Akio Odaka

Laparoscopic gastropexy for acute gastric volvulus: A case report

A 7-year-old girl presented with an acute gastric volvulus that was reduced with a nasogastric catheter. An anterior gastropexy was undertaken laparoscopically. The gastrocolic omentum was deficient along most of the greater curvature, which had allowed organoaxial volvulus. Two years later, gastric volvulus has not recurred. Laparoscopy is an acceptable approach for the evaluation and treatment of children with acute gastric volvulus.

Liver metastasis following pneumoperitoneum with different gases in a mouse model

BackgroundThe validity of using CO2 in laparoscopic tumor surgery has not yet been established. To address this question, we investigated the growth of liver metastases following insufflation with different gases in a mouse laparoscopy model.MethodsMale BALB/C mice inoculated intraportally with colon 26 cells were randomized to undergo pneumoperitoneum with CO2 (n=16), helium (n=16), argon (n=16), or air (n=17), or to act as controls without insufflation (n=17).ResultsThe growth of cancer nodules on the liver 14 days after surgery was greater in mice following insufflation with CO2 (p<0.01), helium (p<0.01), argon (p=0.01), and air (p=0.07) than in control mice. No significant differences were found between the four insufflation groups in the growth of liver metastases.ConclusionThese results suggest that insufflation plays an important role in the development of liver metastases but that the choice of gas may not affect their growth.

The influence of different insufflation pressures during carbon dioxide pneumoperitoneum on the development of pulmonary metastasis in a mouse model

AbstractBackground: The effects of different insufflation pressures on the development of pulmonary metastasis was investigated in a mouse laparoscopy model. Methods: BALB/C mice intravenously inoculated with colon 26 cells were randomized to one of five treatment groups (10 mice per group): pneumoperitoneum at different pressures of 5, 10 or 15 mmHg; full laparotomy for 60 min; or anesthesia control. Cancer nodules on the lung surface 19 days postoperatively were compared between groups. Results: (a) As compared with the control group, pneumoperitoneum at 10 and 15 mmHg and laparotomy enhanced the growth of pulmonary metastases (p < 0.01). (b) The growth of metastases also was greater in laparotomy group mice than in mice undergoing pneumoperitoneum at 5 and 10 mmHg (p < 0.05). Conclusions: These results suggest that the effects of different insufflation pressures on the growth of pulmonary metastases are not identical, and that pneumoperitoneum with high pressure may promote pulmonary metastases similar to those with laparotomy.

Doxorubicin treatment induces tumor cell death followed by immunomodulation in a murine neuroblastoma model.

Chemotherapy of malignant tumors induces tumor cell death. Numerous antitumor agents induce apoptosis of tumor cells, which are subsequently engulfed by phagocytes, initiating an immune reaction. The induction of immunogenic cell death by antitumor agents may be advantageous for antitumor immunity. The purpose of this study was to determine whether doxorubicin is capable of inducing an immunogenic reaction in murine neuroblastoma cells. The murine neuroblastoma cell line (neuro-2a cells) was cultured in a medium containing doxorubicin or cisplatin (CDDP), and induction of cell death was confirmed by cell viability assays. Cluster of differentiation (CD)8α+ lymphocytes were co-cultured with neuro-2a cells that had died following treatment with either doxorubicin or CDDP, and CD11b+ spleen cells or bone marrow-derived dendritic cells (BM-DCs) were added to the culture. Proliferation of CD8α+ lymphocytes and interferon (IFN)-γ production were evaluated. When CD8α+ cells were co-cultured with doxorubicin-treated neuro-2a cells and BM-DCs, CD8α+ cells reacted to anti-CD3/CD28 antibody stimulation, proliferated and increased IFN-γ production. IFN-γ production was more effectively promoted by co-culture with doxorubicin-treated neuro-2a cells than by co-culture with CDDP-treated neuro-2a cells. These findings suggest that doxorubicin is capable of inducing immunogenic cell death in neuroblastoma cells, and thus has an immunological advantage for chemotherapy of neuroblastoma compared with CDDP. BM-DCs are considered to be the key antigen-presenting cells in the immune reaction following the induction of immunogenic neuroblastoma cell death and phagocytosis.

Rare case of disseminated neonatal zygomycosis mimicking necrotizing enterocolitis with necrotizing fasciitis.

A set of monochorionic male twins presented with intestinal perforation. The smaller twin was diagnosed with necrotizing enterocolitis followed by sepsis, disseminated intravascular coagulation, and necrotizing fasciitis of the abdominal wall. The infant died on the fourth day after surgery, 16 days after birth. Surgical specimens and autopsy revealed a disseminated zygomycotic infection. Gastrointestinal zygomycosis followed by necrotizing fasciitis in premature infants is a rare condition and mimics necrotizing enterocolitis clinically. Necrotizing fasciitis after gastrointestinal zygomycosis in premature infants is considered a poor prognostic sign. Gastrointestinal zygomycosis should be considered in the differential diagnosis of necrotizing enterocolitis.

