Suguru Watabe

Laparoscopic cholecystectomy after coronary artery bypass grafting using the right gastroepiploic artery: Report of a case

Abstract.A laparoscopic cholecystectomy (LC) was successfully performed on a 61-year-old man who had undergone coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). He complained of right hypochondralgia 20 days after CABG. Gallstones were diagnosed and a cholecystectomy was performed 9 months after CABG. Under general anesthesia, the operation was performed using a pneumoperitonium. When a laparoscope was inserted, the RGEA pedicle could be clearly recognized. The pedicle obstructed the operating field and made the working space narrower than usual. No ST changes on the electrocardiogram were seen during LC, especially during the initiation of pneumoperitonium, the insertion of the ports, or when retracting the gallbladder. The postoperative course was uneventful. To avoid complications, care should be taken not to stretch the RGEA pedicle during LC, and careful monitoring of the electrocardiogram is also necessary. It is difficult to view the operating field and the RGEA pedicle together. It is therefore better to insert another laparoscope for concomitant monitoring of the RGEA pedicle.

Correlation between expression of orotate phosphoribosyl transferase and 5-fluorouracil sensitivity, as measured by apoptosis index in colorectal cancer tissue

AbstractBackground. 5-Fluorouracil remains a key drug in the treatment of colorectal cancer, and the development of a simple and effective test for selecting patients likely to benefit from postoperative adjuvant chemotherapy is an important objective. Aim of the Study. This study aimed to clarify the feasibility of measuring apoptotic cell rate (AI%) in tumor after short-term oral 5-fluorouracil administration prior to surgery with the objective of establishing a simpler method to test for sensitivity. Methods. Forty-five colorectal cancer patients were allocated to two groups, and 21 patients were given oral 5-FU for 3 d prior to surgery. The AI% in surgical specimen, detected by TUNEL staining, was compared in the 5-FU-loaded and control groups. The correlation of AI% with 5-FU metabolic enzyme mRNA levels in tumor was also evaluated. Results. The AI% was significantly higher in the tumor tissue of patients receiving 5-FU than in the control group (p<0.0005). Although insignificant, thymidylate synthase mRNA level and orotate phosphoribosyl transferase mRNA demonstrated a weak positive correlation with AI%. Conclusions. The AI% measurement in tumor tissue following a 5-FU oral load for 3 d prior to surgery was feasible. It remains to be elucidated if this measurement as a new 5-FU sensitivity test reflects the prognosis with 5-FU-based postoperative adjuvant chemotherapy.

A Case of Benign Bile Duct Stenosis caused by a Clip Two Years after Laparoscopic Cholecystectomy

腹腔鏡下胆嚢摘出術 (laparoscopic cholecystectomy; 以下, LC) 後のクリップによる良性胆管狭窄は比較的まれである. 今回, LCの2年後に良性胆管狭窄を来した1例を経験した. 症例は68歳の男性で, 平成17年5月に胆石症でLCを施行. 平成19年5月に褐色尿と体重減少で受診. 黄疸と肝機能障害があり入院. 腹部CTと磁気共鳴膵胆管撮影検査で中部胆管狭窄が認められた. 直接胆管造影検査ではLC時のクリップ近傍で狭窄が認められた. 腫瘍マーカーに上昇はなく, 胆汁細胞診はclass I.以上より, 胆管癌を疑い平成19年6月手術を施行. 狭窄部を含む胆管を切除. 病理組織学的検査ではinflammatory changeであり, 胆管を圧排していた壁外組織中にLC 時のクリップが認められた. 金属クリップの合併症は増加傾向にあり, 今後は吸収性物質を使用するなど, 金属クリップを使わない工夫が重要と思われる.

Feasibility of measuring 5-fluorouracil catabolic potential by oral loading.

The efficacy of 5-fluorouracil (5-FU) treatment and the incidence of adverse events differ among patients and depend to some extent on individual variations in drug catabolism. This feasibility study aimed to determine the optimum conditions for a 5-FU oral load test, which would allow the simple evaluation of individual differences in 5-FU catabolism. Patients with colon cancer were given oral 5-FU (200 mg/day) for 3 days (n = 36) or a single 100 mg dose (n = 14). Serum concentrations of uracil, dihydrouracil, 5-FU and 5-fluoro-5, 6-dihydrouracil were measured before and after 5-FU administration. The results suggested that a decline in 5-FU metabolism was associated with continuous administration and increasing age. We conclude that a continuous load of 5-FU is necessary in order to predict the efficacy and side-effects of the drug. The 3-day regimen, with its ease of administration, merits further study to assess its possible clinical application.

CLINICOPATHOLOGICAL STUDY OF UNSUSPECTED GALLBLADDER CANCER DIAGNOSED AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Background:  Laparoscopic cholecystectomy (LC) has become a common treatment for benign gallbladder diseases. However, this method has not been established for gallbladder cancer.

A Case of Esophageal Cyst Excised Successfully Using Laparoscopy

Laparoscopic excision of an esophageal cyst was successfully performed on a 29‐year‐old male. The patient, complaining of back pain, was admitted to our hospital for further evaluation of a submucosal esophageal tumor. Close examination revealed a cystic tumor originating from the proper muscular layer at the distal esophagus, measuring 3 cm in diameter. Under general anesthesia, the tumor was excised laparoscopi‐cally without esophageal mucosal injury, with monitering by esophagoscopy. Postoperative esophagography showed no stagnation or stenosis. He was discharged on the 11th postoperative day. The cyst was diagnosed pathologically as an inclusion cyst of the esophagus. Laparoscopic or thoracoscopic surgery is a useful treatment for benign esophageal tumors, because it is less invasive giving more rapid recovery. Concomitant esophagoscopic monitering is beneficial to avoid injury of the esophageal mucosa, especially in such benign tumors that are firmly adherent to the esophageal muscle and mucosal layer.