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Highlights • Lung large-cell neuroendocrine carcinoma (LCNEC) is an aggressive and a rare type of lung cancer. • The prognosis of LCNEC with distant metastasis is extremely poor. • Surgical resection for liver metastasis of LCNEC may improve prognosis., Introduction Lung large-cell neuroendocrine carcinoma (LCNEC) is an aggressive and a rare type of lung cancer, and the prognosis of LCNEC with distant metastasis is extremely poor, with a five-year survival rate of 0%. Here, we report a case of laparoscopic hepatectomy for liver metastasis of lung LCNEC. Presentation of case A 63-year-old man received a routine physical examination, and abnormal chest radiographic findings were observed; chest computed tomography (CT) in our hospital revealed that the patient had left pneumothorax and a lesion measuring 18 mm in the inferior lingular segment of the lung. The patient underwent thoracoscopic lobectomy, and the final pathological diagnosis was lung LCNEC. Four years after surgery, abdominal CT revealed a mass measuring 27 mm in the liver. The patient underwent laparoscopic partial hepatectomy, and postoperative pathological examination showed liver metastasis of LCNEC. There was no sign of recurrence 6 months after hepatectomy. Discussion LCNEC with distant metastasis has a poor response to systemic chemotherapy, and the median survival time of patients with distant metastasis is estimated to be approximately 6 months, with a five-year survival rate of 0%. Although the common site of metastasis from LCNEC is the liver, there are no previous reports of hepatectomy for liver metastasis of LCNEC. Conclusion We report a case of laparoscopic hepatectomy for liver metastasis of lung LCNEC. It is suggested that surgical resection for solitary distant metastasis of LCNEC may improve prognosis.

Background. Portal vein embolization (PVE) of hepatic lobes planned for resection is known to increase the margin of safety in extended hepatic resection. We examined whether volume gain could directly translate into functional gain in the nonembolized hepatic lobes after PVE, using a unique pharmacologic model of hepatic venous isolation and charcoal hemoperfusion. Methods. Lidocaine hydrochloride (8 mg/kg) was infused over 10 minutes in the portal vein of beagles with hepatic venous isolation and charcoal hemoperfusion, which prevented hepatic recirculation of the drug, and the lidocaine first-pass hepatic extraction ratio (Lid-HER) was determined to assess the selective lobar function of the liver. First, the correlation between Lid-HER and hepatic parenchymal weight of the lidocaine perfusion area was studied. Second, PVE was performed of the left portal branch, and Lid-HER of the nonembolized lobes was determined 1 hour or 2 weeks after PVE. Results. Hepatic venous isolation and charcoal hemoperfusion reduced (>95%) the postfilter and systemic lidocaine concentrations compared with prefilter concentrations. In the first study, a significant correlation was demonstrated between Lid-HER and hepatic parenchymal weight ( P =.0023, r 2 = 0.992). In the second study, both weight ratio of the nonembolized lobes relative to the whole liver and Lid-HER of the nonembolized lobes showed significant increases 2 weeks after PVE of 1.7- and 1.9-fold, respectively. Conclusions. Hepatic-weight increase paralleled functional increase, as determined by Lid-HER, in the nonembolized hepatic lobes 2 weeks after PVE. Thus, volume change directly translated into functional change in future remnant noncirrhotic liver after PVE. (Surgery 2002;132:424-30.)

We have previously demonstrated a high prevalence of Sjögren's syndrome (SS) in patients with human T-lymphotropic virus type I-associated myelopathy (HAM) in Nagasaki prefecture. The present follow-up study compared the clinical and laboratory findings of SS with or without human T-lymphotropic virus type I (HTLV-I) antibody in this endemic area for HTLV-I infection. We investigated the clinical and laboratory manifestations in 83 patients with SS and HAM, including histologic examination of labial salivary glands and the prevalence of SS in patients with HAM. Definite SS was diagnosed in 13 out of 20 patients with HAM when the European Community criteria were used. The density of mononuclear cell infiltration in labial salivary glands was higher in HTLV-I-seropositive patients with SS (including patients with HAM) than in HTLV-I-seronegative patients. The volume of saliva and lacrima determined by the Schirmer or Saxon test was lower than normal but was not different among SS-HTLV-I-seronegative patients, HTLV-I-seropositive patients without HAM, and HTLV-I-seropositive patients with HAM. The proportions of patients positive for antinuclear antibody (ANA) and anti-SS-A (Ro) antibody or anti-SS-B (La) antibody were similar in the three groups. However, the low volume of saliva and the frequency of ANA in SS correlated with the degree of mononuclear cell infiltration in labial salivary glands. Our results suggested that HTLV-I infection is related to SS and that laboratory and clinical findings in SS closely correlate with the degree of mononuclear cell infiltration in the salivary glands.

