[Show abstract][Hide abstract] ABSTRACT: This report presents a surgical case of postoperative megarectum in an adult patient with imperforate anus/anorectal malformations. A 71-year-old Japanese male presented with a mass in the lower abdomen which was 15 × 12 × 8 cm in diameter, edema in the right lower extremity, and frequent urination. He had undergone sigmoid loop colostomy for an imperforate anus as a newborn infant. At 28 years of age, the sigmoid loop colostomy was changed to sigmoid divided colostomy in the left lower abdomen. Computed tomography revealed a large cystic mass in the lower abdomen. Retrograde urethrography indicated a rectourethral fistula and megarectum with stones. A small laparotomy incision was created in the right lower abdomen, and the wall of the megarectum was identified. Approximately 2,300 mL of gray muddy fluid was identified and drained. A mucous fistula of the upper rectum was created in the right lower abdomen. This is an extremely rare case of postoperative megarectum in an adult patient with an imperforate anus and rectourethral fistula.
[Show abstract][Hide abstract] ABSTRACT: Mitochondrial transcription factor A (mtTFA) is mandatory for both the transcription and maintenance of mitochondrial DNA. This study aimed to investigate the significance of mtTFA expression in pancreatic ductal adenocarcinoma (PDAC).
Surgical specimens from 93 patients with PDAC who all underwent pancreatectomy were immunohistochemically stained using a polyclonal anti-mtTFA antibody. The relationship between the expression of mtTFA, clinicopathologic factors, and prognosis of these patients were evaluated.
Positive mtTFA expression was significantly associated with lymphovascular invasion and metastatic recurrence in the liver and correlated with an advanced surgical stage. A univariate analysis showed that the patients with positive mtTFA expression had a significantly shorter survival time than those patients with negative mtTFA expression, and a multivariate analysis revealed that mtTFA expression was one of the independent prognostic factors in patients with PDAC. Positive mtTFA expression was significantly correlated with a low apoptotic index but not significantly correlated with the mind bomb homolog-1 (MIB-1) index.
The expression mtTFA worsens the clinical course of patients with PDAC through the inhibition of apoptosis of PDAC cells and is an independent marker for the poor prognosis of the patients with PDAC after pancreatectomy. Mitochondrial transcription factor A may be a novel target for the treatment of PDAC.
[Show abstract][Hide abstract] ABSTRACT: We consider the risk of impaired ventriculoperitoneal shunt (VPS) derived from increased intra-abdominal pressure and shunt infection, when we perform laparoscopic surgery to the patients who have undergone VPS previously. We performed single-incision laparoscopic cholecystectomy (SPS-LC) on 16-year-old woman with VPS. At first, we examined the subcutaneous and intra-abdominal route of the VPS tube by X-ray and clamped VPS tube with the fistula before CO2 insufflation. We released the clamp of the VPS tube and confirmed the drainage of the cerebrospinal fluid from the tip of the VPS tube, after the resection of the gall bladder and CO2 disaffiliation. She recovered without any complications such as the sign of increased intracranial pressure, shunt failure and infection after the surgery. This case illustrates that SPS-LC might be able to perform safely in patients with VPS, if we take steps adequately. We describe the clinical experience of the present case and review the relevant medical literatures.
Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 01/2014; 39(2):276-281. DOI:10.4030/jjcs.39.276
[Show abstract][Hide abstract] ABSTRACT: The presence of a ventriculoperitoneal shunt has been considered to be a contraindication for laparoscopic surgery till date; however, laparoscopic cholecystectomy was recently reported as safe for patients with this shunt.
We present the first case, to the best of our knowledge, of laparoscopic colectomy for cecal cancer in a patient with a ventriculoperitoneal shunt. A 59-year-old woman with a ventriculoperitoneal shunt for hydrocephalus was referred to our hospital with cecal cancer. Laparoscopic cecal cancer resection was performed successfully and uneventfully by manipulating the shunt.
Clamping of the shunt catheter at the subcutaneous region was performed before insufflation of carbon dioxide to prevent adverse effects from the pneumoperitoneum.
We believe that laparoscopic colectomy for colon cancer can be performed safely in patients with a ventriculoperitoneal shunt by optimal manipulation of the shunt.
