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Serologic RhD-negative red cells can cause anti-D alloimmunization if they carry the Asian-type DEL or other DEL variants.

Most of the diseases for which apheresis therapy is indicated are intractable and rare, and each patient has a different background and treatment course prior to apheresis therapy initiation. Therefore, it is difficult to conduct large-scale randomized controlled trials to secure high-quality evidence. Under such circumstances, the American Society for Apheresis (ASFA) issued its guidelines in 2007, which were repeatedly revised until the latest edition in 2019. The ASFA guidelines are comprehensive. However, in the United States, a centrifugal separation method is mainly used for apheresis, whereas the mainstream procedure in Japan is the membrane separation method. The target diseases and their backgrounds are different from those in Japan. Due to these differences, the direct adoption of the ASFA guidelines in Japanese practice creates various problems. One of the features of apheresis in Japan is the development of treatment methods using hollow-fiber devices such as double filtration plasmapheresis (DFPP) and selective plasma exchange and adsorption-type devices such as polymyxin B-immobilized endotoxin adsorption columns. Specialists in emergency medicine, hematology, collagen diseases/rheumatology, respiratory medicine, cardiovascular medicine, gastroenterology, neurology, nephrology, and dermatology who are familiar with apheresis therapy gathered for this guideline, which covers 86 diseases. In addition, since apheresis therapy involves not only physicians but also clinical engineers, nurses, dieticians, and many other medical professionals, this guideline was prepared in the form of a worksheet so that it can be easily understood at the bedside. Moreover, to the clinical purposes, this guideline is designed to summarize apheresis therapy in Japan and to disseminate and further develop Japanese apheresis technology to the world. As diagnostic and therapeutic techniques are constantly advancing, the guidelines need to be revised every few years. In order to ensure the high quality of apheresis therapy in Japan, both the Japanese Society for Apheresis Registry and the guidelines will be inseparable.

全国国立大学附属病院輸血部会議では, 毎年各施設で発生した輸血副作用の集計を行ってきたが, 輸血関連急性肺障害 (Transfusion-related acute lung injury, TRALI) の統一した診断基準が, 2004年に開催されたTRALI Consensus Conferenceにおいて提唱されたため, 呼吸不全を認めた過去の輸血副作用症例の再解析を行った.平成10年度から平成15年度に44施設より報告された呼吸不全を認めた輸血副作用症例は34例であった. 提唱された診断基準で, 8例がTRALI (確診例), 3例がpossible TRALI (可能性例) と診断された. 抗白血球抗体を診断基準に適合する11症中7例 (63%) に認めたが, 抗HLA-classII抗体検査が実施された症例は3例のみであった. なお, 1例は輸血前に急性肺障害 (Acute lung injury, ALI) を認めたこと, 22例は肺野透過性の低下を認めなかったことにより, 診断基準に適合しなかった. 両肺野透過性低下を認めなかった22症例は, TRALIに近い病態が疑われる症例から, 蕁麻疹などの症状を認めアレルギー反応と思われる症例などが含まれた. TRALIによる4例の死亡例を認め, TRALIは, 調査期間内において, 輸血副作用による死亡の原因の第一位であった.

The objective of this survey was to study the present status of autologous blood transfusion practice from January 2001 to June 2001 in Akita Prefecture and to evaluate changes in status by comparison with our previous survey in 1994. Questionnaires were sent to 151 surgical divisions of 34 hospitals with more than 50 beds in Akita Prefecture. A total of 112 answers (74.2%) were collected and evaluated.Autologous blood transfusion programs were conducted in 61 divisions (54.5%) in total. This value was increased compared with the previous result. The percentage of performance of autologous blood transfusion was highest in orthopedics (93.8%), and increased remarkably in gynecology. Status of collection and storage management of predeposit autologous blood further improved. Main practical problems identified in this survey were insufficient workforce in the predeposit method, a shortage of knowledge about hemodilutional methods, anxiety concerning contamination such as bacteria or fat, and insufficient workforce in salvaging methods. In future for allogeneic blood transfusion cases, 34 divisions are planning to institute autologous blood transfusion programs, mainly with predeposit method only or both predeposit and hemodilutional methods.Many divisions pointed out that in the promotion of autologous blood transfusion, it is necessary to arrange equipment and workforce, to enlighten doctors and to relieve limitations on medical insurance concerning autologous blood transfusion.

