Induction of dendritic cell differentiation by granulocyte-macrophage colony-stimulating factor, stem cell factor, and tumor necrosis factor alpha in vitro from lineage phenotypes-negative c-kit+ murine hematopoietic progenitor cells

To elucidate the capacity of murine early hematopoietic progenitor cells (HPCs) to differentiate into dendritic cells (DCs), lineage phenotypes (Lin)-c-kit+ HPCs were highly purified from either wild-type or tumor necrosis factor (TNF) receptor p55 (TNF-Rp55)-deficient mice. Upon culture with granulocyte-macrophage colony-stimulating factor (GM-CSF) and stem cell factor (SCF) for 14 days, wild-type mouse Lin-c-kit+ HPCs did not exhibit characteristic features of DC such as sheet-like projections and veil processes. Moreover, these cells expressed a marginal level of DC markers such as DEC-205, CD86, and barely supported allogenic MLR. However, the addition of mouse TNFalpha generated a large number of cells with typical DC morphology, expression of high levels of Ia, DEC-205, CD86, and function of stimulating allogenic MLR. Moreover, a proportion of these mature DCs and thymic DCs expressed Thy-1 mRNA as well as Thy-1 antigen, whereas freshly isolated splenic DCs did not. These results suggested that DCs generated in our culture system phenotypically resemble thymic ones. In contrast, mouse TNFalpha failed to induce TNF-Rp55-deficient mice-derived Lin-c-kit+ HPCs to generate DCs with characteristic morphology, immunophenotype, and accessory function for T cells under the same culture conditions, suggesting a crucial role of TNF-Rp55 in TNFalpha-mediated DC differentiation from HPCs. Interestingly, human TNFalpha, which can bind to mouse TNF-Rp55 but not TNF-Rp75, was incapable to augment DC generation from wild-type mouse Lin-c-kit+ HPCs. Collectively, these results suggest that TNFalpha has a pivotal role in DC generation from murine early HPCs in collaboration with GM-CSF and SCF through the interaction of TNF-Rp55 and TNF-Rp75.

Effectiveness of fructose-modified chitosan as a scaffold for hepatocyte attachment

Free amino groups of chitosan, a substance which has previously been shown to be a good scaffold for hepatocyte attachment, were covalently modified with fructose. The modification significantly increased the number of cells that could be attached on the surface of chitosan gel. Rat hepatocytes cultivated on fructose-chitosan behaved similarly to those on unmodified chitosan, i.e., they retained the spherical shape they have in vivo, and released much less lactate dehydrogenase than cells attached on a collagen-coated surface. The modification with fructose did not alter the important characteristics of chitosan for hepatocyte culture: liver-specific functions such as urea synthesis and drug metabolism were stably maintained for 5 d in the hepatocytes cultured on fructose-chitosan. In sharp contrast, hepatocytes attached on a collagen-coated surface underwent a severe morphological change, from spherical to flat, and lost almost all their lidocaine-removal activity within 5d. A very thin fructose-chitosan layer was also applied onto the collagen-coated surfaces of polystyrene plates and a dextran microcarrier by crosslinking free amino groups in the chitosan and collagen with glutaraldehyde to fix the thin layer. Hepatocytes on the fructose-chitosan-coated surface retained their spherical shape, masking the cell-flattening effect of the collagen layer. Perfusion culture was then carried out using a hollow-fiber cartridge in which hepatocytes attached on fructose-chitosan-coated microcarriers were suspended in the extracapillary space: the liver-specific functions were stably maintained during 4d of the culture. A fructose-chitosan-coated surface thus appears to be a very promising scaffold for hepatocyte attachment which can be used in cellular biological studies of liver functions, especially in relation to cytochrome P450, as well as in bioartificial liver support systems.

Structures and magnetic properties of dimeric copper(II) benzoylformates. Erratum

The diagram which appeared as Fig. 3 on p. 660 was incorrect [Harada, Tsuchimoto, Ohba, Iwasawa and Tokii (1997). Acta Cryst. B53, 654–661]. The correct figure is shown below.

