Mitral valve repair in patient with absent right superior vena cava in visceroatrial situs solitus

We report on a 74-year-old woman with an absence of right superior vena cava in visceroatrial situs solitus who underwent mitral valve plasty for severe mitral regurgitation. Preoperative three-dimensional computed tomography revealed an absent right and persistent left superior vena cava that drained into the right atrium by way of the coronary sinus. Perioperaively, placement of pulmonary artery catheter, site of venous cannulation, and management of associated rhythm abnormalities were great concern. Obtaining the information about this central venous malformation preoperatively, we performed mitral valve plasty without any difficulties related to this anomaly

Changing conception of indication for peripheral arterial reconstruction surgery.

末梢動脈の慢性閉塞性疾患に対する直達血行再建術の長期の予後は必ずしも満足できるものではない。合成代用血管は，長期の植え込みにより内被の肥厚，退行性変性，および材質の変性の様な合併症により，特に小口径の合成代用血管の適応は極めて限られたものになっている。一方，医用質量分析装置を用いた虚血肢の実験的研究によると，自由に運動させた犬の虚血肢では，急性期に比較すると3カ月以後その組織循環は有意に増加することが明らかとなった。また，家兎を用いた実験的研究によると，炭酸泉浴に高濃度のラドン吸入を合併すると皮下組織の組織循環が約30％増加して，同時に皮下の酸素分圧が上昇することを確かめた。従って，切迫壊死の症例をのぞいて，末梢動脈の慢性閉塞性疾患々肢，特に間欠性跛行に対しては，自 然予後を考慮して歩行負荷，および炭酸泉，ラドン泉の温泉療法を用いた保存的療法が長期の予後上効果的である。Peripheral arterial reconstruction surgery for chronic occlusive diseases has not always produced satisfactory results according to long-term (5-10 years) follow-up studies. Furthermore, application of synthetic vascular prostheses of small caliber for peripheral reconstruction is quite restricted to certain circumstances, because of the complications derived from long-term implantation such as thickening and degeneration of the inner capsule and deterioration of the grafts used. On the other hand, experimental studies on ischemic limbs revealed a significant increase of tissue perfusion in 3, 6 and 12 months following ischemia was induced (p<0.001) compared with the acute ischemic stage in freely moving dogs by means of medical mass spectrometry. In addition, subcutaneous tissue perfusion was found increased by about 30 % with CO(2) bathings in combination with Radon inhalation of high concentration (over 5000 Bq/l), which was accompanied by an elevation of subcutaneous pO(2). Therefore, medical treatments such as walking exercise and bathings with CO(2) and Radon based on the natural history of chronic peripheral arterial occlusive diseases, particularly intermittent claudication, appear feasible

Clinical effects of serial artificial CO(2) baths on degenerative disorders in consideration of the improved tissue perfusion.

組織循環の良不良は，結合織の退行性病変の予後に大いに影響をおよぼすものである。人工炭酸泉を用いた実験的検討で，すでに組織循環の30　％　増加を認めており，臨床的治験により好傾向を示す結果を得つつある。結合織病変を主とする慢性疾患4症例の治験前後に局所組織流量を測定して評価することができた。局所組織流量は医用質量分析装置を介したオンラインシステムで測定計算した。人工炭酸浴は，炭酸ガスキャビン，および人工炭酸浴剤浴を用いた。人工炭酸泉浴は，1カ月より1年におよび，それぞれ自覚症状の著名な改善と，組織流量の増加を定量しえた。人工炭酸泉の連浴による組織流量の改善は、結合織の退行性病変に有効に作用するものである。Tissue perfusion plays an important role in prognosis of the deteriorating connective tissue disorders. Tissue perfusion was evaluated before and after CO(2) treatment on the patients with connective tissue disorders by means of medical mass spectrometer. CO(2) treatment was performed in 2 ways ; one was with CO(2)-cabine, 20 litres per minute at 40℃ for 20 minutes, and the other was with an artificial CO(2) bathing prepared with 2 tablets of BUB-KAO, a 50 g sodium hydrogencarbonate and succinic acid tablet, in 280-litre-tub at 40℃ for 20 minutes. Case 1, 33-year-old female, suffering from chronic rheumatic arthritis with rheumatic thromboangiitis obliterans in the left 5th toe. Main arterial trees were found intact arteriographically. Her joint pain and muscle stiffness have been improved markedly after CO(2) treatment with cabin every day for one month though every medicine for rheumatism made little effect. Case 2, 46-year-old female, suffered from progressive systemic scleroderma. Major blood supply was found not blocked in upper extremities arteriographically. Tissue perfusion was found poor in muscle tissue of each forearm before CO(2) treatment with cabin, whereas an improved tissue perfusion was confirmed after one month of serial CO(2) treatment, leading to ameliorate persistent muscle stiffness, though every medicine for her made slow effect. Case 3, 48-year-old female, suffering from the weakness in strength with no positive laboratory findings of connective tissue disorders. Tissue perfusion has been found quite improved following serial artificial CO(2) bathings for 12 months, being able to work hard every day as a nurse. Serial CO(2) bathing is thought to be very useful in ameliorating the symptoms of deteriorating connective disorders by virtue of an improved tissue perfusion