International Journal of Surgery Case Reports 12/2013; 4(3):330-3. DOI:10.1016/j.ijscr.2013.01.005
[Show abstract][Hide abstract] ABSTRACT: We reviewed clinical features of patients who we treated for obturator hernia. The subjects were 13 patients who underwent an operation for obturator hernia in our hospital between April 2002 and December 2012. The mean age was 78.5 years, and all patients were female. The mean body mass index was 16.8 kg/m(2). The Howship-Romberg sign was present in only 3 patients. All patients were correctly diagnosed by preoperative pelvic computed tomography. All patients underwent operation. Operative procedures included the laparoscopic approach in 8 patients, the open approach in 3 patients and the inguinal approach in 2 patients. The hernia hilus was repaired with a simple closure in 5 patients, and with a mesh in 8 patients. The hernia contents were small intestine in all the patients. Three patients underwent partial resection of the small intestine because of necrosis of the intestine wall. Three patients had a recurrence of the obturator hernia. In our present series, the patients with obturator hernia were slender females at an advanced age. Plevic CT was useful for the diagnosis of obturator hernia.
Journal of UOEH 12/2013; 35(4):273-277. DOI:10.7888/juoeh.35.273
[Show abstract][Hide abstract] ABSTRACT: Introduction:
To date, intra-abdominal surgery in patients undergoing peritoneal dialysis (PD) has been considered to be associated with increased risk even when it is performed laparoscopically. To our knowledge, this is the first case of laparoscopic colectomy for transverse colon cancer in a patient undergoing automated PD (APD).
Presentation of case:
A 67-year-old man undergoing APD for end-stage chronic renal failure secondary to diabetic nephropathy was diagnosed with transverse colon cancer. Laparoscopic tumor resection without removal of the PD catheter was performed uneventfully. After surgery, PD was interrupted for 4 weeks and then safely resumed after confirming no severe complications of anastomotic leakage or intra-abdominal abscess.
In patients undergoing PD, the safety of laparoscopic surgery without removal of the catheter and the optimal timing of resuming postoperative PD with or without temporary hemodialysis remain controversial.
We believe that laparoscopic colectomy can be safely performed in patients undergoing PD. Further case reports and investigations on this procedure with special reference to safety are warranted in future.
International Journal of Surgery Case Reports 04/2013; 4(7). DOI:10.1016/j.ijscr.2013.04.031
[Show abstract][Hide abstract] ABSTRACT: This report presents a rare case with the synchronous occurrence of advanced neuroendocrine carcinoma (NEC) and tubular adenocarcinoma of the rectum. A 52-year-old Japanese male presented with general fatigue and bloody stool. Endoscopic examination showed an ulcerated lesion of the lower rectum. The pathological diagnosis of biopsy specimens from this lesion indicated moderately differentiated adenocarcinoma. He was referred to the surgical outpatient clinic with advanced rectal cancer. Barium enema indicated two lesions in the upper and lower rectum. Computed tomography revealed multiple hepatic metastases. A low anterior resection was performed with lymph node dissection. The resected specimen indicated an elevated lesion with ulceration in the upper rectum and an ulcerated lesion in the lower rectum. Histopathological and immunohistochemical analyses revealed NEC from the upper rectum and moderately differentiated tubular adenocarcinoma from the lower rectum. These two lesions were completely separated from each other. Therefore, this case demonstrates the synchronous occurrence of advanced NEC and tubular adenocarcinoma in the rectum.
Case Reports in Gastroenterology 03/2013; 7(1):117-21. DOI:10.1159/000350252
[Show abstract][Hide abstract] ABSTRACT: We report a case of strangulated ileus due to internal hernia through a defect of the broad ligament of the uterus treated by reduced port surgery (RPS). A 40-year-old woman was admitted to our hospital with lower abdominal pain and vomiting. An abdominal CT scan revealed enlargement of the small intestine within the pelvis and displacement of the uterus toward the right side. RPS was performed under a diagnosis of internal hernia through a defect of the left broad ligament of the uterus. Since intestinal necrosis developed because of the incarceration through a defect of the broad ligament, operation included resection of necrotic intestine and laparoscopic suture of the defect was performed. RPS is technically feasible in this case and produces a less invasiveness and increased cosmetic benefits.
Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 01/2013; 38(1):184-189. DOI:10.4030/jjcs.38.184
[Show abstract][Hide abstract] ABSTRACT: This report presents the case of a patient with Cowden syndrome who had arteriovenous malformations (AVMs) at the jejunum and the ileum and experienced intestinal bleeding. A 54-year-old Japanese male presented with general fatigue and melena. Endoscopic examinations showed gastrointestinal polyposis from the esophagus to the rectum. However, the site of bleeding was not identified. There were some papules on his face and neck. He also had macrocephaly and had multiple papillomas along the gum-line. These findings indicated a clinical diagnosis of Cowden syndrome. Enhanced computed tomography (CT) and angiography analyses indicated the presence of AVMs at the jejunum and the ileum. He was treated with partial resection of the jejunum and ileum including these two AVMs. This was a rare case of two AVMs involving the small bowel in a patient with Cowden syndrome. Enhanced CT was very useful and convenient for the detection of gastrointestinal AVMs in this case.
