Endoscopic full-thickness dissection (EFTD) in the rectum: a case series.

BACKGROUND: Rectal endoscopic full- thickness dissection (EFTD) using a flexible colonoscope is an alternative to the well-established trans-anal endoscopic microsurgery (TEM) and the trans-anal minimally invasive surgery (TAMIS) techniques for resecting dysplastic or malignant rectal lesions. This study evaluated EFTD safety by analyzing outcomes of the first patients to undergo rectal EFTD at the University Hospital of North-Norway. METHODS: The first 10 patients to undergo rectal EFTD at the University Hospital of North-Norway April, 2016 and January, 2021, were included in the study. The procedural indications for EFTD were therapeutic resection of non-lifting adenoma, T1 adenocarcinoma (AC), recurrent neuroendocrine tumor (NET) and re-excision of a T1-2 AC. RESULTS: EFTD rectal specimen histopathology revealed three ACs, five adenomas with high-grade dysplasia (HGD), one NET and one benign lesion. Six procedures had negative lateral and vertical resection margins and in three cases lateral margins could not be evaluated due to piece-meal dissection or heat damaged tissue. Two patients experienced delayed post-procedural hemorrhage, one of whom also presented with a concurrent post-procedural infection. No serious complications occurred. CONCLUSION: Preliminary results from this introductory trial indicate that EFTD in the rectum can be conducted with satisfactory perioperative results and low risk of serious complications.

Implementation of Endoscopic Submucosal Dissection for Gastric Lesions in Norway.

BACKGROUND AND AIMS: Endoscopic submucosal dissection is a minimal invasive method for an en bloc resection of dysplasia or early cancer in the stomach. It was developed in Japan in the 1990s, but thus far has not been widely adopted in Western countries. The aim of this study is to report from the introductory phase of gastric endoscopic submucosal dissection in a small-volume Scandinavian center. MATERIAL AND METHODS: The 15 first patients operated on with endoscopic submucosal dissection in the stomach at the University Hospital of North Norway were consecutively registered in a prospective database and evaluated as a quality assurance study. The indications for the procedures were diagnostic or therapeutic. RESULTS: Three patients had benign lesions, three had low-grade dysplasia, five had high-grade dysplasia, two had neuroendocrine tumors, and two had early gastric cancers (T1b). The R0 resection rate was 83%. One neuroendocrine tumor was directed to surgery. No recurrences have been detected after the median of 6 months, and with the exception of one delayed bleeding being treated endoscopically, no serious complications occurred. Two perforations were perioperatively closed with clips. CONCLUSION: This is the first report on gastric endoscopic submucosal dissection in Scandinavia. Preliminary results from an introductory phase indicate that endoscopic submucosal dissection for dysplasia or early gastric cancer may be conducted safely and with acceptable results even in a small-volume center, assuming that surgeons and gastroenterologists in a region direct cases to one individual who can learn this skill.

Spigelian-cryptorchidism syndrome: a case report and discussion of the basic elements in a possibly new congenital syndrome.

Pediatric cases of Spigelian hernias are rare. Only a few reports on this condition, in combination with ipsilateral cryptorchidism and testis in the hernia sac, have been published. We report on Spigelian hernia in a 3-week-old boy containing both the ipsilateral testis, without a gubernaculum and an incarcerated loop of the small intestine. It has been suggested that the combination of Spigelian hernia and ipsilateral cryptorchidism is part of a new syndrome. We discuss whether the lack of a gubernaculum and an inguinal canal reported in other similar cases may be additional elements of this new syndrome. We present a comprehensive overview of pediatric patients with Spigelian-cryptorchidism syndrome reported in the English language literature. In 75% of male infants with Spigelian hernia, there is an associated ipsilateral cryptorchidism, and in 87% of these patients, the testis is found inside the hernia sac. Thus, the surgeon dealing with a congenital Spigelian hernia should look for an undescended testis and be prepared to find it in the hernia sac.

Introducing an asymmetric cleft lift technique as a uniform procedure for pilonidal sinus surgery.

BACKGROUND AND AIMS: Asymmetric techniques for surgery in pilonidal sinus disease (PSD) have been reported to provide better results than simple excision and closure in the midline. The aim of this retrospective study was to evaluate the results after introducing the Bascom asymmetric cleft lift procedure in our hospital on a day care basis. MATERIAL AND METHODS: From a total of 33 patients operated from April 2002 to September 2004 with the Bascom asymmetric cleft lift technique, we were able to contact 29 who were invited to a follow up study. Eighteen (62%) of these patients accepted a consultation in the outpatient clinic while 11 (38%) were interviewed by phone. RESULTS: At follow up mean 17 (range 10-27) months after the operation 24 (83%) of the wounds were healed while recurrences were present in 5 (17%) of the patients. In two of the patients with recurrences errors in the procedures were identified. Further results related to pre-, per- and postoperative conditions are discussed in this paper. CONCLUSION: Early results after surgery for PSD with the Bascom asymmetric cleft-lift technique are promising. The technique has now become our standard procedure for treating chronic, symptomatic PSD.

Early events of hepatic metastasis formation in mice: role of Kupffer and NK-cells in natural and interferon-gamma-stimulated defense.