Structural characterization of mouse monoclonal antibody 13-1 against a porphyrin derivative: identification of a disulfide bond in CDR-H3 of Mab 13-1

The amino acid sequence of a mouse monoclonal antibody Mab13-1, a catalytic antibody against TCPP (meso-tetrakis(4-carboxyphenyl)porphyrin), was confirmed by mass spectrometric (MS) peptide mapping. The amino-terminal sequence of the heavy chain was established by MS/MS analysis of the isolated N-terminal peptide. The presence of a unique disulfide bond between Cys93H and Cys102H was identified by MS peptide mapping and sequence analysis of an S-S containing peptide. Positions of other disulfide bonds were identified to be conserved. The non-conserved disulfide bridge was found to be resistant as other intra-chain disulfide bonds against reduction under non-denaturing condition, and to be buried inside the molecule. This extra disulfide bond is expected to support antigen-binding by restricting the flexibility of CDR-H3 loop, and it might be favorable for the recognition of a plane antigen, a porphyrin derivative.

Effect of thromboxane A2 antagonists on bronchial hyperresponsiveness induced immediately after interleukin-8 inhalation in guinea-pigs

1. Although repeated intranasal administration of interleukin-8 (IL-8) causes bronchial hyperresponsiveness (BHR) mediated via thromboxane A2 (TXA2) and airway neutrophil accumulation in guinea-pigs, the acute effect of inhaled IL-8 is unclear. We performed this study to clarify the acute effect of IL-8 on bronchial responsiveness and the role of TXA2. 2. The effects of inhaled IL-8 on bronchial responsiveness and of the TXA2 antagonists, S-1452 (0.01 and 0.1 mg kg-1) and ONO-NT-126 (1.0 or 10 micrograms kg-1), on IL-8-induced BHR were examined by use of a modified Konzett-Rössler method in guinea-pigs. 3. Inhaled IL-8 at 100 ng ml-1, which failed to induce significant changes in Pao (pressure at the airway opening), enhanced an increase in Pao induced by subsequent inhalations of ascending doses (50-200 micrograms ml-1) of methacholine and histamine, suggesting the potentiating effect of IL-8 on bronchial responsiveness. No significant leukocyte infiltration was observed histologically sixteen minutes after the IL-8 inhalation. Both S-1452 and ONO-NT-126 reduced the IL-8-induced BHR. 4. In conclusion, IL-8 rapidly causes BHR via TXA2 release in guinea-pigs.

Pivotal role of interleukin-8 in the acute respiratory distress syndrome and cerebral reperfusion injury

Neutrophil recruitment is one of the hallmarks of acute inflammation. A potent neutrophil chemotactic and activating factor, interleukin-8 (IL-8), has been demonstrated to be elevated in body fluids in various human diseases and experimental animal models. Recent investigations on animal disease models using blocking antibodies to IL-8 have revealed the essential involvement of IL-8 in acute inflammation. We previously reported that the administration of a neutralizing antibody against IL-8 prevented the neutrophil infiltration and neutrophil-mediated tissue injury in several animal studies. In addition, we have recently demonstrated that anti-IL-8 treatment is also effective in prevention of two models that are very relevant to clinical situations: cerebral reperfusion injury and endotoxemia-induced acute respiratory distress syndrome-like lung injury. These results further support the hypothesis that IL-8 has a pivotal role and is a novel target for therapeutic intervention in neutrophil-mediated injury.

Neutrophil behavior in pancreas and liver and the role of nitric oxide in rat acute pancreatitis

