Time course change of the insulin requirements during the perioperative period in hepatectomy and pancreatectomy by using an artificial pancreas STG-55

Introduction

To investigate changes in insulin requirements over time in patients who underwent hepatectomy and pancreatectomy with perioperative glycemic control by an artificial pancreas (STG-55).

Materials and methods

We included 56 patients (22 hepatectomies and 34 pancreatectomies) who were treated with an artificial pancreas in the perioperative period and investigated the differences in insulin requirements by organ and surgical procedure.

Results

The mean intraoperative blood glucose level and total insulin doses were higher in the hepatectomy group than in the pancreatectomy group. The dose of insulin infusion increased in hepatectomy, especially early in surgery, compared to pancreatectomy. In the hepatectomy group, there was a significant correlation between the total intraoperative insulin dose and Pringle time, and in all cases, there was a correlation with surgical time, bleeding volume, preoperative CPR, preoperative TDD, and weight.

Conclusions

Perioperative insulin requirements may be mainly dependent on the surgical procedure, invasiveness, and organ. Preoperative prediction of insulin requirements for each surgical procedure contributes to good perioperative glycemic control and improvement of postoperative outcomes.

Correction: Time course change of the insulin requirements during the perioperative period in hepatectomy and pancreatectomy by using an artificial pancreas STG-55

[This corrects the article DOI: 10.1007/s13340-023-00623-3.].

The preoperative M2BPGi score predicts operative difficulty and the incidence of postoperative complications in laparoscopic liver resection

BACKGROUND

Liver fibrosis or cirrhosis frequently makes parenchymal transection more difficult, but the difficulty score of laparoscopic liver resection (LLR), including the IWATE criteria, does not include a factor related to liver fibrosis. Therefore, this study aimed to evaluate M2BPGi as a predictor of the difficulty of parenchymal transection and the incidence of postoperative complications in LLR.

METHODS

Data from 54 patients who underwent laparoscopic partial liver resection (LLR-P) and 24 patients who underwent laparoscopic anatomical liver resection between 2017 and 2019 in our institution were retrospectively analyzed. All cases were classified according to M2BPGi scores, and reserve liver function, intraoperative blood loss, and postoperative complications were compared among these groups.

RESULTS

Sixteen cases (29.6%) were M2BPGi negative (cut-off index < 1.0), 25 cases (46.3%) were 1+ (1.0 ≤ cut-off index < 3.0), and 13 cases (24.1%) were 2+ (cut-off index ≥ 3.0). M2BPGi-positive cases had significantly worse hepatic reserve function (K-ICG: 0.16 vs 0.14 vs 0.08, p < 0.0001). Intraoperative bleeding was significantly greater in M2BPGi-positive cases [50 ml vs 150 ml vs 200 ml, M2BPGi (-) or (1+) vs M2BPGi (2+), p = 0.045]. Postoperative complications (Clavien-Dindo ≥ II) were significantly more frequent in M2BPGi-positive cases [0% vs 4% vs 33%, M2BPGi (-) or (1+) vs M2BPGi (2+), p = 0.001].

CONCLUSION

M2BPGi could predict surgical difficulty and complications in LLR-P. In particular, it might be better not to select M2BPGi (2+) cases as teaching cases because of the massive bleeding during parenchymal transection.

Outcomes of lung metastasis from pancreatic cancer: A nationwide multicenter analysis

BACKGROUND

Although distant metastasis from pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, some single center studies reported that lung metastasis has a favorable prognosis. The aim of this study is to evaluate the prognostic value of site-specific metastasis after pancreatectomy for PDAC, with a focus on lung metastasis.

METHODS

Data from 117 cases of lung metastasis after pancreatectomy were collected retrospectively from 23 institutions in Japan. To compare the sites of metastasis we also collected the data of 134 patients with liver only metastasis, 67 patients with peritoneal only metastasis and 121 patients with locoregional recurrence alone.

