Hand-assisted laparoscopic total pancreatectomy for a main duct intraductal papillary mucinous neoplasm of the pancreas

The laparoscopic approach to pancreatectomy entails a number of restrictions in performing major pancreatic surgery. This report describes a hand-assisted laparoscopic total pancreatectomy performed for a main duct intraductal papillary mucinous neoplasm of the pancreas. Dissection of the gastroduodenal artery and splenic artery, and the transection of the duodenum were done through the midline mini-laparotomy, while mobilization of the spleen and the pancreatic tail and body, and Kocher’s maneuver were performed using the hand-assisted laparoscopic approach. Furthermore, dissection of lymph nodes in the hepatoduodenal ligament, removal of the gallbladder, division of the hepatic duct, tunneling of the pancreas, and dissection of the pancreas from the superior mesenteric vein and superior mesenteric artery were possible to perform safely under a pure laparoscopic technique with an excellent laparoscopic view. The reconstruction procedures were performed through the mini-laparotomy. The hand-assisted laparoscopic total pancreatectomy should be considered for the treatment of selected patients because it has various advantages as one type of minimally invasive surgery.     

Ets-1在前列腺癌组织中的表达及其临床意义

目的 探讨原癌基因Ets-1在前列腺组织中的表达及其与前列腺癌组织学分级的关系.方法 利用免疫组化法检测Ets-1在4例正常前列腺组织,12例良性前列腺增生组织和53例前列腺癌组织中的表达.结果 Ets-1蛋白的阳性表达在前列腺癌细胞的胞浆及胞核内均可见,79%的前列腺癌组织中Ets-1呈阳性表达,而在良性前列腺组织细胞中无表达或仅有微弱表达,差异有显著性意义(P<0.05).在前列腺癌组织中,Gleason评分高危组Ets-1阳性表达率明显高于Gleason中危组和低危组(P<0.05).结论 与良性前列腺组织对照相比,Ets-1有肿瘤特异性,其表达与前列腺癌的组织学分级相关,可作为前列腺癌病变程度及临床预后判断的一个分子标志.     

MR diagnosis of adenomyomatosis of the gallbladder and differentiation from gallbladder carcinoma: importance of showing Rokitansky-Aschoff sinuses.

OBJECTIVE: We evaluated the MR imaging features of adenomyomatosis of the gallbladder with particular emphasis on Rokitansky-Aschoff sinuses. MATERIALS AND METHODS: MR images of 17 patients with histologically proven adenomyomatosis were retrospectively reviewed. The presence of Rokitansky-Aschoff sinuses was evaluated and analyzed; four T2-weighted (fast spin-echo with a surface coil, with or without breath-holding, fast spin-echo with a phased-array coil with breath-holding, and half-Fourier rapid acquisition with relaxation enhancement with breath-holding) and two contrast-enhanced dynamic pulse sequences were studied. These six pulse sequences were separately rated on a 5-point scale by two radiologists for comparison. Interobserver differences were evaluated. Other MR findings were also analyzed. RESULTS: Among the six pulse sequences studied, three T2-weighted with breath-holding sequences were found to be superior to the other three sequences in showing Rokitansky-Aschoff sinuses. In particular, the half-Fourier rapid acquisition with relaxation enhancement was scored the highest by the two observers and received the highest kappa coefficient in our statistical analysis of the scoring. Diffuse-type adenomyomatosis typically showed early mucosal and subsequent serosal enhancement. Localized adenomyomatosis exhibited homogeneous enhancement, showing smooth continuity with the surrounding gallbladder epithelium. CONCLUSION: MR imaging may be able to provide important information in the diagnosis of adenomyomatosis.     

