Laparoscopic decompression of a stricture of the celiac artery caused by the median arcuate ligament in a gastric cancer patient: A case of report.

Stricture of the celiac artery caused by the median arcuate ligament induces abdominal ischemic symptoms and aneurysm near the pancreatic head. However, the need to treat asymptomatic patients is unclear. We safely performed surgical decompression of a stricture of the celiac artery by MAL in an asymptomatic patient at the same time as gastrectomy for gastric cancer. After surgery, the stricture of the celiac artery had disappeared as demonstrated by CT scan and 3-D CT angiography.

[A case of gastric follicular lymphoma resected and diagnosed with laparoscopy and endoscopy cooperative surgery].

A woman in her 70s was diagnosed with a protruding mucosa-associated lymphoid tissue (MALT) lymphoma during a secondary health examination. After eradication of Helicobacter pylori, a biopsy revealed gastric follicular lymphoma (FL) and the lesion was still protruding one year later. 18F-fluorodeoxyglucose positron emission tomography showed focal nodular hypermetabolic activity, suggesting that FL may have transformed into a diffuse large B-cell lymphoma. Upper gastrointestinal endoscopy, colonoscopy, and capsule endoscopy showed no other lesions in the gastrointestinal tract, and bone marrow biopsy showed no permeation into the marrow. Therefore, this lesion, which appeared as a submucosal tumor, was limited to the stomach. Laparoscopy and endoscopy cooperative surgery was performed, because it allows for correct pathological diagnosis while removing only a minimal portion of the stomach wall. Histological findings showed follicular structures consisting of abnormal lymphoid cells. Immunohistochemical analysis revealed that neoplastic cells were positive for CD20, CD79a, Bcl-2, CD10, and c-MYC, but negative for CD3, CD5, and cyclin D1. Finally, we diagnosed this lesion as a primary gastric FL.

An extrapancreatic solid-pseudopapillary neoplasm in the greater omentum.

A solid pseudopapillary neoplasm (SPN) is an uncommon pancreatic tumour that usually occurs in young women. Tumours outside the pancreas (e.g. in the ovary, retroperitoneum or omentum) are rare. We report a case of an SPN arising from the greater omentum in a 78-year-old male who presented with a month-long history of abdominal pain and a palpable abdominal mass. Laboratory data showed inflammation and anaemia. CT and magnetic resonance imaging revealed a well-defined encapsulated mass measuring 18 cm in the upper right abdomen. The tumour was completely removed via surgery, and pathologic examination confirmed a diagnosis of an SPN in the greater omentum.

Imaging findings of gastric calcifying fibrous tumour.

Calcifying fibrous tumours (CFTs) are rare benign lesions that usually affect the soft tissues, the mesentery and the peritoneum. Gastric CFT is particularly rare. Here, we report a CFT found incidentally in a 31-year-old male. The mass was well circumscribed and showed partial calcification on the CT scan, with dark signal intensity seen on T2 weighted MRI. To the best of our knowledge, there is very limited published information concerning imaging findings of CFTs. We discuss the CT scan and MRI findings of this patient, which can be considered typical for gastric CFT, and present a review of the limited literature available.

Long-term survival outcomes of advanced gastric cancer patients who achieved a pathological complete response with neoadjuvant chemotherapy: a systematic review of the literature.

BACKGROUND: A pathologic complete response (pCR) can sometimes be induced by intensive or long-term neoadjuvant chemotherapy (NAC). This prognostic research study based on a systematic review of the literature evaluated the impact of a pCR on the long-term survival of gastric cancer (GC) patients. METHODS: Articles were extracted from PubMed and the Japanese medical search engine "Ichu-shi," using the terms "GC," "NAC," and "pCR." Articles were selected based on the following criteria: (1) full-text case report, (2) R0 resection following NAC for locally advanced GC, and (3) pathological complete response in both the primary stomach and in the lymph nodes. A questionnaire regarding the patients' prognoses was sent to the corresponding authors of the articles selected in July 2013. RESULTS: Twenty-four articles met the criteria. Twenty authors responded to the questionnaire. Finally, 22 patients from 20 articles were entered into the present study. The median follow-up time (range) of the survivors was 76 (range 13-161) months. Tumors that were stage III/IV (86%: 19/22) and of an undifferentiated histology (61.9%: 13/21) were dominant. An S1-based regimen was frequently selected for the NAC. All patients underwent R0 resection and D2/D3 lymphadenectomy. The overall survival and recurrence-free survival rates at 3 and 5 years were 96% and 85% and 91% and 75%, respectively. CONCLUSIONS: Although a pCR was a relatively rare event, a high pCR rate would be helpful to select the regimen and courses of NAC, especially when the pathological response rates are similar.

