The association of esophageal hiatus hernia with Mallory-Weiss syndrome

The incidence of esophageal hiatus hernia in Mallory-Weiss syndrome was analyzed from endoscopic findings in order to clarify the association with Mallory-Weiss syndrome. Hiatus hernia was diagnosed from findings of both esophagoscopy and gastroscopy. In 23 patients with Mallory-Weiss syndrome confirmed by endoscopy, hiatus hernia was found 21 cases (91.3%), in which 9 (39.1%) were definite hernias and 12 (52.2%) were minor hernias. In 80 control cases of various gastrointestinal diseases, definite hernia was found in 7 cases (8.8%), and minor hernia was found in 13 cases (16.2%). The incidence of hiatus hernia in Mallory-Weiss syndrome was thus significantly higher than that in the control group. The incidence of hiatus hernia evaluated only by esophageal findings was lower than that evaluated by combined findings from the gastric and esophageal directions. These results indicate that evaluation from the gastric direction is an essential procedure for the diagnosis of esophageal hiatus hernia and that hiatus hernia is one of the predisposing factors for the development of Mallory-Weiss syndrome.     

Suppressive effect of ethanol on the expression of hepatic asialoglycoprotein receptors augmented by interleukin-1β, interleukin-6, and tumor necrosis factor-α

Blood levels of inflammatory-related cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, are elevated in patients with alcoholic liver diseases. We investigated the effects of these cytokines and ethanol on the expression of hepatic asialoglycoprotein receptors (AGPRs) in a human hepatoblastoma cell line, HepG2. An [¹²⁵I]-asialo-orosomucoid binding assay showed significant increases in surface AGPR numbers in HepG2 cells by treatment with IL-1β, IL-6, and TNF-α, to levels which were approximately 130% of the values in untreated control cells. However, the enhanced AGPR numbers induced by treatment with these cytokines were markedly suppressed, to 70%–80% of the number in the untreated cells, by treatment with ethanol. Immunological detection of AGPR with a specific antibody demonstrated that the modulation of surface AGPR numbers was correlated with the cellular expression levels of AGPR. These results suggest that, although IL-1β, IL-6, and TNF-α stimulate the synthesis of hepatic AGPR, ethanol suppresses the expression of AGPR augmented by these cytokines. This leads to an increase in serum asialo-orosomucoid levels caused by the disordered catabolism mediated by AGPR in patients with alcoholic liver disease. (Received Dec. 5, 1997; accepted May 22, 1998)     

Extracellular and Intracellular Regulation of Biliary Lecithin Hydrophobicity

Bromosulfophthalein and papaverine have beendemonstrated to inhibit biliary lipid secretion withoutaffecting secretion of bile salts in normal rats,so-called uncoupling. Bromosulfophthalein inhibits the capacity of intracanalicular bile saltmicelles to induce biliary lipid secretion, andpapaverine inhibits vesicular transport within thehepatocyte. We compared the effects ofbromosulfophthalein and papaverine on biliary lipid secretion in normalSprague-Dawley rats and Eizai hyperbilirubinuria rats.The fatty acyl chain saturation in biliary lecithinincreased during bromosulfophthalein infusion and decreased during papaverine infusion inSprague-Dawley rats. Bromosulfophthalein had no effecton biliary lipid secretion in Eizai rats, whilepapaverine induced uncoupling. The degree of fatty acylchain saturation in biliary lecithin was unchangedduring bromosulfophthalein infusion, but decreased withpapaverine in Eizai rats. We deduce that selection ofbiliary lecithin species occurs at various points in the lipid transport pathway at intracellularand intracanalicular sites.     

Motor evoked potential monitoring can evaluate ischemic tolerance to carotid artery occlusion during surgery

Journal of Clinical Monitoring and Computing - Balloon test occlusion (BTO) is a useful examination for evaluating ischemic tolerance to internal carotid artery (ICA) occlusion. The aim of this...     

Clinical characteristics and management of gastric tube cancer after esophagectomy

Background

Gastric cancer is the second most common malignancy, overlapping with thoracic esophageal cancer (TEC). Among them, metachronous gastric tube cancers after TEC surgery have been increasing. The aims of this study were to examine the clinicopathological factors and treatment outcomes of gastric tube cancer (GTC) after TEC surgery.

Methods

Thirty-three GTCs in 30 cases after TEC treated between 1997 and 2016 were investigated retrospectively.

Results

Most cases were males. The median interval from TEC surgery to GTC occurrence was 57 (6.5–107.5) months. Almost 2/3 lesions occurred in the lower third of the gastric tube (21/33); 29 lesions (in 26 cases) were superficial cancers, and 4 lesions were advanced cancers. Twenty-two lesions of superficial cancer were differentiated type, and the remaining seven lesions were undifferentiated type. Treatment for superficial cancer had previously been performed with partial gastric tube resection (10 lesions), and the number of cases undergoing endoscopic submucosal dissection (ESD) had increased recently (19 lesions). Most cases with superficial cancer survived without relapse. Four lesions of advanced cancer were found after a relatively long interval following TEC surgery. Most lesions of advanced cancer were scirrhous, undifferentiated type, and they died due to GTC.

Conclusion

GTCs may occur late in the postoperative course following TEC surgery. If they are discovered at an early stage, these lesions can be cured with ESD. Long-term periodic endoscopic examinations after TEC surgery are important.

     

The use of a mini-laparotomy in total abdominal colectomy for mucosal ulcerative colitis

BACKGROUND/AIMS: Minimally invasive surgery, with its advantages of early return to normal activity and good cosmetic results, is an important goal in the treatment of patients with mucosal ulcerative colitis. The aim of this study was to compare outcomes utilizing a mini-laparotomy approach to total abdominal colectomy for mucosal ulcerative colitis with those of the conventional approach. METHODOLOGY: Eleven patients scheduled to undergo the first (total abdominal colectomy) of a 2 or 3-stage operation for mucosal ulcerative colitis via a mini-laparotomy between 1999 and 2001 were prospectively studied. The mini-laparotomy described here involves total abdominal colectomy performed through a skin incision shorter than 7 cm. Seven similar patients who underwent conventional laparotomy between 1995 and 1998 served as the control group. RESULTS: The mini-laparotomy approach was accomplished in 9 patients (81.8%). Patient characteristics between cases and controls were similar. Postoperative intervals until standing, walking, flatus, urinary catheter removal, and tolerance of solid diet were significantly shorter in the mini-laparotomy group (P = 0.031, P = 0.023, P = 0.0033, P = 0.0093, and P = 0.023, respectively). CONCLUSIONS: A mini-laparotomy approach to total abdominal colectomy appears feasible and safe in selected patient with mucosal ulcerative colitis and poses an attractive alternative to conventional laparotomy in patients similar to those presented here.