We placed a Gianturco self-expanding metallic stent across the recurrent stricture of an esophagojejunostomy in a patient with gastric cancer. Though excellent passage of food resulted, intractable reflux occurred. Two months later the patient succumbed to recurrent tumor. At autopsy, the stent was patent and was partially covered by esophageal mucosa. There were narrow but deep ulcers around the stent hooks. The Gianturco metallic stent may provide an additional option for treating recurrent enteric strictures after other methods fail. Further refinements of the technique appear necessary.

Aged↗

PubMedDate not supplied

Role of preoperative transcatheter arterial oily chemoembolization for resectable hepatocellular carcinoma.

To clarify the effect of preoperative transcatheter arterial oily chemoembolization (TAOE) for resectable hepatocellular carcinoma (HCC) on long-term survival after curative resection, we retrospectively evaluated 60 patients with and 68 patients without preoperative TAOE. Although there was no substantial difference in the clinical backgrounds between the two groups, the 5-year survival rate was lower for the patients with preoperative TAOE than for those without TAOE: 24% versus 63%, respectively (p < 0.05). A worse survival rate was particularly observed for the cirrhotic patients with TAOE than for those without TAOE: 35% and 72% at 4 years, respectively (p < 0.01). As the cause of death, liver failure and gastrointestinal bleeding were more frequent in the patients with TAOE (13.3% versus 1.5%;p < 0.05). Although the TAOE seemed to retard intrahepatic recurrence during the first 1.5 years after operation (1.7% versus 10.3%;p < 0.05), the overall cancer death rate was similar between the two groups (18.3% versus 11.8%). Therefore we suggest that preoperative TAOE must not be performed for resectable HCC as a routine procedure, particularly in patients with cirrhosis. A prospective randomized trial is warranted to elucidate the merits and demerits of preoperative TAOE for surgically resectable HCC.

Adult↗

PubMedDate not supplied

Safety studies of a novel starch, pullulan: chronic toxicity in rats and bacterial mutagenicity.

This study was designed to assess the potential toxicity of pullulan, a starch-like substance produced by Aureobasidium pullulans that is proposed for use as a texturizer for meat and meat substitutes and as a flavour substrate. Sprague-Dawley rats (15/sex/group) were administered pullulan as a dietary admixture at levels of 1, 5 and 10% for a period of 62 wk. Control animals (15/sex) received untreated standard laboratory diet. The feeding study, originally intended to continue for 24 months, was terminated at 62 wk due to poor survival resulting from intercurrent pneumonia which was confirmed by histological findings. At 62 wk of treatment, all survivors were killed, complete gross post-mortem examinations were conducted on all animals, selected organs were weighed and organ/body weight and organ/brain weight ratios calculated. Mean body weights of all treated groups were comparable to controls. There were no indications of an adverse effect of pullulan on food consumption or food efficiency. At termination of the study, haematology and clinical chemistry values of treated animals were comparable to control values. There was no indication of pullulan-related toxicity in terminal organ and body weights. Macroscopic and microscopic examinations revealed no toxic lesions due to treatment. The mutagenicity of pullulan was assessed with and without metabolic activation in Salmonella typhimurium (TA100, TA1535, TA98 and TA1537). Pullulan did not increase the number of revertants per plate in any strain at any dose, including 10,000 micrograms/plate with or without metabolic activation, suggesting that it lacks mutagenic/carcinogenic potential on the basis of these results, it is concluded that pullulan lacks significant toxicological activity. The no-observed-adverse-effect level was 10% (equal to or greater than 4450 mg/kg body weight/day in males and 5080 mg/kg body weight/day in females) which would support use in various foods as a substrate for flavours.

Administration, Oral↗