RESULTS

In patients with lung only metastasis, the median time from recurrence to death (RTD) was 23.1 months, which was better in comparison to other sites of recurrence. In lung metastasis group, the patients who underwent pulmonary resection had better long-term outcomes in comparison to those who did not. (RTD: 29.2 vs 15.2, P < .001). In the multivariate analysis, solitary metastasis (HR 5.03; 95% CI 1.195-21.144, P = .022) and postoperative chemotherapy (HR 14.089; 95% CI 1.729-114.77, P = .023) were identified as significant prognostic factors after lung resection.

CONCLUSIONS

Surgical resection is a favorable option for selected patients with a solitary lung metastasis and for whom adjuvant chemotherapy can be administrated.

Impact of Body Mass Index on Survival of Pancreatic Cancer Patients in Japan

The impact of body mass index (BMI) on postoperative survival in Japanese patients with pancreatic cancer is unclear. We examined the relationship between preoperative BMI and the prognosis of Japanese patients who underwent surgery for pancreatic cancer to determine whether BMI affects these patients' prognosis. Of the patients who underwent pancreatectomy between January 2004 and August 2015 at our institution, 246 were pathologically diagnosed with pancreatic tubular adenocarcinoma; the cancer was located in the pancreatic head (n=161) and in the body and tail (n=85). We classified the patients by BMI: underweight (n=22), normal weight (n=190), and overweight/obese (n=34) groups. We retrospectively analyzed medical records for patient characteristics, lesion location, disease stage, postoperative complications, chemotherapy, and prognosis. Lesion location, disease stage, postoperative complications, and chemotherapy were not significantly different among the BMI groups. The median survival times were as follows (days): all patients, 686; underweight, 485; normal weight, 694; and overweight/obese, 839. In a multivariate analysis, after adjusting for competing risk factors, low BMI was associated with an increased risk of death (normal weight: HR 0.58, p=0.038; overweight/obese: HR 0.54, p=0.059). High BMI was not found to be a postoperative factor for poor prognosis in Japanese pancreatic cancer patients.

Modified Blumgart anastomosis with the "complete packing method" reduces the incidence of pancreatic fistula and complications after resection of the head of the pancreas

BACKGROUND

Postoperative pancreatic fistula (POPF) and its complications remain problems. This study evaluated combination treatment with modified Blumgart anastomosis and an original infection control method (complete packing method) following pancreatic head resection.

METHODS

This study included 374 consecutive patients who underwent pancreatic head resection: 103 patients underwent Cattell-Warren anastomosis (CWA); 170 patients underwent modified Kakita anastomosis (KA); and 101 patients underwent modified Blumgart anastomosis with the complete packing method (BAC). The outcomes of the KA and BAC groups were compared statistically.

RESULTS

The POPF rate was significantly lower in the BAC group than in the KA group (28.8% vs 2.97%; p < 0.01). The overall postoperative complication rate, including SSI and postoperative hemorrhage, was significantly lower in the BAC group.

CONCLUSIONS

The combination of modified Blumgart anastomosis and the complete packing method is a simple and useful method for reducing the incidence of POPF and postoperative complications.

Novel contrast-injection protocol for high-resolution abdominal CT-angiography: vascular visualization improvement with vasodilator

PURPOSE

To evaluate the usefulness of a novel contrast-injection protocol for high-resolution abdominal computed tomography angiography (CTA) using nitroglycerin (NTG).

METHODS

Abdominal CTA was performed in 80 patients using two 64-detector-row CT scanners. Forty patients were examined after administration of sublingual NTG (NTG group), while 40 were examined without NTG administration (non-NTG group). Arterial phase images were acquired with maximum intensity projection and volume rendering. Reduction rates: vessel cross-sectional areas ratio of 10 cm distal to origin at the superior mesenteric artery, contrast enhancements, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were assessed. Three reviewers evaluated degree of depiction of the peripancreatic vasculature using a four-point scale (1 = poor, 4 = excellent).

RESULTS

Reduction rates were significantly lower in the NTG group (P < 0.001), while there were no significant differences in contrast enhancements, SNR, or CNR between groups. Visual evaluation results of the NTG group were significantly better than those of the non-NTG group (P < 0.01).