The behavior of neutrophils in a rat acute pancreatitis model was observed in the pancreas and liver using fluorescence microscopy with an image analyzing system after labeling with a specific fluorescent reagent. Nonviable cells of both organs were also labeled and quantified. The role of nitric oxide in neutrophil accumulation and organ damage was estimated by administering a relatively selective inhibitor of constitutive nitric oxide synthase, N-nitro-L-arginine (L-NNA). The animal model of acute pancreatitis was induced by cerulein injection (80 mg/kg). Two groups were created, one given and the other not given L-NNA (2.5 mg/kg) prior to the induction of pancreatitis. The number of accumulated neutrophils in the pancreas and liver increased in a time-dependent manner. There was a close relation between the distribution of the neutrophils and inviable acinar cells or hepatocytes. When pretreated with L-NNA, the numbers of accumulated neutrophils and nonviable cells increased significantly in the pancreas. In the liver, a more pronounced accumulation of neutrophils was observed after treatment with L-NNA. Although hepatocyte injury was mild despite the neutrophil accumulation in the control, such injury was marked in the group treated with L-NNA. This suggests that neutrophils serve an important role in exacerbating acute pancreatitis and that nitric oxide provides a defense mechanism against neutrophil accumulation in pancreas and liver.

Potentially multicentric hepatocellular carcinoma: clinicopathologic characteristics and postoperative prognosis

When multiple hepatic tumors are present, it is sometimes difficult to distinguish between metastatic and multicentric hepatocellular carcinoma (HCC). To identify the important clinicopathologic features of multicentric HCC, we evaluated the clinical characteristics of patients with multicentric HCC and examined the usefulness of surgical treatment in those patients. A total of 99 patients with multiple HCCs were classified into one of the following two groups according to whether their tumors were multicentric or metastatic: Group MO consisted of 18 patients with tumors thought to have developed synchronously from multicentric origins. Group IM consisted of 64 patients with intrahepatic metastases. In this study 18% of the patients with multiple HCCs were thought to have presented with multicentric tumors. This study revealed that synchronous multicentric HCCs often affected multiple segments of the liver and responded relatively well to partial hepatectomy of individual tumor-affected areas. To appropriately treat potentially multicentric HCC, it is important to understand the histopathologic characteristics of multicentric HCC and diagnose during preoperative and intraoperative ultra-sonography, so surgical treatment may be useful.

Lymph node metastasis in carcinoma of the body and tail of the pancreas

BACKGROUND

There have been no precise reports concerning lymph node metastatic involvement in carcinoma of the body and tail of the pancreas.

METHODS

Histopathological examination of lymph node involvement in 30 specimens obtained from patients who underwent pancreatic resection and wide dissection of lymph nodes, including para-aortic lymph nodes, for carcinoma of the body and tail of the pancreas was performed.

RESULTS

Fourteen of 30 patients had lymph node involvement. The highest incidence of lymph node involvement was around the splenic artery (five of 30 patients), aorta (four of 30) and coeliac trunk (four of 30). No significant difference in survival rate between the lymph node-negative group and the lymph node-positive group was observed, but all patients in the positive group died within 2 years after surgery, and four patients with para-aortic lymph node involvement died from recurrence within 10 months after surgery. Survival rates were significantly worse in patients with histopathological extrapancreatic nerve plexus invasion, retropancreatic tissue invasion, tumour diameter more than 4 cm, histological portal system vein wall invasion and carcinoma invasion of the surgical margins.

CONCLUSION

Although aggressive extended surgery including para-aortic node dissection has been performed, the postoperative survival rate is still low in patients with carcinoma of the body and tail of the pancreas. The high incidence of liver metastasis after surgery is a prime cause of the poor outcome, and effective therapy for postoperative liver recurrence requires evaluation.

Intraoperative radiotherapy for pancreatic carcinoma with hepatic or peritoneal metastases

BACKGROUND/AIMS

The purpose of this study was to determine the efficacy of intraoperative radiotherapy (IORT) for unresectable pancreatic carcinoma associated with hepatic or peritoneal metastasis.

METHODOLOGY

Between 1991 and 1994, 53 patients with pancreatic carcinoma associated with hepatic or peritoneal metastasis underwent surgery. Twenty-four of these patients received IORT, while 29 received no radiation therapy. The efficacy of IORT on the postoperative survival and pain relief for these patients was retrospectively analyzed.

