Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation.

PURPOSE: Although some studies have reported favorable effects of direct hemoperfusion with polymyxin-B-immobilized fiber columns (PMX) for the treatment of septic shock, few studies have demonstrated the efficacy of PMX in studies with a uniform case definition and without any other blood purification techniques. MATERIALS AND METHODS: Fifty-two patients with severe sepsis or septic shock secondary to colorectal perforation were treated with PMX. Hemodynamic alterations and plasma concentrations of endotoxin, interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1Ra), IL-6, IL-8, and IL-10 were evaluated following PMX treatment. RESULTS: We observed a significant reduction in plasma endotoxin in the nonsurvivors immediately after PMX treatment compared to before treatment. Systolic blood pressure was markedly increased and circulating levels of IL-1beta, IL-1Ra, and IL-8 were significantly reduced during a 2-h interval of PMX. CONCLUSIONS: Our findings suggested that PMX treatment appears to adsorb endotoxin and also modulates circulating cytokine during a 2-h interval of direct hemoperfusion in septic patients with such condition.

[Enlightenment activities about home palliative care for a terminal stage of cancer].

In Palliative and End-of-Life Care, it is very important that we support cancer patients being at home as well as for the removal of physical and psychological symptoms. In doing so, Hyogo Prefectural Awaji Hospital and Awaji Medical Association founded the "Awaji Palliative Care Team" in April, 2004. We have conducted a monthly study, for a total of 34 times to date. And we have an open citizen lecture 3 times a year. A doctor from Awaji Medical Association or a nurse from a home nursing station are the main lecturers on "home medical care". A doctor from the Hyogo Prefectural Awaji Hospital gave a special lecture "the latest cancer treatment". We also invited experts of palliative care from outside of the island and carried out a citizen open lecture. We held a total of 6 special lectures so far.

Surgical treatment of celiac artery aneurysm: in situ aortoceliac artery reanastomosis: a case report.

The authors present a rare case of celiac artery aneurysm treated by aneurysmectomy and vascular reconstruction, and they review the past literature. A 57-year-old man was referred to their hospital with a complaint of epigastric discomfort. Abdominal echography, 3-dimensional computed tomography, and selective angiography showed a sole celiac artery aneurysm. At operation, the origin of the celiac artery and adjacent aorta was exposed through a midline transperitoneal approach alone. A 25 x 20 x 25 mm fusiform aneurysm of the celiac artery was found 5 mm distal from its origin. Aneurysmectomy and in situ aortoceliac artery reanastomosis was performed buttressed with a doughnut-shaped Teflon felt under the partial clamp of the abdominal aorta. The left gastric artery arising from the aneurysm was ligated. Postoperative angiography showed good patency of the splenic and common hepatic arteries. He had an uneventful postoperative course with no aggravation of the liver function and was discharged 11 days after operation. Pathological examination of the aneurysmal wall revealed medial degeneration with a tear of the internal elastic lamina and intimal edema. In situ aortoceliac artery reanastomosis after aneurysmectomy, as was done in this case, has not been previously documented in the past literature.

Impact of 5-fluorouracil metabolizing enzymes on chemotherapy in patients with resectable colorectal cancer.

Although 5-fluorouracil (5-FU) is an important drug for colorectal cancer (CRC) treatment, no useful biomarker is currently available to predict treatment response. Since 5-FU is converted into active or inactive forms by orotate phosphoribosyltransferase (OPRT) or dihydropyrimidine dehydrogenase (DPD), a correlation between these enzymes and response to 5-FU has been suggested. However, such a correlation has not been investigated prospectively. Therefore, in the present study, we aimed to prospectively evaluate whether OPRT and DPD were predictive factors of the response to 5-FU treatment in patients with resectable CRC. The present investigation was designed as a multicenter prospective cohort study. OPRT and DPD activities were assessed in biopsy samples, obtained surgically from patients with resectable CRC. The OPRT/DPD ratio was calculated and the cut-off values for this ratio were determined for 5-year disease-free survival (DFS) and overall survival (OS). Patients were treated with 5-FU/leucovorin (LV) regimens and oral 5-FU. The endpoint of this study was the correlation between the OPRT/DPD ratio and 5-year DFS and OS. The cut-off value for the OPRT/DPD ratio was determined by using the maximum χ2 statistic method against 5-year DFS and OS. Sixty-eight patients were enrolled from July 2003 to May 2005. The median follow-up period was 1925 days. The OPRT/DPD ratio cut-off values for 5-year DFS and OS were 0.015 and 0.013, respectively. During the 5-year DFS and OS periods, patients with higher cut-off values had a better prognosis than those with lower ratios (P=0.03 and 0.02, respectively). In conclusion, our results suggest that the OPRT/DPD ratio could be a predictive factor for response to 5-FU/LV adjuvant chemotherapy.

Surgical treatment for acute ischemia caused by bilateral popliteal artery entrapment syndrome in an elderly patient: report of a case.

We report the unusual case of a 73-year-old man who underwent surgery for bilateral popliteal artery entrapment syndrome (PAES). A medial approach was used to operate on the left leg, and the vein bypass was made from the superficial femoral artery to the crural artery through a subfascial route. A posterior approach was used to operate on the right leg and it was found that the mid-popliteal artery passed medial to and beneath the medial head of the gastrocnemius muscle and was severely compressed by an accessory slip of muscle. The vein bypass from the above-knee to below-knee popliteal artery was established through the original route after resection of the accessory slip of muscle. A postoperative arteriogram showed good bypass flow to the bilateral crural arteries. To our knowledge, this case represents the oldest patient with this disorder to be treated by surgery.