Shinji Hato

Attenuation of Liver and Lung Injury after Hepatic Ischemia and Reperfusion by a Cytokine-Suppressive Agent, FR167653

Background: Hepatic ischemia/reperfusion (I/R) injury is an important clinical problem and leads to the release of the proinflammatory cytokines, TNF-α and IL-1. These cytokines play important roles in the induction of polymorphonuclear neutrophil (PMN) activation and infiltration, and induce not only localized hepatic injury but also remote organ injury, especially pulmonary injury. Using a total hepatic ischemia model in rats, we tested our hypothesis that suppression of TNF-α and IL-1 by FR167653 ameliorates I/R injury in the liver and lung. Methods: Male Wistar rats, weighing 240–280 g, were divided into 3 groups, an FR group, a control group and a sham group. In the FR group, FR167653 (1 mg/kg/h) was administered continuously to the animals for 30 min prior to the onset of ischemia and for 2 h after reperfusion. The control group received normal saline. A porto-systemic shunt was placed between the cecal branch of the portal vein and the jugular vein, and total hepatic ischemia was produced for 90 min. The sham group was treated with placement of the porto-systemic shunt only. The 1-week survival rate, liver enzyme activity, hepatic tissue blood flow (HTBF), cytokine mRNA expression, myeloperoxidase (MPO) activity and histological results were studied. Results: The 1-week survival rate and HTBF were significantly higher in the FR group than in the control group. Serum AST, ALT, and LDH levels were significantly lower in the FR group at 30 min, 1 h and 3 h after reperfusion. MPO levels in liver and lung tissue were also significantly lower in the FR group. The expression of IL-1β mRNA remarkably decreased up to 6 h after reperfusion in the FR group. Conclusions: We concluded that the inflammatory cytokines, IL-1β, play important roles in hepatic I/R injury. FR167653 might ameliorate I/R injury and be useful in liver surgery with ischemia.

Abnormal fluorine-18-fluorodeoxyglucose uptake in benign esophageal leiomyoma

A benign esophageal leiomyoma with abnormally increased fluorine-18-fluorodeoxyglucose uptake on positron emission tomography (PET) was resected thoracoscopically. The tumor, of which the maximum standardized uptake value of the lesion was 4.7, was well defined and 38 mm in diameter. Neither mitotic activity nor degeneration was found histologically; and immunoreactivity for CD34, CD117, MIB-1, and glucose transporter-1 was negative immunohistochemically. A diagnosis of gastrointestinal stromal tumor was ruled out by an oncogenic kinase gene mutation study. This case cautions against PET-dependent evaluation for malignant potential of esophageal submucosal tumors.

A rare primary diaphragmatic hemangioma successfully treated by laparoscopic surgery: Report of a case

This report presents a very rare case of a primary diaphragmatic hemangioma, which was successfully treated by laparoscopic surgery. A 64-year-old man with a left diaphragmatic mass without any significant symptoms was treated by laparoscopic surgery and thus was diagnosed to have a diaphragmatic hemangioma following a pathological examination. Laparoscopic treatment in the deep and narrow abdominal spaces such as the diaphragmatic region is very useful as a less invasive treatment, as well as providing an excellent observation from which to make an accurate diagnosis.

Intrathoracic vagal nerve schwannoma preoperative diagnosis is correct because of clinical and characteristic ct findings —A case report and review of the literature—

A 60-year-old man was operated with the clinical diagnosis of intrathoracic vagal nerve schwannoma because of characteristic CT findings and no symptom of neurofibromatosis. Thoracoscopic surgery was performed and it was confirmed pathologically. Intrathoracic vagal nerve tumor is rare, so preoperative diagnosis seems to be difficult. We review the intrathoracic vagal nerve tumors reported in Japan (52 cases of schwannoma and 9 cases of neurofibroma), and analyzed the tumor location, furthermore, the relationship of neurofibromatosis and schwannoma and neurofibroma on vagal nerve tumor.