RESULTS

Postoperative survival was lowest in the subgroup of patients (n = 18) with both hepatic and peritoneal metastases, and this group did not benefit from IORT (IORT, n = 6; no IORT, n = 12) in terms of survival. Similarly, there was no significant difference in the survival rates between patients undergoing IORT (n = 10) and patients without IORT (n = 11) in the subgroup of patients with hepatic metastasis but without peritoneal metastasis. However, patients with peritoneal metastasis but without hepatic metastasis benefited significantly from IORT (IORT, n = 8; no IORT, n = 6) (p < 0.05). Pain relief following IORT was observed in 9 out of 10 patients who had experienced pain prior to surgery.

CONCLUSION

Pancreatic carcinoma associated with peritoneal metastasis but without hepatic metastasis can be palliated by IORT. In addition, pain palliation in patients who require gastrointestinal or biliary drainage can also be achieved by IORT.

Prevention of cerebral edema and infarct in cerebral reperfusion injury by an antibody to interleukin-8

Reperfusion after a transient ischemia is a frequently encountered clinical condition that often causes greater tissue damage than persistent ischemia itself. Reperfusion to rabbit brain, after a transient focal ischemia, induced neutrophil infiltration and aggregation--neither of which were observed in rabbit brain rendered ischemic alone for the same time interval--thereby leading to severe brain edema and infarct. Brain tissue levels of interleukin-8 (IL-8), a potent neutrophil chemotactic cytokine (chemokine), increased significantly at 6 hours after reperfusion, but without a noticeable elevation of plasma IL-8 levels. Moreover, we detected IL-8 protein immunohistologically in the vascular wall and, to a lesser degree, in infiltrated neutrophils, suggesting a local production of IL-8 in reperfused brain tissues. Furthermore, a neutralizing anti-IL-8 antibody significantly reduced brain edema and infarct size in comparison to rabbits receiving a control antibody. These results implicate locally produced IL-8 as a pivotal mediator of cerebral reperfusion and suggest that IL-8 is a novel target for the intervention of this injury.

Structures and Magnetic Properties of Dimeric Copper(II) Benzoylformates

Structures of six dimeric copper(II) benzoylformates (I)–(VI) have been determined by single-crystal X-ray diffraction and the magnitudes of the spin-exchange interaction (H = −2JS1S2) have been determined based on the magnetic susceptibility measurement. (I): Tetrakis(\mu-benzoylformato-O,O′)bis(pyridine)dicopper(II), [Cu(C8H5O3)2C5H5N]2, −2J = 648 cm^{-1}. (II): Tetrakis(\mu-benzoylformato-O,O′)bis(2-methylpyridine)dicopper(II), [Cu(C8H5O3)2C6H7N]2, −2J = 656 cm^{-1}. (III): Tetrakis(\mu-benzoylformato-O,O′)bis(3-methylpyridine)dicopper(II) monobenzene solvate, [Cu(C8H5O3)2C6H7N]2.C6H6, −2J = 649 cm^{-1}. (IV): Tetrakis(\mu-benzoylformato-O,O′)bis(4-methylpyridine)dicopper(II), [Cu(C8H5O3)2C6H7N]2, −2J = 625 cm^{-1}. (V): Bis(2,3-dimethylpyridinium) tetrakis(\mu-benzoylformato-O,O′)bis(chloride)dicopper(II) dibenzene solvate, 2C7H10N.[Cu(C8H5O3)2Cl]2.2C6H6, −2J = 618 cm^{-1}. (VI): Tetrakis(benzoylformato-O,O′)bis(caffeine)dicopper(II) dibenzene solvate, [Cu(C8H5O3)2C8H10N4O2]2.2C6H6, −2J = 651 cm^{-1} (caffeine = 3,7-dihydro-l,3,7-trimethyl-1 H-purine-2,6-dione). In the binuclear cage structure the coordination geometry around the CuII atoms is typical square pyramidal with Cu...Cu distances 2.725 (1)–2.843  (1) Å. An ab initio molecular orbital calculation for the benzoylformate ion indicates that the unusually strong antiferromagnetic interaction in dimeric copper(II) benzoylformates is attributed to the electronic effect of the \alpha-keto group in the bridging carboxylate moiety. This is in accordance with a positive linear relationship between −2J of the copper(II) carboxylates and the diagonal part of the 2p x orbital population of the carboxylate C atom in the symmetrical HOMO, highest occupied molecular orbital (x is parallel to the C—R bond axis in the RCOO^{-} ion).