Purpose: There is evidence that blood transfusion is associated with an increased rate of tumor recurrence. This study was conducted to assess the survival advantage of giving autologous blood instead of allogeneic blood during surgery for esophageal cancer. Methods: We retrospectively analyzed 62 patients who underwent esophagectomy for thoracic esophageal cancer between January 1991 and February 1995 and received allogeneic blood transfusion, and 61 patients operated on between March 1995 and February 1998, who received autologous blood transfusion. The clinicopathological factors and survival rates were compared between the two groups. Results: The clinicopathological factors that influenced prognosis were similar in the two groups; however, a definite survival advantage was evident in the autologous blood transfusion group. According to multivariate analyses, the transfusion of allogeneic blood was an independent prognostic factor (P = 0.0222), as was the presence of metastatic lymph nodes. Patients who received allogeneic blood transfusions perioperatively had more than a twofold greater risk (Hazard ration 2.406) of death over patients who received autologous blood transfusions. Conclusion: Autologous blood transfusion appears to be an independent prognostic factor for the survival of patients with esophageal cancer.

Guidelines for blood transfusion require that a transfusion committee should be established in each hospital to ensure proper blood transfusion. In 1998, Akita Prefecture, Akita Red Cross Blood Center and several major hospitals organized a joint meeting of transfusion committees of Akita Prefecture. This paper introduces the Joint Meeting of Transfusion Committees, and discusses its influence on proper blood usage. The Joint Meeting of Transfusion Committee has been held once a year since 1998 and consists of a special lecture, questionnaire analysis reports, and discussion of specific topics. Among results of a survey conducted in 2001, transfusion committees were established in 30 hospitals and blood transfusion service was established in 8 of a total of 46 hospitals. During a 6-month period (January 2001 to June 2001), red cells were transfused to 3, 046 patients, plasma was transfused to 739 patients and platelets were transfused to 518 patients in 46 hospitals, representing almost the classified total usage of blood in Akita Prefecture. The status of autologous blood transfusion in Akita Prefecture was also by the survey. However, differences in the status of predeposit autologous blood transfusion were significant among hospitals. The Joint Meeting of Transfusion Committees in Akita Prefecture provides a good opportunity for the exchange of information and education for hospitals. The Joint Meeting is also useful in promoting the establishment of blood transfusion services and activating transfusion committees in hospitals.

In the field of plasmapheresis centrifugal technology has recently focused on the collection of peripheral blood stem cells (PBSCs) for both autologous and allogeneic transplantation in patients with malignancies or hematological diseases and on donor plasmapheresis. PBSC transplantation is rapidly replacing bone marrow transplantation in such patients. Various kinds of apheresis equipment were applied and described for PBSC collection. Comparison among machines is described. Allogeneic PBSCs were collected from healthy normal donors. Specific attention to the dose and administration duration of granulocyte colony-stimulating factor and a careful apheresis procedure should be made for donor safety. In platelet transfusion practice, a platelet concentrate product derived plateletpheresis from a single donor is preferable to minimize and to prevent adverse transfusion reactions. The status of platelet collection and its efficacy by various kinds of plateletpheresis equipment are discussed. The Amicus and CCS might be preferable plateletpheresis machines because of their collection efficiencies and wider indication for donors. With the limited number of donors, it is essential that plateletpheresis should be more effectively performed and managed by each regional blood center. The status of plasma and red cell collection by apheresis technologies is described also briefly.

In 1999, the Japan Society of Blood Transfusion organized a small committee on autologous blood transfusion. The committee was assigned to evaluate the status of predeposit autologous blood transfusion in hospitals approved by the Japan Society of Blood Transfusion and to clarify problems concerning the promotion of autologous blood transfusion. Questionnaires were sent to 86 hospitals. Information on each hospital (number of beds, number of doctors and medical technologists approved by the Society, etc), establishment of blood transfusion service, preservation methods, and management and compatibility testing of autologous blood were evaluated. In addition, number of cases and units of autologous blood transfusion from. Jan 1999 to Dec 1999 and status of homologous blood transfusion during operation were analyzed. Predeposit autologous blood transfusion was performed in all 68 hospitals which answered the questionnaire. Blood transfusion service was established in 64 hospitals. However, the place of autologous blood collection and the personnel involved in blood collection were not centralized. Percentage of autologous blood without allogeneic blood cases in cases of blood transfusion during operation was 17% in total. Percentages among hospitals ranged from 3.6% to 76.9%. Percentage of autologous blood units in units of blood used during operation was 12% in total, and ranging from 0.5% to 77.6%. Differences in the status of predeposit autologous blood transfusion were significant among hospitals. Doctors approved by the Japan Society of Blood Transfusion should assume an important role in the promotion of autologous blood transfusion in hospitals.

