Nobuhiro Morinaga

Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy.

BACKGROUND Postoperative ileus limits early hospital discharge for patients who have undergone laparoscopic procedures. Sham feeding has been reported to enhance bowel motility. Here, the effect of gum chewing is evaluated as a convenient method to enhance postoperative recovery from ileus after laparoscopic colectomy. STUDY DESIGN A total of 19 patients who underwent elective laparoscopic colectomy for colorectal cancer participated in the study. Each patient was randomly assigned to one of two groups: a gum-chewing group (n = 10, mean age 58.6 years, range 50 to 71 years) or a control group (n = 9, mean age 60.6 years, range 45 to 80 years). The patients in the gum-chewing group chewed gum three times a day from the first postoperative AM until oral intake. The times of the first passage of flatus and defecation were recorded precisely. RESULTS The first passage of flatus was seen, on average, on postoperative day 2.1 in the gum-chewing group and on day 3.2 in the control group (p < 0.01). The first defecation was 2.7 days sooner in the gum-chewing group (postoperative day 3.1) than in the control group (5.8 days; p< 0.01). All patients tolerated gum chewing on the first operative AM. The postoperative hospital stays for the gum-chewing and control groups were 13.5+/-3.0 days and 14.5+/-6.1 days, respectively. CONCLUSIONS Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility. Gum chewing should be added as an adjunct treatment in postoperative care because it might contribute to shorter hospital stays.

Circulating soluble Fas ligand in patients with gastric carcinoma.

The Fas/Fas ligand (FasL) system is involved in cancer cell death induced by the immune system. Most of the tumors may escape the host immune attack by imitating themselves as immune‐privileged sites by overexpressing FasL. FasL is synthesized as a membrane‐bound protein that can be cleaved to the soluble isoform (sFasL). The objectives of this work were to determine whether the serum concentrations of sFasL in patients with gastric carcinoma were correlated with clinicopathologic features and survival rates.

Animal model of para-aortic lymph node metastasis

The purpose of this study was to establish a model of experimental lymph node metastasis by intra-rectal implantation of human cancer cells in nude mice. Four types of human cancer cell lines (TE-1, MKN-45, HT-29, and MIAPaca-2) were investigated. Tumor cells suspended in Matrigel were injected into the submucosal layer of the rectum. All cancer cell lines produced locally aggressive rectal tumors and, subsequently, para-aortic lymph node metastasis. We were unable to produce other distant metastases in the dying state in such locations as the liver, spleen, lung, and peritoneum. However, using this method, we were able to evaluate the effect of the anti-cancer agent uracil/tegafur (UFT) on primary tumor growth and lymph node metastasis. Oral intake of UFT significantly suppressed implanted tumor volume and inhibited lymph node metastasis. We expect that the process of lymph node metastasis shown in this model will be studied as an experimental model of lymph node metastasis simulating human cancers.

Laparoscopic transgastric tumor-everting resection of the gastric submucosal tumor located near the esophagogastric junction.

Local resection of the stomach is suitable for the treatment of submucosal tumors (SMT). However, it cannot be easily performed laparoscopically on tumors located near the esophagogastric junction. We have developed a new technique, which is called transgastric tumor-everting resection. To identify the location of the SMT laparoscopically without an oral endoscope, an Indiana ink mark was made prior to the operation. The SMT was everted from the gastrotomy and held by the Mini Loop Retractor II. The gastric mucosa could be observed from gastrotomy, allowing us to confirm that the staple line would not cause deformity of the esophagogastric junction. The lesion was then resected, and the gastrotomy was closed simultaneously using the Endo-GIA Universal. This technique is easy, safe, and useful for the laparoscopic resection of gastric SMTs located on the greater curvature or anterior wall of the fornix, near the esophagogastric junction.

Rosai-Dorfman disease of the colon presented as small solitary polypoid lesion

Rosai-Dorfman disease (RDD) was formerly known as “sinus histiocytosis with massive lymphadenopathy”, and cases involving the gastrointestinal tract are rare. We present a case of pure extranodal RDD, resected as a polypoid lesion in colonoscopic study. The patient was a 62-year old woman with a history of sigmoidectomy for unexplained peritonitis. Microscopic study of the polypoid lesion showed the submucosal mass with histological and immunological features of RDD. The whole body computed tomography revealed neither lymphadenopathy nor tumor-like mass.

