A 68-year-old female with unstable angina was treated surgically. She was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with three vessel disease. On a coronary angiogram (CAG), 90% stenoses were found in the left anterior descending coronary artery (LAD), circumflex (CX), and right coronary artery (RCA). She received elective coronary artery bypass grafting (CABG), in which the left internal thoracic artery (LITA) was anastomosed to the LAD and reversed saphenous vein grafts (SVG) were made to segment 12 of the CX, and segment 4PD of the RCA, respectively. The postoperative course was uneventful, but postoperative early graftgraphy revealed distal narrowing of the LITA graft as the so-called "string sign". However, one year post surgery, the LITA string sign was not found and its patency had markedly improved on the second graftgram. It is reported that the LITA "string sign" might cause late graft occlusion. However, this LITA graft evidently enlarged the size and increased the flow of the artery in proportion to myocardial blood demand. To our knowledge, it has not been reported that an in situ LITA string sign on postoperative early graftgram has disappeared in the late phase. We hypothesize that the LITA string sign might be caused by several different factors such as flow competition, spasm, and/or technical problems. In any event, the LITA string sign does not cause graft occlusion in the late postoperative period in every case.
Patent ductus arteriosus (PDA) in adults is occasionally associated with calcification and pulmonary hypertension, for which an anterior approach through a median sternotomy with cardiopulmonary bypass is often used. Sutures are placed without circulatory arrest by using a transpulmonary balloon catheter as an occluder. To secure the suture tie, we used Nélaton's catheters as tourniquets.
We offer a historical overview of endocrine therapy for prostate cancer. Hormone therapy remains the cornerstone of treatment for patients with locally advanced or metastatic prostate cancer. Although this therapy has been traditionally performed by oral estrogen or bilateral orchiectomy, there are now two most important pharmacological hormonal therapies: LH-RH agonist and antiandrogen therapy. We do not have yet sufficient data to conclude whether maximal androgen blockade from the combined use of an LH-RH agonist and an antiandrogen will prolong the survival in patients with metastatic prostate cancer, nor to conclude whether neoadjuvant androgen ablation therapy improves the disease-free survival of patients after radical prostatectomy. New treatment strategies and modalities such as LH-RH antagonists, intermittent hormonal therapy, and antiandrogen monotherapy are appearing and being tested in clinical trials. However, to date there is still no effective therapy for patients who have hormone refractory disease.
P1176 Aims: In partial liver transplantation, when the graft represents less than 30% of the standard liver volume of the recipient, it generally results in graft dysfunction. The cause of the graft dysfunction in small-for-size liver transplantation is likely associated with the excessive portal flow. We investigated the effects of portocaval shunt on the influence of excessive portal flow on the sinusoidal microcirculatory injury in extremely small size liver transplantation in pigs, focusing on the prevention of primary graft nonfunction. Methods: Using pig, the posterior segment of 25% of a whole liver was transplanted orthotopically. The pigs were divided into two groups: group A, graft with portocaval shunt (n=11), and group B, graft without portocaval shunt (n=11). The portocaval shunt was placed by side-to-side anastomosis of the portal vein and the inferior vena cava. Survival rate, portal venous flow, hepatic arterial flow and histological findings were investigated. Results: In group A, eight pigs survived for more than 4 days and the remaining three died of portal vein thrombosis at the anastomotic site of the portocaval shunt or perforated gastric ulcer within 3 days. In group B, all pigs except for one died of liver dysfunction within 24 hours after reperfusion. The portal flow volumes before operation and after reperfusion in group A, were 129.9 ± 32.5 ml/min/100g liver tissue and 57.74±56.23 ml/min/100g liver tissue, respectively. On the other hand, in group B, those volumes before operation and after reperfusion were 125.3±48.5 ml/min/100g liver tissue and 280.0±144.7 ml/min/100g liver tissue, respectively. The changes of portal flow volume after reperfusion were significantly difference between the two groups (p<0.05). In the light microscopical findings in group B, destruction of the sinusoidal lining and bleeding in the peri-portal areas were observed after reperfusion but these finding were not recognized in group A. Conclusions: In this study we clearly demonstrated that an extremely small size graft with the native whole liver volume less than 30% can be successfully transplanted with a portocaval shunt in large animals. These results suggested that excessive portal flow is attributable to postoperative liver dysfunction after small-for-size liver transplantation by sinusoidal microcirculatory injury. The portocaval shunt changed the hepatic hemodynamics and improved the mortality after extremely small size liver transplantation in pigs and may have a clinical role in the salvage of small-for-size liver grafts.
We describe the progress in oral anti-cancer drug therapy for urological cancer. Pure antiandrogen (e.g., flutamide) is widely used as a means of maximal androgen blockade (MAB) in the treatment of prostate cancer. However, all series reported in the past several years did not show positive effects on prolongation of the patient's survival. Evaluations by meta-analysis are in progress. As the mechanism of antiandrogen withdrawal syndrome has been recognized, it was widely accepted that antiandrogen should be discontinued when disease progression or PSA elevation becomes evident. Estramustine was recently clarified as an effective therapeutic agent in the treatment of hormone refractory prostate cancer in combination with oral etoposide. Oral etoposide therapy has been tried as a maintenance or a palliative chemotherapy for non-curative or high-risk germ cell tumor. UFT (a compound of tegafur and uracil) is said to be effective for bladder cancer. It has been also suggested that UFT was partly effective as a means of first-line endocrine chemotherapy for advanced prostate cancer and was a promising agent in the treatment of advanced renal cell carcinoma in combination with Interferon-alpha. Usually the age of the patient with urological malignancy, excluding testicular cancer, is high and complicated. For such patients, an aggressive intravenous chemotherapy can not always be used. Therefore, a less aggressive, less toxic chemotherapy with oral drug is often planned to maintain QOL.
