Endoscopic Submucosal Dissection for Neoplasia of the Greater Curvature of the Upper and Middle Stomach: J-shaped Superficial Cutting and Splashed Dissection.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric neoplasia. However, as the upper and middle body of the greater curvature has a rich vasculature and submucosal fibrosis, ESD of neoplasia in these locations requires a specific strategy. We aimed to investigate the efficacy and safety of the J-shaped superficial cutting and splashed submucosal dissection (JSCS) technique for neoplasia of the greater curvature by comparing ESD using JSCS with conventional ESD. METHODS: Twenty-two patients who underwent ESD for gastric neoplasia affecting the upper and middle body of the greater curvature were divided into two groups for retrospective analysis. Nine patients underwent conventional ESD (c-Group), while 13 underwent ESD with JSCS (j-Group). Primary outcome was the en bloc resection rate. Secondary outcomes included complete resection (R0) rate, procedure time, perforation rate, total bleeding time, and the total number of massive bleeding events and of hemostatic forceps times applied during ESD. RESULTS: There were no significant differences between both groups (c-Group vs j-Group) in en bloc resection rate, or R0 resection rate. Compared with the c-Group, the j-Group tended to have a decreased mean procedure time (mean 133 minutes vs 74 minutes, p=0.11) and perforation rate (11% vs 0%, p=0.41). Compared with the c-Group, the j-Group had significantly fewer bleeding incidents (13.4 times vs 6.6 times, p=0.0095), shorter total bleeding time (17.6 min vs 7.4 min, p=0.036), and fewer usages of hemostatic forceps (6.3 times vs 2.4 times, p=0.026) during ESD. CONCLUSION: Endoscopic submucosal dissection with JSCS is superior to conventional ESD, as it reduces intraprocedural bleeding. This technique has the potential to become the standard strategy for neoplasia affecting the upper and middle body of the greater curvature.

Huge Pseudoaneurysm of the Femoral Artery after Internal Fixation of Femoral Trochanteric Fracture.

Pseudoaneurysm is one of the most serious complications of femoral trochanteric fracture surgery. Since the rupture of pseudoaneurysm may lead to death, early detection is important. We report the case of an 80-year-old male who developed pain in the proximal thigh and severe swelling after internal fixation of a femoral trochanteric fracture with a hip nail. Angiography revealed a pseudoaneurysm of a branch of the deep femoral artery near the interlocking screw. The vascular lesion was immediately treated by transcatheter embolization, and the vascular leakage was completely resolved with catheter embolization. After embolization, the patient's clinical state improved rapidly, and the laboratory values improved to normal after several weeks. The current case study reminds us that pseudoaneurysm can occur after intramedullary nail placement to treat a femoral trochanteric fracture.

Inhibition of peroxisome proliferator-activated receptor gamma activity in esophageal carcinoma cells results in a drastic decrease of invasive properties.

Esophageal cancer is difficult to treat because of its rapid progression, and more effective therapeutic approaches are needed. The PPARgamma is a nuclear receptor superfamily member that is expressed in many cancers. PPARgamma expression is a feature of esophageal cancer cell lines, and in the present investigation, the PPARgamma antagonists T0070907 and GW9662 could induce loss of invasion but could not induce growth reduction or apoptosis at low concentrations (< 10 mM). A high concentration of antagonists (50 microM) inhibited cell growth and induced apoptosis, but these effects did not explain our result at the low concentration. Morphological change, decreased expression of the cell signaling pathway and inhibition of cancer cell invasion were observed in the low concentration. This suggested that PPARgamma antagonists inhibited esophageal cancer cell invasion as well as cell adherence, most likely due to alteration in the FAK-MAPK pathway, and this was independent of apoptosis. These results suggested that PPARgamma plays an important role in cancer cell invasion and that it might be a novel target for therapy of esophageal cancer.

[The evaluation of preoperative and postoperative frontal lobe functions in three operative cases of meningioma].

