Tetsu Yamamoto

Hemoperfusion with a high-mobility group box 1 adsorption column can prevent the occurrence of hepatic ischemia-reperfusion injury in rats

Objective:High-mobility group box 1, a ubiquitous nonhistone chromosomal protein, is passively released from necrotic cells and actively secreted by inflammatory cells. Extracellular high-mobility group box 1 has recently been recognized to be a mediator of hepatic ischemia–reperfusion injury; however, the kinetics of high-mobility group box 1 during hepatic ischemia–reperfusion and the role of high-mobility group box 1 in ischemia–reperfusion injury still remain poorly understood. This study was designed to assess the localization and the kinetics of high-mobility group box 1 during hepatic ischemia–reperfusion injury and the effects of high-mobility group box 1 adsorption column in hepatic ischemia-reperfusion injury. Design:A prospective, randomized animal study. Setting:University medical center research laboratory. Subjects:Male Sprague-Dawley rats. Investigation:The animals underwent 70% partial hepatic ischemia for 60 or 90 mins and were then reperfused. To investigate the high-mobility group box 1 levels in the serum and in the liver, the animals were killed at predetermined periods. As a lethal model, global hepatic ischemia–reperfusion was induced by portal triad cross-clamping for 30 mins. Hemoperfusion therapy using a cellulofine sulfate bead column (high-mobility group box 1 adsorption column) was performed during global hepatic ischemia. Measurements and Main Results:During 60 mins of 70% hepatic ischemia, nuclear high-mobility group box 1 was translocated to the cytoplasm in hepatocytes; however, serum high-mobility group box 1was not increased. Immediately after reperfusion, the serum high-mobility group box 1 was significantly increased (p < .05). High-mobility group box 1 mediated ischemia–reperfusion injury in not only liver but also the remote organ, lung. Removal of excess high-mobility group box 1 in blood using an adsorption column significantly improved animal survival (p < .03) and liver and lung injuries. Conclusions:High-mobility group box 1 plays an important role in the systemic as well as local pathogenesis of hepatic ischemia–reperfusion injury. The removal of excessive high-mobility group box 1 with adsorption column was beneficial and promising option in ischemia-related liver injuries.

Reconstruction of the Gastrointestinal Tract byhemi-doublestapling Method for the Esophagus andjejunum Using Eea Orvil in Laparoscopic Total Gastrectomy and Proximal Gastrectomy

We report the method of anastomosis based on a hemi-double stapling technique (hereinafter, HDST) using a trans-oral anvil delivery system (EEA OrVil) for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. After the gastric lymph node dissection, the esophagus was cut off obliquely to the long axis using an automated stapler. EEA OrVil was orally, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. When it was confirmed that the automated stapler and center rod were made completely linear, the anvil and the main unit were connected with each other and firing was carried out. Then, HDST-based anastomosis was completed. The method may safe laparoscopic anastomosis between the esophagus and reconstructed intestine.

Esophagectomy and hepatic arterial chemotherapy following hepatic resection for esophageal cancer with liver metastasis

We report a patient who had simultaneous transthoracic esophagectomy and hepatic arterial cannulation for chemotherapy following hepatic resection for esophageal cancer with solitary liver metastasis. He had an uneventful postoperative course and received two cycles of postoperative arterial chemotherapy with cisplatinum and 5-fluorouracil. He developed multiple liver metastases 6 months after the surgery. He has been receiving arterial chemotherapy at the outpatient department and is alive 15 months after the surgery. Aggressive esophagectomy and hepatic arterial chemotherapy is the treatment of choice for esophageal cancer with liver metastasis when unresectable metastases are confined to the liver.

HMGB1 is a promising therapeutic target for acute liver failure

ABSTRACT Introduction: Although acute liver failure (ALF) is a rare disease, it continues to have high mortality and morbidity rates due to its many causes. High mobility group box 1 (HMGB1), originally reported as a ubiquitous non-histone chromosomal protein, is a multi-functional protein with varying functions depending on its location, such as in the nucleus, cytoplasm and extracellular space. The role of extracellular HMGB1 as an inflammatory mediator has been well studied, and the elevation of serum HMGB1 has been reported in several diseases that are closely associated with ALF. Areas covered: In this review, we focus on the relationship between causes of acute liver failure, such as viral infection, drug-induced liver injury, ischemia/reperfusion injury, and acute-on-chronic liver failure, and the role of HMGB1. Furthermore, we also consolidate and summarize the current reports of HMGB1-targeting therapies in hepatic injury models. Expert commentary: HMGB1 could be a novel therapeutic candidate for ALF, and the clinical testing of HMGB1-targeting therapies for ALF patients is expected.

