Perioperative use of eicosapentaenoic acid and patency of infrainguinal vein bypass: A retrospective chart review

AbstractBackground:A significant proportion of autogenous vein grafts fail in the long term. Currently, there is no treatment to improve graft patency.Objective:This study was designed to assess the effectiveness of eicosapentaenoic acid (EPA) to prevent late failure of an autogenous vein graft and other perioperative risk factors affecting long-term patency.Methods:A retrospective chart review was performed on grafts of patients who underwent infrainguinal bypass surgery using autogenous vein grafts for peripheral arterial disease in a lower limb. Patients were stratified by the perioperative use of EPA. The EPA group was those patients who administered EPA ≥1 time within 3 months of surgery. The non-EPA group was made up of those patients who did not administer EPA within 3 months of surgery. Primary, assisted primary, and secondary patency rates of the grafts in each group were calculated by the Kaplan-Meier method and compared by the log-rank test. To evaluate the effect of other perioperative risk factors, a Cox proportional hazards analysis was performed.Results:One hundred sixty-one grafts were analyzed from 159 patients who underwent surgery between July 1991 and July 2005. The primary patency rates of the EPA and non-EPA groups were 93% and 86%, 89% and 74%, and 83% and 68% at 1, 3, and 5 years, respectively. In terms of primary patency, the EPA group was significantly better than the non-EPA group (P=0.042). There was no significant difference between the groups in either assisted primary or secondary patency. A Cox proportional hazard analysis found that the minimum graft diameter and perioperative use of EPA were significant factors for primary patency (P=0.002 and P=0.004, respectively). Graft diameter was the only significant factor for assisted primary and secondary patency (P=0.021 and P=0.003, respectively).Conclusion:Although graft diameter was the most important factor for long-term patency of infrainguinal vein bypass grafts, the perioperative use of EPA significantly improved primary patency among these subjects

Production of a macromomycin (MCR)-monoclonal antibody conjugate and its biological activity.

Macromomycin (MCR), an unique membrane-reactive anticancer antibiotic, was incubated with murine monoclonal anti-HLA IgG1 antibody (H-1) in the presence of carbodiimide. The resulting mixture was fractionated with a Sephadex G-200 column. The first and second fractions were shown to contain MCR-(H-1) conjugate by the elution profile, as well as by the Sarcina lutea growth inhibition assay and Ouchterlony double-diffusion method. A membrane immunofluorescence test with anti-MCR and anti-mouse IgG antibodies demonstrated specific localization of MCR-(H-1) on the surface of HLA-bearing NALL -1 cells. MCR-(H-1) inhibited the growth of HLA-lacking NS-1 cells statistically less effectively than MCR alone (p less than 0.01). On the other hand, the conjugate and free MCR equally inhibited the growth and 3H-TdR incorporation of HLA-bearing NALL -1 cells. These results indicate that the antibody-bound MCR retained both MCR and antibody activities, and thus exerted antibody-targeting MCR cytotoxicity in vitro.</p

Lambert-Eaton Myasthenic Syndrome Caused by Nivolumab in a Patient with Squamous Cell Lung Cancer

Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia. Findings from a nerve conduction study and a positive anti-P/Q-type voltage-gated calcium channel antibody made a diagnosis of LEMS. Pyridostigmine and 3,4-diaminopyridine temporarily improved her symptoms. This was the first case of LEMS as a neurological irAE. LEMS should be considered as a possible neurological irAE

Gastric T-cell lymphoma associated with hemophagocytic syndrome

BACKGROUND: Lymphoma-associated hemophagocytic syndrome (LAHS) occurs in mostly extra nodal non-Hodgkin's lymphoma. LAHS arising from gastrointestinal lymphoma has never been reported. Here we report a case of gastric T-cell lymphoma-associated hemophagocytic syndrome. CASE PRESENTATION: A 51-year-old woman presented with pain, redness of breasts, fever and hematemesis. Hematological examination revealed anemia. Gastroscopy revealed small bleeding ulcers in the stomach and the computed tomography scan showed liver tumor. She underwent total gastrectomy for gastrointestinal bleeding and the histopathology revealed gastric T-cell lymphoma. She continued to bleed from the anastomosis and died on the 8th postoperative day. Autopsy revealed it to be a LAHS. CONCLUSIONS: If Hemophagocytic syndrome (HPS) occurs in lymphoma of the gastrointestinal tract, bleeding from the primary lesion might be uncontrollable. Early diagnosis and appropriate treatment are needed for long-term survival

Asthma classification by a score calculated from clinical findings and examinations in subjects sensitive to inhalant allergens.

Twenty-one patients with atopic asthma were classified into three types according to their symptoms (clinical diagnosis): Ia, simple bronchoconstriction; Ib, bronchoconstriction + hypersecretion; and II, bronchiolar obstruction, and this classification was compared with a classification made according to clinical findings and examinations (score diagnosis). Type Ib asthma was characterized by the increased incidence of eosinophils in bronchoalveolar lavage fluid (BALF), while type II was characterized by ventilatory dysfunction in small airways and the increased incidence of neutrophils in BALF. Four patients, whose expectoration was between 50 and 99ml/day, of the 12 with type Ia assessed by clinical diagnosis were evaluated as type Ib by score diagnosis. One patient with type II by clinical diagnosis was assessed as questionable type II by score diagnosis. In the other 16 patients, the clinical and score diagnoses were the same