Platelet concentrate product derived from plateletpheresis from a single donor is preferable in terms of reducing the risks of adverse reactions in platelet transfusion. This study evaluated the status of platelet transfusion and the efficacy and safety of plateletpheresis machines. The average number of donors of platelet product per patient has been decreasing and recently reached nearly 1.0; however, some patients still receive multiple random donor platelet products. Platelet collection efficacy was comparable between the Haemonetics Component Collection System (CCS) and the Multi Component System (Multi). However, the CCS has been shown to be effective in terms of processed blood volume and procedure time, especially in donors with lower hematocrits. These results suggest that the CCS may be preferable and safer for donors with lower hematocrits and lighter body weights. Blood centers should collect platelets more effectively to achieve platelet transfusion with the use of platelets derived from a single donor using effective equipment.

Informed consent in autologous and homologous transfusion medicine was investigated by questionnaires sent to 77 blood transfusion departments of the university hospitals. On homologous transfusion, although 80% of physicians talked with patients about the risks of transfusion, 70% did not ask patients to sign a consent form before receiving blood. Further, most physicians spent no more than 10 minutes explaining to patients the risks and benefits of allogenic blood. With regard to autologous transfusion, more than 80% of physicians mentioned the risks and the benefits of this procedure, and also the procedures for preoperative donation. However, only 41% of physicians required written consent.In conclusion, the physician has the moral duty to inform the patient of the risks and benefits of blood transfusion. Institutions should consider written informed consent separate from surgical consent. This would result in increasing the patient's knowledge and autonomy in transfusion medicine. Further, the ethical and educational elements of informed consent for blood transfusion should be a part the curriculum of residential training or undergraduate study.

The objective of this survey was to study the present status of autologous blood transfusion practice from April 1994 to March 1995 in Akita Prefecture and to evaluate changes in status by comparison with our previous survey in 1993. A questionnaire was sent to 150 surgical divisions of 37 hospitals with more than 50 beds in Akita Prefecture.A total of 132 answers (88%) were collected and evaluated. Autologous blood transfusion programs were conducted in 49 divisions (37.1%) in total, this value being increased compared with the previous result. In addition to enforcement in cardiovascular surgery and orthopedic surgery divisions, autologous blood transfusion was also widely applied in another surgical divisions such as general and neurological surgery and gynecology. No homologous blood was transfused in 84% of total cases. In general, in orthopedic and neurological surgery, and in gynecology divisions, homologous blood was used in less than 10% of cases, with predeposit autologous blood. Ninety-six divisions (73%) answered that they have instituted or are planning to institute an autologous blood transfusion program. However, 44% of general surgery divisions and 58% of neurological surgery division have no plans to introduce autologous blood transfusion due to the specific status of patients. As in the previous survey, several practical problems such as a shortage of manpower or time to participate and the necessity of cooperation with the Japan Red Cross Blood Center were also noted.

The objective of this study is to evaluate the influence of shortened preservation period of concentrated red cells stored in MAP additive solution (RC-MAP), whose preservation period is currently 42 days, on the effective utilization of RC-MAP.Mean duration until the use of blood after blood collection from donors was 10.1 and 8.0 days in 1 unit and 2 unit product of RC-MAP, respectively. Most of all units were used within 21 days after blood collection (93.7% for 1 unit product and 97.8% for 2 unit product of RC-MAP). Most of blood units, which were used at our hospital over 21 days of collection, had already passed 15 days at the time of delivery by the blood center. Forty-six percents of such blood were Rh negative blood and/or were delivered from other prefectures. However, particular reason why they were delivered after 15 days of blood collection was not found in 54% of them. If the preservation period of RC-MAP will be decided to be 21 days or 28 days, the units of discarded blood, which is currently 0 unit at our hospital, is estimated to be 195 units (3.7%) or 67 units (1.3%), respectively. In addition, if the blood over 15 days of blood collection is not supplied from the blood center, the units of discarded blood can be decreased to 128 units (2.5%) for a 21 days preservation period and 27 units (0.5%) for a 28 days preservation period.Our data indicate that the blood centers should supply RC-MAP to all hospitals within 14 days after blood collection in order to achieve the effective utilization of RC-MAP if the preservation period is shortened.

