Updates and Future of Enteroscopy

Video capsule emdoscopy (VCE) and double balloon endoscopy (DBE) have allowed endoscopic observation of the entire small bowel. With introduction of these modalities, we have identi ed new diseases of the small bowel. Although VCE has a safe ability to check the     

A case of gallbladder adenoma with wide base]

A 65-year-old man was referred for a gallbladder elevated lesion. Abdominal US showed a hypoechoic tumor with wide base at the gallbladder body. The maximum velocity of the gallbladder wall blood flow was 20 cm/s. The outermost hyperechoic layer was irregular, but not disrupted on EUS images. We diagnosed the lesion as gallbladder carcinoma with the depth of subserosa. Cholecystectomy was performed and the tumor was diagnosed as tubular adenoma of the gallbladder. The p53 immumostaining was negative. A gallbladder adenoma with wide base is rare, here we report this case with the several considerations.     

Pancreatic division by electrocautery in pancreatoduodenectomy

To assess whether electrocautery is appropriate for cutting the pancreas in pancreatoduodenectomy, we compared leakage of the pancreatojejunostomy (PJ-stomy) in patients who underwent pancreatic division by electrocautery and with a conventional scalpel, in a retrospective study. Eighty-four patients with invaginating end-to-end PJ-stomies (performed in the period 1986—1996) were enrolled in this study; 34 patients underwent pancreatic division with a conventional scalpel (group A) and 50 by electrocautery (group B). Of the 84 patients, 12 (14%) had leakage from the PJ-stomies. In relation to consistency of the pancreatic parenchyma, the incidence of leakage in patients with hard pancreas (1/28; 3.6%) was significantly lower than that in patients with soft or moderate pancreas consistency (11/56; 20%) (P < 0.05). Nine patients (27%) in group A and 3 (6%) in group B presented with leakage. The incidence of leakage was significantly lower in group B than in group A (P < 0.05). Even when patients with hard pancreas were excluded, the incidence of leakage was significantly lower in group B (3/34; 9%) than in group A (8/22; 36%) (P < 0.05). These results suggest that pancreatic division by electrocautery can reduce the incidence of leakage from the pancreatojejunostomy and make pancreatoduodenectomy a safer procedure.     

Interferon-gamma stimulates the expression of CX3CL1/fractalkine in cultured human endothelial cells

CX3CL1/Fractalkine, a CX3C chemokine, is a potent agonist for the chemotaxis and adhesion of monocytes and lymphocytes. It was first identified as a membrane protein in endothelial cells activated with IL-1 or TNF-alpha. We have found the enhanced expression of fractalkine in human umbilical vein endothelial cells stimulated with interferon-gamma (IFN-gamma). Pretreatment of the cells with cycloheximide did not inhibit the expression of fractalkine mRNA. The majority of fractalkine protein was found in the cell lysate, and an antibody-blocking experiment disclosed that fractalkine contributes to the adhesion of mononuclear cells to endothelial monolayers stimulated with IFN-gamma. Vascular endothelial cells produce fractalkine in response to IFN-gamma, and this may play an important role in immune responses by eliciting a traffic of mononuclear cells through the vascular wall.     

Risk quantification for pulmonary complications after lung cancer surgery

Purpose  

The purpose of this study was to identify the risk factors for postoperative pulmonary complications and to develop a scoring system to predict the surgical outcomes in lung cancer patients.     

Impact of early elevation of serum bilirubin during treatment with pegylated interferon and ribavirin in patients with chronic hepatitis C

Aim: Hemolytic anemia is a well‐known adverse effect of interferon and ribavirin combination treatment. Herein, we analyzed the impact of early elevation of serum bilirubin level as a marker for predicting severe anemia during treatment. Methods: We studied 245 chronic hepatitis C patients who received pegylated interferon and ribavirin combination treatment, and divided them using two different threshold levels: (i) elevation of total bilirubin of 0.5 mg/dL or more within 1 week of starting treatment; and (ii) drop of hemoglobin (Hb) by 3 g/dL or more within 4 weeks of starting treatment. We compared the dynamics in each group and then investigated independent factors for predicting a severe Hb drop (≥3 g/dL) at 4 weeks after beginning treatment and dose reduction of ribavirin. Results: Total bilirubin levels at 1 week were significantly higher in patients with a Hb drop of 3 g/dL or more as compared to those with a drop of less than 3 g/dL (P < 0.0001). Hb levels at 4 weeks were significantly lower in the group of 0.5 mg/dL or more increase of total bilirubin levels than in the group with a less than 0.5 mg/dL increase (P < 0.0001). Therefore, elevation of total bilirubin after 1 week of treatment was shown to be an independent factor for predicting severe Hb drop (≥3 g/dL) at 4 weeks (P < 0.0001), and dose reduction of ribavirin during treatment (P = 0.0321). Conclusion: Early elevation of serum bilirubin level was found to be a possible predictive marker of both a severe drop of Hb in the early phase of treatment and dose reduction of ribavirin.     

Effects of 1‐O‐hexyl‐2,3,5‐trimethylhydroquinone on carbon tetrachloride‐induced hepatic cirrhosis in rats

Aim: The present study was undertaken to evaluate the effects of 1‐O‐hexyl‐2,3,5‐trimethylhydroquinone (HTHQ), a synthesized vitamin E derivative, on carbon tetrachloride (CCl₄)‐induced cirrhosis. Methods: Rats were treated with hypodermic injections of CCl₄ twice a week to induce the hepatic cirrhosis, and given drinking water containing HTHQ or solvent. Primary cultures of rat hepatocytes were performed to evaluate the effects of HTHQ on the expression of inducible nitric oxide synthase (iNOS). Results: Masson's staining of rat livers showed fibrosis around pseudo‐lobules in the CCl₄ group, the lesions being reduced in the CCl₄ HTHQ group. Increases in liver tissue hydroxyproline and α₁(I) collagen, α‐smooth muscle actin and iNOS induced by CCl₄, were also markedly diminished by HTHQ. Furthermore, both HTHQ and vitamin E attenuated interleukin‐1β‐induced iNOS protein expression in cultured hepatocytes, the potency of HTHQ being 10‐times higher than that of vitamin E. Conclusion: HTHQ may inhibit development of hepatic cirrhosis in rats, more potently than vitamin E, by inhibiting the iNOS expression in hepatocytes. Because vitamin E has a radical scavenging action, roles of NO and peroxynitrite will be discussed in the effects of HTHQ on the fibrosis.