Masami Mitani

Expression of survivin in esophageal cancer: Correlation with the prognosis and response to chemotherapy

Survivin, a new member of the inhibitor‐of‐apoptosis (IAP) family, has been reported to be expressed in many cancers but not in differentiated normal tissue. Its expression in esophageal cancer, however, has not been reported. We investigated 51 esophageal cancers and their adjacent normal epithelial tissues for mRNA expression of survivin by RT‐PCR. The survivin expression in esophageal cancer tissue was significantly higher than that in normal esophageal tissue (0.211 ± 0.226 vs. 0.057 ± 0.135, p < 0.0001). pN4 tumors had significantly higher survivin expression than the pN0‐3 tumors (p = 0.0093). Fourteen patients with advanced esophageal cancer had received chemotherapy prior to surgery. The survivin expression in the cancer tissue in patients who achieved a partial response (PR) was significantly lower than that in patients with no change (NC) and in patients with progressive disease (PD; 0.099 ± 0.134 vs. 0.320 ± 0.222, p = 0.0434). The median survival for patients with high survivin expression (9.0 months) was less than that for patients with low survivin group expression (30.0 months, p = 0.0023). Survivin expression was one of the significant predictors of survival on univariate analysis (hazard ratio 2.471; 95% confidence interval 1.104‐5.533). The results suggest that survivin expression may provide prognostic information in patients with esophageal cancer.

Use of omentum for mediastinal tracheostomy after total laryngoesophagectomy

BACKGROUND Carcinomas of the cervicothoracic esophagus frequently invade the trachea and complete removal of the tumor often requires mediastinal tracheostomy. Traditionally, this surgical management was associated with high morbidity and mortality. Several types of myoctaneous flaps have been used for mediastinal tracheostomy to reduce the complication. We present our experience with a new technique for construction of mediastinal tracheotomy after total laryngoesophagectomy and reconstruction with the stomach. METHODS The anterior chest wall was amply resected and the distal end of the trachea was placed low between the superior vena cava and aortic arch. We mobilized the entire omentum with the stomach and brought them up to the neck through the posterior mediastinum. The omentum was put around the trachea, main arteries, and the anastomosis. RESULTS Seven mediastinal tracheostomies were performed using this method. There was no hospital death. Complications included respiratory failure (2 patients) and pyothorax (1 patient). Anastomotic leakage and inominate artery rupture were not experienced. Postoperative survival was disease dependent. All patients were discharged with satisfactory oral food intake, good airway condition, and excellent cosmetic appearance. CONCLUSIONS We suggest the use of the omentum as a simple and reliable technique in constructing mediastinal tracheostomy following total laryngoesophagectomy for cervicothoracic esophageal cancer.

Significance of Plasma Thymosin α1 Measurements in Gastric Cancer Patients

Abstract. Thymosin α1 is a cleavage product of prothymosin α. Expression of prothymosin α increases during cell proliferation. Thymosin α1, measurable in plasma, may be an indicator of cell proliferation especially if a cancer is present. In this report we investigated the relation between the clinical behavior of gastric cancer and the plasma thymosin α1 level. Plasma thymosin α1 was measured in 52 gastric cancer patients using a newly developed radioimmunoassay. Twenty-one tumors and lymph nodes were examined for thymosin α1 using immunohistochemistry. The plasma thymosin α1 level was higher in gastric cancer patients than in normal volunteers; and it was higher in patients with lymph node involvement than in those with negative nodes. Immunohistochemical study of thymosin α1 showed positivity in 52% of gastric cancers and 100% of lymph node metastasis. We concluded that a high level of plasma thymosin α1 suggests aggressive behavior of a gastric cancer, such as lymph node involvement.