This study evaluated the status of the use of platelet concentrate supplied from the Japan Red Cross blood center from April, 1989 to December, 1993. The units of platelet concentrate supplied were significantly increased in recent 2 years. The percentage of platelet concentrate products procured by apheresis was more supplied in 1993. The percentage of the patients who received only 1 or 2 unit product of platelet concentrate was approximately 40% until February, 1993, however, the number of patients receiving only more than 5 unit product of platelet concentrate was being increased since May, 1993. In addition, the number of donors transfused to the patient was significantly decreased to 2.13-3.71 donor number/patient in recent several months. Fifty four percent of the patients and 84% of the units transfused were for those with hematological diseases for which frequent platelet transfusion was performed. In hematological disease patients, an average platelet count was 20000-30000/μl before platelet transfusion. The levels of platelet counts were significantly lower in the patients with aplastic anemia and MDS compared with acute leukemia patients.

The objective of this survey was to study the present status of autologous blood transfusion practice from April 1992 to March 1993 in the hospitals including small clinics without blood transfusion service in Akita prefecture. A questionnaire was sent to 146 surgical divisions of 37 hospitals with more than 50 beds in Akita prefecture.A total of 129 answers (88.4%) were collected and evaluated. Autologous blood transfusion program was performed in 42 divisions (32.6%) in total. Predeposit autologous blood transfusion was widely applied. Enforcement percentage of autologous blood transfusion was higher in cardiovascular surgery and orthopedic surgery divisions compared with other surgical divisions. No homologous blood was transfused in 76% of total cases and 46% and 82% cases in cardiovascular surgery and orthopedic surgery, respectively. Ninety four divisions (73%) answered that they are performing or planning one of various autologous blood transfusion programs in future. However, 29% of general surgery divisions have no plans to perform autologous blood transfusion. Several practical problems such as a shortage of man power or time to participate, short preservation duration of predeposit blood and unavailability of erythropoietin for the program were pointed out to perform predeposit autologous transfusion program. Cooperation by the Japan Red Cross blood center was strongly requested in autologous transfusion practice. Since the MAP autologous blood needs to be separated by centrifugation, separation and freezing of autologous blood products were specially requested to be performed by the blood center.

This study evaluated the usage of concentrated red cells stored in MAP solution (RC-MAP), whose stored period is extended to 42 days, in comparison with ordinary concentrated red cells (CRC). Units of discarded blood, numbers of cross-match in each lot and the duration until the use of blood after blood collection from donors were studied both in RC-MAP and CRC.Only three units (0.1%) were discarded due to the expiration of stored period in 2386 units of RC-MAP, while 81 units (5.2%) were discarded in CRC. Although mean numbers of cross-match were comparable between RC-MAP and CRC, the numbers of lot that were cross-matched more than 4 times were significantly greater for RC-MAP than CRC. In addition, the duration until the use of blood were significantly longer for RC-MAP than CRC. These results suggest that RC-MAP is more effective in the usage of red cell concentrates than CRC. Meanwhile more than 93% of RC-MAP were used within 21 days after blood collection, especially 98% of RC-MAP were used in blood type A within that period. This indicates that most of RC-MAP can be used at the time as high quality red cells. RC-MAP were also alternatively used with washed red cells or leucocyte poor red cells in case, because of its excellent removal of plasma, granulocytes and lymphocytes compared with CRC.

This study summarized the cases of autologous blood transfusion in the Akita University Hospital since 1989 and evaluated the effects of autologous blood transfusion on the usage of homologous blood for surgical procedures.A total of 279 cases were entered in the autologous blood donation programs since 1989. No homologous blood was transfused for 232 cases (83%) in total and 49 cases (68%) and 148 cases (87%) in cardiovascular surgery and orthopedic surgery, respectively. Since MAP solution has been introduced in autologous blood donation programs, leap frog or switch back method will not be applied to collect autologous blood for a long period. The MAP autologous blood donation can make the program easier. In some of the surgical procedures with predeposit autologous blood, the average units of homologous blood prepared were decreased compared with the cases without autologous blood. However, C/T ratio of homologous blood was increased in the some cases with autologous blood. In such cases, the units of MSBOS should be allocated depending on the units of autologous blood prepared.Autologous blood donation programs and the MSBOS system should be closely linked to evaluate, thus, effective blood usage can be achieved.

