[An anastomosis assist mirror; a new device for off-pump coronary artery bypass].

An anastomosis assist mirror for off-pump coronary artery bypass (OPCAB) is described. This new device is designed to make a view of the circumflex coronary artery which is often troublesome to access during OPCAB. It is composed of 3 parts: a small circular mirror, a paper clip and a flexible arm between the mirror and the clip. The paper clip is situated at an edge of a sternal retractor. The mirror is positioned beside the sheer surface of the lateral wall of the heart by regulating the flexible arm. It shows a flat, reflective view of the anastomotic site and makes an anastomosis easy. The device enables us to avoid excessive manipulation on the heart and hemodynamic instability, thereby reducing unnecessary volume overload, inotropic drugs or mechanical cardiac assistance.

[Graft holding system; a new device for coronary artery bypass grafting].

A new graft holding system for coronary artery bypass grafting was described. This system was an application of a memo-clip, which was composed of a flexible arm and 2 paper clips at both ends. A graft was wrapped by a piece of sponge and pinched indirectly by one of the clips. The other clip was fixed at an edge of the sternal retractor. Regardless of the size of the graft or the amount of the surrounding tissue, the graft can be fixed securely at one's pleased position due to a flexible arm of the device. Intimal injury can be avoided referring to the gentle holding of a piece of sponge. It enables us to place precise stitches and to minimize handling, anastomosis time, and leakage.

Natural history of colorectal carcinoma: can the tumor volume doubling time be predicted by radiologic findings or immunohistochemical variables?

BACKGROUND AND OBJECTIVES: The factors influencing the growth rate of colorectal carcinoma have not been determined. The aim of this study was to clarify the relationship between the doubling time (DT), morphology, and proliferating cell nuclear antigen, Ki-67 and p53 immunohistochemistry in colorectal carcinoma. METHODS: Thirty-three patients (37 lesions) were studied retrospectively. The DT was calculated and correlated with the initial and final tumor size, morphologic shape, and immunohistochemical results. RESULTS: The DT ranged from 2.4 to 48.0 months (mean: 12.0 months). The mean DT of the early-stage carcinomas was significantly longer than that of the advanced carcinomas. In the latter group, both slowly growing and rapidly growing tumors were observed. The DT showed no correlation with the initial or final size and shape of the tumors on radiographs, or with the immunohistochemical results. CONCLUSIONS: Our data revealed that it is not possible to evaluate the growth rate of colorectal carcinomas based on their morphological shape, cellular proliferative activity, or tumor suppressor gene activity.

Inferior mesenteric varix demonstrated by 99mTc-red blood cell gastrointestinal bleeding study.

Reported here is a case of an inferior mesenteric varix demonstrated by 99mTc-red blood cell (RBC) scintigraphy performed for gastrointestinal bleeding in a 47-year-old man. It was shaped like a question mark ranging from the left upper abdomen to the pelvis. This is the first report of scintigraphic recognition of an inferior mesenteric varix.

Correlation between tumor volume doubling time and histologic findings in gastric smooth muscle tumors: clinical implications of tumor volume doubling time.

To assess the clinical implications of the tumor volume doubling time of gastric smooth muscle tumors based on a comparison with the histologic findings, seven tumors (four leiomyomas and three leiomyosarcomas) were followed up by consecutive upper gastrointestinal studies between March 1985 and December 1993. The patients were four men and three women with an average age of 58 years (range: 50-71 years). The observation period ranged from 6 to 51 months, with an average of 35 months. All tumors were surgically resected and the histologic diagnosis was confirmed. The following microscopic features were evaluated: 1) mitotic rate, 2) nuclear atypia, and 3) cellularity. Each tumor was also evaluated for the presence or absence of necrosis, hemorrhage, and degeneration. The doubling time ranged from 5 to 27 months with a mean of 16 months. There was a strong negative correlation between the mitotic rate and the doubling time (r = -0.935, P = 0.0019). The doubling time was also significantly related to nuclear atypia, but the number of tumors studied was so small that its reliability was questionable. The doubling time was not related to any other histologic findings. This study shows that the doubling time is useful for estimating the malignant potential of gastric smooth muscle tumors, and that tumors with a doubling time of 16 months or less should be considered as malignant.

Natural history of minute sessile colonic adenomas based on radiographic findings. Is endoscopic removal of every colonic adenoma necessary?

PURPOSE: With the development of colonoscopy and double-contrast barium enema, detection of minute sessile colonic adenomas has increased. We evaluated progression of these lesions radiologically and attempted to clarify the natural history. METHODS: A total of 125 minute sessile adenomas (< or = 5 mm in size) with histologic confirmation were examined by double-contrast barium enema at an interval of more than one year. The average follow-up period was 24 (range, 12-36; standard deviation, 9.4) months. To allow for differences in magnification, adenomas increasing in size by 2 mm or more were defined as growing, and the other lesions were defined as unchanged. RESULTS: Eighty-six adenomas showed no interval change in size. Four adenomas decreased 1 mm in size, and 27 adenomas increased 1 mm in size. The remaining eight adenomas (6 percent) increased by 2 or 3 mm in size. None of the adenomas showed any morphologic changes. There was also no difference in degree of histologic atypia between growing and unchanged adenomas. None of the adenomas developed into carcinomas during the follow-up period. CONCLUSIONS: These data show that most minute sessile adenomas remain unchanged in size and morphology over the long term. Accordingly, these adenomas probably should be followed up radiologically or endoscopically to avoid excessive polypectomy.

Colonic submucosal tumors: comparison of endoscopic US and target air-enema CT with barium enema study and colonoscopy.

PURPOSE: To compare the imaging characteristics of colonic submucosal tumors at endoscopic ultrasound (US) and target air-enema computed tomography (TACT) with those at conventional double-contrast barium enema study and colonoscopy. MATERIALS AND METHODS: Twenty consecutive patients with suspected colonic submucosal tumors at barium enema study and colonoscopy underwent endoscopic US, TACT, or both. Morphologic features and posture-related change in shape of tumor were evaluated with barium enema study, color and consistency of tumor with colonoscopy, internal echogenicity of tumor and layer of origin in normal colonic wall with endoscopic US, and CT attenuation number with TACT. RESULTS: Eight lipomas, seven carcinoids, three leiomyomas, four lymphangiomas, and one hemangioma were found at histologic examination. Lipomas and lymphangiomas had characteristic findings at endoscopic US and TACT. The differential diagnosis of the other submucosal tumors was facilitated by using endoscopic US. CONCLUSION: Endoscopic US and TACT may play a valuable role in the evaluation of colonic submucosal tumors.

Endoscopic ultrasonography in the assessment of colonic wall invasion by adjacent diseases.

For assessing the direct invasion of the colonic wall by pelvic or abdominal tumors, endoscopic ultrasonography was performed prospectively in patients who were suspected of having colonic wall invasion by barium enema. Three patients with ovarian cancer, two with endometriosis, and one with pancreatic cancer were included in this study. Preoperative endoscopic ultrasonography (EUS) revealed the relationship between the tumor and the colon in all cases. A surgical procedure was performed in all patients: resection of the tumor and a portion of the invaded colon (4) and removal of the tumor (only adhesion) (2). A correct preoperative diagnosis of the depth of tumor invasion was obtained in five of the six (83%) cases. In patients with pelvic or abdominal tumors, preoperative EUS may be useful for evaluating the presence and the degree of invasion of the colonic wall by the tumor.