Chemotherapy on QOL and night sleep of CC patients

Background : The aim of this study was to investigate quality of life (QOL) and night-time sleep disturbance in colon cancer patients with middle risk chemotherapy for proper antiemetic therapy. Methods : The study enrolled 139 patients with colorectal cancer. All patients received oxaliplatin or irinotecan-based chemotherapy. Patients completed a questionnaire about chemotherapy-induced nausea and vomiting and sleep disturbance. Sleep disturbance was checked, and the relationship between sleep disturbance and nausea was analyzed. Results : The prevalence of nausea was 48.9% (68 / 139). The degree of the nausea was slight / moderate / severe in 51 / 11 / 6 patients, and 12 patients had vomiting. Appetite showed no change / slightly decreased / half / one-fourth / none in 51 / 34 / 33 / 6 / 7 patients. There were significant differences in the mental component summary (MCS) score and the role-social component score (RCS). (MCS : nausea(+) vs nausea(-) 46.4 ± 1.1 vs 54.1 ± 1.1 p < 0.01 RCS : nausea(+) vs nausea(-) 33.1 ± 2.1 vs 41.6 ± 2.1 p < 0.01). Using the MCS with a cut-off score of 50, patients were divided into two groups, and nausea was significantly correlated with a low MCS score. Furthermore, patients were divided into two groups using a Pittsburgh Sleep Quality Index cut-off score of 6, and sleep disturbance was correlated with old age and second-line chemotherapy. Conclusions : Nausea affects QOL and night-time sleep of colon cancer patients with middle risk chemotherapy

Potential of adenovirus-mediated REIC/Dkk-3 gene therapy for use in the treatment of pancreatic cancer

Background and AimThe reduced expression in immortalized cells REIC/the dickkopf 3 (Dkk-3) gene, tumor suppressor gene, is downregulated in various malignant tumors. In a prostate cancer study, an adenovirus vector carrying the REIC/Dkk-3 gene (Ad-REIC) induces apoptosis. In the current study, we examined the effects of REIC/Dkk-3 gene therapy in pancreatic cancer. MethodsREIC/Dkk-3 expression was assessed by immunoblotting and immunohistochemistry in the pancreatic cancer cell lines (ASPC1, MIAPaCa2, Panc1, BxPC3, SUIT-2, KLM1, and T3M4) and pancreatic cancer tissues. The Ad-REIC agent was used to investigate the apoptotic effect in vitro and antitumor effects in vivo. We also assessed the therapeutic effects of Ad-REIC therapy with gemcitabine. ResultsThe REIC/Dkk-3 expression was lost in the pancreatic cancer cell lines and decreased in pancreatic cancer tissues. Ad-REIC induced apoptosis and inhibited cell growth in the ASPC1 and MIAPaCa2 lines in vitro, and Ad-REIC inhibited tumor growth in the mouse xenograft model using ASPC1 cells. The antitumor effect was further enhanced in combination with gemcitabine. This synergistic effect may be caused by the suppression of autophagy via the enhancement of mammalian target of rapamycin signaling. ConclusionsAd-REIC induces apoptosis and inhibits tumor growth in pancreatic cancer cell lines. REIC/Dkk-3 gene therapy is an attractive therapeutic tool for pancreatic cancer

Hepatitis C Virus-specific T-cell Response Correlates with Hepatitis Activity and Donor IL28B Genotype Early after Liver Transplantation

