Video assisted thoracoscopy or laparoscopy for enucleation of esophageal leiomyoma: A seven-year single center experience of 75 cases.

OBJECTIVE: Leiomyoma is the most common benign tumor of the esophagus. Extra mucosal enucleation is the standard treatment. Herein we evaluated the feasibility and the outcomes of Minimally Invasive Surgery (MIS) using video-assisted thoracoscopic (VATS) or laparoscopic surgery (VALS) for esophageal leiomyoma enucleation. SUBJECTS AND METHODS: Retrospective study of patients who were treated via VATS or VALS for esophageal leiomyoma enucleation in "Hanoi Viet Duc Hospital" from 2010 to 2017 by the same operator. The operative approach, tumor size, complications and outcomes after surgery were recorded. RESULTS: Seventy-five patients were included. Mean age was 41.9 (range 20-68) years. The male/female sex ratio was 2.1:1. Fifty-five patients had clinical symptoms (73.3%). Tumors were identified in the upper third (12%), middle third (51%), and lower third (37%) of the esophagus. Mean tumor size was 3.7 (range 2-11) cm. VALS enucleation was performed in 23 patients who had leiomyoma located near the cardia (gastroesophageal junction or abdominal esophagus). The remaining 52 patients underwent right (n=42) or left VATS (n=10). Five patients (6.7%) sustained esophageal mucosa injury during dissection, repaired by MIS without late morbidity. A mini-incision (2 mini-laparotomies and 1 thoracotomy) was required in three patients (4%) due to large tumor size or mucosal injury. The mean operative time was 105min in VATS and 174min in VALS. No major perioperative surgical or medical complications were reported. The mean duration of hospital stay was 7.2 (range 5-12) days. CONCLUSIONS: MIS enucleation of esophageal leiomyoma is technically safe and associated with a high therapeutic success rate with low medico-surgical morbidity. VATS could be applied for almost all esophageal leiomyoma tumors; however, the VALS approach was preferred for tumors located near the gastroesophageal junction in order to create an anti-reflux valve after enucleation.

Enhanced expression of transferrin receptor 1 contributes to oncogenic signalling by sphingosine kinase 1.

Sphingosine kinase 1 (SK1) is a lipid kinase that catalyses the formation of sphingosine-1-phosphate (S1P). Considerable evidence has implicated elevated cellular SK1 in tumour development, progression and disease severity. In particular, SK1 has been shown to enhance cell survival and proliferation and induce neoplastic transformation. Although S1P has been found to have both cell-surface G-protein-coupled receptors and intracellular targets, the specific downstream pathways mediating oncogenic signalling by SK1 remain poorly defined. Here, using a gene expression array approach, we have demonstrated a novel mechanism whereby SK1 regulates cell survival, proliferation and neoplastic transformation through enhancing expression of transferrin receptor 1 (TFR1). We showed that elevated levels of SK1 enhanced total as well as cell-surface TFR1 expression, resulting in increased transferrin uptake into cells. Notably, we also found that SK1 activation and localization to the plasma membrane, which are critical for its oncogenic effects, are necessary for regulation of TFR1 expression specifically through engagement of the S1P G-protein coupled receptor, S1P2. Furthermore, we showed that blocking TFR1 function with a neutralizing antibody inhibits SK1-induced cell proliferation, survival and neoplastic transformation of NIH3T3 fibroblasts. Similar effects were observed following antagonism of S1P2. Together these findings suggest that TFR1 has an important role in SK1-mediated oncogenesis.

Diagnosis of diabetic gastroparesis on Tc-99m hepatobiliary scintigraphy.

Diabetic gastroparesis is a common problem in diabetics, especially insulin-dependent diabetics. The diagnosis usually is suggested on plain radiographs and confirmed on either upper gastrointestinal barium series or radionuclide gastric emptying studies. The clinical diagnosis is not always easy and some patients may present atypically with right upper quadrant pain simulating acute cholecystitis. In these patients, hepatobiliary scintigraphy may be the initial investigation performed and may first demonstrate unsuspected gastroparesis. Therefore, it is useful for the nuclear medicine physician to be aware of this entity to ensure early diagnosis and prompt treatment. The authors report one such case of diabetic gastroparesis that was diagnosed initially on a Tc-99m hepatobiliary scan.

