Tsuyoshi Sano

Poly I:C enhances production of nitric oxide in response to interferon-γ via upregulation of interferon regulatory factor 7 in vascular endothelial cells.

The effect of poly I:C on interferon (IFN)-γ-induced nitric oxide (NO) production in vascular endothelial cells was examined using murine aortic endothelial END-D cells. Poly I:C augmented IFN-γ-induced NO production although it alone did not induce the NO production. Poly I:C augmented the NO production via enhanced expression of an inducible NO synthase protein. Poly I:C did not affect the activation of Janus kinase (JAK) 1/2, and signal transducer and activator of transcription (STAT) 1 in IFN-γ signaling. Moreover, there was no significant difference in the IFN-γ-induced interferon regulatory factor (IRF) 1 expression between the presence and absence of poly I:C. Poly I:C led to the activation of IRF7 in END-D cells. Inhibition of poly I:C signaling by amlexanox, an inhibitor of TANK-binding kinase (TBK) 1 and IκB kinase (IKK) ε, abolished the augmentation of IFN-γ-induced NO production. Therefore, poly I:C was suggested to augment IFN-γ-induced NO production at the transcriptional level via enhanced IRF7 activation.

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

The postoperative pancreatic fistula (POPF) rate for duct‐to‐mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct‐to‐mucosa versus invagination pancreaticojejunostomy.

The G2 checkpoint inhibitor CBP-93872 increases the sensitivity of colorectal and pancreatic cancer cells to chemotherapy

CBP-93872 suppresses maintenance of DNA double-stranded break-induced G2 checkpoint, by inhibiting the pathway between ataxia-telangiectasia mutated (ATM) and ATM- and Rad3-related (ATR) activation. To examine the potential use of CBP-93872 for clinical applications, we analyzed the synergistic effects of platinum-containing drugs, oxaliplatin and cisplatin, pyrimidine antimetabolites, gemcitabine and 5-fluorouracil (5-FU), in combination with CBP-93872, on cell lethality in colorectal and pancreatic cancer cell lines. Treatment with CBP-93872 significantly increased cancer cell sensitivities to various chemotherapeutic agents tested through suppression of checkpoint activation. Our results thus reveal that combination treatment of CBP-93872 with known chemotherapeutic agents inhibits phosphorylation of ATR and Chk1, and induces cell death.

Incidence and risk factors for anastomotic stenosis of continuous hepaticojejunostomy after pancreaticoduodenectomy.

There have been no reports showing the incidence of anastomotic stenosis of continuous hepaticojejunostomy (HJ) and identifying its risk factors for patients who underwent pancreaticoduodenectomy (PD).

Anatomy of the right colic vein and pancreaticoduodenal branches: a surgical landmark for laparoscopic complete mesocolic excision of the right colon

PurposeKnowledge of mesenteric venous anatomy is important to safely perform laparoscopic complete mesocolic excision (CME) of the right colon. Despite their previously reported diversity, consistent features of the right colonic and pancreatic veins can be discerned. The objective of this study was to evaluate anatomical consistency of the right colic vein (RCV) and the pancreaticoduodenal vein associated with the colic vein (PDV-C).MethodsThis study included 125 consecutive patients undergoing contrast-enhanced multidetector-row CT of the abdomen. Images of 100 of these cases were retrospectively reviewed for the positioning of the colonic, gastric and pancreatic veins associated with the superior mesenteric vein (SMV). RCV were classified as three types: Type-I, running on the ventral aspect of the pancreatic head and draining into the right lateral wall of the SMV; Type-II, running apart from the pancreatic head and directly draining into the SMV; and Type-III, draining into the tributaries of the SMV.ResultsThe RCV was identified in 88% of cases, in which the frequencies of Type-I, -II and -III anatomies were 84.1, 9.1, and 6.8%, respectively. All of the Type-I RCVs formed a common trunk with other veins, including the gastroepiploic vein (93.2%) and the superior RCV (59.5%). The PDV-C joined the RCV in 63.5% of the Type-I cases.ConclusionsAnatomical consistency of the RCV together with the PDV-C is present in the majority of cases. Our findings support the view that the appearance of the veins is a useful landmark for laparoscopic CME of the right colon.

