Venous Congestive Ischemic Colitis After Sigmoid Colectomy: A Case Report.

Venous congestion is a possible cause of ischemic colitis following colorectal surgery. As such, congestive ischemic colitis should be considered in such cases where the mesenteric artery is preserved. Herein, we describe the case of a 73-year-old man who presented to the hospital with a two-week history of difficult defecation and frequent mucous stools and was subsequently diagnosed with refractory ischemic enterocolitis due to venous congestion. The patient had undergone resection of the sigmoid colon cancer with preservation of the inferior mesenteric artery 11 months before presentation. Contrast-enhanced abdominal computed tomography revealed edematous wall thickening on the anal side of the anastomosis. A colonoscopy revealed a normal mucosa extending from the anastomosis to the descending colon; however, mucosal swelling, erythema, and erosion were observed on the rectal side of the anastomosis. Based on these findings, he was diagnosed with ischemic colitis. After two months of ineffective conservative treatment, the patient underwent surgery. Ischemic colitis was diagnosed as venous congestion based on the histopathological examination. Preservation of the mesenteric artery may result in ischemic colitis due to an imbalance between the arterial and venous blood flow. Chronic ischemic colitis due to venous congestion should be considered in cases of mesenteric artery preservation to reduce anastomotic leakage.

Unexpected findings during colon cancer surgery: A rare complication of ventriculoperitoneal shunt.

Background: Complications such as infections and obstructions of the ventriculoperitoneal (VP) shunt are common. However, VP shunt trapped on the serosal side of colon cancer is rare, and there is no clear treatment strategy. Case Description: A 72-year-old man presented with a 1-month history of constipation, diarrhea, and weight loss. His medical history consisted of subarachnoid hemorrhage and hydrocephalus 13 years earlier, for which endovascular coiling and VP shunting were performed. Colonoscopy showed a sigmoid mass, the biopsy of which revealed tubular adenocarcinoma. Computed tomography demonstrated circumferential wall thickening of the sigmoid colon without evidence of metastasis, with the lesion surrounding the tip of the VP shunt. He underwent laparoscopic surgery for sigmoid colon cancer. Unexpectedly, the VP shunt was trapped in the serous side of the tumor, and both the shunt and tumor were excised. Microscopic examination revealed inflammation and fibrosis, but no cancer cells were found in the serosa surrounding the embedded VP shunt tip. Conclusion: Bowel perforation due to a VP shunt is a rare but emergency condition. If the perforation occurs around cancerous tissue, it must be handled with extreme care; excising the shunt along with the tumor may be the safest treatment method. Clinicians need to pay attention to the end of the VP shunt when performing surgery for patients with cancer and VP shunt.

Large bowel obstruction caused by a colonic polyp.

A large bowel obstruction (LBO) is an emergency condition that requires early diagnosis and prompt treatment, and it is also crucial to identify the cause of the obstruction. Here, we describe a 76-year-old woman who presented to the hospital with a 1-day history of abdominal pain and vomiting and was diagnosed with LBO. Endoscopic findings showed that the cause of the LBO was initially determined to be a Bormann Type I tumour in the sigmoid colon. However, the surgery was performed later; the pathological findings led to the diagnosis of colonic obstruction caused by a colonic polyp in the sigmoid colon narrowed by chronic diverticulitis. Colonic polyps rarely cause LBO. Poor observation due to colonic stenosis can mask the morphology of the lesion. In cases of LBO, colonic polyps should be differentially diagnosed in addition to colon cancer.

A Rare Cause of Haemorrhagic Shock: Rupture of Gastric Wall Seeding of Hepatocellular Carcinoma.

Ruptured hepatocellular carcinoma (HCC) can lead to peritoneal dissemination. However, gastric wall seeding from HCC is exceedingly rare, and little is known about its clinical course. Herein, we report a case of an 88-year-old man who presented with a four-hour history of nausea, vomiting, and upper abdominal pain. He has a history of ruptured HCC during surgery. The patient underwent an emergency laparotomy on account of haemorrhagic shock, which confirmed the diagnosis of ruptured HCC with gastric wall seeding. The findings from this study showed that the ruptured HCC can seed into the stomach wall, and the implanted lesions may rupture and lead to life-threatening haemorrhagic shock. Surgery is an effective treatment for bleeding from the implanted lesions.

Successful preoperative diagnosis and minimally invasive surgery of bile duct schwannoma.

Bile duct schwannomas are rare benign tumors that frequently mimic more life-threatening tumors. Till date, only a few of these tumors have been diagnosed preoperatively. Herein, we report the case of a 68-year-old man who presented with a 1-day history of epigastralgia. The patient was preoperatively diagnosed with bile duct schwannoma using transpapillary biliary forceps biopsy and underwent local resection without major complications. The findings of our study indicate that endoscopic tumor biopsy may be helpful in diagnosing bile duct schwannoma before surgery; thus, enabling surgeons to plan an appropriate surgery while avoiding overtreatment.

A case of suicide by helium gas.

Helium is a colorless, tasteless, and odorless gas that is used as a lifting gas for air balloons and small airships due to its high level of safety. In recent years, it has become easy to search the Internet for methods to commit suicide, and the use of helium gas for this purpose has recently been garnering attention. We report a case of a male in his 30's in which helium gas was used to commit suicide. He was found unconscious on a bed with a plastic bag covering his head. When emergency personnel arrived at the scene, he was in cardiac arrest and remained in cardiac arrest at the time of his arrival at the hospital. Continued cardiopulmonary resuscitation resulted in a return of spontaneous circulation. Head computed tomography showed the corticomedullary border was indistinct. Fifteen hours at the hospital, the patient died. Recently, there has been an increasing trend for suicide being performed according to methods obtained through the Internet or mass media. Although there are only a few cases of suicide by helium gas in Japan, attention must be paid to this issue as the number of such cases may increase in the future.