Lymph node metastasis in carcinoma of the body and tail of the pancreas

BACKGROUND

There have been no precise reports concerning lymph node metastatic involvement in carcinoma of the body and tail of the pancreas.

METHODS

Histopathological examination of lymph node involvement in 30 specimens obtained from patients who underwent pancreatic resection and wide dissection of lymph nodes, including para-aortic lymph nodes, for carcinoma of the body and tail of the pancreas was performed.

RESULTS

Fourteen of 30 patients had lymph node involvement. The highest incidence of lymph node involvement was around the splenic artery (five of 30 patients), aorta (four of 30) and coeliac trunk (four of 30). No significant difference in survival rate between the lymph node-negative group and the lymph node-positive group was observed, but all patients in the positive group died within 2 years after surgery, and four patients with para-aortic lymph node involvement died from recurrence within 10 months after surgery. Survival rates were significantly worse in patients with histopathological extrapancreatic nerve plexus invasion, retropancreatic tissue invasion, tumour diameter more than 4 cm, histological portal system vein wall invasion and carcinoma invasion of the surgical margins.

CONCLUSION

Although aggressive extended surgery including para-aortic node dissection has been performed, the postoperative survival rate is still low in patients with carcinoma of the body and tail of the pancreas. The high incidence of liver metastasis after surgery is a prime cause of the poor outcome, and effective therapy for postoperative liver recurrence requires evaluation.

Effect of electrochemically deposited apatite coating on bonding of bone to the HA-G-Ti composite and titanium

The surfaces of hydroxyapatite-glass-titanium (HA-G-Ti) functionally gradient composite and titanium bars were treated with electrochemical apatite deposition, and a cathodic current was applied at 62 degrees C in a solution containing calcium and phosphate ions. Specimens with and without the electrochemical surface treatment were implanted in the femurs of Japanese white rabbits. The rabbits were sacrificed at 3, 6, and 9 weeks after implantation, and the bonding strengths of bone to these specimens were determined by a pull-out method. At 3 and 6 weeks after implantation the specimens with the electrochemical surface treatment showed larger values for the Weibull modulus and characteristic strengths than those of untreated specimens, whereas there was no remarkable difference in the results at 9 weeks. Especially the pull-out strengths of surface-treated specimens were significantly larger than the untreated ones at 3 weeks after implantation. Scanning electron microscopy and Fourier transform infrared absorption spectroscopy of the specimen surface after implantation demonstrated that formation of new bone was enhanced by the electrochemical surface treatment. It can be concluded that the electrochemical surface treatment undoubtedly contributes to the early stage fixation between bone and implant.

Delayed development of nervous system in mice homozygous for disrupted microtubule-associated protein 1B (MAP1B) gene

Microtubule-associated protein 1B (MAP1B), one of the microtubule-associated proteins (MAPs), is a major component of the neuronal cytoskeleton. It is expressed at high levels in immature neurons during growth of their axons, which indicates that it plays a crucial role in neuronal morphogenesis and neurite extension. To better define the role of MAP1B in vivo, we have used gene targeting to disrupt the murine MAP1B gene. Heterozygotes of our MAP1B disruption exhibit no overt abnormalities in their development and behavior, while homozygotes showed a slightly decreased brain weight and delayed nervous system development. Our data indicate that while MAP1B is not essential for survival, it is essential for normal time course development of the murine nervous system. These conclusions are very different from those of a previous MAP1B gene-targeting study (Edelmann, W., M. Zervas, P. Costello, L. Roback, I. Fischer, A. Hammarback, N. Cowan, P. Davis, B. Wainer, and R. Kucherlapati. 1996. Proc. Natl. Acad. Sci. USA. 93: 1270-1275). In this previous effort, homozygotes died before reaching 8-d embryos, while heterozygotes showed severely abnormal phenotypes in their nervous systems. Because the gene targeting event in these mice produced a gene encoding a 571-amino acid truncated product of MAP1B, it seems likely that the phenotypes seen arise from the truncated MAP1B product acting in a dominant-negative fashion, rather than a loss of MAP1B function.