Sphincter-preserving surgery for recurrent pelvic malignancy using a hybrid procedure of open laparotomy and transanal endoscopic approach

BackgroundSurgery for the treatment of recurrent pelvic malignancy is challenging. Sphincter-preserving surgery (SPS) has been applied in limited cases. Transanal endoscopic approach (TEA) has been used for primary rectal cancer, predominantly for hybrid transabdominal-transanal total mesorectal excision. Here, we describe the use of TEA as a hybrid approach in a case of recurrent ovarian cancer.Case presentationA 59-year-old woman had recurrence of serous ovarian adenocarcinoma in the vaginal stump, near the site of anastomosis from a rectal resection 18xa0months previously. We used a hybrid approach comprising conventional open laparotomy and TEA to accomplish sphincter preservation. In addition to sphincter preservation, TEA allowed for the creation of a “terminal” space, which was made by anterior dissection between the rectum and the vagina. We employed TEA to create an opening in the scar tissue along the sacrum, which was used as a “guide” for pelvic dissection to prevent nerve injury. After exteriorization of the tumor, bowel continuity was achieved by hand-sewn coloanal anastomosis with a protective diverting ileostomy. Pathological examination revealed no involvement of the surgical margins. The diverting ileostomy was taken down 8xa0months postoperatively.ConclusionA hybrid approach comprising conventional open laparotomy and TEA allowed for safe and secure SPS and complete excision of a recurrent pelvic malignancy. This hybrid surgical approach expands the use of SPS in highly selected cases.

Intrapericardial diaphragmatic hernia into the pericardium after esophagectomy: a case report

BackgroundIntrapericardial diaphragmatic hernia (IPDH), defined as prolapse of the abdominal viscera into the pericardium, is a rare clinical condition. This case illustrates the possibility of IPDH after esophagectomy with antethoracic alimentary reconstruction, although such hernias are extremely rare. IPDH often presents with symptoms of bowel obstruction such as abdominal discomfort or vomiting. If not properly treated, life-threatening necrosis and/or perforation of the herniated contents may occur.Case presentationA 68-year-old Japanese man underwent subtotal esophagectomy with three-field lymph node dissection for treatment of esophageal cancer. Completion gastrectomy with perigastric lymph node dissection was also performed because the patient had previously undergone distal partial gastrectomy for treatment of gastric cancer. The alimentary continuity was reconstructed using the pedicled jejunal limb through the antethoracic route. When we separated the diaphragm from the esophagus and removed xiphoid surgically to prevent a pedicled jejunal limb injury, the pericardium was opened. The patient was readmitted to our hospital because of abdominal discomfort and vomiting 6xa0months after the esophagectomy. A diagnosis of IPDH after esophagectomy was made. The patient was treated by primary closure of the diaphragmatic defect using vertical mattress sutures and additional reinforcement of the closing defect using a graft harvested from the rectus abdominis posterior sheath. The postoperative course was uneventful, and he was discharged on the seventh day after hernia repair.ConclusionsThis patient’s clinical course provides two important clinical suggestions. First, we must be aware of the possibility of iatrogenic IPHD after esophagectomy with antethoracic alimentary reconstruction. Second, a graft from the rectus abdominis posterior sheath is beneficial in the treatment of IPDH.

A case of solid pseudopapillary neoplasm spontaneously ruptured into duodenum: Report of a case

There have been no reports of ruptured solid pseudopapillary neoplasm (SPN) into adjacent organs. A 22-year-old female was referred to our hospital for treatment of a pancreatic head tumor. Compute...

Feasibility of umbilical loop ileostomy in overweight and obese patients with rectal cancer during laparoscopic surgery: Preliminary results

We examined the feasibility of umbilical diverting ileostomy for overweight and obese patients with rectal cancer undergoing laparoscopic surgery. Four patients who were overweight or obese (BMIu2009>u200927u2009kg/m2) were initially scheduled for the creation of a conventional loop ileostomy. Intraoperatively, however, this was considered too complicated because of thick subcutaneous fat, bulky mesentery, or both. Instead, patients received a diverting ileostomy with the placement of an umbilical stoma. All patients had protruding umbilical ileostomies. No severe stoma‐related complications were encountered. One patient had minor skin dehiscence, and another had paralytic ileus but resumed oral intake after a short time. Performing a temporary loop ileostomy at the umbilicus was safe and feasible in this small group of overweight and obese patients. This stoma placement may avoid the problems inherent to conventional loop ileostomy in obese subjects.

Bile Leakage After Hepatectomy for Liver Tumors

This study aimed to clarify the predictive factors for bile leakage after hepatectomy for liver tumor in terms of the International Study Group of Liver Surgery (ISGLS) definition. Between August 2006 and July 2012, 242 patients with a diagnosis of liver tumor underwent hepatectomy in our department, and the total bilirubin level of peritoneal drainage fluid prior to removal of the abdominal drains was examined. The data on all of the patients were analyzed retrospectively to identify the factors that might significantly affect the postoperative bile leakage. There was no grade C bile leakage, and grade A was documented in 65 patients (26.9%) and grade B in 7 patients (2.9%) in terms of the ISGLS definition. Although there was no significant difference in postoperative hospital stay between grade A bile leakage only and those without bile leakage (P = 0.933), a significant difference was noted between grades A and B (median, 11.0 versus 21.0 days; P < 0.001). Multivariate analysis revealed 4 independent s...