In patients with colorectal cancer which invades the urinary bladder, urinary diversion such as ileal conduit or ureterocutaneostomy has been employed after total resection of the urinary bladder. Recently we successfully performed an ileocecal cystoplasty after total resection of the urinary bladder with subtotal cystectomy to conserve the neck of the urinary bladder in a patient with colonic cancer invading the upper portion of the bladder, for which physiological urination through the urethra could be kept. During two years after the operation, the patient suffered from no pyelonephritis. Urinalysis revealed slight pyouria, but no bacteriurea was demonstrated. Drop infusion pyelography revealed no hydronephrosis nor hychoroureter. Retrogarade vesicography showed no reflux to the ileum beyond the ileocecal valve. The ileocecal valve has been effective against the urinary reflux. Ileocecal cystoplasty is an easy and safe operative procedure with less post operative complications; enables the patient to urinate through the urethra; and offers better quality of life than that by urinary diversion. Ileocecal cystoplasty may be recommended in patients with colorectal cancer which invades the upper portion of urinary bladder.

This study evaluated the usage and discard of all the blood products (124533 units) supplied from the Japan Red Cross blood center from April in 1989 to Marchin 1993.The units of fresh whole blood and stored whole blood purchased and used significantly decreased during 4 years. The units of fresh whole blood purchased was 22% in 1992 compared with those in 1989. The purchase and use of platelet concentrate significantly increased, especially in recent 2 years.The percentage of discarded blood was extremely lowered to 0.78% in 1992. Discards of whole blood and red cell concentrate due to inadequate management at the ward were especially decreased. The units of red cell concentrate discarded due to the expiration of stored period were also decreased because of the introduction of concentrated red cells stored in MAP solution (RC-MAP) in April 1992.Frequent communication between our division and the doctors in charge was necessary to reduce the discard of platelet concentrate which were over ordered for patients. In addition, the blood management system should be clearly understood among the doctors to reduce the discards of whole blood and red cell concentrate.

肝血流障害時に, prostaglandin (PG) E1が肝血行動態におよぼす影響について実験的に検討した.雑種成犬21頭を開腹し, まず門脈, 肝動脈血流量を超音波トランジェットタイム血流計で, 肝組織血流量を電解式組織血流計で測定し, これらを対照値とした.次に, ローラーポンプを用いて肝動脈血流量, 門脈血流量を0%, 50%に調節する肝流入調節群を作成し, その際の門脈血流量, 肝動脈血流量, 肝組織血流量を測定した.その結果, 門脈血流量を0%にすると肝動脈血流量は161%に著増するのに対し, 肝動脈血流量を0%にしても門脈血流量は変化しなかった.また, 門脈, 肝動脈血流量を0%にした時の肝組織血流量は各78%, 70%に減少した.一方, PGE1を0.2μg/kg/min末梢静脈から持続注入すると, 門脈, 肝動脈, 肝組織血流量はおのおの増加し, 門脈, 肝動脈血流量を0%にした時の肝組織血流量は各88%, 82%と良好であった.したがってPGEI投与は手術にともなう肝血流障害を改善しうる.

Percutaneous transhepatic biliary drainage is widely used to relieve bile duct obstruction which can be caused by bile duct or pancreas carcinomas. Although the incidence is low, insemination of carcinoma along the transhepatic catheter tract is considered to be a serious complication of percutaneous transhepatic biliary drainage. The authors present a case of intrahepatic insemination of bile duct carcinoma along the catheter that subsequently underwent a curative resection consisting of pancreaticoduodenectomy and right hepatic lobectomy. It is suggested that a percutaneous biliary endoprosthesis through the tumor should be avoided in patients in whom a possible curative resection can be considered. External biliary drainage should only be performed in order to minimize the manipulation of the tumor in such patients.

To reduce the operative insult of hepatectomy, right transdiaphragmatic approach was adopted in 2 cases of hepatocellular carcinoma with liver cirrhosis and 1 case of metachronous hepatic metastasis from carcinoma of the papilla of Vater. Operations were carried out uneventfully and postoperative course was satisfactory. Analyses of liver function tests and arterial ketone body ratio affirmed the minimal operative insult of this approach. It is assessed that this approach is useful for the resection small hepatic tumor near by the diaphragma in patients with poor hepatic functional reserve.

Three patients with hepatic failure after segmentectomy for hepatocellular carcinoma associated with liver cirrhosis were treated with plasma exchange, and one could survive but the remaining 2 died. Histologic analysis of the 2 death cases resulted in that deteriorated liver cell necrosis was seen in both non-cancerous liver tissues obtained during surgery and liver tissues at necropsy. No preoperative live function tests could predict the degree of these liver impairments developed during and after surgery. Plasma exchange should be introduced in such patients in coma grade II, however sepsis and DIC may easily compromise the efficacy. To prevent such infections, an intravascular indwelling catheter used as a blood access should be payed more attention and be exchanged in time.

