[Experience of gamma-detecting probe for the survey of sentinel node in gastroesophageal malignancies].

Gamma-detecting probe NAVIGATOR GPS (Autosuture Japan) was evaluated by using of 99mTc. Linearlity of counting in radioactivity was fairly good, but the sensitivity of the prove is so low, that sentinel node (SN) should contain the 3.7 x 10(-3) MBq (0.1 microCi) of 99mTc or more for the most effective use of it. And the count rate of the gamma-detecting probe was influenced by the distance and angle from the 99mTc source variously. It is important for the operator to know such characteristics of the gamma-detecting probe in order to obtain the correct SN judging.

[Effect of ischemia and reperfusion on hepatic regeneration following partial hepatectomy in cirrhotic rat liver].

Hepatic regeneration of cirrhotic liver following partial hepatectomy was evaluated in the rats following portal triad cross clamp (Pringle's maneuver). Cirrhotic rats were induced by repeated intraperitoneal injection of thioacetamide. Sixty eight percent of partial hepatectomy was performed under general anesthesia with or without total hepatic normothermic ischemia. Pringle's maneuver consisted of 4 times repetition of the combination of 15-minute ischemia and 15-minute reperfusion. Rats were sacrificed on 1, 7, and 28 postoperative days. The increasing rate of regenerated liver, the labeling index (LI) by histochemical measurement of BrdU positive hepatocyte, biochemical tests of the blood were evaluated in non cirrhotic and cirrhotic rats. Cirrhotic rats tolerated Pringle's maneuver well, without portal congestion as observed in non cirrhotic rats, suggesting the formation of porto-systemic shunt in cirrhotic rats. The inhibition in DNA synthesis and hepatic regeneration rate was observed in liver cirrhosis. However, no statistical significant difference in hepatic regeneration was observed in cirrhotic rats with or without Pringle's maneuver. In conclusion, the rat with cirrhotic liver tolerated Pringle's maneuver well and the maneuver itself was not harmful for hepatic regeneration following the partial resection.

Effect of repeated portal-triad cross-clamping during partial hepatectomy on hepatic regeneration in normal and cirrhotic rats.

The effects of ischemia/reperfusion during 70% partial hepatectomy on hepatic regeneration was evaluated in normal rats and thioacetamide-induced cirrhotic rats. Total hepatic ischemia and reperfusion (15 min each) by portal-triad cross-clamping was repeated two times in normal rats and four times in cirrhotic rats during hepatectomy. The labeling index of hepatocytes on Day 1 after operation (POD) and hepatic regeneration ratio on POD 28 were measured. In normal rats, the repeated ischemia/reperfusion decreased the survival rate from 100 to 77% (P < 0.05), lowered the hepatocyte labeling index from 33.5 +/- 2.5 to 16.7 +/- 6.5%, and diminished the hepatic regeneration ratio from 199 +/- 17 to 137 +/- 12% (P < 0.01). However, portal-systemic shunt improved those levels to 100, 30.6 +/- 13.7, and 169 +/- 19%, respectively (P < 0.01). In cirrhotic rats, no portal congestion was observed and hepatic regeneration was not suppressed by ischemia/reperfusion. Thus, portal pooling and the reperfusion of pooled portal blood may be the cause of inhibition on hepatic regeneration and not ischemia/reperfusion of the liver itself. Therefore, repeated portal-triad cross-clamping for short periods of time during the resection of cirrhotic liver is not harmful for hepatic regeneration.

Changes of serum bilirubin fraction in postoperative liver failure cases treated by plasmapheresis: an effective marker for evaluation of bilirubin removal.

Utility of a new method of bilirubin fractionation was evaluated in monitoring the effectiveness of plasma exchange (PE) performed in 10 postoperative cases with liver failure. Fractionation of serum bilirubin by high-performance liquid chromatography demonstrated a higher delta bilirubin (B delta) peak against lower conjugated bilirubin peaks [monoconjugated bilirubin (MCB) and diconjugated bilirubin (DCB)] in the three recovered cases. The calculated ratio of MCB/B delta and the ratio of B delta/(MCB + DCB + B delta) in the recovered cases showed statistically significant different against seven unrecovered cases (p less than 0.01). These results suggest that the recovered cases had a different quality hyperbilirubinemia and a different disease entity before PE as well as a different response to PE, and this novel method for serum bilirubin subfraction is considered a useful marker in selecting a patient responsive to PE.

In vivo and in vitro evaluation of bilirubin removal in postoperative hyperbilirubinemia patients.

The effect of plasma adsorption (PA) on bilirubin removal by a porous type anion exchange resin (Medisorba BL, Kuraray) was evaluated in vitro PA and in vivo PA and plasma exchange (PE) in postoperative hyperbilirubinemia patients. Serum and plasma bilirubin were measured by routine biochemical tests, fractionated by high-performance liquid chromatography, and its reduction and rebound were compared. In vitro and in vivo PA indicated the selectivity in bilirubin removal against measured molecules. Changes in bilirubin fractions after PA showed higher adsorbance of conjugated bilirubin (21.4-30.8%) and less adsorbance of delta (85.7%) and unconjugated bilirubin (73.7%). These differences were not observed after PE. But rebound of serum total bilirubin levels after PA was more than that after PE. It is suggested that PA by the resin is selective and has a different metabolic effect on bilirubin during and after PA as compared with PE.

Therapeutic plasmapheresis for liver failure after hepatectomy.

Therapeutic plasmapheresis (PP) for liver failure following the resection of primary liver cancer was evaluated retrospectively. PP was repeated two to three times per week using plasma exchange (PE) with fresh frozen plasma as a substitution fluid in all eight cases and direct hemoperfusion (DHP) in two cases. PE effectively decreased serum bilirubin and/or improved hepatic encephalopathy in six of eight patients and prolonged survival time (p less than 0.05, chi-square test). DHP was not effective. Liver failure following the resection of damaged liver differs from acute liver failure in both the condition itself and the reaction to PP. Fractionation of serum bilirubin using high performance liquid chromatography showed differences in the ratio of delta bilirubin in one survivor versus two who died and was effective in selecting a patient who would respond to PE. In conclusion, PE is effective in prolonging survival time after liver failure in hepatectomized patients compared to conventional therapy.