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Although further studies are warranted, VAC therapy may have a role in facilitating rehabilitation and improving the prognosis of SSI cases after major cardiovascular operations.

To the Editor: Intimal hyperplasia surrounding the suture line remains the leading cause of graft failure after coronary artery bypass graft surgery and peripheral vascular bypass surgery. Immunosuppressive drugs, such as tacrolimus, have been shown to inhibit the development of intimal hyperplasia (1,2). We have developed a novel drug-eluting suture coated with tacrolimus (DE-suture). The purpose of the present study performed on a porcine model was to determine the efficacy of the new suture coated with tacrolimus in preventing intimal hyperplasia.The surface of a 7-0 polyvinylidene difluoride (PVDF) suture was coated with tacrolimus using a bioabsorbable polymer for controlled release of the drug. The porcine models used for the suture experiments were randomized into the following 3 groups: the control group (n ϭ 6), in which noncoated sutures were used; the low-dose DE-suture group (n ϭ 6), in which low-dose (0.13 weight percent) tacrolimus-coated sutures were used; and the high-dose DE-suture group (n ϭ 6), in which high-dose (0.40 weight percent) tacrolimus-coated sutures were used.The femoral artery was dissected free from the anesthetized animals. After proximal and distal cross-clamping, half-transverse arteriotomy was performed in the femoral artery, followed by interrupted suturing. Four weeks after implantation, femoral arteries were harvested. The paraffin-embedded arterial specimens were stained with hematoxylin-eosin and immunostained using an alpha-smooth muscle actin antibody and a factor VIII antibody to evaluate the degree of intimal hyperplasia and reendothelialization at the anastomotic site. To characterize neointimal hyperplasia, the ratio of intimal thickness at the suture versus nonsuture sites was calculated.In regard to the arterial wall morphology, the nonsutured reference site on the arterial wall including the neointimal area showed no intimal hyperplasia. The control group showed significant neointimal hyperplasia at the suture site (the ratio of intimal thickness at the suture/nonsuture sites: 23.0 Ϯ 5.0), whereas the low-and high-dose DE-suture groups showed significant reduction of the neointimal thickness (to 11.0 Ϯ 4.3 and 8.3 Ϯ 3.3; p Ͻ 0.05) versus control (Figs. 1A to 1C and 1J). However, there was no difference in the intimal thickness ratio at the suture/nonsuture sites between the low-and high-dose DE-suture groups. The neointima at the suture site contained the smooth muscle cells (SMC) in all groups (Figs. 1D to 1F).Histological analyses demonstrated a significantly less pronounced medial inflammatory response and adventitial fibrosis in both the DE-suture groups as compared with that in the control group (p Ͻ 0.05). In all groups, the arterial lumen was lined by endothelial cells (EC) showing positive immunohistochemical staining for factor VIII, which is an important factor for vascular healing (Figs. 1G to 1I).Tacrolimus (FK506, Asellas Pharma Inc., Tokyo, Japan) was discovered in 1984 from the fermentation broth of a Japanese soil sample on Mt. Tsukuba that contain...

Hepatocellular carcinoma (HCC) is often treated most effectively by resection. Although improved surgical procedures and perioperative care have made hepatic resection safe, the prognosis of patients with HCC is still poor because of the high incidence of postoperative recurrence. The most common site of extrahepatic recurrence is the lung. However, because of its multiplicity and concurrent recurrence in the liver remnant, resection of pulmonary metastases form HCC is rarely beneficial. We report two cases of long-term survival after repeated pulmonary resection of metastasis from HCC. At the time of this report the two patients were free of disease, 110 months and 107 months, respectively, after their initial hepatectomy. These case reports show that pulmonary metastases from HCC can be successfully resected in selected patients.

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