Description of pylorus-preserving pancreaticoduodenectomy in elderly patients.

BACKGROUND/AIMS The aim of this paper is to examine the safety and feasibility of pylorus-preserving pancreaticoduodenectomy in elderly patients. METHODOLOGY The study population consisted of 40 consecutive patients. They were divided into two groups: Group A (<75 years old) and Group B (=75 years old). Reconstruction with a vertical duodenojejunostomy and internal pancreatic drainage with an omental wrapping was performed on the patients in both the groups. RESULTS Less time was required to complete the operations in Group B (280±20min) than in Group A (386±88min; p=0.0006). Intraoperative blood loss in Group B was significantly lesser (365±109g) than that in Group A (629±249g; p=0.0026). No statistically significant difference was observed between both groups, in terms of the length of time required until food intake resumed and length of hospital stay. Although the rate of postoperative complication was higher in Group B (10.0%), no statistically significant difference was observed. CONCLUSIONS Pylorus-preserving pancreaticoduodenectomy with a vertical duodenojejunostomy and internal pancreatic drainage with an omental wrapping seems safe and can be performed on elderly patients without a significant risk of complications.

Liver Hemorrhage Due to Idiopathic Peliosis Hepatis Successfully Treated With Hepatic Artery Embolization

Peliosis hepatis is an extremely rare condition that may cause fatal hepatic hemorrhage and liver failure. We report a case of liver hemorrhage due to idiopathic peliosis hepatis. A 60-year-old woman was admitted to our hospital with slight right hypochondriac pain. She went into hemorrhagic shock, and computed tomography (CT) showed multiple low-density areas in the right liver with massive subcapsular blood collection. Selective transfemoral arteriography of the celiac artery revealed no signs of vascular malformation or tumor stain, but showed signs of pooling in the right posterior segmental artery. The artery was embolized with particles of gelatin sponge, and hemostatic control was successful. Although peliosis hepatis is extremely rare, the diagnosis is significant because of its urgent clinical status, and transarterial embolization is a useful and minimally invasive procedure for liver hemorrhage due to peliosis hepatis.

Increased thermosensitivity of mouse colorectal carcinoma cells transfected with human FUT1 gene

The thermal responses of mouse colorectal carcinoma cells were investigated in the wild type cells and the transfected cells with human FUT1 gene which encodes alpha 1,2fucosyltransferase. The heat sensitivity was observed to increase in the FUT1 gene transfected cells and the effect of hyperthermia at 44 degrees C on these cells was demonstrated to be significant (P<0.001) to the wild type cells even though no remarkable difference in the expression of the heat shock protein, Hsp70 was found in these cells. Thus the expression of alpha 1,2fucosylated antigens seemed to increase the heat sensitivity in mouse colorectal carcinoma cells.

Ten-Year Survival of a Patient Treated with Stereotactic Gamma Knife Radiosurgery for Brain Metastases from Colon Cancer with Ovarian and Lymph Node Metastases: A Case Report.

Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

A novel model for invasion of cancer cells using the submucosal layer of the human stomach.

An in vitro model for studying the invasion mechanism of cancer cells was established using the submucosal layer of the human stomach. Submucosa prepared from a surgical specimen was maintained in an organ culture. The cytoarchitecture of the cultured submucosa remained well preserved; viability remained for over 2 weeks. When human gastric cancer cell lines MKN45, MKN74, and Kato III were seeded onto the submucosal slices, cancer cells of MKN45 and KATO III invaded the submucosa 3 days after inoculation. However, MKN74 cells were not seen in the submucosal slices. Our invasion model, which mimics the in vivo conditions of the submucosa of human stomach, may make it possible to analyze actual events of human gastrointestinal malignant cell invasion in normal submucosa in vitro. The usefulness of our invasion model lies in the choice of the submucosal layer of the human stomach as the host tissue. The histarchitecture of the submucosal slices indicates that the model has potential for studies of the mechanism of interactions between carcinoma cells and host tissue similar to interactions that may occur in vivo. Moreover, this method allows the continuous microscopic observation of cells within the living submucosa. Using this model, a novel approach to controlling the local invasion of tumor cells may lead to a promising, radical cure for these intractable neoplasms. Our model system is an in vitro model that is facile, inexpensive, and experimentally manipulative.