CONCLUSION

Abdominal CTA using NTG improved visualization of the abdominal peripheral vessels. This improved arterial view may be beneficial for preoperative evaluation of the arterial anatomy.

Intra-Aortic Balloon Occlusion (IABO) may be useful for the management of secondary aortoduodenal fistula (SADF): A case report

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Secondary aortoduodenal fistula is one of life-threatening complication after surgical treatment for abdominal arterial aneurysm.

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The most important factor for acute management is controlling the bleeding from the fistula.

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Intra-aortic balloon occlusion may be one option for management of secondary aortoduodenal fistula.

Introduction

Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after aortic reconstruction. Although a number of reports describing treatments for SADF have been published, the optimal management is unclear. A review of the literature suggested methods of reconstruction, control of bleeding, and reduction of infection in the management of SADF. The most important factor for acute intervention is controlling the bleeding from the fistula. We report one case treated using intra-aortic balloon occlusion (IABO) for SADF.

Presentation of a case

We describe a case of secondary aortoduodenal fistula that occurred seven years following aortobifemoral reconstruction for abdominal aortic aneurysm.

Discussion

Early control of bleeding is essential for survival of the patient. Emergency laparotomy or endovascular stenting frequently have been chosen as interventions, although each approach has significant limitations. Emergency laparotomy for patients with hemodynamic instability may create excessive physiologic stress, and endovascular stenting may not be available at every surgical facility. The use of IABO for cases of intraperitoneal bleeding due to trauma has been previously described. IABO is relatively easy to implement, and enabled us to control the bleeding from the aorta more rapidly than other strategies.

Conclusion

Based on a review of the literature and our own experience, IABO should be considered as one option for the management of SADF.

Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction

Progress in double-balloon endoscopy (DBE) has allowed for the diagnosis and treatment of disease in the postoperative bowel. For example, a short DBE, which has a 2.8 mm working channel and 152 cm working length, is useful for endoscopic retrograde cholangiopancreatography in bowel disease patients. However, afferent loop and Roux-limb obstruction, though rare, is caused by postoperative recurrence of biliary tract cancer with intractable complications. Most of the clinical findings involving these complications are relatively nonspecific and include abdominal pain, nausea, vomiting, fever, and obstructive jaundice. Treatments by surgery, percutaneous transhepatic biliary drainage, percutaneous enteral stent insertion, and endoscopic therapy have been reported. The general conditions of patients with these complications are poor due to cancer progression; therefore, a less invasive treatment is better. We report on the usefulness of metallic stent insertion using an overtube for afferent loop and Roux-limb obstruction caused by postoperative recurrence of biliary tract cancer under short DBE in two patients with complexly reconstructed intestines.

Hereditary Spherocytosis in a Middle-aged Man Complicated with Common Bile Duct Stones

Hereditary spherocytosis is the most common form of hemolytic anemia and is characterized by spherical, osmotically fragile erythrocytes that are selectively trapped by the spleen. Hereditary spherocytosis is typically diagnosed in childhood. We herein experienced a rare case of hereditary spherocytosis diagnosed in middle age. The patient presented with cholelithiasis and hyperbilirubinemia. He had no anemia and was asymptomatic with mild splenomegaly. In the differential diagnosis of these symptoms, the possibility of hereditary spherocytosis should be considered, even in patients who are middle-aged and lack anemia.

[A case of a patient who underwent resection of the remnant pancreatic cancer following a distal pancreatectomy for invasive ductal carcinoma]

Herein, we report the case of a patient who underwent resection of the remnant pancreas for pancreatic cancer following a distal pancreatectomy for invasive ductal carcinoma. An 81-year-old woman underwent a distal pancreatectomy. The tumor was found to be pancreatic cancer. The tumor was histologically diagnosed as a poorly differentiated tubular adenocarcinoma (Stage I). An abdominal computed tomography (CT) performed 17 months later revealed a 13 mm tumor in the remnant pancreatic head. A remnant pancreatectomy was performed. The histological diagnosis was a moderately differentiated tubular adenocarcinoma (StageIII). Remnant pancreatic cancer is rare following a pancreatectomy for invasive ductal carcinoma. The course of remnant pancreatic cancer can be followed with imaging. Long-term follow-up of patients who have undergone a pancreatectomyis, therefore, essential.

