Richiko Beppu

Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy

m A 79-year-old woman was admitted to our hospital with dysphagia and chest pain that she had experienced for 20 years (Eckardt score: 7).1 A barium swallow examination howed a corkscrew appearance characteristic of diffuse sophageal spasm (DES) (Fig. 1A). Esophageal manomery showed simultaneous and multiple peaked contracions associated with more than 20% of wet swallows, hereas mean the simultaneous contraction amplitude as over 30 mm Hg (Fig. 1B). Therefore, the patient eceived a diagnosis of DES.2,3 With no response after 6 months of medical therapy with calcium channel blockers, a peroral endoscopic myotomy (POEM) was performed4 (Fig. 2A-C) with approval from the institutional review board of Fukuoka University Hospital and with the written informed consent of the patient. In this case, simultaneous contractions were observed in the upper thoracic esophagus. A long esophagomyo-

Opposite effects of thrombospondin-1 via CD36 and CD47 on homotypic aggregation of monocytic cells.

Thrombospondin-1 (TSP-1), an extracellular matrix protein, has a multimodular structure and each domain specifies a distinct biological function through interaction with a specific ligand. In this study we found that exogenously added TSP-1 inhibits phorbol myristate acetate (PMA)/LPS-induced homotypic aggregation of human monocytic U937 cells, whereas the 70-kDa fragment of TSP-1 generated by the proteolytic cleavage of the intact molecule promotes the homotypic aggregation. The aggregation was also inhibited by anti-CD47 mAb or the 4N1K peptide, of which sequence is derived from the CD47-binding site of TSP-1 and absent in the 70-kDa fragment. In contrast, the augmented cell aggregation by the 70-kDa fragment was hampered by anti-CD36 mAb or antibody against the CD36-binding site of TSP-1. The cell aggregation of U937 cells was completely blocked, even in the presence of the 70-kDa fragment, by mAb against leukocyte function associated antigen-1 (LFA-1) or intercellular adhesion molecule-1 (ICAM-1). We therefore propose that TSP-1 may regulate LFA-1/ICAM-1-mediated cell adhesion of monocytes/macrophages by either the inhibitory effect through CD47 or the promoting effect through CD36 depending on which domain/fragment is functional in a given biological setting.

Soluble thrombospondin-1 suppresses T cell proliferation and enhances IL-10 secretion by antigen presenting cells stimulated with phytohemagglutinin.

Thrombospondin-1 (TSP-1) is different from other components of the extracellular matrix (ECM) regarding its production and distribution. TSP-1 is considered to be released in large quantity in inflammatory sites and exogenously added TSP-1 does not bind to preformed ECM but instead binds to cells. To define the physiological role of TSP-1 in the immune system, we studied the influence of TSP-1 on the in vitro culture of T cells and antigen-presenting cells (APCs) in the presence of phytohemagglutinin. By adding soluble TSP-1 to the culture, T cell proliferation was suppressed and anti-inflammatory cytokine IL-10 secretion by APCs was enhanced. The enhanced expression of IL-10 was also demonstrated at the mRNA level by RT-PCR using multiprimer kit for cytokines. The suppression of T cell proliferation and the enhancement of IL-10 secretion with soluble TSP-1 was inhibited by adding RGDS peptide or heparin. This result indicates that the effect of soluble TSP-1 may be caused by binding to its ligand(s) on T cells and/or APCs, resulting in transducing regulatory signals to the cells or disturbing appropriate interaction between T cells and APCs. We therefore propose that TSP-1 is an immunosuppressive modulator which may play a role in inflammatory sites.

Early Start of Chemotherapy after Resection of Primary Colon Cancer with Synchronous Multiple Liver Metastases: A Case Report

The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary colorectal cancer and synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. Here, we present a case in which combination chemotherapy with capecitabine and oxaliplatin (XELOX) was started within 1 week after a right hemicolectomy for synchronous multiple liver metastases. To our knowledge, this is the first report of the start of chemotherapy, involving treatments such as folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and XELOX, within 1 week after a colorectal cancer operation with anastomosis. The findings suggest possible changes in the start time of chemotherapy after surgery in the future.

Efficacy and safety of endoscopic submucosal dissection under general anesthesia.

AIM To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) under general anesthesia. METHODS From January 2011 to July 2014, 206 consecutive patients had undergone ESD under general anesthesia for neoplasms of the stomach, esophagus, and colorectum were enrolled in this retrospective study. The efficacy and safety of ESD under general anesthesia were assessed. RESULTS The en bloc resection rate of esophageal, gastric, and colorectal lesions was 100.0%, 98.3%, and 96.1%, respectively. The complication rate of perforation and bleeding were 0.0% and 0.0% in esophageal ESD, 1.7% and 1.7% in gastric ESD, and 3.9% and 2.0% in colorectal ESD, respectively. No cases of aspiration pneumonia were observed. All complications were managed by conservative treatment, with no surgical intervention required. CONCLUSION With the cooperation of an anesthesiologist, ESD under general anesthesia appears to be a useful method, decreasing the risk of complications.

Long‐term outcome of peroral endoscopic myotomy for achalasia treatment in a 9‐year‐old female patient

Achalasia is a primary motility disorder with incomplete lower esophageal sphincter relaxation; it has an annual incidence of 0.11 cases per 100 000 children. Peroral endoscopic myotomy (POEM) is a new endoscopic treatment method for achalasia. Reports about POEM in pediatric patients are rare. We herein report the case of a 9‐year‐old female patient with achalasia who underwent POEM. The patient underwent endoscopic balloon dilatation because medication was not effective at a previous hospital; however, endoscopic balloon dilatation was not effective either. She then underwent successful POEM upon admission at our hospital. The patient was symptom‐free at 2 years postoperatively with no signs of esophagitis in the absence of proton‐pump inhibitor therapy.