We provide a research update regarding novel therapeutic strategies to prevent the development of kidney disease and summarize the latest proceedings in this field. Chronic progressive kidney disease carries severe consequences and has limited treatment options. The purpose of this review is two-fold. The first aim is to provide a concise overview of the strategies of gene therapy, including pyrrole-imidazole polyamides (PI polyamides). PI polyamides are a new type of small compound that inhibit gene expression by binding to the minor groove of DNA. A PI polyamide that targets rat transforming growth factor-β1 was designed as a gene-silencing agent for progressive kidney disease. In the future, control of gene expression by PI polyamides may ameliorate progressive kidney diseases that are not treatable with current medicine. Future therapeutic strategies aimed at alteration of the immune responses through manipulation of Fcγ receptor interactions by the use of PI polyamides could be explored in the model of lupus nephritis. Thus Fcγ receptor gene therapy provides an attractive strategy to develop an immunotherapy as a general treatment option. The second aim is to summarize the published data regarding the role of bone marrow stem cells in renal repair after acute and chronic kidney injury. Currently, much of our knowledge of renal protective effect of dedifferentiated fat (DFAT) cells is obtained through animal research. The results to date indicate that DFAT cells may provide a source for cell therapy for severe progressive kidney disease. Our goal is to understand the mechanism of renal protection by DFAT cells and to develop stratagems utilizing DFAT cells for the eventual treatment of patients with kidney disease. The importance of conservative regenerative medicine has recently been demonstrated. It has become apparent that angiotensin II receptor blockade (ARB) improves the proliferation and function of endothelial progenitor cells in hypertension, suggesting that ARB is useful to repair hypertensive renal injury. In this review, we will focus on the role of gene therapy and regenerative medicine as therapeutic modalities in kidney disease.
Purpose: Sivelestat sodium (Siv.) is a selective inhibitor of neutrophil elastase that can be used to treat acute lung damage at the onset. There have not yet been sufficient studies of the effectiveness of the intraoperative or postoperative preventive use of this drug. Therefore we investigated the effectiveness of the intraoperative use of this drug for acute lung injury during lung cancer surgery. Methods: The patients with lung cancer were randomly divided into 2 groups of 5. The groups were comprised of 5 male and female patients, ranging from 60 to 80 years of age, with an average age of 70 years. Nine patients underwent lobectomy and1 patient underwent pneumonectomy. We administered Siv. at 0.2 mg/kg/h for 24 hours to the Siv. group after anesthesia induction. Results: Two patients in the Siv. group exhibited postoperative complications (chylothorax and acute cardiac failure). There were no significant differences between the groups in regards to E-XDP, HMGB1, BNP and IL-1β. Although statistical significant difference was not observed for pulmonary oxygenation, the PaO2/FiO2 ratio was maintained. Conclusion: We cannot conclude that the use of Siv. was effective during intraoperative period of lung cancer surgery. However, there is the possibility that Siv. reduced the impairment of pulmonary function during the postoperative period. Thus, it is now necessary to further investigate the duration of use and dose for prophylactic treatment with Siv.
BACKGROUND: We introduced hand-assisted laparoscopic gastrectomy (HALG) for gastric disease in Jan. 2005. Herein, we present our operative procedure and the results, and then evaluate the feasibility of HALG. METHOD: From January 2005 to Jun 2009, we performed hand-assisted laparoscopic distal gastrectomy/pylorus preserving gastrectomy (HALDG/HALPPG) in 63 patients, hand-assisted laparoscopic total gastrectomy (HALTG) in 19 patients and handassisted laparoscopic proximal gastrectomy (HALPG) in 13 patients. In each procedure, GelportTM was attached to the 7 cm minilaparotomy of the xiphoid process and two 12-mm-trocars and two 5-mm-trocars were inserted into the same locations respectively. Reconstruction in HALDG/HALPPG implemented Billroth-I or Roux-en-Y, in HALTG implemented Roux-en-Y and in HALPG implemented Jejunal pouch interposition. In all cases, we performed the reconstruction through the minilaparotomy of the xiphoid. RESULTS: The average operating time was 209, 251 and 229 min for HALDG/HALPPG, HALTG, and HALPG, respectively. The average blood loss was 50 g, 134 g, 91 g and the average postoperative stay was 13 days, 17 days, 14 days, respectively. There were no perioperative complications and conversion to open surgery was not necessary in any of the cases. CONCLUSION: HALG is easily acceptable for surgeons who are accustomed to open surgery. We believe that HALG is feasible and one of the good options for surgery of gastric disease.
We report a case of epiphrenic esophageal diverticulum that was resected 4 years 9 months after it was first observed. A 47-year-old man exhibited an epiphrenic esophageal diverticulum of 2.5 cm in size during a health screening examination. He was followed but was asymptomatic. About 4 years later, the diverticulum size was enlarged to 5 cm during the health screening examination. Six months later, he presented with symptoms, including heart burn and esophageal reflux. Resection of the diverticulum was performed with Heller myotomy, Dor fundoplication and Hill fixation. The postoperative course was good. In case of esophageal diverticulum, which is symptomatic or becomes enlarged during follow-up, surgery should be performed. As part of the surgical procedure, it is important to prevent post-operative esophageal reflux.
A 50-year-old woman was referred to our hospital with nausea, vomiting, and right lower abdominal pain. Abdominal X-ray showed distension of the intestine with a niveau on admission, and it was diagnosed as ileus. She had a history of hospitalization for 7 months due to pulmonary tuberculosis. After admission, an ileus tube was inserted. Endoscopy of the colon and double contrast colonography showed a round ulcer with annular stricture at the hepatic flexure of the ascending colon. Tuberculin reaction test was positive. Laparotomy was performed under the diagnosis of ileus due to intestinal tuberculosis. The observation of Langerhans giant cells surrounding the ulcer in the cecum by histopathology suggested intestinal tuberculosis. In the case of ileus with a history of pulmonary tuberculosis, intestinal tuberculosis should be considered in the differential diagnosis.
We report our experiences with two infants with Kasabach-Merritt syndrome. The first case exhibited a hemangioma in his right shoulder. We treated him with corticosteroids, radiation therapy, and interferon alpha. After treatment with interferon alpha was initiated, the size of the hemangioma decreased and his platelet counts and other markers of coagulation returned to the normal range. However, since afebrile convulsion occurred after 8 weeks of interferon treatment, we decreased that treatment thereafter. The second case exhibited a hemangioma in his left arm, and we treated him with corticosteroid and radiation therapy. After the initiation of radiation therapy, the size of the hemangioma decreased and his platelet counts returned to the normal range. Neither patient has experienced recurrence. These cases support the notion that the proper treatment must be selected in a step-by-step manner, based on the status of each individual patient and on the balance between the efficacy and adverse effects of treatment.