Hemorrhagic colitis caused by Escherichia coli O157:H7--unusual ultrasonographic and computed tomography findings.

Hemorrhagic colitis due to Escherichia coli O157:H7 occurs sporadically but widely throughout North America. Radiographically this condition may mimic ischemic colitis, inflammatory bowel disease, acute appendicitis or appendiceal abscess. Correlation of radiologic and clinical findings is required to ensure diagnostic accuracy and avoid unnecessary surgical intervention.

Diagnosis of bleeding mycotic iliac aneurysm on technetium-99m renal scan.

Since abdominal aneurysms are common in the elderly, it is not unusual to see incidental aneurysms on renal scintigraphy performed for other reasons. However, the initial discovery of a bleeding aneurysm on a renal scan in a patient with salmonella septicemia who has no other obvious focus of infection should be considered suspicious for mycotic aneurysm. A prompt diagnosis is crucial to avoid catastrophic outcome associated with delayed surgical intervention.

Acute unilateral pulmonary nonventilation due to mucous plugs.

Acute bronchial obstruction by mucous plugs may be manifested clinically by dyspnea, hypoxemia, and respiratory alkalosis mimicking pulmonary thromboembolism. In eight cases with complete interruption of ventilation to an entire lung, chest radiography failed to reveal the extent of the obstruction. Perfusion was substantially less affected than ventilation. Routine ventilation-perfusion scintigraphy with technetium-99m DTPA aerosol aids in the diagnosis of acute major bronchial obstruction in patients with suspected pulmonary thromboembolism.

Acute tubular necrosis secondary to rhabdomyolysis with complete absence of renal perfusion.

Absent renal perfusion on a Tc-99m DTPA radionuclide study was observed in a patient with acute tubular necrosis following rhabdomyolysis. Complete recovery was achieved with conservative treatment. Absence of renal perfusion does not indicate a nonviable kidney.

An antibody to dihydropyridine calcium entry blockers. A comparison with the calcium channel receptor in skeletal muscle.

Antibodies that recognize dihydropyridine (DHP) calcium entry blockers were elicited from rabbits. A sensitive and specific radioimmunoassay for dihydropyridines was developed and its specificity compared to the DHP binding site in skeletal muscle membranes. The antibody bound [3H]nitrendipine with a higher affinity (KD = 0.155 nM) than did the DHP receptor of skeletal muscle (KD = 1-3 mM); however, in contrast to the DHP receptor, the antibody recognized only those DHP drugs with meta-nitrophenyl substituents at the 4-position on the DHP ring. Both the antibody and receptor exhibited stereospecificity, with each site recognizing the (+)-isomer of nicardipine as the more potent. This antibody should prove useful in our studies of some potentially irreversible DHP molecules.

Reversal effect of isaxonine on modifications of rat polymorphonuclear migration by colchicine.

Using a modified Boyden chamber, random migration and chemotaxis of rat polymorphonuclear leucocytes (PMN) were assessed after incubation in vitro in a solution of colchicine (1.5 X 10(-5) M). The results obtained were compared to random migration or chemotaxis of the same cellular pool treated in vitro or in vivo by N-isopropyl-amino-2-pyrimidine phosphate (isaxonine 4.10(-5) M or 75 and 150 mg/kg respectively). Isaxonine partially inhibited the effect of colchicine on PMN chemotaxis while random migration remained unaffected. Isaxonine might partially inhibit the noxious effect of colchicine on microtubule disruption by a direct effect (polymerization of free tubulin) and/or indirect effect (impairment of disorganizing activity) on PMN microtubules.

Placental abruption and subchorionic hemorrhage in the first half of pregnancy: US appearance and clinical outcome.

In 30 pregnant patients who experienced vaginal bleeding between 10 and 20 weeks gestation, subchorionic hematomas were demonstrated on ultrasound examination. In 18 patients (60%), the margin of the placenta was separated from the uterine wall. In 15 patients the outcome was favorable (full-term delivery of normal infant) and in 15 patients the outcome was unfavorable (seven preterm births, four stillbirths, three spontaneous abortions, one therapeutic abortion). The major prognostic factor related to pregnancy outcome was the volume of the hematoma and, to a lesser extent, the relative volume of the hematoma (volume of hematoma divided by volume of gestational sac). For a volume less than 60 ml, the outcome tended to be favorable, and for a relative volume less than 0.4, the outcome tended to be favorable.