Surgical manipulation of a tumor may result in increased influx of tumor cells into the systemic and portal circulation and give rise to formation of metastases. In addition, major surgery has been reported to cause profound immunosuppression. In an attempt to increase the host-antitumor immune mechanisms following surgery we have studied the effect of preoperative administration of interferon-gamma, related to the antimetastatic effects of Kupffer cells (KC) and natural killer cells (NK-cells) in the early phase of liver metastasis formation. Colon carcinoma cells were injected into the superior mesenteric vein of syngeneic mice and after 17 days metastases were quantified by weight, number, and uptake of [125I]iododeoxyuridine. Unstimulated control mice developed 10.5 surface nodules per liver 17 days following injection of colon carcinoma cells into the superior mesenteric vein of syngeneic mice. This figure was only 2.6 in mice stimulated with a single dose of 1000 IU IFN-gamma 4 h prior to inoculation of tumor cells. Administration of GdCl3, which is reported to deplete and block the function of Kupffer cells, 24 h prior to tumor cell inoculation resulted in a 5-fold tumor mass increase relative to control. Injection of anti-asiolo-GM1 antiserum, which eliminates the hepatic NK-cells, induced a 10-fold increase in tumor mass. These results indicate an important early antimetastatic function of hepatic NK-cells and KC and that presurgical administration of IFN-gamma may be important for eliminating circulating tumor cells and inhibiting development of residual tumors.

Inhibition of establishment and growth of mouse liver metastases after treatment with interferon gamma and beta-1,3-D-glucan.

The purpose of this study was to investigate the combined antitumor effect of aminated beta-1,3-D-glucan (AG) and interferon-gamma (IFN-gamma) in an experimental liver metastasis model. Liver metastases were established by inoculation of C-26 colon carcinoma cells into the superior mesenteric vein of syngeneic mice. Treatment of mice started 24 hours after inoculation of tumor cells by daily intravenous injections of either AG, IFN-gamma, or a combination of both for a duration of 6 days. The resultant liver metastases were then quantified after an additional period of 11 days. Combination of IFN-gamma and AG inhibited the growth of liver metastases almost entirely. IFN-gamma was also very efficient, while AG alone did not exert any significant antitumor effect. These results, along with histological studies from mice receiving AG and IFN-gamma, indicated that activation and recruitment of liver macrophages may be a part of the mechanism responsible for the inhibition of metastatic growth observed in this study.

Serum gamma-glutamyltransferase and alkaline phosphatase during experimental liver metastases. Detection of tumour-specific isoforms and factors affecting their serum levels.

Tumour-specific isoenzymes and tumour markers in serum are potentially useful in the detection and monitoring of liver metastases. An experimental rat model was used in the search for such isoenzymes and to study factors affecting their serum levels. Splenic injection of CC531 colon carcinoma cells in syngeneic WagRij rats caused liver metastases after 3 weeks with concomitant and significant increases in serum levels of gamma-glutamyltransferase (GT) and alkaline phosphatase (ALP). The presence of tumour-specific isoforms of both enzymes, as well as increased amounts of the liver isoform of ALP, were demonstrated in serum. The serum levels of the tumour variants were clearly related to their elimination rates from the circulation. Thus, the slow clearance of the tumour ALP resulted in high serum levels of this isoform, compared with the more rapid elimination of tumour GT and its lower serum level. When using another colon carcinoma cell line (DHD/K12), metastatic to liver in BD IX rats, no increases in serum GT were detected. This was related to the rapid elimination from the circulation of the GT variant from the DHD/K12 metastatic tissue. The relatively high amount of the tumour ALP isoform detected in serum during growth of the CC531 liver metastases indicated that this isoform could be useful as a marker of tumour growth.

Cytotoxic effect of cytokines on murine colon carcinoma cells involves TNF-mediated apoptosis.

We have studied the cytotoxic effect of TNF-alpha on C-26 murine colon carcinoma cells in vitro. Treatment with TNF-alpha alone did not result in any demonstrable cytotoxicity. However, when combined with IFN-gamma, the cytotoxic effect of TNF-alpha was enhanced in a dose-dependent manner. An agonistic TNF-R1 specific antibody and recombinant human TNF-alpha both exerted a cytotoxic effect when combined with IFN-gamma, suggesting that the cytotoxicity was mediated through the TNF-R1. The cytotoxicity was associated with production of nitric oxide without any direct involvement in the cytotoxic effect. At the ultrastructural level, treated cells displayed a typical apoptotic morphology which was not accompanied by internucleosomal cleavage of DNA as shown by conventional electrophoresis.

Distribution of colon cancer cells permanently labeled by lectin-mediated endocytosis of a trap label.

A method was elaborated for high-yield 125I-trap labeling of rat colon carcinoma cells using conjugates of dichlorotriazine aminofluorescein and bovine serum albumin substituted with either N-acetylgalactosamine or N-acetylglucosamine as vehicles. Fluorescence microscopy revealed that the ligands accumulated in perinuclear vesicles that were probably lysosomes. Monensin inhibited accumulation by 40%, signifying receptor-mediated endocytosis. Competition experiments revealed that the same receptor(s) mediated endocytosis of the two neoglycoproteins. Accumulation of label was greatly enhanced in the absence of serum, resulting in a labeling efficiency of at least 15 cpm/cell, with no sign of toxic effects. At least 75% of the initially accumulated radioactivity resided in the cells 4 days after labeling. After that the loss of radioactivity was linear with time and stabilized at 1.1%/day for at least 2 weeks. Injection of labeled carcinoma cells i.v. into syngeneic rats revealed a very rapid clearance from the circulation. Isolation of the liver cells 24 h later revealed that a great proportion of the administered cells or their remnants had been engulfed by sinusoidal Kupffer and endothelial cells; the parenchymal cells contained a smaller proportion of label. In conclusion, we have developed a technique of labeling colon carcinoma cells with 125I and fluorescein utilizing specific lectin-like receptors for endocytosis. Since the label is trapped intralysosomally, it will also label Kupffer cells and other members of the reticuloendothelial system after internalization. These features make the procedure well suited for studies on the fate of the colon carcinoma cells after administration in vivo. Since the label is trapped intralysosomally for an extended length of time, parameters such as the formation of metastasis and elimination by phagocytosis can readily be determined.