Surgery Today 12/2012; 43(5). DOI:10.1007/s00595-012-0460-x · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chemotherapy-induced nausea and vomiting(CINV)is one of the side effects causing significant psychological and physical suffering in patients receiving chemotherapy. First-generation 5-HT3 receptor antagonists(ondansetron, granisetron and ramosetron)are available, but some patients are still not treated adequately. Palonosetron is a second-generation 5-HT3 receptor antagonist with a prolonged duration of action and a higher receptor binding affinity than first-generation agents. In the present study, we aimed to compare the antiemetic efficacy of palonosetron vs. ramosetron in preventing acute and delayed CINV. Patients received palonosetron followed by ramosetron, and the antiemetic effects were evaluated by the Multinational Association of Supportive Care in Cancer Antiemesis Tool(MAT). A total of 22 patients with colon cancer receiving chemotherapy were included in the efficacy analyses. Nine patients were observed with acute nausea, and 11 patients with delayed nausea. Relief of symptoms was observed in 3 patients with acute nausea and 4 patients with delayed nausea by switching from ramosetron to palonosetron. There was no significant difference of improvement in the acute phase, there was significantly suppressed in the delayed phase.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(11):1671-1674.
[Show abstract][Hide abstract] ABSTRACT: Cancer cells generally have a high rate of glycolysis and produce larger quantities of lactate as compared to the surrounding normal cells. Monocarboxylate transporter 4 (MCT4) is one of the proton pumps exchanging the lactate through the plasma membrane. The prognostic significance of MCT4 expression has not been evaluated in patients with colorectal cancer (CRC). Surgical specimens from 105 CRC patients were immunohistochemically stained using a polyclonal anti-MCT4 antibody. The relationships among the MCT4 expression, clinicopathological factors and prognosis were evaluated. A total of 53 (50.5%) of the 105 patients with CRC were determined to have tumors positive for MCT4 expression. The expression of MCT4 significantly correlated with the tumor size, depth of invasion, lymph node metastasis, distant metastasis and TNM staging. The survival rate of the patients who were positive for MCT4 expression was significantly lower than that of patients with negative MCT4 expression. Positive MCT4 expression was a significantly poor prognostic factor, as determined by both univariate and multivariate analyses. Therefore, positive MCT4 expression appears to be a useful marker for tumor progression and prognosis in patients with CRC.
Experimental and therapeutic medicine 09/2012; 3(1):25-30. DOI:10.3892/etm.2011.361 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the usefulness of urinary N(1),N(12)-diacetylspermine (DiAcSpm) measured by the colloidal gold aggregation method as a tumor marker for colorectal cancer (CRC). The preoperative urine of 113 CRC patients was collected, and the urinary DiAcSpm was measured by a reagent kit for DiAcSpm determination based on colloidal gold aggregation using automatic biochemical analyzers. The urinary DiAcSpm levels significantly correlated with distant metastasis and Tumor-Node-Metastasis (TNM) stage. The positive rates of urinary DiAcSpm were significantly higher than those of serum carcinoembryonic antigen (CEA) or cancer antigen 19-9 (CA19-9) in stages 0+I, II, III and IV. The positive rates of urinary DiAcSpm were also significantly higher than those of serum CEA or CA19-9 in the early and advanced CRC groups according to the Japan Classification of Colorectal Cancer. Therefore, urinary DiAcSpm, measured by a reagent kit for DiAcSpm determination based on colloidal gold aggregation, may be useful as a non-invasive tumor marker in patients with CRC.
[Show abstract][Hide abstract] ABSTRACT: Mitochondrial transcription factor A (mtTFA) is necessary for both the transcription and maintenance of mitochondrial DNA (mtDNA). The present study investigated the relationship between clinicopathological factors, prognosis and the immunohistochemical expression of mtTFA in the tumors of patients diagnosed with primary colorectal cancer (CRC). Surgical specimens from 105 colorectal patients were immunohistochemically stained using a polyclonal anti-mtTFA antibody. The relationships among the mtTFA expression, clinicopathological factors and prognosis were evaluated. A total of 47 (44.8%) of the 105 patients with CRC were determined to have positive mtTFA expression. The positive expression of mtTFA significantly correlated with lymph node metastasis, distant metastasis and advanced TNM staging. On the other hand, negative mtTFA expression showed a tendency to correlate with high Ki-67 index. The survival of patients with positive mtTFA expression was significantly worse than that of patients with negative mtTFA expression. The positive mtTFA expression appears to be a useful marker for tumor progression and poor prognosis in patients with CRC.