A solid pseudopapillary neoplasm without cysts that occurred in a patient diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a case report

Introduction

Solid pseudopapillary neoplasm of the pancreas is a rare neoplasm that has been reported to account for between 0.17% and 2.7% of all non-endocrine tumors of the pancreas. It is usually seen in young women. Because solid pseudopapillary neoplasms are rarely aggressive and have low-grade malignant potential and an excellent prognosis after complete resection, it is an ideal pancreatic tumor for treatment by minimally invasive surgery. Therefore, making an accurate pre-operative diagnosis is very important.

Case presentation

A 24-year-old Japanese man who had been found to have mild transaminase elevations at a medical check-up visited our hospital for further examination. Abdominal computed tomography showed a 40mm-diameter tumor in the pancreatic tail and mild fatty liver. He was admitted to our hospital for additional examination. The abdominal contrast-enhanced computed tomography scan taken at our institution showed an increasingly enhanced mass of 40mm diameter in the pancreatic tail. Ultrasonography showed a low-level echoic mass of 35mm diameter in the pancreatic tail. T1-weighted magnetic resonance imaging showed low signal intensity in the tail of the pancreas. T2-weighted magnetic resonance imaging showed high signal intensity there. Diffusion magnetic resonance imaging showed high signal intensity. An endoscopic ultrasound yielded the same results as the abdominal ultrasonogram. In addition, [¹⁸F]-fluorodeoxyglucose positron emission tomography/computed tomography showed abnormal accumulation (maximum standardized uptake value, 6.53). This finding raised our suspicion of a pancreatic malignant tumor. However, the patient could not be confidently diagnosed solely on the basis of imaging. Endoscopic ultrasound-guided fine-needle aspiration was performed, which led us to a diagnosis of solid pseudopapillary neoplasm. On that basis, we performed minimally invasive surgery (spleen-preserving laparoscopic distal pancreatectomy).

Conclusion

Atypical solid pseudopapillary neoplasm without cysts should be considered when diagnosing pancreatic tumors. A definitive pre-operative diagnosis of solid pseudopapillary neoplasm made on the basis of endoscopic ultrasound-guided fine-needle aspiration can guide the surgical approach used.

Diagnosis of a solid pseudopapillary neoplasm using EUS-FNA

A woman in her 50s was found to have a pancreatic mass on abdominal ultrasound. The tumor measured 40 mm in diameter and included a cystic lesion and calcification. In this case, we suspected a diagnosis of solid pseudopapillary neoplasm (SPN) due to the findings observed on various images. However, we were unable to exclude the possibility that the lesion was a neuroendocrine tumor. Therefore, we performed endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA). In addition, in order to confirm the diagnosis of SPN, we performed minimized resection (segmental pancreatectomy). Obtaining a definitive preoperative diagnosis of SPN using EUS-FNA can guide the surgical approach.

[A case report of successful control of liver metastasis from duodenal cancer with combined S-1 and docetaxel chemotherapy]

A 70-year-old man with abdominal pain and anemia was diagnosed with duodenal cancer upon upper gastrointestinal endoscopy and biopsy. Pancreatoduodenectomy was performed. Pathological findings were duodenal cancer, T 4 SI (Panc) N0P0V0A0H0. Three months after operation, abdominal CT showed multiple liver metastasis. He then underwent combined chemotherapy consisting of two weeks administration of S-1 (80 mg/body) followed by one week rest and injections of docetaxel (40 mg/body) every three weeks as one course. Metastatic tumors were gradually reduced and successfully controlled,and there was no other recurrence until he died about three years later of another illness. Combined S-1 and docetaxel chemotherapy is known to be effective for esophageal cancer, gastric cancer and other digestive cancer, as well as for duodenal cancer.

