Screening study on hemolysis suppression effect of an alternative plasticizer for the development of a novel blood container made of polyvinyl chloride

Abstract: The aim of this study is to identify a plasticizer that is effective in the suppression of the autohemolysis of the stored blood and can be used to replace di(2-ethylhexyl) phthalate (DEHP) in blood containers. The results of hemolysis test using mannitol-adenine-phosphate/red cell concentrates (MAP/RCC) spiked with plasticizers included phthalate, phthalate-like, trimeliate, citrate, and adipate derivatives revealed that di-isononyl-cyclohexane-1,2-dicarboxylate (Hexamoll , and diisodecyl phthalate (DIDP) exhibited a hemolysis suppression effect almost equal to that of DEHP, but not other plasticizers. This finding suggested that the presence of 2 carboxy-ester groups at the ortho position on a 6-membered ring of carbon atoms may be required to exhibit such an effect. The hemolytic ratios of MAP/RCC-soaked polyvinyl chloride (PVC) sheets containing DEHP or different amounts of DINCH or DOTP were reduced to 10.9%, 9.2-12.4%, and 5.2-7.8%, respectively (MAP/RCC alone, 28.2%) after 10 weeks of incubation. The amount of plasticizer eluted from the PVC sheet was 53.1, 26.1-36.5, and 78.4-150 mg/mL for DEHP, DINCH, and DOTP, respectively. PVC sheets spiked with DIDP did not suppress the hemolysis induced by MAP/ RCC because of low leachability (4.8-6.0 mg/mL). These results suggested that a specific structure of the plasticizer and the concentrations of least more than 10 mg/mL were required to suppress hemolysis due to MAP/RCC

Laparoscopic resection of a gastrointestinal stromal tumor larger than 5 cm: Report of a Case

A 46-year-old woman was admitted to our hospital and was diagnosed with a gastric submucosal tumor at the medical examination. Upper endoscopic examination revealed a submucosal tumor in the lower body of the stomach. Abdominal computed tomography (CT) revealed a large tumor of dimensions 51 × 32 mm in the lower body of the stomach with a mixed appearance: a solid part exhibiting a contrast effect and a cystic part exhibiting no contrast. Endoscopic ultrasonic fine needle aspiration biopsy (EUS-FNAB) was performed, and a gastrointestinal stromal tumor (GIST) was diagnosed by immunohistopathological examination. Laparoscopic surgery with five ports was performed for resection. After securing the safety margin the tumor was resected circumferentially using an ultrasonically activated device (USAD). Resection entailed a significant portion of the gastric wall. During surgery, a support yarn hooked in the minor axis direction, and the defect was closed using an automatic suturing device three times. According to the third edition of the GIST clinical practice guidelines, indications for laparoscopic resection of GISTs over 5cm have been relaxed. It was considered that careful laparoscopic resection would be possible even though this was a large GIST exceeding 5 cm

Laparoscopic resection of a gastrointestinal stromal tumor larger than 5 cm: Report of a Case

A 46-year-old woman was admitted to our hospital and was diagnosed with a gastric submucosal tumor at the medical examination. Upper endoscopic examination revealed a submucosal tumor in the lower body of the stomach. Abdominal computed tomography (CT) revealed a large tumor of dimensions 51 × 32 mm in the lower body of the stomach with a mixed appearance: a solid part exhibiting a contrast effect and a cystic part exhibiting no contrast. Endoscopic ultrasonic fine needle aspiration biopsy (EUS-FNAB) was performed, and a gastrointestinal stromal tumor (GIST) was diagnosed by immunohistopathological examination. Laparoscopic surgery with five ports was performed for resection. After securing the safety margin the tumor was resected circumferentially using an ultrasonically activated device (USAD). Resection entailed a significant portion of the gastric wall. During surgery, a support yarn hooked in the minor axis direction, and the defect was closed using an automatic suturing device three times. According to the third edition of the GIST clinical practice guidelines, indications for laparoscopic resection of GISTs over 5cm have been relaxed. It was considered that careful laparoscopic resection would be possible even though this was a large GIST exceeding 5 cm