[Show abstract][Hide abstract] ABSTRACT: Micafungin (MCFG), an echinocandin antifungal agent, exhibits antifungal activity against Candida albicans and non-albicans Candida. The fungicidal activity of MCFG against clinical isolates of Candida species was investigated, and the clinical efficacy of MCFG in therapy of deep mycosis in surgery was studied using the AKOTT algorithm. The minimum inhibitory concentration and minimum fungicidal concentration values of fluconazole were ≤0.06-4 and >64 μg/ml, respectively, for each strain, whereas these values of MCFG were 0.008-0.5 and 0.016-1 μg/ml, suggesting that MCFG provided superior fungicidal ability against Candida albicans and non-albicans Candida. The subjects were separated into two groups: group A consisted of 20 subjects with both persisting fever refractory to broad-spectrum antibiotics and positive reaction to β-D: -glucan test, and group B consisted of 20 subjects with either of those conditions. The overall response was evaluated as "effective" in 17 patients (85%) and 20 patients (100%) in groups A and B, respectively. In total, response was evaluated as "effective" in 37 patients (92.5%) and "ineffective" in 3 patients (7.5%). These findings suggest that MCFG administration should be used as empirical therapy for deep mycosis in surgically ill patients as it was shown to be an effective antifungal drug lacking serious adverse effects.
Journal of Infection and Chemotherapy 03/2012; 18(5). DOI:10.1007/s10156-012-0381-z · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Malignant fibrous histiocytoma (MFH) is a common sarcoma affecting soft tissues of the body, especially of the extremities or trunk. Prognosis of the abdominal MFH is usually poor.
A 52-year-old female presented to our surgical outpatient clinic with a lower abdominal tumor that had been gradually increasing in size. Clinical examination revealed a firm, irregularly surfaced, fixed, painless, child-head-sized tumor located in her lower abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed a polycystic tumor at the lower abdomen which was 15 × 13 × 11 cm in diameter and encased the colorectum to the left back side. A barium enema and a colonoscopy showed direct invasion to the rectum. In 2001, the tumor had been excised along with a low anterior resection of the rectum because of direct invasion. The origin of this tumor was the mesorectum. The weight of the excised tumor was 1,500 g, including 800 ml of a brown fluid. A histopathological diagnosis revealed a common type of MFH, in which mitotic figures are frequently seen.
This patient has survived without recurrence, for approximately 8 years since the completed tumor resection. It is important to obtain a complete resection during the MFH treatment.
World Journal of Surgical Oncology 02/2011; 9:15. DOI:10.1186/1477-7819-9-15 · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Modification of transcription factors by anticancer agents plays an important role in both apoptotic and survival signaling. Here we report that both DNA topoisomerase I and II inhibitors such as SN-38 and etoposide, but not cisplatin, 5-fluorouracil or actinomycin D, can induce phosphorylation of the transcription factor Sp1. Furthermore, DNA topoisomerase inhibitors were shown to transactivate GC-box-dependent promoters such as the SV40 and vascular endothelial growth factor promoters. The phosphorylated form of Sp1 was detectable within 30 min of etoposide treatment and was greatly diminished by the presence of the PI3K inhibitor wortmannin and by DNA-dependent protein kinase (DNA-PK) knockdown. We also confirmed that the phosphorylated form of DNA-PK was increased by treatment with both etoposide and SN-38. Taken together, these findings demonstrate a novel genomic response to anticancer agents that induce Sp1 phosphorylation, and might contribute to tumor progression and drug resistance.
Cancer Science 07/2007; 98(6):858-63. DOI:10.1111/j.1349-7006.2007.00476.x · 3.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Drug-induced modifications of transcription factors play important roles in both apoptosis and survival signaling. The data presented here show that the DNA topoisomerase II poison TAS-103 transactivated the SV40 promoter in a GC-box-dependent manner and induced Sp1 acetylation in cells expressing p300. This activity was not observed in cells lacking p300. TAS-103 treatment also enhanced the p300 content of the nucleus and the interaction of p300 with Sp1. Cellular susceptibility to TAS-103 was correlated with p300 expression but not with topoisomerase II expression. Furthermore, the presence of p300 significantly sensitized cancer cells to TAS-103 but not to cisplatin. Taken together, these findings demonstrate novel genomic responses to anticancer agents that modulate Sp1 acetylation and Sp1-dependent transcription in an apoptotic pathway.