Pediatric ileoileal intussusception with a lipoma lead point: a case report.

Intussusception is a common cause of mechanical bowel obstruction among children, with older children being more likely to have a pathological lead point. Intestinal neoplasms are rare and small intestinal lipomas are even less common. Herein we describe a case of a 7-year-old boy with ileoileal intussusception, with an ileal lipoma as the pathological lead point. Computed tomography was useful pre-operatively for revealing intussusception due to lipoma as the pathologic lead point.

[Bevacizumab therapy for a colorectal cancer patient or hemodialysis with hepatic metastasis].

We report our experience with a case of colorectal cancer treated with chemotherapy for a liver metastasis patient on hemodialysis. The patient was a 67-year-old man with a history of chronic renal failure, who was on hemodialysis since 2005. High anterior resection was performed for sigmoid colon and rectal cancer in January, 2010. After starting chemotherapy while planning to use FOLFOX6+bevacizumab(BV)as a postoperative standard chemotherapy, in combination with hemodialysis three times a week while performing dose escalation, administration postponement was continued for myelosuppression that was considered to be the effect of oxaliplatin. Oxaliplatin was administered for only 2 courses, and was then changed to BV+sLV5FU2 therapy. We continued treating the metastases approximately on schedule. Imaging revealed, the liver metastases were CR because they had disappeared. The BV use case of the dialysis case had few reports, but was thought to be able to use it by careful administration safely.

[Effectiveness of postoperative adjuvant chemotherapy using S-1 plus CDDP for type 4 gastric cancer].

BACKGROUND: Our aim was to evaluate postoperative adjuvant chemotherapy using S-1 plus cisplatin(S-1/CDDP)for type 4 gastric cancer. METHODS: We investigated 18 patients who had undergone curative operations for type 4 gastric cancer. They were classified into two groups of patients, one using S-1/CDDP(group A: 9)and one using S-1 alone(group B: 9), after surgery between 2000 and 2010. Median survival time(MST)and survival rates were reported retrospectively. Patients as- signed to group A were treated with the following regimen: S-1, 80-120mg/day(body surface area 1. 25m2>: 80mg/day, 1. 25-1. 5m2: 100mg/day, 1. 5m2<: 120mg), was administered for 21 consecutive days followed by a 14-day rest period, and CDDP, 60mg/m2, was administered on day 8 for 5 courses. After this course, S-1 80mg/m2 was given for 18 months. S- 1(80-120mg/day, body surface area 1. 25m2>: 80mg/day, 1. 25-1. 5m2: 100mg/day, 1. 5m2<: 120mg)was administered for 28 days followed by 14-day rest as one course. RESULTS: MST differed significantly between group A and group B (MST; group A: 1, 603 vs group B: 955 days). The overall survival rate at 5 years was 64. 8% in group A and 13% in group B, and the overall survival rate in group A was statistically better than that in group B(p=0. 02). CONCLUSION: Postoperative adjuvant chemotherapy using S-1/CDDP for resected type 4 gastric cancer contributes to prolonged life, compared with using S-1 in overall survival.

[Type 4 advanced gastric cancer responding to histological complete response after neoadjuvant S-1 combined with CDDP therapy-report of a case].

A 75-year-old man with type 4 advanced gastric cancer was referred to our hospital. We diagnosed the tumor as cStage III B(cT4a, cN2, cM0)gastric cancer. We selected neoadjuvant S-1 combined with CDDP therapy for him. After 2 courses of chemotherapy, the extension of the gastric wall improved. After an additional 2 courses of chemotherapy, the primary tumor revealed a partial response(PR), judged from a barium meal study and upper GI endoscopic findings, and a total gastrectomy with lymph node dissection was performed. The pathological specimens showed no cancer cells in the gastric wall and lymph nodes, so the histological effect was judged as Grade 3.

[A case of advanced gastric cancer with tumor embolus in the portal vein successfully treated with S-1 and CDDP therapy].

A 50-year-old man with advanced gastric cancer and a tumor embolus in the portal vein was referred to our hospital. We diagnosed the tumor as cStage III B (cT3, cN2, cH0, P0, M0) gastric cancer, and selected neoadjuvant S-1 (80 mg/m2) and CDDP (60 mg/m2) therapy for him. After 2 courses of chemotherapy, the embolus in the portal vein disappeared. After additional chemotherapy, the primary tumor and regional lymph node revealed a partial response (PR), and judging from the results from the barium meal study, upper GI endoscopic findings and CT scan, a total gastrectomy with lymph node dissection was performed.

[Investigation of epiphora following S-1 therapy].