手術侵襲の腹腔内臓器への影響をみるため, 開腹術を施行した胃癌, 胆道疾患, その他の疾患30例について, レーザードップラー血流計による術中の肝, 胃, 小腸組織血流量の変化を検索し, 術後肝機能異常との関係についても検討した. その結果, 肝組織血流量 (左葉) は, 胃亜全摘群 (n=6), 胃全摘群 (n=5), 胆道良性群 (n=9), 胆道悪性群 (n=5), その他の群 (n=5) で, それぞれ, 手術中に79.0%, 69.0%, 114.3%, 56.7%, 97.8%となり, 胃全摘群, 胆道悪性群で減少が著しかった.一方, 小腸組織血流量は, 各群でそれぞれ, 97.8%, 125.1%, 94.1%, 101.7%, 109.5%と維持されており, 門脈血流量が維持され, 肝動脈血流量が減少する間接的な所見と考えられた. トランスアミナーゼ値の変化では, 胆道悪性群, 一部の胆道良性群に高値を示し, 肝への圧迫操作が肝機能に悪影響を与えると考えられた.

門脈本幹の遮断による肝内血行動態の変化を明らかにするために,脾皮下固着ラットを用いて,門脈遮断後,経時的に門脈終末枝圧と中心静脈圧との変化をmicropuncture法によって測定し,肝組織血流量および求肝性副血行路の形成状態との関連癒検討した.門脈結紮により,門脈終末枝圧,門脈終末枝-中心静脈圧較差,肝組織血流量は低下したが,門脈終末枝圧,圧較差は結紮後4週で,肝組織血流量は同じく3日で対照値に復した.門脈造影では,門脈結紮1週後より求肝性副血行路の形成を認め,4週後で著明となり肝内門脈枝も明瞭に造影された.門脈終末枝圧,門脈終末枝-中心静脈圧較差の回復は求肝性副血行路形成の経過とよく相関したことから,結紮後早期に代償性の肝動脈血流量増加があり,4週では求肝性副血行路形成によって門脈血流量が回復するものと推測された.

ThioacetamideをWistar系雄性ラットに最長32週間経口投与し,肝硬変形成過程の肝実質細胞および胆管上皮細胞の細胞動態をBromodeoxyuridineによるLabelling IndexとFlow CytometryによるDNAヒストグラムを用いて検討した.肝実質細胞はThioacetamide投与後8週までに4c細胞優位から2c細胞優位に変化し,肝硬変の再生結節は2c細胞で構成されていた.肝実質細胞のLabelling Indexはこの2c細胞増殖期と硬変化の初期に上昇するが,肝硬変の像が確立された再生結節ではむしろ低下し,これは前癌病変としての性格をもたないと考えられた.一方,胆管上皮細胞のLabelling IndexはThioacetamide投与直後から上昇し肝硬変形成過程でも高値を持続し,胆管類似組織の起源になることが示唆され,さらにこれら胆管類似組織の増生しているcholangio-fibrosisのLabelling Indexは著しく高く,前癌病変としての特性をもつものと考えられた.

To examine the safety of using a high-flow three-way stopcock in a blood circuit during extracorporeal blood purification therapy, we studied the risk of development of hemolysis and clot formation in both ex vivo and in vivo extracorporeal circulation. In the ex vivo study, no significant difference was observed in the decrease in hematocrit (HCT) or increase in the potassium level between the three-way stopcock group and the control group. Nor was there a significant difference in the change in inlet pressure between the two groups. Thus, it was shown that the risk of hemolysis caused by the use of a high-flow three-way stopcock on both the outlet side and inlet side would be small. In the in vivo cases, there was no significant difference in the decrease in HCT or the increase in inlet pressure between the three-way stopcock group and control group, suggesting that it is clinically possible to incorporate a high-flow three-way stopcock into a blood circuit.

There is evidence that blood transfusion is associated with an increased rate of tumor recurrence. This study was conducted to assess the survival advantage of giving autologous blood instead of allogeneic blood during surgery for esophageal cancer.We retrospectively analyzed 62 patients who underwent esophagectomy for thoracic esophageal cancer between January 1991 and February 1995 and received allogeneic blood transfusion, and 61 patients operated on between March 1995 and February 1998, who received autologous blood transfusion. The clinicopathological factors and survival rates were compared between the two groups.The clinicopathological factors that influenced prognosis were similar in the two groups; however, a definite survival advantage was evident in the autologous blood transfusion group. According to multivariate analyses, the transfusion of allogeneic blood was an independent prognostic factor ( P = 0.0222), as was the presence of metastatic lymph nodes. Patients who received allogeneic blood transfusions perioperatively had more than a twofold greater risk (Hazard ration 2.406) of death over patients who received autologous blood transfusions.Autologous blood transfusion appears to be an independent prognostic factor for the survival of patients with esophageal cancer.