[Pathological complete response in advanced gastric carcinoma by S-1/CDDP combination chemotherapy].

A59 -year-old woman was referred to our hospital for a close examination and treatment of an advanced gastric carcinoma. A physical examination and CT scan showed that the right cervical and axillar lymph nodes were swelling, and a histopathological examination of the axillar lymph node revealed metastatic growth of the gastric carcinoma (Stage IV). Then, we started S-1/CDDP combination chemotherapy. S-1 (80 mg/m2/day)was orally administered for 3 weeks followed by 2 weeks of rest, and CDDP (60 mg/m2) was administered by drip on day 8. Since the distant metastases were greatly reduced after 6 courses of combination therapy, a distal gastrectomy with lymph nodes dissection (D2) was performed. Histopathological examination of the resected tissues revealed no residual cancer cells, suggesting a pathologically complete response. The clinical course after the operation went well without any complications, and the patient is alive with no evidence of recurrence 1 year after surgery. S-1/CDDP combination chemotherapy appears to be one of the effective treatments for advanced gastric carcinoma.

Differential epigenetic regulation of BDNF and NT-3 genes by trichostatin A and 5-aza-2'-deoxycytidine in Neuro-2a cells.

To understand epigenetic regulation of neurotrophins in Neuro-2a mouse neuroblastoma cells, we investigated the alteration of CpG methylation of brain-derived neurotrophic factor (BDNF) promoter I and neurotrophin-3 (NT-3) promoter IB and that of histone modification in Neuro-2a cells. Bisulfite genomic sequencing showed that the CpG sites of BDNF promoter I were methylated in non-treated Neuro-2a cells and demethylated following 5-aza-2'-deoxycytidine (5-aza-dC) treatment. In contrast, methylation status of the NT-3 promoter IB did not change by 5-aza-dC treatment in Neuro-2a cells. Furthermore, we demonstrated that BDNF exon I-IX mRNA was induced by trichostatin A (TSA) treatment. However, NT-3 exon IB-II mRNA was not induced by TSA treatment. Chromatin immunoprecipitation assays showed that the levels of acetylated histones H3 and H4 on BDNF promoter I were increased by TSA. These results demonstrate that DNA methylation and/or histone modification regulate BDNF gene expression, but do not regulate NT-3 gene expression in Neuro-2a cells.

Valproic acid induces up- or down-regulation of gene expression responsible for the neuronal excitation and inhibition in rat cortical neurons through its epigenetic actions.

Valproic acid (VPA), a drug used to treat epilepsy and bipolar mood disorder, inhibits histone deacetylase (HDAC), which is associated with the epigenetic regulation of gene expression. Using a microarray, we comprehensively examined which genes are affected by stimulating cultured rat cortical neurons with VPA, and found that the VPA-treatment markedly altered gene expression (up-regulated; 726 genes, down-regulated; 577 genes). The mRNA expression for brain-derived neurotrophic factor (BDNF) and the alpha4 subunit of the GABA(A) receptor (GABA(A)Ralpha4), known to be involved in epileptogenesis, was up-regulated, with the increase in BDNF exon I-IX mRNA expression being remarkable, whereas that for GABA(A)Rgamma2, GAD65 and 67, and the K(+)/Cl(-) co-transporter KCC2, which are responsible for the development of GABAergic inhibitory neurons, was down-regulated. The number of GAD67-positive neurons decreased upon VPA-treatment. Similar changes of up- and down-regulation were obtained by trichostatin A. VPA did not affect the intracellular Ca(2+) concentration and the phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2), suggesting its direct action on HDAC. The acetylation of histones H3 and H4 was increased in the promoters of up-regulated but not down-regulated genes. Thus, VPA may disrupt a balance between excitatory and inhibitory neuronal activities through its epigenetic effect.

Regulation of neurotrophin-3 gene transcription by Sp3 and Sp4 in neurons.

Neurotrophin-3 (NT-3), a neurotrophin member, plays crucial roles in neuronal development, function and plasticity. Previous studies have demonstrated that NT-3 gene transcription is driven by alternative promoters A and B, located upstream of exons 1A (EIA) and 1B (EIB), respectively. However, the transcription factors and DNA elements that drive NT-3 gene transcription remain to be identified. Here, we analysed the promoter region of the NT-3 gene and found that an NT-3 transcript containing EIB is predominantly expressed in cortical neurons which preferentially utilize promoter B, and two tandemly repeated GC-boxes, located between -100 and -60 base pairs within promoter B, are required for the transcription. Electrophoretic mobility shift and chromatin immunoprecipitation assays revealed that both specificity protein (Sp)3 and Sp4 were able to bind to the Sp1 binding sequences within the GC boxes. Expression of dominant-negative Sp3 and Sp4 small interfering RNA in cortical neurons reduced the activity of the NT-3 gene promoter. Over-expression of Sp1 family members, especially Sp4, resulted in an increase of the NT-3 gene promoter. These findings indicate that the NT-3 gene is a target gene for Sp4 that is abundantly expressed in the brain.