It is not known how the immune system targets hepatitis C virus (HCV)-infected HLA-mismatched hepatocytes under immune-suppressed conditions after orthotopic liver transplantation (OLT). In addition, the relationship between the HCV-specific immune response and IL28B variants as predictors of HCV clearance has not been well-characterized. We determined the IL28B polymorphisms for 57 post-OLT HCV carriers, and we assessed the HCV-specific immune responses by measuring the peripheral blood mononuclear cell-derived HCV-specific interferon-gamma (IFN-γ) response using an enzyme-linked immunospot assay. At 1-3 years after OLT, patients with no active hepatitis showed higher total spots on the immunospot assay. At＞3 years after OLT, patients with resolved HCV showed higher levels of core, NS3, NS5A, and total spots compared to the chronic hepatitis patients. The IL28B major genotype in the donors correlated with higher spot counts for NS5A and NS5B proteins at 1-3 years after OLT. In the post-OLT setting, the HCV-specific immune response could be strongly induced in patients with no active hepatitis with an IL28B major donor or sustained virological response. Strong immune responses in the patients with no active hepatitis could only be maintained for 3 years and diminished later. It may be beneficial to administer IFN treatment starting 3 years after OLT, to induce the maximum immunological effect

Predictive Factors for Successful Vaccination Against Hepatitis B Surface Antigen in Patients Who Have Undergone Orthotopic Liver Transplantation

Post-orthotopic liver transplantation (OLT) hepatitis B recurrence is well-controlled with a nucleos(t)ide analogue and hepatitis B immunoglobulin (HBIG) combination, but the high cost and the potential risk of unknown infection associated with HBIG remain unresolved issues. Low-cost recombinant hepatitis B virus (HBV) vaccine administration is a potential solution to these problems. We retrospectively analyzed the rate and predictive factors of HBV vaccine success in 49 post-OLT patients: liver cirrhosis-type B (LC-B), n=28 patients; acute liver failure-type B (ALF-B), n=8; and non-HBV-related end-stage liver disease (non-B ESLD) who received a liver from anti-hepatitis B core antibody-positive donors, n=13. A positive anti-hepatitis B surface antibody response was achieved in 29% (8/28) of the LC-B group, 88% (7/8) of the ALF-B group, and 44% (4/9) of the adult non-B ESLD group. All four non-B ESLD infants showed vaccine success. The predictive factors for a good response in LC-B were young age, marital donor, and high donor age. ALF-B and non-B ESLD infants are thus good vaccination candidates. LC-B patients with marital donors are also good candidates, perhaps because the donated liver maintains an efficient immune memory to HBV, as the donors had already been infected in adulthood and showed adequate anti-HBV immune responses

Dynamic computed tomography is useful for prediction of pathological grade in pancreatic neuroendocrine neoplasm

BACKGROUND AND AIM: Pathological grading is important in defining the therapeutic strategy in pancreatic neuroendocrine neoplasm (PNEN) but is difficult for unresectable cases. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in the diagnosis of PNEN, but its usefulness for pathological grading is not well established. No studies have examined the diagnostic ability of dynamic computed tomography (CT) for pathological grading of PNEN. We investigated the usefulness of EUS-FNA and dynamic CT in the diagnosis and pathological grading of PNEN. METHODS: In this retrospective study, 39 PNEN patients finally diagnosed via EUS-FNA and/or surgical resection underwent dynamic CT. Pathological samples were diagnosed based on WHO2010; staging was based on the European Neuroendocrine Tumor Society classification. The proportion of the quantification value in the tumor to the pancreatic parenchyma in arterial phase was defined as the CT ratio. Immunohistochemical staining with CD31 was performed to evaluate microvessel density (MVD). We evaluated the relationship between pathological grade, CT ratio, and MVD. RESULTS: By using EUS-FNA, 35 of 39 (90%) cases were diagnosed as PNEN. As for pathological grade, 15 of 35 (43%) cases could be identified correctly. CT ratio could predict pathological Grade 3 disease. The sensitivity, specificity, and diagnostic accuracy were 100%, 94%, and 95%. MVD was significantly correlated with CT ratio (r = 0.83, P < 0.0001) and pathological grade (P = 0.0074). CONCLUSIONS: Computed tomography ratio has a relationship with pathological grade in PNEN, which would help decide therapeutic strategy in unresectable cases and cases in which pathological grading is difficult