We report three cases of frontal meningioma with their pre- and post-operative evaluations of higher brain functions, especially of frontal lobe functions. All of the cases showed the improvement of the frontal lobe functions after the tumor removal. The evaluations of frontal lobe functions in benign brain tumors such as a meningioma are reported only in a few cases. The evaluations of frontal lobe functions in the operative cases of benign brain tumors provide many interesting and valuable informations about frontal lobe functions. So we must be more interest in evaluations in higher brain functions and accumulate cases for the further analysis of higher brain functions.

[A case report of the chondroma arising from the falx cerebri].

We have reported a case of chondroma arising from the falx cerebri in a 60-year-old female with no neurological symptom. The tumor was revealed as a round mass, attached to the falx cerebri, with marginally scattered calcification on CT scan and with slight enhancement on MRI images. And cerebral angiogram presented a mass with no tumor stain on the external carotid angiography against our preoperative diagnosis of falx meningioma. A subtotal removal of the mass was performed with the diagnosis of chondroma on pathological examination. The chondroma arising from the falx cerebri is extremely rare with only 15 reported cases in the literature. We have presented the first case in Japan and reviewed the previous reports.

[Coil embolization with a hyperform occlusion balloon for an acutely ruptured wide-necked basilar tip aneurysm: case report].

A 54-year-old woman was admitted to our hospital because of severe headache. CT scan demonstrated subarachnoid hemorrhage (SAH), and cerebral angiography revealed a wide-necked basilar tip aneurysm with a bleb and a small basilar artery-left superior cerebellar artery aneurysm. She was treated with coil embolization using a neck remodeling technique one day after SAH. Guiding catheters were introduced into the bilateral vertebral artery via the transfemoral route. A Hyperform occlusion balloon catheter was introduced into the left posterior cerebral artery (PCA) through the left vertebral artery, and was placed at the neck of the basilar tip aneurysm for neck remodeling. Then, the microcatheter for coil deployment was placed in the dome of the aneurysm through the right vertebral artery. The coil was deployed in the aneurysm while the balloon was inflated across the neck. The inflated Hyperform occlusion balloon was partially herniated into the dome of the aneurysm. The distal part of the balloon was positioned in the left PCA segment, and its proximal part was positioned in the basilar artery. The balloon conformed easily to the aneurysmal neck and its surrounding vessel structure. When the balloon was deflated, the coil did not protrude into the parent artery, and was stable in the aneurysm. Angiography immediately after the procedure showed complete occlusion of the aneurysm with patency of both PCAs. The Hyperform occlusion balloon is very compliant and supple, so it easily changes from its cylindrical shape when inflated to expand into the origin of the arterial branches emerging from the aneurysm neck. We think this balloon is a useful device for treating wide-necked aneurysms located at arterial bifurcation.

[Direct carotid approach for carotid angioplasty and stenting with a small incision: a technical case report].

Direct carotid puncture is an important option in endovascular surgery when a guiding catheter is not advanced into the common carotid artery because of arterial tortuosity. However, hemostasis after the procedure is not easy and hematoma formation from the puncture site sometimes causes serious complications. We present our carotid angioplasty and stenting (CAS) method with a direct carotid puncture and a small incision. An 85-year-old male with transient ischemic attack had severe left carotid artery stenosis. CAS was planned considering his age, but arterial tortuosity prevented a guiding catheter from being introduced into the left common carotid artery. Following this, the left common carotid artery was exposed with a small skin incision under local anesthesia, and a direct carotid puncture was made. A 7-French short sheath was carefully advanced and positioned into the left common carotid artery and a self-expandable stent was delivered through it. Upon completion of the procedure, the puncture point of the vascular wall was sutured with 6-0 proline immediately after withdrawing the sheath, and the skin was closed. A direct carotid puncture with a small incision can be performed safely. This method can reliably stop bleeding from the puncture site and also avoid the need for prolonged manual compression of the carotid artery under systemic anticoagulation and antiplatelet therapy. We think our method is useful for accessing corotid artery stenosis when the transfemoral approach is difficult.