Inhibitory effect of drug-free hybrid liposomes on metastasis of human neuroblastoma.

PURPOSE: Hybrid liposomes composed of vesicular and micellar molecules have been used as drug-delivery systems. It has become clear that hybrid liposomes alone have an inhibitory effect against the growth of various tumor cells. The present study was designed to determine whether a drug-free hybrid liposome composed of dimyristoylphosphatidylcholine (DMPC) and polyoxyethylenealkyl ether (EO) [90 mol% DMPC/10% C(12)(EO)(21) (HL21), 90 mol% DMPC/10% C(12)(EO)(23) (HL23), or 90 mol% DMPC/10% C(12)(EO)(25) (HL25)], inhibit the liver metastasis of human neuroblastoma cells and thus increases survival. METHODS: A human neuroblastoma cell, TNB9, and BALB/C-nu/nu athymic mice were used in this study. First, we determined the inhibitory effect of the hybrid liposomes on TNB9 cells in vitro. Next, to determine the inhibitory effect of the hybrid liposomes on metastasis of neuroblastoma cells to the liver, we made a murine hepatic metastasis model by implanting TNB9 cells (2 × 106) in the spleen of the mice and compared anatomic appearance, weights, and histological findings of the livers of treated mice and control mice 60 days after the beginning of a 7-day intraperitoneal injection of a hybrid liposome. We also compared survival rates using the Kaplan-Meier method. RESULTS: In mice implanted with TNB9 neuroblastoma cells and treated with HL21 or HL25, no histological evidence of metastasis was found, the weight of the liver was normal, and survival was a mean of 88 and 87.9 days, respectively. In contrast, mice treated with HL23 and control mice had countless tumor cell masses histologically, their liver weight was increased, and their survival was 73.0 and 68.6 days, respectively. CONCLUSIONS: Two kinds of hybrid liposomes, HL21 and HL25, inhibit metastasis of human neuroblastoma cells to the liver, and thus increase survival.

Laparoscopic sleeve gastrectomy with duodenojejunal bypass: technique and preliminary results.

BACKGROUND: Obesity and metabolic disorders related to it have become a serious problem in Asia. Furthermore, gastric cancer in Asia is one of the frequent diseases on which to perform treatments. We introduced the technique of laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG/DJB) for patients with a risk of gastric cancer and compared the results of our initial series with those of other procedures. METHODS: Twenty-one patients underwent a LSG/DJB from April 2007 to November 2008. The mean preoperative weight and body mass index (BMI) were 108.0 kg and 41.0 kg/m(2), respectively. High risks of gastric cancer were determined as having a Helicobacter pylori positive with atrophic change of mucosa or a family history of gastric cancer. Operations were performed with five ports. Initially, SG and dissection of posterior wall of duodenum were carried out. Subsequently, DJB was added with 50-100 cm of biliopancreatic tract and 150-200 cm of alimentally tract. DJB consisted of a jejunojejunostomy created by a linear stapler and hand sewing closure and duodenojujunostomy by hand sewing with two layers. RESULTS: A LSG/DJB was performed successfully in all patients. The mean operation time was 217 +/- 38 min. The weight loss and percent excess BMI loss for LSG/DJB were similar to those for laparoscopic Roux-en-Y gastric bypasses. There was no mortality; however, one patient had leakage from a staple line of esophagogastric junction and reqiured drainage and stenting. No dumping, stenosis, marginal ulcer, or nutritional problems were observed during postoperative follow-up. All of the main comorbidities improved after this procedure. CONCLUSION: LSG/DJB is a feasible, safe, and effective procedure for the treatment of morbidly obese patients with the risk of gastric cancer.

Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity.

