Scott D Niles | PubMed Health

PubMed2005

Hemicolectomy with concomitant heated intraperitoneal chemotherapy: a case study.

The use of heated intraperitoneal chemotherapy is an emerging new adjunct in the treatment of adenocarcinoma of the colon. However, documentation regarding perfusion circuitry and techniques associated with this therapy remain largely undescribed. After consultation with the surgical service team, a custom designed circuit was constructed for this procedure. Institutional approval and informed consent were obtained for surgical debulking and heated intraperitoneal chemotherapy for a 58-year old female. After surgical resection, a right hemicolectomy was performed and pathological specimens obtained. A modified custom circuit using a roller pump was first primed with 3 liters of Dianeal PD-2 and recirculated until temperature of 41 degrees C was obtained. The circuit was then connected to the patient for infusion of perfusate via Blake drains placed in the deep pelvis. Two additional drains were placed in the subdiaphragmatic space for return. Perfusate containing 30 mg of Mitomycin-C was circulated at 600-800 mL/min for 60 min at 41 degrees C. An additional 10 mg of Mitomycin-C was then administered through the circuit for an additional hour under similar conditions. Upon completion, a washout procedure was performed with 2 additional liters of Dianeal PD-2. The patient tolerated the procedure well and was discharged postoperative day 7. We describe the successful use of a perfusion-administered heated intraperitoneal chemotherapy regimen as an integral part of successful treatment of adenocarcinoma of the colon.

Adenocarcinoma↗

PubMed2004

Neonatal vulnerability to ischemia and reperfusion: Cardioplegic arrest causes greater myocardial apoptosis in neonatal lambs than in mature lambs.

OBJECTIVES: Apoptosis is a mechanism for deletion of injured or obsolete cells that is distinct from necrosis and mediated by mitochondrial release of cytochrome c caspase activation. Because myocardial apoptosis is a part of normal fetal and postnatal maturation, we hypothesize that neonatal myocardium is more vulnerable to undergo myocardial apoptosis than mature myocardium after cardioplegic arrest. METHODS: Newborn and mature lambs (n = 5 in each group) underwent cardiopulmonary bypass, antegrade crystalloid hyperkalemic cardioplegic arrest for 60 minutes, and a 6-hour recovery period. Myocardium was examined by using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-digoxigenin nick end labeling (TUNEL), Western blotting, in vitro kinase assays, and fluorometric assays of the activity of caspases 3, 8, and 9. Myocardium from nonoperated control subjects (n = 5 in each age group) was also obtained. RESULTS: More TUNEL-positive nuclei were present in the newborn postcardioplegic myocardium (P =.04). Caspase 3, 8, and 9 activities were 1.6-fold, 1.5-fold, and 1.4-fold greater in the newborn postcardioplegic myocardium (P =.04, P =.01, and P =.01, respectively). The Bax/Bcl-2 ratio was higher in the newborn postcardioplegic myocardium (P =.04). Apoptosis signal-regulating kinase 1 activity and cleaved caspase 3 levels were higher in the newborn postcardioplegic myocardium (P =.02 and P =.009). Mitochondrial release of cytochrome c was greater in the newborn postcardioplegic myocardium (P =.009). CONCLUSIONS: The increased Bax/Bcl-2 ratio in the newborn myocardium suggests a proapoptotic state that is manifested by greater TUNEL staining, cytochrome c release, and cleavage of caspase 3. Increased apoptosis signal-regulating kinase 1 activity suggests greater oxidative stress, immature mechanisms to ameliorate oxidative stress, or both in the neonatal myocardium. Mitochondrial release of cytochrome c suggests that apoptosis-related mitochondrial dysfunction might contribute to early postoperative myocardial dysfunction in the neonate.

Animals↗