Feeding catheter gastrostomy at esophagectomy with gastric tube reconstruction through posterior mediastinal route

We introduce our novel and original idea of placing a feeding catheter gastrostomy (FCG) at esophagectomy with gastric tube reconstruction through the posterior mediastinal route. The 9-Fr catheter was inserted into the jejunum through the gastric tube by the creation of submucosal and Witzel tunnels on the gastric antrum. Among the 45 patients who underwent FCG, the catheter was guided to the anterior abdominal wall through the sub-diaphragm route in 25 patients (group A) or the extra-peritoneal route with the overlapping of catheter entry by the omentum in 20 patients (group B). There were no cases of spontaneous catheter prolapse or bowel obstruction. Five out of 45 patients (11.1%), including 4 (16%) in group A and 1 (5%) in group B, showed mild and transient localized peritonitis after catheter removal. The extra-peritoneal route with omental cover is recommended for safe indwelling catheterization. FCG is useful for avoiding jejunostomy-related bowel obstruction.     

Antitumor and anti-metastatic effects of cyclooxygenase-2 inhibition by celecoxib on human colorectal carcinoma xenografts in nude mouse rectum

We examined the effects of the preferential cyclooxygenase-2 (COX-2) inhibitor celecoxib on tumorigenesis, angiogenesis, apoptosis, vascular endothelial growth factor (VEGF) protein expression and metastasis in HT-29 human colorectal carcinoma cell xenografts in nude mouse rectum. COX-2 mRNA expression was examined in the xenograft and metastatic sites. The antitumor effect of celecoxib in the xenografts was evaluated by measuring the weight of the peri-ano-rectal tumor. The anti-metastatic effect of celecoxib was assessed by quantification of lymph node and lung metastases by amplification of a cancer-related human DNA by TaqMan PCR. The effects of celecoxib on angiogenesis, apoptosis, prostaglandin E2 (PGE2) production and VEGF protein expression in the xenografts were evaluated by means of microvessel density (MVD) counting, terminal deoxynucleotidyl transferase-mediated nick end labeling assay, quantitative enzyme-linked immunosorbent assay and western blotting, respectively. The rectal xenograft model showed lymph node and lung metastases with enhanced expression of COX-2 mRNA in each organ. Celecoxib inhibited rectal xenograft growth in a dose-dependent manner as follows: 150?ppm, 33.0% (p=0.000220); 750?ppm, 46.4% (p=0.0000292); 1500?ppm, 63.4% (p=0.0000109). Celecoxib inhibited lymph node metastasis in a dose-dependent manner as follows: 150?ppm, 86.7% (p=0.0263); 750?ppm, 90.3% (p=0.00638); 1500?ppm, 96.0% (p=0.000894). Celecoxib also inhibited lung metastasis as follows: 750?ppm, 53.3% (p=0.0107); 1500?ppm, 78.3% (p=0.00022). Celecoxib (1500?ppm) significantly inhibited PGE2 production by 68.4% (p=0.000157) and MVD counting by 48.2% (p=1.3x10-12) and induced apoptosis 2.5-fold (p=3.0x10-14) in the rectal xenograft. Celecoxib suppressed VEGF protein expression in the rectal xenograft. These studies demonstrate that celecoxib reduces the growth and metastatic potential of colorectal carcinoma in mice through COX-2 inhibition, anti-angiogenesis and apoptosis induction. The studies using HT-29 human colorectal carcinoma cell xenografts in nude mouse rectum also provide important information that supports that the COX-2 inhibitor celecoxib has a high potential for use as a clinical agent for inhibition of hematological and lymphatic metastases of colorectal cancer.     

Serum level of HE4 is closely associated with pulmonary adenocarcinoma progression

The human epididymis 4 (HE4) protein is expressed in the epididymis and respiratory tract. We previously reported that HE4 is also expressed in pulmonary adenocarcinoma. The purpose of this study was to investigate serum levels of HE4 as a biological marker in pulmonary adenocarcinoma. As the trained set, 102 patients with pulmonary adenocarcinoma who underwent surgery in our institute from 2008 to 2011 were evaluated. They were compared with 58 healthy controls and 16 cases of benign lung disease. In the validation, we used 104 patients with pulmonary adenocarcinoma operated on between 2000 and 2007. Postoperative changes of serum HE4 levels were investigated in 35 patients. The level of HE4 was determined by enzyme immunometric assay and compared with clinicopathological factors. In the trained set, HE4 levels in sera in pulmonary adenocarcinoma were significantly higher than in healthy controls and benign lung disease. Receiver operating characteristic curve showed that HE4 was a good discriminator of pulmonary adenocarcinoma (cut-off point, 50.3 pM; area under curve, 0.825; 95?% confidence interval, 0.76?C0.89, p?<?0.001). In the validation set, serum HE4 levels were significantly correlated with age, nodal status, and carcinoembryonic antigen. Furthermore, postoperative increase of HE4 serum levels showed a significant correlation with recurrence (p?=?0.032). The 5-year overall survival rate was 52.6?% in the HE4-positive group compared with 97.1?% in the HE4-negative group (p?=?0.001). These data showed that HE4 expression in sera is associated with progression of pulmonary adenocarcinoma and a possible biomarker.     