Adjuvant arterial infusion chemotherapy after resection of hepatocellular carcinoma with portal thrombosis: a pilot study

BACKGROUND/PURPOSE

The prognosis of hepatocellular carcinoma (HCC) with tumor thrombosis of the main trunk or major branches of the portal vein (mPVTT) is extremely poor, even if it is curatively resected. Uncontrollable multiple metastases to the residual liver are often observed within several months after the operation. We report here the results of a pilot study, showing the efficacy of adjuvant arterial infusion chemotherapy after the resection of HCC with mPVTT.

METHODS

Twelve patients had curative resection of HCC with mPVTT. Six of the patients were treated by the arterial infusion of a chemotherapeutic agent via a subcutaneously implanted injection port after curative resection of HCC with mPVTT. The initial course consisted of the daily administration of cisplatin (CDDP) and continuous infusion of 5-fluorouracil (5-FU). This was followed by the weekly or biweekly administration of CDDP and subsequent infusion of 5-FU until the cumulative dose of 5-FU reached 15 g.

RESULTS

The median overall survival time was 58.0 months with adjuvant chemotherapy and 8.0 months without adjuvant chemotherapy. The median disease-free interval was 15.0 months with adjuvant chemotherapy and 4.0 months without adjuvant chemotherapy. Adverse reactions were tolerable nausea and loss of appetite.

CONCLUSIONS

This chemotherapeutic regimen achieved favorable results and may be useful as adjuvant chemotherapy in treating patients after curative resection of HCC with mPVTT.

Gastric carcinoma with psammomatous calcification after Billroth II reconstruction: case report and literature review

A case of gastric carcinoma with psammomatous calcification arising in the remnant stomach after Billroth II reconstruction is reported. Borrmann type 1 gastric carcinoma was detected in the remnant stomach of an 82-year-old woman, who had a past history of distal partial gastrectomy for a perforated gastric ulcer, with Billroth II reconstruction at 40 years of age. Histologically, the tumor was a tubular adenocarcinoma that invaded the muscularis propria. Numerous psammoma bodies were found in the lumens of the tumor glands. Dystrophic calcification of gastric cancer is rare and psammomatous calcification of gastric cancer has only been reported in five cases previously. To our knowledge, this is the first case of gastric carcinoma with psammomatous calcification arising in the remnant stomach. We also review previously published reports regarding gastric carcinoma with psammomatous calcification.

Ratio of branched chain amino acid to tyrosine after hepatectomy

The roles of branched chain amino acids (BCAAs) and the tyrosine (Tyr) profile after liver resection were investigated using an inexpensive enzymatic method that was recently developed to quantify their concentrations. The preoperative BCAAs-to-Tyr ratio (BTR) was significantly correlated with the preoperative indocyanin green clearance ratio. The BTR decreased immediately after surgery in all patients, but it was significantly lower in those who had undergone major hepatectomies. After the infusion of BCAA-enriched amino acid solution, the BTR increased substantially, being significantly higher in patients who had not suffered an elevation in total bilirubin after liver resection. These findings indicate that this new enzymatic method to quantify the concentration of BCAAs and Tyr is useful to control the infusion of amino acids and to study the role of amino acid metabolization during the perioperative period.

[A case of bronchogenic in situ carcinoma originating in fourth order bronchi]

A case of bronchogenic in situ carcinoma originating in forth order bronchi was reported. Sputum cytology showed class IV in lung cancer mass screening in a 69-year-old male, although X-ray was negative. Bronchofiber scopy was repeated twice, and fine granular change of spur between Blai and ii was found in the second time. Right upper lobectomy was underwent, and post-surgical histology was in situ squamous cell carcinoma. The literature on early lung cancer was reviewed, and implication for management of bronchofiberscopic early lung cancer in general rule for clinical and pathological record of lung cancer was discussed.