beta 2-Microglobulin (beta 2-m) is a major constituent of amyloid fibrils in hemodialysis-associated amyloidosis (HAA), a serious complication in patients on long-term hemodialysis. The most distinctive pathological feature of HAA is the deposition of amyloid fibrils with subsequent articular inflammation and destruction. However, the pathological role of beta 2-m is not well known at present. We investigated the effects of beta 2-m on the production of proteinases from synovial fibroblasts isolated from patients with rheumatoid arthritis. beta 2-m stimulated synovial fibroblasts to produce stromelysin, a neutral matrix metalloproteinase (MMP-3). The production of MMP-2 and of a tissue inhibitor of metalloproteinase-1 (TIMP-1) were not enhanced by beta 2-m-treated synovial fibroblasts. Stromelysin is capable of degrading several components of the extracellular matrix and believed to be the key enzyme causing articular destruction in inflammatory joint diseases. Our results suggest a novel role for beta 2-m in articular inflammation and destruction mediated by stromelysin in HAA.

A single catheter technique of hepatic venous isolation and charcoal hemoperfusion (HVI-CHP) using a 4-lumen/2-balloon (4L-2B) catheter was developed to perform high-dose intra-arterial chemotherapy of the liver. Herein we report the technique, safety, and pharmacokinetics of this system in comparison with the original double-balloon technique.Sixteen patients with malignant liver tumors were treated by hepatic arterial infusion (HAI) with adriamycin at a dose of 100 mg/m2 under HVI-CHP. Seven patients underwent HVI-CHP by the double-balloon technique (group A), in which filtered hepatic effluent and the rest of the inferior vena caval blood were separately drawn and returned to the left axillary vein. The other nine patients were treated by the single catheter technique (group B). In group B, hepatic effluent was isolated by balloon inflations and directed to filters through fenestrations of one major lumen of a 4L-2B catheter. The filtered blood was returned straight to the right atrium through the other major lumen of the catheter.All patients in group A had a smooth stepwise induction of HVI-CHP, whereas one of nine patients in group B developed severe hypotension requiring interruption of HVI. The hepatic venous flow rate in group B during HVI-CHP was significantly higher than that in group A (P0.05). Systemic adriamycin exposure, as assessed by the area under the time concentration curve in systemic serum, was significantly higher in group A compared to that in group B (P0.01).The single catheter technique is hemodynamically tolerable and feasible in the majority of patients with malignant liver tumors. In view of systemic drug exposure, the single catheter technique is superior to the original double-balloon technique.

Background. We recently developed a novel system of direct hemoperfusion under hepatic venous isolation in an attempt to achieve high-dose intraarterial chemotherapy for patients with malignant liver tumors. We report here the results of treatment of these patients with advanced hepatocellular carcinoma. Methods. Adriamycin (100 to 150 mg/m2) was administered into the hepatic artery of 15 patients, under conditions of extracorporeal drug elimination by direct hemoperfusion under hepatic venous isolation. Hepatic venous isolation was accomplished mainly by the double-balloon technique with an occlusion catheter and a balloon catheter. The isolated hepatic venous blood was filtered by direct hemoperfusion and pumped to the left axillary vein. Results. During 5 minutes of adriamycin infusion, the mean drug extraction ratios of the direct hemoperfusion filters were 91%±9% (mean±SD). The amount of drug removed by the system was 26.4%±16.0% of the amount of drug administered. Two patients died, one of necrotizing pancreatitis and the other of hepatic arterial thrombosis. Both deaths were related directly to the hepatic arterial catheter. Other side effects included hemolysis related to the system of hemoperfusion (87%), chemical hepatitis (80%), leukopenia less than 3000/mm3 (67%), alopecia (33%), and nausea and vomiting (20%). Nine (64%) of 14 evaluable patients had objective tumor responses, with a median duration of response of 6.2 months. Conclusions. This approach offers an effective therapeutic option for patients with advanced hepatocellular carcinoma.

The minimal graft volume still remains unclear in partial liver transplantation (PLT). The purpose of this study was to determine whether portal decompression with the aid of a portahepatic vein shunt (PHVS) could improve survival in the extremely reduced size liver transplantation in dogs. After donor hepatectomy, the liver was reduced to 27% of the recipient whole liver consisting of the right lateral and caudate lobes. The reducted grafts with PHVS (group A,n = 6) or without PHVS (group B,n = 6) were orthotopically transplanted. All group A animals survived more than 3 days (the longest: 7 days), whereas all group B animals died within 48 h (P