Near-infrared spectroscopy for noninvasive evaluation of chest wall ischemia immediately after left internal thoracic artery harvesting

OBJECTIVE: The conclusions remain controversial about whether the sternal blood flow is preserved or diminished after internal thoracic artery (ITA) harvesting for coronary artery bypass grafting (CABG), especially in diabetic patients. We investigated the blood supply of the chest wall noninvasively using near-infrared spectroscopy (NIRS) immediately after CABG. METHODS: The study group comprised 30 patients who underwent CABG using a skeletonized left ITA through median sternotomy. As a control group, three nondiabetic patients undergoing valve surgery through median sternotomy were also included. On arrival of the patient in the intensive care unit immediately after surgery, two reflectance sensors were placed on the bilateral parasternal regions at the fourth intercostal space to record regional oxygen saturation (rSO(2)) and hemoglobin index (HbI) continuously approximately for 17 h. RESULTS: The differences in right and left values (R-L rSO(2) and R-L HbI) were significantly greater in the diabetic patients than in the nondiabetic patients (3.74% +/- 2.47% vs. 1.98% +/- 1.67 %, p = 0.036; and 0.28 +/- 0.19 vs. 0.13 +/- 0.13, p = 0.020). The R-L HbI was significantly greater in the on-pump patients than in the off-pump patients, although there was no significant difference in R-L rSO(2). Both R-L rSO(2) and R-L HbI were similar among the control, nondiabetic, and off-pump patients. CONCLUSION: The technique of NIRS enables noninvasive, continuous monitoring of chest wall perfusion immediately after ITA harvesting. Our study using NIRS showed a decrease in blood flow and oxygen metabolism of the hemisternum after LITA harvest in diabetic CABG patients.     

Effective treatment of acute pain and related symptoms in elderly with herpes zoster

BACKGROUND: The incidence of herpes zoster increases with age. Immediate pain relief is required for prevention of postherpetic neuralgia (PHN) and also its related symptoms that worsen the general condition because acute herpetic pain often interferes with sleep, mood, and general activities in elderly patients. Nerve block is useful to relief acute pain and recommended for prevention of PHN. Tricyclic antidepressant drugs have antinoticeptive effect in acute pain in experimental models, in addition to its antidepressant effect. METHODS: Forty elderly patients with herpes zoster within 3 months after the onset underwent nerve blocks and received tricyclic antidepressant drugs. We assessed the effect of treatments and adverse effects. RESULTS: No significant adverse effects were found in elderly patients who had received nerve blocks and/or tricyclic antidepressant drugs. Alleviation of acute pain was obtained in more than 80% of patients, and in all patients depressive state and/or disturbance of the general condition were significantly improved. CONCLUSIONS: With careful technique and assessment of patients, both nerve block and tricyclic antidepressant drugs were beneficial and safe treatments in elderly patients with herpes zoster.     

Surgical resection of primary liposarcoma of the anterior mediastinum.

We report on the rare and surgical treatment of a case of primary mediastinal liposarcoma. A 64-year-old male complained of hoarseness for one month and was admitted to our hospital because of an abnormal shadow, which was postulated to be an anterior mediastinal tumor on a chest computed tomography (CT) scan. Horizontal T1-weighted magnetic resonance imaging (MRI) showed an anterior mediastinal round mass with a signal intensity similar to that of subcutaneous fat, which was 6.5 cm in diameter. An operation similar to extended thymectomy was perfomed through a median sternotomy. Histological examination of the resected specimen revealed that the tumor was composed of well-differentiated liposarcoma and pleomorphic malignant fibrous histiocytoma and the tumor was diagnosed as a de-differentiated liposarcoma. We discuss it with reference to a collective review of the Japanese literature for surgical cases of primary liposarcoma of the mediastinum.     

Perimembrane Aurora-A Expression is a Significant Prognostic Factor in Correlation with Proliferative Activity in Non-Small-Cell Lung Cancer (NSCLC)