Macular Dysfunction in Oguchi Disease with the Frequent Mutation 1147delA in the SAG Gene

Aim/Background: A 1-bp deletion (1147delA) in the SAG (also known as arrestin or S-antigen) gene is the most frequently seen mutation in Japanese patients suffering from Oguchi disease, a recessively inherited stationary night blindness. We investigated macular function in a patient with Oguchi disease with the 1147delA mutation. Methods: A 43-year-old Japanese male patient was diagnosed with Oguchi disease. The patient underwent complete ophthalmic examinations, including spectral-domain optical coherence tomography and Humphrey visual field testing. Full-field electroretinograms (ff-ERG) and multifocal ERG (mf-ERG) were recorded. Mutational analysis of the SAG gene was performed. Results: Corrected visual acuity was good in both eyes. Funduscopy showed retinal pigment epithelium atrophy along the vascular arcade bilaterally. The inner segment-outer segment (ISOS) boundary lines were preserved in the foveal and parafoveal areas, whereas ISOS boundary defects and thinning of the outer nuclear layer (ONL) were seen outside the preserved ISOS boundary. Humphrey testing showed significant paracentral field defects in both eyes. In addition to an absence of rod responses, cone and 30-Hz flicker responses were markedly reduced in ff-ERG. The central (ring 1) and paracentral (ring 2) responses with normal latencies were relatively preserved, but the outer waveforms (rings 3-5) were attenuated and prolonged in mf-ERG. The deletion mutation (1147delA) was identified homozygously. Conclusions: The reduced/delayed mf-ERG responses and visual field defects in paracentral macula areas are most likely to be correlated with ISOS boundary defects and thinning of the ONL. Macular dysfunction can occur in Oguchi disease with the 1147delA mutation in the SAG gene.     

Change in anterior chamber depth following combined pars plana vitrectomy,phacoemulsification, and intraocular lens implantation using different types of intraocular lenses

Purpose  

To examine whether the type of intraocular lens (IOL) used in combined pars plana vitrectomy, phacoemulsification, and IOL implantation affects the changes in anterior chamber depth over time.     

Biodistribution of humanized anti-VEGF monoclonal antibody/bevacizumab on peritoneal metastatic models with subcutaneous xenograft of gastric cancer in mice

Purpose

Vascular endothelial growth factor (VEGF) is correlated with peritoneal metastasis of gastric cancer, increasing vascular permeability accompanied by accumulation of ascites. The aim of the current study is to investigate the biodistribution of bevacizumab in a peritoneal metastatic model of gastric cancer and to clarify which is more suited to treatment of peritoneal metastasis, systemic or regional therapy.

Methods

A highly peritoneal-seeding cell line of gastric cancer, OCUM-2MD3, which exhibited high production and release of VEGF was used in this study. The biodistribution of bevacizumab was investigated using peritoneal metastatic models together with subcutaneous xenografts, and ¹²⁵I-radiolabelled bevacizumab was administrated to these models subcutaneously (s.c.) or intraperitoneally (i.p.), respectively. In addition, the anti-tumor response of bevacizumab and paclitaxel was assessed as single agents or in combination using peritoneal metastatic models.

Results

In the analysis of biodistribution, ¹²⁵I-bevacizumab administrated i.p. indicated low peritoneal clearance. On the other hand, s.c. administration of ¹²⁵I-bevacizumab showed preferential accumulation in subcutaneous tumors and peritoneal nodules, with a high blood concentration. In peritoneal metastatic models, the effects of bevacizumab were found for both the growth inhibition of peritoneal nodules (P < 0.01) and the reduction of ascites (P < 0.05). These effects were more prominent by s.c. administration compared with i.p. administration and were increased in combination with i.p. paclitaxel.

Conclusion

Bevacizumab should be administrated systemically compared to regionally, and the combination with i.p. paclitaxel has a potential to be useful for patients with peritoneal metastasis of gastric cancer.     

Early postoperative evaluation of retinal function by electroretinography after vitreous surgery for idiopathic epimacular membrane

Purpose

In this study, we used the PuREC to carry out electroretinography (ERG) measurements using skin electrodes to assess changes before and after microincision vitreous surgery (MIVS) for epiretinal membrane (ERM) and evaluate the stress on retinal function soon after MIVS.

Methods

The study subjects were 18 eyes of 18 patients who underwent MIVS for ERM simultaneously with cataract surgery. ERG measurements were performed using a skin electrode on the day before vitreous surgery, on the day after surgery, and 1 week later. The amplitude and implicit time of each waveform were measured, and the changes between preoperative results and those 1 day and 1 week postoperatively were investigated.

Results

Preoperatively, the dark-adapted (DA) 0.01 ERG, the DA 3.0 ERG a-wave amplitude, and the light-adapted (LA) 3.0 ERG b-wave amplitude were significantly smaller in affected eyes compared with their fellow eyes (P < 0.05, Wilcoxon’s signed-rank test). The day after surgery, all-wave amplitude showed no significant difference compared to preoperatively (repeated-measures analysis of variance (ANOVA) post hoc test). One week after surgery, the LA 3.0 ERG for b-waves and flicker ERG amplitude had improved from the value on the day after surgery (P < 0.05, ANOVA post hoc test).

Conclusions

Cone ERG components have improved within 1 week after surgery by MIVS for ERM.

     

Scleral corneal 1-plane incision cataract surgery

The scleral corneal 1-plane incision for cataract surgery technique uses a single knife to perforate the anterior chamber from the sclera via the cornea by making a corneal valve that is 1.0 to 1.5 mm long. The technique is easy and reproducible. Even if incisions are widened to 6.0 mm, they readily self-seal with little surgically induced corneal topographic changes. Because surgical manipulations through a short scleral tunnel are easy and intraoperative mishaps can be dealt with smoothly, this incision technique can be used by those with relatively little surgical experience.