Yukio Terashita

Decreased expression of DFF45/ICAD is correlated with a poor prognosis in patients with esophageal carcinoma

DNA fragmentation factor 45 (DFF45)/inhibotor of caspase activated DNAse (ICAD) forms a complex with DFF40/CAD and inhibits its DNA cleaving function during apoptosis. DFF45 also functions as a chaperone for native DFF40 and is necessary for its function. It has been indicated that defects in the apoptotic pathway may exist in neoplastic cells.

Aberrant nuclear localization of β-catenin without genetic alterations in β-catenin or Axin genes in esophageal cancer

Backgroundβ-catenin is a multifunctional protein involved in two apparently independent processes: cell-cell adhesion and signal transduction. β-catenin is involved in Wnt signaling pathway that regulates cellular differentiation and proliferation. In this study, we investigated the expression pattern of β-catenin and cyclin D1 using immunohistochemistry and searched for mutations in exon 3 of the β-catenin gene and Axin gene in esophageal squamous cell carcinoma.Materials and methodsSamples were obtained from 50 esophageal cancer patients. Immunohistochemical staining for β-catenin and cyclin D1 was done. Mutational analyses of the exon3 of the β-catenin gene and Axin gene were performed on tumors with nuclear β-catenin expression.ResultsFour (8%) esophageal cancer tissues showed high nuclear β-catenin staining. Overexpression of cyclin D1 was observed in 27 out of 50 (54%) patients. All four cases that showed nuclear β-catenin staining overexpressed cyclin D1. No relationship was observed between the expression pattern of β-catenin and cyclin D1 and age, sex, tumor size, stage, differentiation grade, lymph node metastasis, response to chemotherapy, or survival. No mutational change was found in β-catenin exon 3 in the four cases with nuclear β-catenin staining. Sequencing analysis of the Axin cDNA revealed only a splicing variant (108 bp deletion, position 2302–2409) which was present in the paired normal mucosa.ConclusionA fraction of esophageal squamous cell carcinomas have abnormal nuclear accumulation of β-catenin accompanied with increased cyclin D1 expression. Mutations in β-catenin or axin genes are not responsible for this abnormal localization of β-catenin.

Ambulatory laparoscopic cholecystectomy: An audit of day case vs overnight surgery at a community hospital in Japan.

AIM To evaluate the applicability and safety of ambulatory laparoscopic cholecystectomy (LC) and to compare day case and overnight stay LC. METHODS Data were collected retrospectively and consecutively for day case and overnight stay LC patients from July 1, 2009 to April 30, 2011. Outcomes were analyzed for patient demographics, operation time, blood loss during operation and frequency and reasons for unexpected or prolonged hospitalization in each group. RESULTS There was no hospital mortality and no patient was readmitted with serious morbidity after discharge. 50 patients received a day case LC and 19 had an overnight stay LC. There was a significant difference in age between both groups (P < 0.02). There were no significant differences between the day case LC performed (n = 41) and failed (n = 9) groups and between the day case LC performed and the one night stay LC (n = 12) groups. There was a significant difference in age between the one night stay and more nights stay LC groups (P < 0.05). Thus, elderly patients showed a tendency to like to stay in hospital rather than being a day case. The proportion of unexpected or prolonged hospitalization was not significantly different between the day case and overnight stay LC groups, when the patients request was excluded. CONCLUSION Day case LC can be performed with a low rate of complications. In overnight stay patients, there are many who could be performed safely as a day case. Moreover, we need to take special care to treat elderly patients.

Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: Suture line reinforcement of the weak point of the anastomosis.

Background Few studies have been designed regarding optimal reinforcement of the crotch of a side-to-side anastomosis. The purpose of this study was to clarify the weak point of the side-to-side anastomosis and to evaluate the effect of bioabsorbable reinforcement material. Methods Fresh pig small bowel was used for all experiments. A side-to-side anastomosis was performed using a linear stapler, and the burst pressure of the anastomosis was measured. Three separate experiments were done. In experiment 1, the weak point and the burst pressure of that point were defined. In experiment 2, the burst pressure of the side of the anastomosis was measured. In experiment 3, we evaluated the effect of Neoveil® to strengthen the weak point of the anastomosis. Results The weak point of the side-to side anastomosis was the crotch and the burst pressure was 39.8 ± 5.7 mmHg. The burst pressure of the side of the anastomosis was 109.9 ± 7.9 mmHg. This was significantly higher than the burst pressure of the crotch (P = 0.008). The burst pressure of the crotch in the group with Neoveil® was 83.3 ± 14.9 mmHg. This pressure was significantly higher than the group with no Neoveil® reinforcement (P = 0.001). Conclusion These findings suggest that the use of Neoveil® as a buttressing material is associated with reinforced staple lines and increased crotch burst pressures compared to non-buttressed staple lines. Neoveil® was found to perform comparably to clinically available buttress materials in this ex vivo model. Reinforcement of the weak point of the side-to-side anastomosis with Neoveil®may lead to fewer anastomotic leaks.

Superior staple formation with powered stapling devices

/10.10 15 A ence: al Ce l: þ81 ura@ F1 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 The development and improvement of stapling devices has aided in advancing surgical techniques. Moreover, these devices have shortened operative time and improved perioperative safety [1]. Cartridges are manufactured with a variety of different staple heights, which correspond to the thickness of the intended tissue [2]. After the stapler is fired, staples are formed into B-shaped staples. The shape of a staple that is formed by a stapling device is one industryaccepted indicator of device performance; typically a Bshaped staple is considered the most important indication of a secure anastomosis [3–6]. In recent years, powered stapling devices have been developed and are widespread. With the controlled speed of stapling, it is claimed that staple formation became superior, but there is no detailed report concerning these results. In previous reports, stapled organs were disintegrated by chemical dissolution to evaluate the shape of the staples [5]. Therefore, the arrangement of the staples collapsed. This makes it impossible to evaluate the status of the staple as a whole. To evaluate the characteristics of the stapler, it is very useful for all the staples to be observed in the original sequence. In this study, we stapled the intestine with a manual and a powered stapler; the shapes of the formed staples were compared between these staplers to verify the superiority of the powered stapling devices. Additionally, we compared these stapler with a method of gradually squeezing the handle multiple times or a method of stapling immediately after the jaws were closed. 85 86 87 88 89

Reinforcement Material on the Intestinal Stump Staple Line-The Effect and Mechanism of Reinforcement

Background: In gastrointestinal surgery, the quality of anastomosis is one of the most important factors influencing the postoperative course. The purpose of this study was to verify the effectiveness and the mechanism of one type of reinforcement material. Methods: We analyzed the effect of Neoveil on the rate of staple line failure. Fresh pig small bowel was used. Neoveil sheets were placed on the anvil alone, cartridge alone or both sides of the stapler. Groups were: A, without Neoveil; B, the cartridge and anvil; C, the cartridge alone; D, the anvil alone. The burst pressures were measured. Results: In group A, a leak occurred at the intestinal stump in 5 of 10 cases (As). In the other 5 cases, the mesenteric side burst before failure of the staple line (Am). In groups B, C, and D, the mesenteric side burst before failure of the staple line. The median leak pressure was 100±46 mm Hg in group A (As; 57±6, Am; 143±12). In the other groups, the leak pressures were approximately Original Research Article 140 mm Hg. In group As, the middle staple only exists on the edge of stump. In group Am, however, both sides of the 3-row staple line exist on the edge of stump. Conclusion: The burst pressure of the stump became the result of the bipo of the stump staple line is affected by the arrangement of the staples. Neoveil obtaining a stronger staple line.