Teruyuki Usuba

Purification and identification of monoubiquitin-phosphoglycerate mutase B complex from human colorectal cancer tissues

Ubiquitin‐conjugated proteins in human colorectal cancer tissues were analyzed by the immunoprecipitation with the antibody FK2 against conjugated ubiquitin followed with SDS‐PAGE. In these immunoprecipitable proteins, a 38‐kDa protein was abundant in the tumor regions but almost absent in the adjacent normal regions in 17/26 patients, thus we attempted to purify it. Using immunoaffinity chromatography with the antibody FK2 followed by gel filtration and SDS‐PAGE, approximately 10 pmol of this protein was separated from 34 g of the pooled cancerous tissue and transferred onto a PVDF membrane. The 38‐kDa protein was further digested with Achromobacter protease I, resulting in several peptide fragments. Amino acid sequences of these peptides showed complete sequence identity to those derived from either ubiquitin or phosphoglycerate mutase‐B, suggesting that the 38‐kDa protein is monoubiquitinated phosphoglycerate mutase‐B, whose calculated mass is 37,369 Da. Western blot using an antibody against phosphoglycerate mutase‐B revealed the presence of the 38‐kDa protein in the anti‐ubiquitin immunoprecipitates derived from the tumor regions, but not from normal counterparts. In addition, part of non‐ubiquitinated phosphoglycerate mutase‐B (29 kDa) was also found in the anti‐ubiquitin immunoprecipitates, whose levels were higher in the tumor regions than in the adjacent normal regions. These results suggest that monoubiquitination of phosphoglycerate mutase‐B as well as formation of a noncovalent complex containing ubiquitin and phosphoglycerate mutase‐B increases in colorectal cancer and novel modification of phosphoglycerate mutase‐B might have a pathophysiological role.

Is modified devine exclusion necessary for gastrojejunostomy in patients with unresectable pancreatobiliary cancer

PurposeGastrojejunostomy is often performed as palliative surgery for unresectable pancreatobiliary cancer. Modified Devine exclusion (MDE) is a technical variation of gastrojejunostomy, which partially separates the mid-portion of the stomach. We conducted this study to assess whether MDE is necessary for gastrojejunostomy in patients with unresectable pancreatobiliary cancer.MethodsWe compared the postoperative results of MDE (n = 26) with those of conventional gastrojejunostomy (CGJ; n = 20) performed palliatively for unresectable pancreatobiliary cancers.ResultsThe morbidity rates were 38% after MDE and 50% after CGJ, with 23% and 40% of patients suffering delayed gastric emptying, respectively. Two of the CGJ group patients could never eat again. Modified Devine exclusion slowed the progression of anemia in all of the patients with duodenal bleeding.ConclusionModified Devine exclusion may be effective for patients with unresectable pancreatobiliary cancer.

Technical and mechanical risk factors for postoperative pancreatic fistula in pancreaticojejunostomy.

BACKGROUND/AIMS The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy. METHODOLOGY Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA. RESULTS The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0±1.4/4.2±2.0mm, total number of sutures for DMA was 6.8±1.6/7.0±2.8, whereas mean interval between sutures was 1.4±0.5/2.1±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF. CONCLUSIONS The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.

Successful adjuvant bi-weekly gemcitabine chemotherapy for pancreatic cancer without impairing patients’ quality of life

BackgroundAlthough adjuvant gemcitabine (GEM) chemotherapy for pancreatic cancer is standard, the quality of life (QOL) in those patients is still impaired by the standard regimen of GEM. Therefore, we studied whether mild dose-intensity adjuvant chemotherapy with bi-weekly GEM administration could provide a survival benefit with acceptable QOL to the patients with pancreatic cancer.MethodsAfter a phase I trial, an adjuvant bi-weekly 1,000 mg/m2 of GEM chemotherapy was performed in 58 patients with pancreatic cancer for at least 12 courses (Group A). In contrast, 36 patients who declined the adjuvant bi-weekly GEM chemotherapy underwent traditional adjuvant 5FU-based chemotherapy (Group B). Careful periodical follow-ups for side effects of GEM and disease recurrence, and assessment of patients’ QOL using the EORTC QOL questionnaire (QLQ-C30) and pancreatic cancer-specific supplemental module (QLQ-PAN26) were performed. Retrospectively, the degree of side effects, patients’ QOL, compliance rate, disease-free survival (DFS), and overall survival (OS) in Group A were compared with those in Group B.ResultsNo severe side effects (higher than Grade 2 according to the common toxicity criteria of ECOG) were observed, except for patients in Group B, who were switched to the standard GEM chemotherapy. Patients’ QOL was better in Group A than B (fatigue: 48.9 ± 32.1 versus 68.1 ± 36.3, nausea and vomiting: 26.8 ± 20.4 versus 53.7 ± 32.6, diarrhea: 21.0 ± 22.6 versus 53.9 ± 38.5, difficulty gaining weight: 49.5 ± 34.4 versus 67.7 ± 40.5, P < 0.05). Compliance rates in Groups A and B were 93% and 47%. There was a significant difference in the median DFS between both groups (Group A : B =12.5 : 6.6 months, P < 0.001). The median OS of Group A was prolonged markedly compared with Group B (20.2 versus 11.9 months, P < 0.005). For OS between both groups, univariate analysis revealed no statistical difference in 69-year-old or under females, and T1–2 factors, moreover, multivariate analysis indicated three factors, such as bi-weekly adjuvant GEM chemotherapy, T2 or less, and R0.ConclusionsAdjuvant chemotherapy with bi-weekly GEM offered not only the advantage of survival benefits but the excellent compliance with acceptable QOL for postoperative pancreatic cancer patients.