Purpose Aurora-A, also known as STK15/BTAK, is a member of the protein serine/threonine kinase family, and experimental studies have revealed that Aurora-A plays critical roles in cell mitosis and in carcinogenesis. However, no clinical studies on Aurora-A expression in non-small-cell lung cancer (NSCLC) have been reported. Thus, the present study was conducted to assess the clinical significance of Aurora-A status. Experimental Design A total of 189 consecutive patients with resected pathologic (p-)stage I-IIIA, NSCLC were retrospectively reviewed, and immunohistochemical staining was used to detect Aurora-A expression. Results Aurora-A expression was negative in 31 patients (16.4%); among Aurora-A positive patients, 124 patients showed pure diffuse cytoplasmic Aurora-A expression and the other 34 patients showed perimembrane Aurora-A expression. Perimembrane Aurora-A tumors showed the highest proliferative index (PI) (mean PIs for negative, diffuse cytoplasmic, and perimembrane tumors: 49.2, 41.7, and 63.5, respectively; P < .001). Five-year survival rates of Aurora-A negative, diffuse cytoplasmic, and perimembrane patients were 67.8%, 66.7%, and 47.6%, respectively, showing the poorest postoperative survival in perimembrane patients (P = .033). Subset analyses revealed that perimembrane Aurora-A expression was a significant factor to predict a poor prognosis in squamous cell carcinoma patients, not in adenocarcinoma patients. A multivariate analysis confirmed that perimembrane Aurora-A expression was an independent and significant factor to predict a poor prognosis. Conclusions Perimembrane Aurora-A status was a significant factor to predict a poor prognosis in correlation with enhanced proliferative activity in NSCLC.     

Expression of the Prothymosin-α Gene as a Prognostic Factor in Lung Cancer

Prothymosin-α (PTα) is known to play a role in cell proliferation, and the PTα mRNA level may reflect the degree of proliferation of tumor cells. It has been reported that PTα mRNA levels are higher in human colon and liver cancer tissues than in the adjacent normal tissues. We examined the mRNA levels of PTα and c-myc in 20 lung cancers, using Bas 2500Mac systems. The PTα and c-myc mRNA levels in lung cancer tissues were higher than those in normal lung tissues; however, the PTα mRNA levels did not correlate with the stage or pathological subtype of the lung cancer and there was no correlation between the expression of PTα and c-myc. PTα mRNA overexpression in lung cancer was correlated with a poor prognosis. Received: October 13, 2000 / Accepted: May 15, 2001     

Tape-guided living donor left hepatectomy

A procedure of tape-guided living donor left hepatectomy is described. A tape was placed along the anterior wall of the inferior vena cava for left liver with caudate lobe, and along Arantius' ligament for left liver without caudate lobe. The final step of liver transection was applied by dividing the liver parenchyma under tape guidance. This procedure contributed to safe and accurate anatomic procurement of left liver grafts in living donor hepatectomy.     

Mismatch recovery of regional cerebral blood flow and brain temperature during reperfusion after prolonged brain ischemia in gerbils

BACKGROUND: Recovery of cerebral reperfusion after stroke or cardiac arrest can take a long time. We aimed to identify differences in the postischemic recovery of physiologic parameters between short and prolonged brain ischemia. METHODS: Eighteen Mongolian gerbils were assigned to one of three groups: 5-minute (G5), 15-minute (G15), or 30-minute (G30) ischemia. With the use of our original microspectroscopy system, global ischemic reperfusion was performed. We measured changes in regional cerebral blood flow (r-CBF), microvessel diameter, and brain temperature (BrT) simultaneously. We also monitored somatosensory evoked potentials (SEPs) to evaluate electrophysiologic response. RESULTS: Both G5 and G15 showed concurrent recovery of r-CBF and BrT with hyperemia and hyperthermia, respectively, 10 to 15 minutes after reperfusion. The increase in BrT was <1 degree C and recovered to baseline within 60 minutes after reperfusion. In G30, recovery of r-CBF was significantly delayed relative to that of BrT. The increase in BrT was >2 degrees C, peaking approximately 15 minutes after reperfusion, and then maintained increases of >1 degree C for 120 minutes. SEPs in G5 and G15 showed concomitant recovery with that of r-CBF, whereas SEP recovery in G30 was delayed relative to that of r-CBF, eventually disappearing. All except one of the G30 gerbils died within 24 hours, but all in G5 and G15 survived. CONCLUSIONS: These results suggest that mismatch recovery of r-CBF and BrT after prolonged ischemia initiates metabolic derangement in brain tissue, leading to the electrochemical dysfunction and mortality.