BACKGROUND: We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for super morbid obesity in patients with an initial body mass index (BMI) of <50 or > or =50. METHODS: Between October 2005 and January 2008, we performed LSG in 30 patients. There were 20 males and 10 females with a mean age of 38 years. Mean initial body weight and BMI were 139 kg and 49.1 kg/m(2), respectively. Sleeve gastrectomy was carried out using a linear stapler from the greater curvature of the antrum 5 cm proximal from the pyloric ring up to the angle of His alongside a 45-Fr. bougie. RESULTS: Laparoscopic procedures were performed successfully in all patients. The mean operation time was 92 min, and blood loss was minimal. The BMI change and weight loss at the 1-, 3-, 6-, 9-, 12-, and 18-month follow-up points of patients with an initial BMI of <50 and > or =50 were 34.2 and 57.4, 32.1 and 53.7, 29.6 and 50.8, 29.5 and 51.2, 27.8 and 52.2, and 29.7 and 45.5 kg/m(2) and 96.8 and 172.2, 89.5 and 157.0, 83.4 and 144.8, 84.0 and 145.4, 78.0 and 153.4, and 84.5 and 119.5 kg, respectively. The patients with a BMI of <50 obtained good outcomes, but weight loss reached a plateau at 9 months after surgery in patients with a BMI of > or =50. Postoperative complications included leakage, bleeding, stricture, and peritonitis in one patient each. There was no surgical mortality. Most of the co-morbidities improved after surgery. CONCLUSIONS: Sleeve gastrectomy is a feasible and safe treatment for super morbid obesity, but evaluation of long-term outcome is necessary to determine whether it is a durable procedure in terms of effectiveness. We expect that patients with a BMI of <50 are good candidates for LSG as a definitive treatment, and, if those with a BMI of > or =50 hope for further weight loss, a second-step procedure may be required.

Has laparoscopic bariatric surgery been accepted in Japan? The experience of a single surgeon.

BACKGROUND: Obesity is steadily increasing in Asia due to factors such as a lack of exercise, adoption of a more Western diet, changing lifestyles, environments, or stresses. Even in Japan, this tendency is notable, and metabolic syndrome has become widely recognized. However, bariatric surgery is still uncommon in Japan. There are no adequate data regarding the experience and outcome of bariatric surgery in Asia. Here, we report on the current status of morbid obesity and the outcomes of bariatric surgery by a single surgeon in Japan. METHODS: Between February 2002 and January 2008, we have performed laparoscopic bariatric surgery for morbid obesity in 178 cases. They consisted of laparoscopic Roux-en-Y gastric bypass (LRYGBP) in 105 cases, laparoscopic sleeve gastrectomy (LSG) in 26 cases, laparoscopic sleeve gastrectomy with duodenal jejunal bypass (LSG/DJB) in 14 cases, laparoscopic adjustable gastric banding (LAGB) in 13 cases, and laparoscopic biliopancreatic diversion with duodenal switch in one case under the same protocol of follow up. The first author of this paper performed all procedures. RESULTS: One hundred and thirty-eight patients with a follow-up of over 3 months after surgery were enrolled. LRYGBP accounted for 72% of all bariatric procedures. The reduction of weight and body mass index (BMI) in LRYGBP and LSG showed similar results. These outcomes were superior to those of LAGB. Percentage of excess BMI loss (%EBMIL) of LRYGBP showed greater reductions at follow-ups 6, 9, 12, and 18 months after surgery compared to that of LRYGBP and LAGB. All procedures resulted in over 50% of %EBMIL after 18 months of follow-up. There was no postoperative mortality within 30 days after surgery. Preoperative comorbidity including diabetes mellitus, hypertension, and hyperlipidemia were resolved or improved after surgery in most patients. CONCLUSION: In bariatric surgery, LRYGBP is the most effective treatment for morbid obesity, while LAGB has a low risk of postoperative complications. LSG is also a safe procedure for supermorbidly obese patients. We expect that bariatric surgery will be a common procedure for patients with morbid obesity in Japan.

Periodic duplex ultrasonography screening together with elective percutaneous transluminal angioplasty in the management of graft arteriovenous fistulas for hemodialysis.

PURPOSE: To evaluate the effectiveness of regular duplex ultrasonography in the management of graft arteriovenous fistulas for hemodialysis. METHODS: Between March 1997 and December 2004, we prospectively studied consecutive patients who underwent polytetrafluoroethylene graft arteriovenous (AV) fistulae in the upper extremity with a subsequent regular duplex ultrasound examination for the identification of stenosis. The main ultrasound-guided indication for percutaneous transluminal angioplasty (PTA) was the identification of 50% or more venous stenosis. The assisted primary and secondary patency rates of vascular access were calculated in these 36 patients and were then compared with those in 19 patients who had undergone graft AV fistula before the start of regular ultrasonographic screening. RESULTS: The mean follow-up lasted 25 months. PTA procedures were performed in 24 patients, of which 13 patients received multiple PTAs. The half survival time (secondary patency) of the graft was 49 +/- 3.8 months in patients who had undergone ultrasound screening followed by elective PTA, which was significantly (P < 0.01) longer than the 22 +/- 7.1 months observed in patients who had not undergone regular duplex ultrasound screening. CONCLUSION: The prospective monitoring of AV fistula with ultrasound is a simple and reliable technique for detecting graft AV outflow stenosis. Elective PTA is therefore considered to be an effective therapy for the maintenance of hemodialysis access.