The use of minimally invasive surgery for lymph node recurrence after endoscopic mucosal resection of superficial esophageal cancer

A 73-year-old man was diagnosed with superficial esophageal cancer, and endoscopic mucosal resection was performed. Histologically, the lesion was found to be a squamous cell carcinoma invading the muscularis mucosae without vascular invasion. The patient was followed without being given adjuvant therapy, and lymph node recurrence along the lesser curvature of the stomach was found after 2.5 years. He underwent laparoscopic removal of the metastatic lymph node and cholecystectomy for cholecystolithiasis. He had two courses of adjuvant chemotherapy and showed no recurrence during 3 years of observation. Although the effectiveness of surgical resection for nodal recurrence of esophageal cancer remains controversial, this case highlights the possibility of salvage resection using minimally invasive surgery.

A method of gastric conduit elevation via the posterior mediastinal pathway in thoracoscopic subtotal esophagectomy

BackgroundDespite efforts to improve surgical techniques, serious complications still sometimes occur. Use of a physiological posterior mediastinal pathway has increased given advances such as automated anastomotic devices and a reduction in the incidence of anastomotic sufficiency. Until now the gastric conduit created has been protected by an echo probe cover and, sown to the ventral side of polyester tape placed through the abdomen to the neck, and then blindly elevated to the neck. We report on a new method of gastric conduit elevation.MethodsTwo 60-cm lengths polyester tape are ligated at both ends to form a loop. An echo probe cover of 10 cm in diameter and 50 cm in length is prepared and the tip cut off, forming a cylinder. The knots in the previously looped polyester tape are inserted into the echo probe cover. The looped polyester tape and echo probe cover is ligated with silk approximately 5 cm in front of the knots on both sides.After dissection is carried out according to practice, the previously crafted polyester tape is inserted into the chest cavity. One end of polyester tape is fixed to the distal esophageal stump with the clips, with the opposite end fixed to the proximal esophageal stump. The echo probe cover that connects the proximal esophagus and distal esophagus is monitored for the presence of creases along the long axis to ensure there are no twists in the echo probe cover.We carry out a laparoscopic-assisted perigastric lymph node dissection, make a small skin incision, and guide part of the thoracic esophagus and stomach outside the body.Either one of the two lengths of polyester tape is connected to the gastric conduit. By pulling up this length of polyester tape from the neck, the gastric conduit can pass through the echo probe cover and be elevated to the neck.ResultsNo perioperative complications such as bleeding or difficulty of the gastric conduit elevation were recognized with this method.ConclusionsThis method is considered to serve as a useful technique for gastric conduit elevation.

Bevacizumab-induced intestinal perforation in a patient with inoperable breast cancer: a case report and review of the literature

BackgroundGastrointestinal perforation is known as a serious adverse event, but, for breast cancer, there are very few reports of gastrointestinal perforation. This report highlights gastrointestinal perforation caused by bevacizumab for breast cancer, which is of special interest because gastrointestinal perforations caused by bevacizumab are very rare in breast cancer.Case presentationWe describe the case of 54-year-old Japanese woman. She was diagnosed as having inoperable breast cancer T2 N1 M1 (pleura, peritoneum), Stage IV, and received chemotherapy by paclitaxel. There was reduction in the primary tumor and disappearance of the pleural effusion; however, the ascites did not change. We performed diagnostic laparoscopy which revealed that her whole peritoneum was thickened, and her small intestine, colon, and her omentum were grouped and formed an omental cake. We submitted a part of her peritoneum to pathological examination and diagnosed the peritoneum dissemination of breast cancer. On the basis of these results, paclitaxel and bevacizumab combination chemotherapy was started, and a decrease in ascites was seen. However, a gastrointestinal perforation occurred on 26th day of second cycle of bevacizumab + paclitaxel, and we performed an emergency operation. In the operation, the omental cake was resolved, and we could search the full length of the gastrointestinal tract. Two small perforations of her small intestine were seen. We performed simple closures for perforations, and peritoneal lavage and drainage. She was in a state of septic shock, but it improved. It was thought that the small intestinal perforations were caused by the bevacizumab-additional chemotherapy which was very effective.ConclusionsWe report a very rare and valuable case. This case suggests that the risk of gastrointestinal perforation must be considered in a case of bevacizumab administration, and it is necessary to determine carefully the patient administered bevacizumab, regardless of the type of cancer.