Platelet product derived from single donor plateletpheresis is required to reduce the risks of adverse reactions by blood transfusion. The objectives of this study are to evaluate the status of platelet collection and its efficacy by various kinds of plateletpheresis equipment and to assess the achievement of platelet transfusion by platelet product derived from a single donor. Since the blood centers have introduced some kinds of efficient plateletpheresis equipment, large units of platelet products have been supplied mainly for the patients. Amicus and CCS might be preferable plateletpheresis machines because of their collection efficiencies and wider indication for donors. The average number of donors of platelet product per patient has recently reached nearly 1.0, and around 90% of patients have received platelet product derived from a single donor in the recent several years. However, platelet transfusion derived from a single donor has not yet been completely achieved. Each regional blood center should seriously consider the efficacy of each plateletpheresis equipment and arrange the equipment to collect platelets more effectively to achieve platelet transfusion from a single donor.

Blood is usually irradiated by x-ray to prevent graft-versus-host-disease. However, plasma potassium levels of irradiated blood are rapidly increased during preservation in irradiated blood. The objectives of this study were to develop a rapid blood transfusion system for which irradiated blood can be used and to evaluate the capability of blood purification of the system. Packed red blood cells (RBC) were irradiated (15 Gy x-ray) at 21 days and preserved until 42 days after collection. A blood mixture of RBC and plasma was perfused through a dialyzer at 25, 50, 100, and 200 ml/min. Dialysate was perfused at 100, 100, 500, and 500 ml/min, respectively. Preperfusion levels of sodium, 121; potassium, 35; and chlorine, 76 mEq/L were changed to sodium, 144 to 146; potassium 2.5 to 3.0; and chlorine, 105 to 110 mEq/L, which were comparable with the levels in dialysate after perfusion for 25, 50, and 100 ml/min perfusion groups. For the 200 ml/min perfusion group, potassium was 5.3 mEq/L after perfusion which was slightly higher than other groups, but 84% of the potassium was removed by the system. Citrate levels were significantly decreased to 3.4, 28, 31, and 81 mg/dl for the 25, 50, 100, and 200 ml/min groups, respectively, after perfusions. The rapid transfusion system composed of the dialyzer and the blood pumps was effective in the removal of potassium and in the normalization of electrolytes. Irradiated blood with high levels of potassium can be safely and effectively used for this system in cases requiring massive rapid blood transfusion.

The objective of this study was to develop an easy and simple experimental rat model of total hepatectomy, hepatic ischemia and extrahepatic portal obstruction. The first operation involved transposing the spleen with its scarified capsule in a subcutaneous pouch to produce portasystemic anastomosis. Total hepatectomy was easily performed in a lobe-by-lobe fashion 2 weeks following the first stage operation. Anhepatic rats receiving a glucose infusion survived for about 10 hours and all died of acute hepatic failure. Hepatic support systems can be accurately evaluated in this anhepatic rat model because of its uniformity. Sixty minutes of hepatic ischemia was able to be performed in rats with a transposed spleen for a portasystemic shunt and no complicated or technically involved procedure was required for the ischemic model. No rats died due to technical difficulties, suggesting the reliability and reproducibility of this ischemic model. An animal model resembling extrahepatic portal vein obstruction was also obtained by ligation of the portal vein; a simple maneuver which was able to produce collateral veins to the liver and cavernous transformation, as similarly seen in clinical patients with extrahepatic portal obstruction. Because these 3 animal models were so easily achieved in the rat, and since the changes in hepatic function and formation of the collaterals to the liver after portal vein occlusion are still poorly understood, this model should prove valuable for future study.

An animal model resembling clinical cases with extrahepatic portal vein obstruction was developed. The changes in hepatic mitochondrial function and the hepatic hemodynamics including hepatic regional blood flow, portal venous pressure, and portogram were evaluated to assess the effect of portal vein obstruction in the model. Portal vein ligation in this model was a simple and easy maneuver and could produce collateral veins to the liver--cavernomatous transformation--which were obviously seen in clinical patients with extrahepatic portal obstruction. Hepatic blood flow was significantly decreased until 5 days after portal vein ligation; however, hepatic blood flow was gradually increased and reached the normal value at 3 weeks after portal vein ligation due to the formation of the collateral veins to the liver. Respiratory parameters of mitochondria were gradually decreased and reached the lowest levels at 5 days after portal vein ligation, while they recovered to normal values in accordance with increasing hepatic blood flow at 3 weeks after portal vein ligation. In extrahepatic portal obstruction, although the liver is temporarily deteriorated by portal vein obstruction such as portal vein thrombosis, hepatic blood flow and the liver functions are to be normally improved with the formation of collateral veins to the liver.

