Regenerative muscles are required for swallowing and mastication, and are important for functional recovery from diseases involving oral muscular defects. Therefore, we generated three-layer hybrid sheets, similar to oral mucosal structures containing submucosal muscles, using rabbit oral mucosa epithelial, mesenchymal, and myoblastic progenitor cells, and examined the structural proteins. Each cell type was obtained from rabbit oral mucosa using enzymatic digestion. Isolated mesenchymal and myoblastic cells were multi-differentiated into osteoblasts, adipocytes, and chondrocytes or myotubes. Isolated epithelial cells were cultured on collagen gels containing isolated mesenchymal cells for 2 weeks, and these epithelial–mesenchymal cell sheets were laminated onto myoblastic cell sheets. The engineered hybrid sheets were multi-stratified in the epithelial and myoblastic layers in a time-dependent manner, expressing intermediate cytoskeletal filament proteins of epithelium and muscle. Hybrid sheets also expressed extracellular matrix basement membrane proteins. Immature cell markers for epithelial and myoblastic cells were observed continuously in hybrid sheet cultures. We established engineered three-dimensional rabbit oral mucosa hybrid sheets containing each immature cell type in vitro.

The surgical anatomical bypass (ANA) procedures for juxtarenal aortic occlusion (JAO) have been recently developed. However, there are some critical conditions, in which we should be cautious concerning the indications of ANA. Between 1984 and 1993 in Kurume University Hospital, 17 patients with JAO were operated upon. The most common cheifcomplaint was claudication (70.6%). Acute deterioration due to ischemia was recognized in two patients (11.8%). ANA was performed in 15 patients (88.2%) and extra-anatomical bypass (EXT) in 2 with severe calcification of the aorta (11.8%). Hospital deaths occured in three patients with ANA (17.6%), whose background included two acute deterioration and one cerebral infarction with hemiplegia. As an early postoperative complication, acute renal failure occurred in one patient and subileus in two. In the presence of poor general condition, acute deterioration, or severe aortic calcification, the EXT-procedure is the choice of surgical treatment for JAO.

We present the outcome of surgical management for thoracoabdominal aneurysms in 27 patients during the past 22 years. Ischemia of visceral organs was successfully prevented by axillo-femoral temporary bypass using a 10mm PTFE graft with an 8mm branch for main visceral vessels and partial extracorporeal circulation perfusing visceral organs. No other significant problems were encountered. Paraplegia occurred in 5 patients (18.5%). Three of them had received reconstruction of the intercostal arteries. Patients treated by spinal fluid drainage developed no paraplegia. The Crawford inclusion and Piehler bypass techniques were useful in reconstructing the main visceral vessels. Two patients died of ruptured proximally anastomosed thoracic aorta after a thromboexclusion technique. Early death occurred in three patients and late death in one.

Between 1961 and 1994, 121 patients our hospital were treated by conservative and surgical therapy for acute (67 patients) and chronic (54 patients) type B aortic dissection. Among the acute type B aortic dissections, two patients died before operation and 4 patients underwent surgical treatment in the acute phase. The false channel was occluded due to thrombosis in 30 patients. 9 in 31 patients with patent false channels required surgical therapy in the chronic phase. 46 of 54 patients with chronic type B aortic dissection underwent surgical treatment and 9 other patients were not operated on because of the false channel was not enlarged, nearly thrombosed type and refusal to operate. The long-term survival rate appeared to be better in cases acute closing aortic dissection than in cases of aortic dissection with patent false channels. Among the 54 patients who required surgical treatment in the chronic phase, there were eight early deaths (13.3%). Among chronic phase surgical cases, the long term survival rate appeared to be similar to that in type B aortic dissections treated by conservative therapy. Therefore, we consider that type B aortic dissections with acutely thrombotic false channels should be treated by medical therapy, while type B aortic dissection with patent false channel should be treated surgical treatment in the subacute phase or early chronic phase.

Palliative radiotherapy, when properly administered, contributes to improving the quality of life of patients. Although the usefulness of radiotherapy has been increasingly recognized, the need for palliative radiotherapy from home healthcare institutions has not yet been met. Although there are patients undergoing home care who would benefit from radiotherapy to improve their quality of life, it is difficult to determine the indication in the home care setting, where diagnostic imaging tests are not readily available. In addition, patients undergoing treatment at home often have a lowered performance status, making frequent visits to the hospital difficult and limiting their means of transportation. Under these circumstances, we have been providing palliative radiotherapy in cooperation with home care clinics.