[A severe case of reexpansion pulmonary edema in an asthmatic patient]

A 60-year-old man with poorly controlled bronchial asthma was proposed for an emergency appendectomy. His preoperative chest X-P revealed that his left lung was completely collapsed with pneumothorax, but its onset was unclear. Following the left thoracocentesis, appendectomy was performed under general anesthesia (oxygen-halothane). About one hour after the thoracocentesis, pinkish foamy tracheal secretion was massively drained and its protein concentration was 3.8 g.dl-1.PaCO2 was 95 mmHg and PaO2 was 69 mmHg (FIO2 1.0). His chest X-P showed signs of pulmonary edema in his left lung and infiltrating shadow was observed in his right lung. IMV with PEEP, aminophylline and prednisolone improved his respiratory status and on the 11 th day he was weaned from the respirator. In a case of pneumothorax with unclear duration like ours, it is necessary to consider the possibility of the reexpansion pulmonary edema.

Activation of HLA-A2-specific memory B cells in severe combined immunodeficient mice

Peripheral blood leukocytes of all five HLA-A2-sensitized patients produced significant levels of human IgG (> or = 0.25 micrograms/ml) following polyclonal activation in vitro, but PBLs from only one patient (K.H.) who had been transfused recently (< 4 weeks) produced detectable anti-HLA-A2 IgG. PBLs from this in vitro responder and from one in vitro nonresponder (L.G.) were transferred intraperitoneally into SCID mice. A low level (range, 5-40 ng/ml) of human anti-HLA-A2 IgG was detected in the serum of the mice without additional stimulation. This anti-HLA-A2 IgG response was boosted (range, 40-200 ng/ml) when mice received a human skin xenograft or an early challenge with x-irradiated human leukocytes intraperitoneally. Although the anti-HLA antibodies produced were specific for HLA-A2, the boosting of anti-HLA-A2 IgG production did not require the expression of the HLA-A2 protein, since either HLA-A2-negative skin xenografts or HLA-identical x-irradiated PBLs enhanced the production of anti-HLA-A2 IgG. Dose-response of transferred PBLs and kappa:lambda composition of individual mouse anti-HLA-A2 production suggested that low-frequency human memory B-cell clones were stimulated to proliferate and/or triggered to become high Ab secretors by skin graft or PBL boost.

Chronic human skin graft rejection in severe combined immunodeficient mice engrafted with human PBL from an HLA-presensitized donor

Mice with severe combined immunodeficiency (C.B-17 scid [SCID]) accepted xenografts of adult human peripheral blood leukocytes injected intraperitoneally as evidenced by production of human immunoglobulin (IgG and IgM), and circulation of human leukocytes in peripheral blood. SCID mice also accepted human split-thickness skin xenografts. Passenger leukocytes present in small numbers in such skin grafts could also recirculate in host peripheral blood and make detectable levels of human immunoglobulin. To test the immunocompetence of the transferred human PBL, SCID mice received a human skin xenograft from a second donor (HLA-mismatched with the PBL donor) either before (n = 6) or after (n = 23) xenografting of PBL. Skin was monitored daily for signs of rejection, and rejection was scored by histology 3-4 weeks after the second graft (PBL or skin) was placed. Of 19 SCID injected with PBL from an HLA presensitized patient (L.G.), 7/19 (37%) rejected a subsequent HLA-mismatched skin xenograft. Two of six SCID (33%) rejected a previously established skin xenograft when PBL were administered afterward. The rejection of the human skin was chronic, of relatively late onset (3-4 weeks), and was characterized grossly by contraction, glassy surface, and thickening. Histopathologic examination showed lymphocyte infiltration into the dermis with endothelial cell cuffing and destruction of capillaries, as well as lymphocyte tagging of the basal epidermis, hyperkeratosis, lymphocyte exocytosis and single epidermal cell necrosis. Immunostaining with monoclonal antibody to human CD2 or mouse CD3 revealed that human, but not mouse T lymphocytes were tagging the dermis/epidermis junction and infiltrating the epidermis of rejecting skin grafts. We conclude that a form of human skin graft rejection may be reproduced in an SCID mouse. The immune status of the transferred cells (sensitized vs. normal) and the lymphocytes ability to recirculate in SCID peripheral blood appear to be factors limiting the rejection process.

