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This experiment was aimed to investigate the changes in the blood flow (splenic arterial blood flow; S.B.F and pancreatic tissue blood flow; P.T.B.F) and the changes of production of prostaglandins (prostacyclin and thromboxane A_2) in canine segmental pancreatic graft before and after transplantation. Furthermore, we investigated correlation between the blood flow of the transplanted pancreas (S.B.F and P.T.B.F) and the changes of production of these two prostaglandins in it according to preservation time after transplantation. This experiment consisted of 17 dogs divided into two groups; short-term (3 hours) preserved group (group I, N=12), long-term (24 hours) preserved group (group II, N=5). In group I, after transplantation, both S.B.F and P.T.B.F increased significantly with enhanced production of prostacyclin. While, in group II, they decresed significantly with enhanced production of thromboxane A_2 and reduced production of prostacyclin. Graft function was monitered by daily fasting blood glucose level in each 5 dogs of both group. Four dogs in group I and only one dog in group II survived with functioning grafts for two weeks. But in group I, one graft was lost at 4 days from vascular thrombosis. On the other hand, in group II, two grafts were subsequently lost at 1 and 8 days from vascular thrombosis and the other two grafts were never functioning after transplantation. These results suggested that there was a significant correlation between the productive system of prostacyclin & thromboxane A_2 and the blood flow of the transplanted pancreas in canine segmental pancreatic transplantation, and enhanced production of thromboxane A_2 might be responsible for vascular thrombosis after transplatation. For this reason, good function of the graft after segmental pancreatic transplantation may be possible by inhibiting the production of thromboxane A_2,even if preservation time is long.

As a surgical method for the treatment of unresectable hepatocellular carcinoma (HCC), we developed a new therapy which consists of intermittent hepatic arterial occlusion (IHAO) during infusion chemotherapy by the use of double lumen balloon catheter inserted into the hepatic artery. This therapy was performed in 23 cases with unresectable HCC. Antineoplastic effects judged by Karnofsky's criteria were I-B in 19,I-A in three and 0-0 in one case. It was proved that the anticancer drug remained for a longer period at higher concentrations in the liver during IHAO. With the advance of gradual induction of thrombosis from peripheral hepatic artery by frequent HAO, liver dysfunction, growth of collateral vessels and repatency after induction of thrombosis could be suppressed. We conclude that this new therapy is a safe and more effective procedure for unresectable HCC and will have a wide application.

Clinical advantage of terbutaline sulfate (Bricanyl^[○!R]) was evaluated for four patients with anastomotic leakage after gastric operation. Terbutaline sulfate was administered subcutaneously or intravenously for the purpose of inhibiting exocrine pancreatic secretion during a few weeks just after anastomotic leakage was recognized. After this treatment, the injured anastomosis was completely healed and no surgical treatment was not necessitated in all cases. In conclusion terbutaline sulfate is useful for anastomotic leakage after gastric operation.

Heterotopic autotransplantation of the distal pancreas with enteric drainage was performed to preserve the pancreatic function after total or subtotal pancreatectomy in 4 cases of cancer of the pancreas and 3 cases of chronic pancreatitis. In cases of cancer of the pancreatic head who necessitated regional total pancreatectomy for large vascular involvements by the cancer, only the distal pancreas segment which was revealed to be free of cancer invasion by intraoperative pathologic examination was autotransplanted to the iliac vessels. Their pancreas grafts have been functioning and normoglycemia could be maintained without exogenous insulin administration. The present cases of the pancreatic cancer are alive and free from recurrence at present (the longest follow-up duration is 25 months). In cases of chronic pancreatitis with diffuse calcification or no dilatation of the pancreatic duct, distal subtotal pancreatectomy was done and the removed pancreas segment was autotransplanted to the iliac vessels with enteric drainage. Their grafts have survived, and normoglycemia without insulin administration could be maintained in all cases but one who had required insulin administration preoperatively. Painless effect was satisfactory (the longest follow-up duration is 56 months). In conclusion, segmental autotransplantation of the distal pancreas is effective to improve the quality of life after total or subtotal pancreatectomy.

Several palliative operations are performed for obstructive jaundice caused by an unresectable malignant tumor in the region of the head of the pancreas, duodenum, and hepatic duct. These procedures are not ideal as there are losses of bile in the external drainage, obstruction of the anastomosis by tumor invasion and ascending biliary tract infection in cases of internal drainage. Failure of sutures is lethal in these poor risk patients. Choledochojejunorrhaphy plus the application of an internal T-tube splint of silicone rubber should keep the drainage patent for a longer period.

故 本庄一夫先生三回忌追悼講演会 平成元年12月3日 於 都ホテル