload, it could even be an energy source for aortic counterpulsation.

Animals↗

PubMedDate not supplied

A compressive type skeletal muscle pump as a biomechanical energy source.

The purpose of this study was to assess the applicability of the conditioned latissimus dorsi muscle as an energy source for circulatory assist devices. The authors developed a pneumatic chamber as a muscle actuator. The pneumatic chamber placed between latissimus dorsi muscle and chest wall was compressed by the burst stimulated muscle and, thereby, converted muscle contractile power into pneumatic pressure. The authors report the performance of the implanted pneumatic chamber at a chronic phase, and the capability of the conditioned muscle in situ as an energy source for circulatory assist devices. Six adult mongrel dogs were used. At the first operation, a pacemaker for muscle conditioning and the pneumatic chamber were implanted. After 12 weeks of muscle conditioning, the performance of the pneumatic chamber with conditioned muscle was evaluated. The pressure generating capability of a chamber buried in fibrous adhesions was reduced to approximately 65% of that of a chamber without adhesions. The stroke volume and stroke work of the assist device driven by the developed pneumatic pressure were measured. The maximum stroke work of the circulatory assist was greater than the stroke work of the right ventricle, but less than that of the left ventricle. In respect to stroke volume, the pneumatic chamber could drive the circulatory assist device against not only a pulmonary range of afterload, but also a systemic range of afterload, when high pre load was available. These results indicate that the compressive skeletal muscle pump with conditioned latissimus dorsi muscle generates acceptable hemodynamic work for right ventricular bypass or aortic counterpulsation. In the long-term, the interface between tissue and actuator is the major obstacle to developing a muscle powered assist device.

Animals↗

PubMedDate not supplied

Surgical repair for supravalvular aortic stenosis: intermediate to long-term follow-up.

BACKGROUND AND AIM OF THE STUDY: Supravalvular aortic stenosis (SAS) has been surgically treated by either single-sinus or bisinus patch repair. This article reviews intermediate to long-term results of repair in patients with SAS at our institute. METHODS: Between 1974 and 1995, eight patients underwent surgical repair for SAS. The age range was 1.3 to 14 years (mean 7.3 years). The morphology was the discrete type in seven patients and the diffuse type in one patient. The pressure gradient across the obstruction was 20 to 105 mmHg (mean 68 mmHg). Two patients in the early period of the series underwent single-sinus patch repair, and six underwent bisinus patch repair (pantaloon-shaped patch, extended aortoplasty). RESULTS: There were no operative deaths, and the mean pressure gradient was reduced to 23 mmHg (p < 0.001) in the early postoperative period. The median follow-up period was 8.0 years (1.8-17.3 years). One patient with diffuse type SAS required reoperation 12.8 years later due to progression of the stenosis, and died after the operation. The remaining seven patients were alive and well at the last follow-up, when the pressure gradient ranged from 6 to 31 mmHg (reoperation excluded). CONCLUSION: Surgical repair for discrete type SAS provides satisfactory results in the intermediate to long-term follow-up.

Adolescent↗

PubMedDate not supplied

Peritoneal washings cytology combined with immunocytochemical staining in pancreatic cancer.

BACKGROUND/AIMS: Peritoneal washings from patients with pancreatic cancer demonstrate malignant cells in 0-58% of patients. But the significance of their potential for implantation and growth after radical surgery has not been clarified. METHODOLOGY: Peritoneal washings were collected from 74 consecutive pancreatic cancer patients during a 5-year period and studied by conventional staining and immunocytochemical staining using anti-CEA and anti-CA 19-9. Fifty of the 74 patients were resectable and the others were nonresectable. RESULTS: Seven out of 8 patients with macroscopic peritoneal metastasis were positive in conventional staining, but all 8 patients were positive in immunocytochemical staining. Five of the 66 (8%) patients without macroscopic peritoneal metastasis were positive in conventional staining, but the positive rate increased to 14 of 66 (22%) in immunocytochemical staining. There was no statistically significant difference in post-operative cumulative survival rate between the 13 positive cytology patients and 37 negative cytology patients without macroscopic peritoneal metastasis. CONCLUSIONS: The positive rate of peritoneal washings cytology was increased in this study by the use of immunocytochemical staining in addition to conventional staining. No statistically significant difference in post-operative cumulative survival rate between positive cytology patients and negative cytology patients without macroscopic peritoneal metastasis was observed.

Adenocarcinoma↗

PubMedDate not supplied

Polymorphism of tumor necrosis factor in esophageal, gastric or colorectal carcinoma.

BACKGROUND/AIMS: Several microsatellite polymorphisms located in the tumor necrosis factor locus on the chromosomal region 6p21.3 in the major histocompatibility complex region have been associated with malignant neoplasms and autoimmune diseases. In this study, we focused on the polymorphisms of tumor necrosis factor a and d from gastrointestinal carcinoma patients to ascertain whether they can be useful to predict these neoplasms. METHODOLOGY: We examined esophageal, gastric, and colorectal cancers (47, 53, 77 patients, respectively), and 213 normal controls. To compare the microsatellite polymorphisms of tumor necrosis factor a, d in Japanese individuals, dioxyribonucleic acids were extracted from normal mucosa (cancer patients) and from peripheral blood monocytes (the normal controls) by polymerase chain reaction. RESULTS: The frequency of tumor necrosis factor a3 allele was significantly higher in gastric cancer (P = 0.012) and that of tumor necrosis factor d7 allele was significantly higher in the colorectal cancer than the normal controls (P = 0.037). That of tumor necrosis factor a10 was significantly lower in the gastric cancer than the normal controls (P = 0.008). CONCLUSIONS: Microsatellite polymorphisms of tumor necrosis factor a and d might be significantly correlated with carcinogenesis of specific neoplasms, and may be useful for predicting these cancers.

