Left-sided acute appendicitis with intestinal malrotation.

Intestinal malrotation is a rare anomaly of rotation and fixation of the midgut. Left-sided appendicitis occurs in association with two types of congenital anomalies, situs inversus and intestinal malrotation. We describe a rare case of left-sided acute appendicitis with intestinal malrotation in a 14-year-old boy, in which computed tomography (CT) was useful for a preoperative diagnosis.

[A case of hepatic metastasis from colon cancer successfully treated with 5-FU, levofolinate (l-LV) and low-dose CPT-11].

The patient was a 67-year-old man in whom hepatic metastasis from transverse colon cancer was detected 15 months after transverse colectomy (D2). We treated the patient by systemically administering 2 courses of 5-FU 750 mg/day with l-LV 350 mg/day (once weekly for 6 weeks per course). Assessment of therapeutic effects by CT showed PD in the patient. As a second-line therapy, we treated the patient by systemically administering 3 courses of 5-FU 750 mg/day, l-LV 350 mg/day and CPT-11 40 mg/day x 3 days (once a week for 4 weeks per course). After 3 courses of this chemotherapy, CT examination revealed a reduction in the tumor size of the liver, and CEA levels decreased at the end of this chemotherapy. This chemotherapy also showed no high-grade toxicities. l-LV/5-FU/low-dose CPT-11 seems to be effective for metastatic colon cancer, and safe from the toxicity standpoint.

Design of a new technique using a free tracheal autologous graft for reconstruction of the cricoid cartilage and trachea.

PURPOSE: We devised a new operative procedure to recreate a supporting framework using a free tracheal autologous graft for cricoidal and tracheal defects. METHODS: We used this new transplantation method to repair the airway defect in five patients who underwent total thyroidectomy with resection of the airway for advanced thyroid cancer. A free graft was taken from the anterior aspect of the trachea and placed over the defect. The surface of the transplanted graft was then surrounded by the adjoining muscle flap. The orifice created by taking the graft was used as a temporary tracheostomy during the early postoperative period. RESULTS: Fiberscopic examinations and computed tomography scans done over 3-7 years postoperatively showed no airway deformity, subglottic stenosis, graft necrosis, or local recurrence in any of the five patients. The tracheal stoma closed spontaneously within 5 months after the operation in three of the five patients. CONCLUSION: The advantages of this procedure are: the free tracheal graft has as much strength as a prosthesis to support the respiratory tract; the autologous graft is biologically compatible; and the procedure can be completed in one surgical field and adopted for primary and secondary repair of the tracheal defect.

Evaluation of warm ischemia-reperfusion injury using heat shock protein in the rat liver.

We focused on heat shock protein 70 (HSP70) as a marker of viability in hepatic warm ischemia-reperfusion. Segmental hepatic warm ischemia was produced in rats for 15, 30, 60, 90, 120, or 180 min. Liver sections were evaluated at 30, 60, and 120 min of reperfusion. Expression of HSP70 and messenger RNA (mRNA), apoptosis, and apoptosis-associated genes such as Bcl-2 and Bax were studied. Expression of HSP70 and mRNA was augmented as warm ischemia was prolonged, but was markedly suppressed in livers with more than 120 min of ischemia. The highest accumulation of HSP70 was observed in the nucleus. In livers subjected to longer duration of warm ischemia, necrosis and apoptosis were evident and Bcl-2 mRNA expression and Bcl-2/Bax protein ratio were markedly diminished. Apoptosis may be related to the process of cellular injury induced by warm ischemia-reperfusion. Expression of HSP70 and the Bcl-2 family can be effective markers of viability in hepatic warm ischemia-reperfusion.