A case of small cell carcinoma of the stomach

We report a rare case of small cell carcinoma of the stomach with metastasis to the liver and invasion of the pancreas, which was associated with acute peritonitis due to perforation of the stomach. CPT-11/CDDP chemotherapy achieved a partial response. A 60-year-old man suddenly developed abdominal pain and visited the emergency room. We diagnosed acute peritonitis due to perforation of the digestive tract because CT scan showed free air in the abdominal cavity. An emergency operation was performed with an omental patch for closing the perforated hole in the stomach. Excisional biopsy was performed to the small liver nodule. Histological findings showed that the liver nodule was metastasis from small cell carcinoma. There was no finding from the thoracic CT scan, but gastroscopy revealed a giant tumor, which was diagnosed as small cell carcinoma in histology. Therefore, we diagnosed small cell carcinoma of the stomach with liver metastasis and invasion of the pancreas. After operation, one course of FP chemotherapy was performed, but the liver metastasis increased in size. Then we changed to CPT-11/CDDP chemotherapy as second-line therapy, and achieved partial remission (PR) of both the liver metastasis and gastric tumor.     

Effect of three flavonoids isolated from Japanese Polygonum species on superoxide generation in human neutrophils

Three flavonoids, quercetin 3- O-glucoside-2'-gallate (QGG), quercetin 3- O-rhamnoside-2'-gallate (QRG) and kaempferol 3- O-glucoside-2'-gallate (KGG) were isolated from Japanese Polygonum species. The effect of these flavonoids on stimulus-induced superoxide generation in human neutrophils was assayed by measuring the reduction of cytochrome c. The tyrosyl or serine/threonine phosphorylation of neutrophil proteins and the translocation of p4(phox) and p67(phox) to the cell membrane were detected using specific monoclonal antibodies. The flavonoids used in this experiment significantly suppressed stimulus-induced superoxide generation in a concentration-dependent manner. FMLP-induced tyrosyl phosphorylation or PMA-induced serine/threonine phosphorylation and the translocation of the cytosolic proteins p47(phox) and p67(phox) to the cell membrane were suppressed in parallel to the suppression of the stimulus-induced superoxide generation.     

Beneficial effect of FR183998, a Na+/H+ exchanger inhibitor, on porcine pancreas allotransplantation retrieved from non-heart-beating donors

Activation of Na(+)/H(+) exchanger (NHE) may have an important role in the ischemia/reperfusion injury by producing intracellular calcium overload. Recent studies have shown a beneficial effect of an NHE inhibitor on the ischemia/reperfusion injury in the heart. In this study, we examined the effect of FR183998, a potent NHE inhibitor, in porcine pancreas allotransplantation from non-heart-beating Landrace pig donors (NHBDs). The four experimental groups included: untreated with no preservation (group 1; n = 3), treated with no preservation (group 2; n = 5), untreated with preservation (group 3; n = 6), and treated with preservation (group 4; n = 4). The preservation was made in ice-cold University of Wisconsin (UW) solution for 24 hours. The groups treated received 1 mg/kg FR183998 before donor cardiac arrest and 10 mg in the UW solution flush in situ. Serum blood glucose, insulin, and amylase were measured daily. An intravenous glucose tolerance test (IVGTT) was performed on the postoperative day (POD) 7 when pigs were sacrificed for histological examination. Graft survival rates on that day in groups 1,2,3, and 4 were 3 of 3; 5 of 5; 3 of 6; and 4 of 4, respectively. The mean K values of IVGTT in groups 3 and 4 were 0.78 +/- 0.10 and 1.27 +/- 0.16, respectively, which were significantly different (P < .05). Upon histological examination, pancreatic tissue in group 3 showed more severe edema and necrosis than other groups. FR183998 may be considered beneficial for ischemia/reperfusion injury to pancreatic grafts from NHBDs.     

Peritoneal shunt tube migration into the stomach--case report--

A 47-year-old man presented with repeated headache and feverishness 3.5 years after undergoing ventriculoperitoneal shunt surgery for normal pressure hydrocephalus secondary to subarachnoid hemorrhage. Abdominal computed tomography revealed that the peritoneal catheter was encased by fibrous tissue and the distal end of the catheter had migrated into the stomach. The diagnosis was spontaneous gastric perforation by the ventriculoperitoneal shunt. The fibrous tissue was expected to seal the very small gastric perforation, so the catheter was successfully extracted through a scalp incision without abdominal surgical intervention.     