Clinical application of a new monoclonal antibody (19B7) against PIVKA-II in the diagnosis of hepatocellular carcinoma and pancreatobiliary malignancies

OBJECTIVES

A new monoclonal antibody (19B7) against prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) was clinically applied in patients diagnosed with hepatocellular carcinoma and pancreatobiliary malignancies, and the results were compared with those obtained using the conventional monoclonal antibody (MU-3) against PIVKA-II.

METHODS

The assays were the standard E-1023 using MU-3, a high sensitivity kit using MU-3 and a highly sensitive avidin-biotin complex method, and a new monoclonal antibody (19B7) kit.

RESULTS

The rate of PIVKA-II positivity in patients with hepatocellular carcinoma (n = 182) was 44% with E-1023, 55.5% with the high sensitivity kit, and 58.2% with the new monoclonal antibody kit. Small liver cancers <2 cm in diameter (n = 45) had a positivity rate of 15.6% with E-1023, 26.7% with the high sensitivity kit, and 31.1% with the new monoclonal antibody kit. The incidence of PIVKA-II positivity in patients with pancreatobiliary carcinoma (n = 91) was 29.7% with the high sensitivity kit and 52.7% with the new monoclonal antibody kit. The PIVKA-II ratio (plasma concentration with the high sensitivity kit/plasma concentration with the new monoclonal antibody kit) was calculated as > 1.0 in 89 of the 113 (78.8%) patients with hepatocellular carcinoma with the new monoclonal antibody kit assay level above 0.002 arbitrary units/ml, compared with <1.0 in almost all patients with pancreatobiliary malignancies.

CONCLUSIONS

MU-3 has much greater affinity for PIVKA-II in hepatocellular carcinoma than does 19B7, whereas 19B7 has much greater affinity for PIVKA-II in pancreatobiliary malignancies than does MU-3. The new monoclonal antibody, 19B7, is useful for diagnosing hepatocellular carcinoma and can also distinguish patients with hepatocellular carcinoma from those with other pancreatobiliary malignancies when combined with a PIVKA-II assay using the conventional monoclonal antibody, MU-3.

Intracavity frequency doubling of a diode-pumped 946-nm Nd:YAG laser with bulk periodically poled MgO LiNbO(3)

We report what we believe is the first cw quasi-phase-matched intracavity frequency doubling of a diode-pumped 946-nm Nd:YAG laser by use of bulk periodically poled MgO-LiNbO(3). A maximum second-harmonic power of 5.9 mW was obtained at a laser diode power of 500 mW. The blue beam profile showed a TEM(00) single spatial mode of low ellipticity (1:1) because there was no walk-off problem. Bulk periodic domain inversion was accomplished by a corona discharge method with a first-order modulation period of 4.75 microm for a wavelength of 946 nm over a 2-mm interaction length in Z-cut 0.4-mm-thick MgO-LiNbO(3).

Hepatic resection for hepatocellular carcinoma with a tumor thrombus extending to inferior vena cava

The significance of hepatic resection for hepatocellular carcinoma with a tumor thrombus in the inferior vena cava (IVC) is clarified. We operated on 4 patients with HCC who had a tumor thrombus extending to the IVC through the hepatic vein under hepatic vascular exclusion (HVE). In all patients the hepatic resections and thrombectomies were successful without major complication. One patient accompanied with a tumor thrombus in the portal vein had a rash recurrence in the remnant liver and died 6 months after operation. However, three patients without tumor thrombus in the portal vein survived relatively longer post-operatively. Hepatic resection for HCC with tumor thrombus in IVC is acceptable treatment as it is safe. It is considered that better prognoses can be maintained when a tumor thrombus is located only in the hepatic vein, and not in the portal vein.