The effectiveness of palliative resection for advanced esophageal carcinoma: Analysis of 24 consecutive cases

Abstract.Purpose: In some patients who already have advanced esophageal cancer at the time of presentation, symptoms like the inability to eat, and complications such as bronchoesophageal fistula are so debilitating that palliative resection may be beneficial. However, resection of the esophagus is associated with significant risk, and whether this operation should be performed for palliation remains controversial. Because few reports have been published on this subject, we retrospectively analyzed 24 patients with esophageal cancer who underwent palliative resection.Methods: Esophageal resection was performed with palliative intent in 12 patients and with curative intent in another 12 who were left with residual cancer.Results: There was no operative death. All of the ten patients who had been unable to eat preoperatively were able to eat after the operation, and four patients with a life-threatening bronchoesophageal fistula were free of symptoms after the operation. Two patients died in hospital during the postoperative chemotherapy but the other 22 were discharged. The mean survival period was 264 days.Conclusions: With improved postoperative care, the risk of palliative esophageal resection is no longer considered unacceptable.

Effect of Whole Body Hyperthermia on Ischemia and Reperfusion Injury of Rat Intestine: Real-Time ATP Change Studied Using 31P-MRS

We studied the effect of hyperthermia pretreatment on subsequent small intestinal ischemia and reperfusion (I/R) injury in the rat. Systemic hyperthermia has been reported to induce heat shock proteins (HSPs) in several organs [1-6]. We examined the expression of HSP72 in the small intestinal mucosa using Western blotting and immunohistochemistry. We monitored energy metabolism using magnetic resonance spectroscopy continuously during a 60-min ischemia and the following 120 min of reperfusion. Expression of HSP72 in the small intestine was significantly increased at 6–8 h after hyperthermia. Intestinal ischemia was induced by clamping the superior mesenteric artery. Heating of the rat conferred substantial resistance to the I/R injury. In the untreated rats, β-ATP decreased during ischemia (37.1 ± 15.5% of the pre-ischemic value) and recovered on reperfusion, but reached only ∼50% of the pre-ischemic value after 120 min of reperfusion. However, β-ATP in the pretreated rats was maintained during ischemia at significantly higher levels and on reperfusion reached ∼80% of the pre-ischemic value. These results indicate that hyperthermia protects the rat intestine from the I/R injury by unknown mechanisms which may include the induction of HSPs.

Mesenteric venous thrombosis associated with protein C deficiency

Abstract: An 83-year-old man had gradually worsening abdominal pain and vomiting. Laparotomy revealed segmental intestinal infarction resulting from thrombosis in the superior mesenteric vein. Necrosed intestine was resected and anastomosis was performed successfully. The patient was anticoagulated with intravenous heparin and nafamostat mesilate followed by oral aspirin. He recovered rapidly. Blood chemistry revealed protein C deficiency, while protein S and antithrombin III levels were normal. Laboratory evaluation of these proteins may help define the cause of mesenteric venous thrombosis.

Gastroesophagostomy after proximal gastrectomy using a double stapling technique1

Proximal gastrectomy is preferred for early gastric cancer in the upper part of the stomach to preserve the function of the stomach after surgery, 1,2 Gastroesophagostomy is one of the common reconstructional methods for proximal gastrectomy, but without using an antireflux procedure, this method results in a high incidence of reflux esophagitis, 3 Some modified techniques have been reported to avoid these problems. 4-6 We report a new method of gastroesophagostomy using a double stapling technique after proximal gastrectomy. This procedure is simple and safe, and seems to confer functional antireflux mechanism on the newly formed gastroesophageal junction.

A Case of Neutropenic Enterocolitis Following Aplastic Anemia.

症例は75歳の男性で, 再生不良性貧血の経過中に右下腹部痛, 発熱を訴え来院した. 右下腹部に圧痛, 反跳痛を認め, 腹部CT検査, 超音波検査にて回盲部の腫脹腸管を認めたため, neutropenic enterocolitisを疑い緊急開腹した. 画像検査でみられたごとく, 回腸末端より上行結腸まで腫脹しており, 盲腸は壊死様の色調であったため回盲部切除術を施行し, 自動吻合器を使用し端側に吻合した. 術後は抗生剤, G-CSFなどを使用し好中球数の増加とともに順調に回復した.本症は好中球減少時といった限られた状況で発症するため, 該当例においては腹痛, 発熱, 下痢などの臨床症状をみた場合に本症を念頭におき, 早期に対処することが望まれる.