Deep inferior epigastric perforator flap for foot reconstruction using an external pedicle

When it is necessary to apply free flaps for foot reconstruction, the choices are limited. Conventionally, split-thickness skin-grafted muscle flaps and fasciocutaneous flaps from the back or thigh have been two major options, but these methods take substantial time to wearing normal shoes. As an alternative, the authors use the deep inferior epigastric perforator (DIEP) flap with an external pedicle. After elevation and thinning of the flap, the vascular pedicle is anastomosed at a site distant from the skin defect of the foot. About 20 days after that, the pedicle is severed, and the skin island is trimmed and sutured. This method provides thin and wide coverage within a limited time, and donor-site morbidity is minimal both functionally and aesthetically.     

Anterior lumbar interbody fusion: changes in area of the dural tube, disc height, and prevalence of cauda equina adhesion in magnetic resonance images

OBJECTIVE: Many investigators have reported satisfactory outcome in anterior lumbar interbody fusion (ALIF) performed for lumbar disc herniation or "multiply operated back" (MOB), but without comparing preoperative and postoperative dural tube area and cauda equina adhesion in magnetic resonance imaging (MRI). We conducted this study to determine these data in ALIF performed for lumbar disc herniation and MOB. METHODS: Thirty-two patients who underwent ALIF, involving 38 discs, were studied. In MRI obtained before and after surgery (interval 9-48 months, mean 19.2 months), cross-sectional areas of the lumbar dural tube were measured from axial T2-weighted images using a computer-linked digitizer. At 30 disc levels operated on, the cauda was identified in images; cauda equina adhesions were classified according to Matsui et al (grade I-III). Clinical improvement was scored. RESULTS: Bony union was observed in radiographs of all patients. Preoperative and postoperative cross-sectional areas of the lumbar dural tube were 1.32 +/- 0.4 and 1.87 +/- 0.5 cm, respectively, and expansion ratio was 1.43 +/- 0.4. Recovery did not correlate with expansion ratio. Positive correlation was noted between expansion ratio and disc height ratio. At 30 disc levels where cauda equina was identified, 22 represented grade I and 8 represented grade II. At three of the latter, prior surgery had been performed via a posterior approach. CONCLUSIONS: No significant difference was noted in occurrence of grade II adhesions between primary ALIF and ALIF performed for MOB. Dural tube expansion was accomplished even without exposure of the tube, and cauda equina adhesion was uncommon in primary ALIF.     

Excessive portal flow causes graft failure in extremely small-for-size liver transplantation in pigs

AIM: To evaluate the effects of a portocaval shunt on the decrease of excessive portal flow for the prevention of sinusoidal microcirculatory injury in extremely small-for-size liver transplantation in pigs. METHODS: The right lateral lobe of pigs, i.e. the 25% of the liver, was transplanted orthotopically. The pigs were divided into two groups: graft without portocaval shunt (n = 11) and graft with portocaval shunt (n = 11). Survival rate, portal flow, hepatic arterial flow, and histological findings were investigated. RESULTS: In the group without portocaval shunt, all pigs except one died of liver dysfunction within 24 h after transplantation. In the group with portocaval shunt, eight pigs survived for more than 4 d. The portal flow volumes before and after transplantation in the group without portocaval shunt were 118.2±26.9 mL/min/100 g liver tissue and 270.5±72.9 mL/min/100 g liver tissue, respectively. On the other hand, in the group with portocaval shunt, those volumes were 124.2±27.8 mL/ min/100 g liver tissue and 42.7±32.3 mL/min/100 g liver tissue, respectively (P<0.01). As for histological findings in the group without portocaval shunt, destruction of the sinusoidal lining and bleeding in the peri-portal areas were observed after reperfusion, but these findings were not recognized in the group with portocaval shunt. CONCLUSION: These results suggest that excessive portal flow is attributed to post transplant liver dysfunction after extreme small-for-size liver transplantation caused by sinusoidal microcirculatory injury.     

Lignan derivatives and a norditerpene from the seeds of Vitex negundo

A new phenyldihydronaphthalene-type lignan, vitedoin A (1), a new phenylnaphthalene-type lignan alkaloid, vitedoamine A (2), and a new trinorlabdane-type diterpene, vitedoin B (3), were isolated from the seeds of Vitex negundo along with five known lignan derivatives (4-8). Their chemical structures were determined mainly on the basis of NMR and MS data. Compounds 1, 2, and 4-7 showed stronger antioxidative activity than alpha-tocopherol using the ferric thiocyanate method. Compounds 1, 2, and 4-7 showed higher radical-scavenging effect on the stable free radical, 1,1-diphenyl-2-picrylhydrazyl, than L-cysteine.