Tumor necrosis factor receptor p55 is essential for intrahepatic granuloma formation and hepatocellular apoptosis in a murine model of bacterium-induced fulminant hepatitis

Accumulating evidence implicates tumor necrosis factor (TNF) and Fas systems in liver injury, although the interaction between these two systems remains to be investigated. In this study, we examined Propionibacterium acnes-primed TNF receptor p55-deficient (TNFRp55-/-) or Fas-deficient MRL/MpJ Lpr/Lpr mice challenged with lipopolysaccharide (LPS). Priming with P. acnes caused mononuclear cell infiltration into the hepatic lobules and granuloma formation in the livers of TNFRp55 wild-type mice. Subsequent LPS challenge caused massive liver injury and a marked increase in transaminase levels, leading to acute lethality in control wild-type mice. In contrast, the same treatment caused few pathological changes in livers of TNFRp55-/- mice, and all animals survived. P. acnes and subsequent LPS challenge induced granuloma formation and apoptotic changes, respectively, in livers of MRL/MpJ Lpr/Lpr mice. However, liver injury was 50% of that in control MRL/MpJ +/+ mice, suggesting some role of the Fas-Fas ligand system in this liver injury model. On the other hand, an agonistic anti-Fas antibody caused massive apoptosis and hemorrhagic changes of the liver without any priming with P. acnes, leading to death in both TNFRp55-/- and control wild-type mice. These results suggest that TNFRp55 but not Fas was involved in P. acnes-induced granuloma formation as well as subsequent LPS-induced liver injury and that TNFRp55 and Fas independently induced apoptosis of hepatocytes in vivo.

Sudden death in chronic dialysis patients

METHODS

Causes of sudden death were investigated in 113 chronic dialysis patients who died during the 10-year period from July 1979 to January 1989; postmortem examination was performed on 93 of the cases (autopsy rate; 82.3%). Sudden death was regarded as death 24 h after the onset of acute illness in patients without any restriction in their daily activities. There were 35 sudden death cases out of the 93 autopsied chronic dialysis patients. We analysed the causes of sudden death for all chronic dialysis patients and for those who died suddenly.

RESULTS

The mean age of the 93 cases was 61.4 +/- 10.5 years (+/-SD). Stroke was the most frequent cause of death (24 cases, 25.8%) in the 93 autopsied cases. This was followed by cardiac disease in 18 (19.4%), infectious disease in 16 (17.2%), malignancy in 14 (15.1%), and dissecting aortic aneurysm in 5 (5.4%). The mean age of the 35 sudden death cases was 60.9 +/- 10.9 years. Of the 35 sudden death cases in chronic dialysis patients, dissecting aortic aneurysm was the most common cause of sudden death (5 cases, 14.3%), followed by cerebral haemorrhage in three (8.6%), acute subdural haematoma in three (8.6%), acute myocardial infarction in two (5.7%), cerebral infarction in two (5.7%), and subarachnoidal haemorrhage in one (2.9%).

CONCLUSIONS

Dissecting aortic aneurysm, leading frequently to stroke as a cause of sudden death in chronic dialysis patients, at least in Japan, should be carefully differentiated from other cardiac diseases in chronic dialysis patients, such as severe atherosclerosis.

Hepatic resection for hepatocellular carcinoma

BACKGROUND

The significance of pTNM staging of hepatocellular carcinoma (HCC) as a prognostic factor after hepatic resection was evaluated.

PATIENTS AND METHODS

The prognoses were analyzed in 262 patients treated with hepatic resection for HCC.

RESULTS

As a whole, the pTNM stages correlated well with the survival rates. The survival rates of stage I and II patients were significantly higher than those of stages III and IV. However, there was no significant difference in survivals between stage I and II, and between stage III and IV-A. The survival rates of the patients treated with segmentectomy or lobectomy in stages I and II were significantly higher than those with subsegmentectomy or smaller resection. Multivariate analysis revealed that tumor size greater than 2 cm, multiple gross tumors, surgical margin less than 1 cm, and Child C classification were independently significant factors of poor survival.

CONCLUSIONS

The results of hepatic resection for HCC should be stratified by pTNM staging and by Child classification of hepatic function before comparison.