ANALYSIS OF BURIED BUMPER SYNDROME AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY DUE TO USE OF A BUTTON-TYPE KIT

Background:  Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Along with the widespread use of the button‐type kit, BBS is encountered frequently.

Impact of delayed gastric emptying after pancreaticoduodenectomy on survival

Delayed gastric emptying (DGE), a common postoperative complication of pancreaticoduodenectomy, is not considered a life‐threatening complication. In the present study, we analyzed the risk factors for DGE and its impact on long‐term prognosis.

Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation.

Accidental gallbladder perforation frequently occurs during laparoscopic cholecystectomy and may increase the risk of infection. However, the necessity of antimicrobial prophylaxis for these patients is unclear. The aim of this study was to examine the clinical outcomes and necessity of antimicrobial prophylaxis after laparoscopic cholecystectomy with gallbladder perforation.

Relative displacement of anastomotic site of pancreato-jejunostomy in pancreatico-duodenectomy: a novel surgical reconstructive technique

IntroductionIntra-abdominal hemorrhage following pancreatic fistula is a fatal complication after pancreatico-duodenectomy. Intra-abdominal hemorrhage has reportedly decreased with the use of fibrin glue or polyglycolic acid felt and wrapping of the skeletonized vessels by omentum or falciform ligament. However, there are no extremely effective methods for the prevention of hemorrhage. Here, we report our novel and simple method for the prevention of intra-abdominal hemorrhage due to pancreatic fistula.MethodsThe anastomotic site of the pancreato-jejunostomy in pancreatico-duodenectomy is displaced from the superior to inferior side of the transverse mesocolon through a small window created on the left side of the middle colic artery of the transverse mesocolon. This procedure is expected to prevent exposure of the skeletonized vessels to activated pancreatic juice from a pancreatic fistula after lymph node dissection, decreasing the incidence of hemorrhage. Two drains are placed on the superior and inferior sides of the transverse mesocolon. We performed this procedure in seven patients and compared the amylase level in the drainage fluid from the superior and inferior sides.ResultsThere was no difference in the fluid amylase level from the drains between the superior and inferior sides, because a pancreatic fistula was not present in all our patients. Therefore, we could not evaluate the efficacy of this method in the current study.ConclusionsOur procedure is theoretically expected to prevent intra-abdominal hemorrhage and will be an option in pancreatico-duodenectomy, especially for patients with a soft pancreas. However, it is necessary to evaluate the performance and results of this procedure in many more patients.

4742 Technique and outcome of percutaneous endoscopic enterostomy after total gastrectomy.

Introduction: Since Ponsky, Gauderer first reported in 1980, PEG has spread rapidly in US and has now becomestandarde a procedure gastrostomy. However, in those d Europe cases that total gastrectomy have was performed, endoscopic jejunostomy was regarded contra-indication. As performed Percutaneous Endoscopic Enterostomy for those patients who underwent total gastrectomy we actively, we report success rate, preoperative tests, perioperative technique, complication, long term prognosis. Subject and Method: The subjects we have tried PEE are 30 cases (sex: 18 cases of male, 12 cases of female, age 64.5 yrs. Old (36~84 yrs. Old)). The purpose of making PEE was 18 cases of feeding, 12 cases of decompression. The reconstruction method of total gastrectomy was, 26 cases of Roux-en Y(posterior colon), 1 case of Roux-en Y (anterior colon), 2 cases of Ileo-colon interposition, 1 case of small intestine interposition. As a rule preoperative test included abdominal x-ray in supine positionand gastrography test of gastrointestine and abdominal CT test upon intubating stomach tube or injectinggastrographine. Similar to PEG procedure, PEE was made with the same kit (24 Fr One-Step Button) in the pull methodunder local anesthetic. In order to decide thepuncture site and to avoid erroneous puncture in enteral, we performed fiber light test(illumination) to observe the light emitted from endoscope through the abdominal wall, finger push test to see the pressureapplied onto the abdominal wall by finger at the expected puncturesite, water injection test to inject water throughendoscope and observe the enteral tract with extracorporeal ultrasonic. After the operation as a rule prophilactic antibiotec was administered for 3 days, and nutrition was started from the third day. 16 Fr N-G tube for decompression was intubated through the enterostomy button. Result: PEE procedure was possible in 23 cases (.7%), puncture of enteral tract were 21 cases in jejunum, 1 case of duodenum and 1 case of large bowel. The average operating time was 22.8 min. (16~42 min.) and complications were 6 cases of peristomal infection (26.1%), 4 cases of furyonikuge (17.4%) and 1 case of peristomal pain (4.3%) which were relatively minor kind and there was no serious complication. Average survival day was 192.5 days (20~565 days) and 14 patients (60.9%) were transferred to home care. Conclusion: With careful preoperative test and proper operating procedure, PEE is considered safe method and offers substantial clinical merits.