Thioacetamideをラットに4ヵ月(短期)間および8ヵ月(長期)間投与して肝硬変を作成した.その肝組織から分画したミトコンドリアと,あらかじめ肝細胞を分離洗浄した後,それより分画したミトコンドリアの呼吸能を比較した.その結果,肝組織から分画したミトコンドリア呼吸能は硬変肝で有意に低下し,かつ長期投与群の低下が著明であった.それに対し,分離肝細胞から分画したミトコンドリア呼吸能では正常肝と硬変肝との間に大差はなく,かthioacetamideの投与期間による差も認められなかった.一方,ミトコンドリア画分の電顕像では硬変肝において形状の不均一がみられ,かつ対照肝のミトコンドリアより小さい傾向がみられた.これらの成績から,肝組織より分画したミトコンドリアの機能低下は,肝細胞の存在する環境-線維化,血流不全,呼吸阻害因子の混在など-に由来することが多く,ミトコンドリア自体の障害は少ないものと推定された.

OMOKAWA, S, KOYAMA, K., SUZUKI, K. and ASANUMA, Y. Mitochondrial Function of Isolated Rat Hepatocytes from Normal and Cirrhotic Liver. Toho ku J. Exp. Med., 1989, 158 (4) 265-268-Mitochondrial fractions were obtained from purely isolated hepatocytes of the normal and cirrhotic livers. Mitochondrial function of isolated hepatocytes was evaluated to compare between those from the normal and those from the cirrhotic livers in addition to the evaluation of the mitochondrial function of the normal and cirrhotic liver tissues. Rispiratory control, ADP/O ratio and ATP synthesis were significantly lower in the cirrhoti cliver tissue than those in the normal liver tissue. However, the mitochondrial function of isolated hepatocytes showed no difference between norma l and cirrhotic groups. By electron microscopic examination, debris was more observed in the mitochondrial fractions from the normal and cirrhotic tissues compared to those from hepatocytes. However, no difference of the shape and size of the mitochondria was seen between the fraction from hepatocytes and that from the tissue in each group. These results suggest that, as far as hepatocyte itself is concerned, thecirrhotic liver preserves the sufficient function as well as the normal liver.

MATSUSHIRO, T, CHO, H., NAGASHIMA, H., OMOKAWA, S, YAMAMOTO, K., HARIU, T. and TATEYAMA, T. Factors Affecting the Cholesterol Dissolution Ability of Human Bile. Tohoku J. exp. Med., 1981, 135 (1), 51-61 - Bile samples were obtained from 13 patients with cholesterol gallstones at laparotomy. Control bile samples were obtained from 15 patients with gastric cancer or gastric ulcer. One mixed stone was cut in half and serial thin sections, 10μm in thickness, were prepared from the cut surface. The solubility of cholesterol in these gallstone sections after immersion in the bile samples was observed microscopically after 1, 3, 5 and 24hr. Of 15 control bile samples, 9 showed a marked cholesterol dissolution after 1hr, and 6 showed it after 3 and 5hr. Three out of 13 bile samples from the patients with cholesterol stones dissolved the gallstone section after 1hr, and 7 after 3 and 5hr. The dissolution was not observed in the remaining 3 bile samples. Cholesterol and total bile acid concentrations of the control bile were significantly higher than those of the bile from the cholesterol gallstone patients (p

During the last 6 years, 19 infants with sepsis have been treated with exchange blood transfusions 47 times, and 13 patients survived. However, this procedure is compromised by antibody formation against WBCs and platelets. Accordingly, a miniature system for on-line plasma exchange (PE) between septic infant and healthy parent has been developed and evaluated using a canine model. Escherichia coli, at a dose of 5 X 10(9) CFU/ml/kg, was injected intravenously into 17 puppies that were divided into 3 groups; untreated; sham treated; and PE in which 80 ml/kg of plasma in each septic puppy was replaced during 2 hr with fresh plasma simultaneously obtained from healthy adult dogs. Four of 5 puppies survived in the PE group, while all other puppies died within 24 hr. In the PE group, viable cell counts of E. coli and endotoxin decreased significantly, and opsonic activity improved. This system is effective and applicable for treatment of sepsis in infants.