Muscle Strength and Walking Ability After Laparoscopic Hernioplasty Versus Conventional Repair

Abstract.Purpose: We examined muscle strength and walking ability after hernia repair to compare the effects of laparoscopic hernioplasty and conventional repair. Methods: Twenty-seven patients with primary inguinal hernias were randomly divided into two groups according to the surgical procedure: 15 patients were treated with laparoscopic hernioplasty and 12 with conventional repair. Two types of muscle testing around the inguinal region, one by manual examination and one using a musculator, were done preoperatively and 1 week postoperatively. Walking exercise tests were performed at the same time as muscle testing. Results: Manual examination showed that the postoperative muscle strength of the iliopsoas muscle was decreased in six patients from the conventional repair group, but not in any of those from the laparoscopic hernioplasty group. The musculator showed decreased strength of the iliopsoas muscle after conventional repair, but not after laparoscopic hernioplasty. The walking exercise test showed that conventional hernia repair influenced walking. Conclusion: A decline in muscle strength of the iliopsoas muscle and walking ability was evident after conventional repair, but not after laparoscopic hernioplasty. Thus, laparoscopic hernioplasty is superior to conventional repair from the perspective of muscle testing and walking ability.

Gallbladder volvulus in a child with mild clinical presentation

Gallbladder volvulus in children is rare. Pre-operative diagnosis is considered difficult because of the nonspecific symptoms and inflammatory blood analysis findings. Sometimes diagnosis is confirmed at laparotomy. Many reports mention that the chief complaints of this disease are sudden and severe abdominal pain. We report a case of gallbladder volvulus in a boy with mild clinical symptoms and laboratory data of nonspecific inflammation. A reconstructed coronal CT abdominal view showed clearly the gallbladder torsion. Laparoscopic cholecystectomy was performed and postoperative course was uneventful. Recent reports have suggested the effectiveness of MRI. This case highlights the utility of a reconstructed coronal view of abdominal CT in successful pre-operative diagnosis for gallbladder volvulus in children.

Umbilical approach using the sliding-window method to avoid a large abdominal incision: report of two pediatric cases

The sliding-window method of minimally invasive abdominal surgery was introduced in adults. Here, we describe its use in children. Two girls below age 12 underwent minilaparotomy by this method through umbilical incisions. Conditions requiring the operations were a large omental cyst in one patient and splenomegaly and cholelithiasis in the other. Postoperative courses were uneventful, and cosmetic results were acceptable. An umbilical approach using the sliding-window method is a practical way to avoid large abdominal incisions in pediatric patients undergoing major abdominal surgery.

Anorectal Agenesis with a Rectourethral Fistula Diagnosed in an Adult: Report of a Case

We report an unusual case of anorectal agenesis with a rectourethral fistula diagnosed in a 48-year-old man. The patient presented after noticing hematuria, although he had been aware of urinary leakage from his colostomy with occasional fecal urine for about 4 years. He had had a double-barrel colostomy created soon after birth for an imperforate anus, with revision at the age of 4 years to correct a prolapse of the stoma, but his malformation had never been repaired. We performed a physical examination, which did not reveal a perineal fistula, but urethrocystography demonstrated high anorectal agenesis with a rectourethral fistula. Thus, we resected the rectourethral fistula and created an end-colostomy. The patient had an uneventful postoperative course, and was discharged in good health on postoperative day 19. To our knowledge, this is the oldest patient to be diagnosed with anorectal agenesis and undergo resection of a rectourethral fistula.

Chemoimmunotherapeutic effect of combined treatment with ex vivo generated antigen-presenting immune cells and conventional antitumor agents in a mouse neuroblastoma model

PURPOSE Combining antitumor immunotherapy with conventional intensive multimodal therapy may be considered for advanced neuroblastoma. We investigated combination therapy with ex vivo generated immunostimulatory cells and intraperitoneal doxorubicin. METHODS Immunogenic death of neuro-2a neuroblastoma cells was induced by doxorubicin or cisplatin (negative control). Mouse bone marrow cells were cultured with granulocyte-macrophage colony-stimulating factor, followed by addition of doxorubicin-killed neuro-2a cells with or without interleukin-4 and/or CpG-oligodeoxynucleotide to induce immunostimulatory cells. CD8α+ lymphocytes were cocultured with killed neuro-2a cells and immunostimulatory cells, and interferon-γ was measured in the supernatant. Furthermore, female A/J mice were injected with viable neuro-2a cells, followed by immunostimulatory cells and doxorubicin. Then intraabdominal tumor nodules were evaluated. RESULTS Bone marrow-derived immunostimulatory cells only promoted interferon-γ production by CD8α+ lymphocytes after first being stimulated by doxorubicin-killed neuro-2a cells and interleukin-4, followed by CpG-oligodeoxynucleotide. These cells had a surface antigen expression profile compatible with activated dendritic cells and suppressed tumors in mice intravenously injected with neuro-2a cells. Despite a similar surface antigen profile, the in vivo antitumor effect was stronger after injection of immunostimulatory cells induced by doxorubicin-killed neuro-2a cells compared with cells induced by cisplatin-killed neuro-2a cells. Moreover, interferon-γ production was greater when CD8α+ lymphocytes were cocultured with doxorubicin-killed neuro-2a cells and immunostimulatory cells rather than with cisplatin-killed cells. CONCLUSION Cells with antitumor activity can be induced from bone marrow cells. Combining such cells with doxorubicin may activate antitumor immunity in tumor-bearing mice. Interactions between induced immunostimulatory cells and conventional chemotherapy might be important for antitumor immunity.