We report the frequency of lacrimal passage disorder and the outcomes of treatment. This retrospective study was performed on 55 cases that were treated with S-1 for at least 1 month. We asked patients about ocular symptoms. An ophthalmic surgeon examined all patients and diagnosed lacrimal passage disorder in 6 of 55 patients (12. 5%). The mean dose of S- 1 was 10, 300 mg, and the average period to onset of lacrimal passage disorder was 5. 7 months. The causes of epiphora included occlusion/stenosis of lacrimal canaliculus, occlusion of lacrimal puncta and stenosis of nasolacrimal duct. Lacrimal surgery was performed in all 6 patients and epiphora improved. Lacrimal passage disorder may result from systemic treatment of patients with S-1. Symptoms of lacrimal passage disorder improved with early detection and treatment by insertion of a silicone tube.

Effects of ultrasonic skeletonization of the gastroepiploic artery on endothelial nitric oxide production.

OBJECTIVE: : The right gastroepiploic artery (GEA) is a reliable conduit for coronary artery bypass grafting. Recently, ultrasonic skeletonization in graft harvesting has attracted attention as an alternative technique to increase the length and caliber size of grafts. The influence of GEA skeletonization using an ultrasonically activated device with that using an electrosurgical unit was compared from the viewpoint of production of nitric oxide (NO). METHODS: : Fourteen pigs were used in this study. The GEA were harvested using an ultrasonically activated device (group ultrasonically activated device [USAD], n = 7) or electrocautery (group E, n = 7). Blood sampling was performed at the following three times from the distal end of the GEA: (1) preskeletonization, (2) pedicle, and (3) postskeletonization. Plasma NOx (NO metabolites) levels were measured by chemiluminescent assay. Moreover, in excised specimens, the expression of nitric oxide synthase was examined immunohistologically. RESULTS: : In group USAD, the preskeletonization basal level of plasma NOx in GEA was 25.7 ± 10.9 µmol/L, which then increased to 26.9 ± 10.5 µmol/L (pedicle) and 32.2 ± 12.1 µmol/L (postskeletonization). In group E, the preskeletonization basal plasma NOx level in GEA was 28.9 ± 11.4 µmol/L, which changed to 27.5 ± 8.9 µmol/L (pedicle) and 21.8 ± 8.3 µmol/L (postskeletonization). The results of multivariate analysis indicated that the patterns of changes in plasma NOx level were significantly different in both groups (P = 0.024). In group USAD, post hoc multiple comparison tests revealed a significant difference between preskeletonization and postskeletonization (P = 0.037). CONCLUSIONS: : Ultrasonically skeletonized GEA showed increased effective graft length, higher free flow capacity, and increased endothelial NO production than that prepared using an electrosurgical unit.

An innovative balloon-type surgical device for atrial fibrillation.

BACKGROUND: The maze procedure and its modifications are the surgical treatment for atrial fibrillation. In an attempt to achieve a less invasive operation, we developed a balloon-type device for electric pulmonary vein isolation and evaluated its effectiveness macroscopically and microscopically. METHODS: We created a left heart system model from 20 pigs. Based on a mold, a balloon was made with silicone resin. When this balloon was inflated, all pulmonary vein orifices were pressed and ablated by probes using radiofrequency and cryotherm as energy sources. Macroscopic and microscopic evaluations were performed. RESULTS: Complete circular ablation by radiofrequency was confirmed in 2 of 3 veins. The transmural denaturation was pathologically confirmed in all areas ablated at 80 degrees for 2 minutes. The complete circular ablation line and the transmural denaturation were macroscopically and microscopically confirmed after cryoablation at -100 degrees for 2 minutes using liquid nitrogen. CONCLUSIONS: This study proved that the balloon is effective in simplifying pulmonary vein isolation and has potential to become an instrument that contributes to less invasive operations in the near future.

[A case of recurrent gastric cancer that responded dramatically to docetaxel and 5'-DFUR combination chemotherapy].

A 54-year-old man suffering from Borrmann type 4 advanced gastric cancer with pancreatic invasion and paraaortic lymph node metastases underwent a total gastrectomy, which was a radical C operation. From postoperative month 4, he visited our hospital with multiple liver metastases and increased lymph node metastases. After chemotherapy with CDDP and 5-FU, CDDP and UFT was administered on an outpatient basis. The effect of this therapy was PD, therefore, docetaxel and 5'-DFUR combination chemotherapy was performed as second line therapy. After 2 courses of this therapy, the size of liver and lymph node metastases was reduced and the effect of this therapy was PR. The patient has undergone 4 courses of this therapy and is maintaining a clinical PR. It is conceivable that docetaxel and 5'-DFUR combination chemotherapy is useful for patients with advanced and recurrent gastric cancer, even if they had been treated with 5-FU administration as first line therapy.