Renal transplantation from HLA-haploidentical living-related donors: the effects of donor-specific blood transfusions and different immunosuppressive regimens

One-hundred-nine HLA-haploidentical living related renal transplants have been retrospectively analysed to compare the effect of donor-specific blood transfusion (DST) and different immunosuppressive regimens on graft survival and acute rejection. The recipients were divided into four groups according to the immunosuppressive therapy. Group 1 (n = 44): conventional therapy with posttransplant azathioprine (AZP) + methylprednisolone (MP). Group 2 (n = 25): pretransplant DST + posttransplant AZP + MP. Group 3 (n = 12): triple-drug therapy with posttransplant AZP + MP + cyclosporine (CS). Group 4 (n = 25): pretransplant DST + posttransplant AZP + MP + CS. The five-year actuarial survival rates for groups 1, 2, 3 and 4 were 48%, 73%, 79%, and 89%, respectively. The graft survival rate in group 3 was significantly (p less than 0.01) better than that in group 1. The transfusion effect was reduced, and appears as a 10% improvement in the graft survival in the cyclosporin era compared with a 25% improvement at pre-cyclosporin era. Furthermore, the incidence of the first rejection episode was decreased in recipients that received DST. The present study revealed that DST, as pretransplant conditioning has a definite impact on rejection-free long-term graft survival in HLA-haploidentical living-related kidney recipients and the most favorable outcome in such patients could be achieved by DST pretreatment in conjunction with posttransplant triple-drug therapy including cyclosporine.

Expression of the interleukin 2 receptor beta chain (p75) in renal transplantation--applicability of anti-interleukin-2 receptor beta chain monoclonal antibody

The interaction of interleukin 2 with specific cellular receptors plays an essential role in the allostimulated proliferation and differentiation of T cells. Recent chemical linking studies have demonstrated that the human high-affinity IL-2 receptor is a membrane complex composed of at least two distinct subunits, which are the p55 (alpha-chain) and p75 (beta-chain) subunits. The IL-2R beta chain is supposed to play a role in the signal transduction of IL-2, but the exact mechanism is still unknown. In this study, we investigated the effects of a newly established anti-IL-2R beta chain monoclonal antibody (MoAb, TU-27) on the induction of cytotoxic T lymphocytes (CTLs) using the cell-mediated lympholysis (CML) assay. TU-27 in combination with H-31, a MoAb directed against the IL-2R alpha chain, produced inhibition of cytotoxicity, while TU-27 alone could not inhibit cytotoxicity, while TU-27 alone could not inhibit cytotoxicity at any concentration. TU-27 plus H-31 prevented the expansion of CD4+ cells and CD8++ cells in mixed lymphocyte culture (MLC). Furthermore, we examined the serial changes in the expression of the IL-2R beta chain on peripheral blood lymphocytes from renal transplant recipients using two-color immunofluorescence flow cytometry, so as to investigate correlations between IL-2R beta chain expression and the occurrence of allograft rejection. Here, we report that the IL-2R beta chain is expressed on CD4-positive (CD4+) cells and strongly CD8-positive (CD8(+)+) cells in association with acute rejection, indicating that IL-2R beta chain expression appears to increase on alloreactive T cells.

[The effect of pressure support ventilation on breathing patterns and the work of breathing]

We assessed breathing patterns during pressure support ventilation (PSV) and its relationship with the work of breathing in 10 postoperative patients. With increasing levels of pressure support, minute ventilation and tidal volume increased with a decrease in respiratory frequency. Increased minute ventilation was achieved by increased mean inspiratory flow. Duty cycle, however, decreased with PSV. This decrease might allow the diaphragm a longer rest period between contractions, which might decrease the risk of diaphragmatic fatigue. Furthermore, PSV reduced the inspiratory work added by a ventilator to near zero. Oxygen consumption was also decreased with PSV. We conclude that PSV improved the breathing patterns and minimized the work of breathing spontaneously via a ventilator.