Alleles↗

PubMedDate not supplied

Clinical usefulness of the immunostaining of the tumor markers in pancreatic cancer.

The effect of the rapid immunostaining of gastrointestinal cancer-associated antigens, CA19-9, CEA, DUPAN2, and CA50 was discussed for intraoperative pathological diagnosis of pancreatic cancer. The method can be completed in only 13 minutes with microwave irradiation to accelerate the incubation of the primary antibody. Only 3 seconds of irradiation at 500 W for fresh-frozen sections produced specific antigen staining of greater intensity than that obtained with longer incubation by the conventional method. Preservation of the tissue structure was satisfactory with minimal nonspecific background staining enabling us to diagnose the intrapancreatic spread of cancer. This method was also applied to intraoperative peritoneal washing cytology. As with frozen section biopsy, the sensitivity of intraoperative cytology is greater than by the conventional staining method, which is able to achieve more precise staging of pancreatic cancers. Our rapid immunoperoxidase staining method on the cryostat section of pancreatic biopsy specimens and on cytology samples provides important information to determine an appropriate operative approach for pancreatic cancer.

Adenocarcinoma↗

PubMedDate not supplied

The role of extended radical operation for pancreatic cancer.

BACKGROUND/AIMS: To clarify the indication of extended operation for pancreatic carcinoma, a clinical study was carried out. METHODOLOGY: From July 1981 to 1999, 196 of 307 (63.8%) patients with pancreatic carcinoma underwent resection of the tumor. Portal vein resection was performed in 145 of these 196 (74.0%) resected cases. The postoperative survival rate was studied according to the operative and histopathological findings. RESULTS: In spite of the aggressive surgery, there was no patient who survived over 3 years after operation in the group carcinoma-positive on the surgical margins. Patients who survived over 3 years postoperatively were observed in the group of carcinoma-free surgical margins. CONCLUSIONS: The most important indication of extended operation combined with portal vein resection for pancreatic cancer is to obtain surgical cancer-free margins. There is no indication of extended operation for cases in which surgical margins will become cancer-positive, if such an operation is employed.

Constriction, Pathologic↗

PubMedDate not supplied

Gene therapy for pancreatic cancer.

Despite improvements in surgical care and locoregional therapy, the prognosis of patients with pancreatic cancer has seen little improvement over the last several decades. It is difficult to diagnose pancreatic cancer at its earliest stages when it is amenable to cure by surgical resection because it is too small to produce symptoms in the affected patient. Recent improvements in radiographic modalities aimed at earlier detection and extent of cancer spread have enabled the clinician to provide the most efficacious treatment regimen possible. Nevertheless, pancreatic cancer is very aggressive locally and frequently metastasizes to the liver and peritoneum. New strategies are necessary to treat pancreatic cancer and gene therapy offers hope in this regard. Many studies have revealed the promise of gene therapy in the treatment of pancreatic cancer in rodent models. Early clinical trials are ongoing to evaluate the success of these gene therapy regimens in humans. In this article we review the gene therapy strategies currently employed in the fight against pancreatic cancer, including antisense strategies, gene-directed prodrug activation therapy, promoter gene strategies, and oncolytic viral therapy.

Animals↗

PubMedDate not supplied

Presence of nickel in alpha-2 macroglobulin isolated from human serum by high performance liquid chromatography.

A two-step procedure was devised for purification of alpha 2-macroglobulin (alpha 2 M) from human serum by high performance liquid chromatography (HPLC) on "Superose 6" gel-filtration medium and "Mono-Q" ion-exchange medium. The isolated protein reacts with specific alpha 2 M-anti-serum upon immunoelectrophoresis, migrates as single protein band on SDS-acrylamide gel electrophoresis, and yields an approximate molecular weight of 7 x 10(5) Mr upon HPLC size-exclusion chromatography. Presence of nickel in the purified serum alpha 2 M was demonstrated by Zeeman electrothermal atomic absorption spectrophotometry, consistent with findings decades ago by less refined and sensitive techniques.

Adult↗

PubMedDate not supplied

Isolated interruption of the aortic arch.

We report a case of a 4-year-old girl with interruption of the aortic arch without a patent ductus arteriosus or intracardiac shunts. The anomaly was successfully corrected with the use of a 14 mm Dacron prosthetic graft to bypass the interrupted segment. The postoperative course was uneventful.

Aorta, Thoracic↗

PubMedDate not supplied

Reconstruction with insertion of expanded polytetrafluoroethylene (EPTFE) for iliac venous obstruction.

Surgical therapy for DVT in the legs, including reconstruction of the blood circulation system and thrombectomy with a Fogarty catheter, is not always satisfactory, as indicated by the variety of opinions both for and against them. However, it is also a fact that postphlebitic syndrome can result from incomplete treatment. Therefore, surgical approaches should by given priority in the acute stage of the disease. In 5 patients who showed either complete obstruction or insufficient removal of thrombi from the proximal region in leg DVT, we performed crossover femoro-femoral bypass using EPTFE (including two wire reinforced grafts) and were able to obtain good long-term patency over periods of 8-18 months.

Aged↗