A Case of Isolated Superior Mesenteric Artery Dissection Resulting in Recurrent Necrosis of the Small Intestine.

Isolated superior mesenteric artery dissection (ISMAD) is a rare cause of acute abdominal conditions. Most cases of ISMAD have a favorable prognosis, and only a few cases of ISMAD-associated intestinal necrosis have been reported. A 75-year-old male was referred to our department because of abdominal pain and portal venous gas detected on imaging. Computed tomography suggested ileal necrosis, necessitating emergency surgery. Indocyanine green was used for blood flow assessment; however, no fluorescence was observed in the ileum proximal to the Bauhin valve, leading to the decision for ileocecal resection. On postoperative day 6, abdominal pain recurred when meals were resumed. As a surgical intervention for ISMAD, a bypass was created using the left great saphenous vein as a graft between the superior mesenteric artery and the right external iliac artery. This case highlights a rare occurrence where intestinal necrosis recurred due to ISMAD. We propose that in cases of ISMAD with concomitant intestinal necrosis, a more aggressive revascularization strategy for the dissected segment of the superior mesenteric artery may be required.

Investigation of the Utility and Safety of Dynamic Computed Tomography with Vasodilators.

BACKGROUND: Dynamic computed tomography (CT) angiography is useful for evaluating of hepatic vascularity. Although vasodilators increase hepatic blood flow, the utility of dynamic CT with vasodilators is unclear. Here we investigated the utility and safety of dynamic CT with vasodilators. METHODS: A prospective case-control radiographic evaluation using abdominal dynamic CT with and without vasodilator was performed at a single center between October 2015 and September 2016. We compared the CT values in Hounsfield units of the aorta; celiac artery; and common, right, and left hepatic arteries in the arterial phase and the main trunk; right and left branches of the portal vein; and right, middle, and left hepatic veins in the portal phase with and without vasodilators. The region of interest was set in each element of the liver vasculature. Four radiological technologists independently and visually compared the scores of the portal vein (P-score) and hepatic vein (V-score) on a 5-point scale with and without vasodilators. RESULTS: The CT values of arteries and veins using vasodilators were significantly higher than those without vasodilators. With and without vasodilators, the P-scores were 3.1 ± 1.2 and 4.0 ± 1.1 (P < 0.05) and the V-scores were 3.3 ± 1.4 and 4.3 ± 1.0 (P < 0.05). Only one patient with vasodilator use had transient hypotension and recovered immediately without medication. CONCLUSION: Dynamic CT with vasodilators can provides better visualization of vascular structures.

Clinical importance of preoperative and postoperative prognostic nutritional index in patients with pancreatic ductal adenocarcinoma.

BACKGROUNDS/AIMS: The prognostic nutritional index (PNI) is based on the albumin concentration and absolute lymphocyte count and is designed to assess the nutritional and immunological status of patients. In this study, we evaluated the prognostic importance of the preoperative and postoperative PNI in patients who underwent curative resection of pancreatic ductal adenocarcinoma (PDAC). METHODS: From 2006 to 2017, 50 patients with PDAC underwent curative resection at our hospital. We performed distal pancreatectomy (DP) with splenectomy in 15 patients, pancreaticoduodenectomy (PD) in 27 patients, PD combined with portal vein partial resection in 6 patients, and total pancreatectomy with splenectomy in 2 patients. We compared the preoperative PNI and postoperative PNI (1 and 2 months postoperatively) and analyzed the prognostic importance for these patients. RESULTS: The mean PNI significantly decreased from 45.5 preoperatively to 39.8 at 1 month postoperatively (p<0.001), but recovered to 42.7 at 2 months postoperatively. In 23 patients, the PNI at 2 months postoperatively recovered to the preoperative level (recovered group), but in the remaining 27 patients, the PNI at 2 months postoperatively did not reach the preoperative level (non-recovered group). The overall median survival time in the recovered group (29 months) was significantly longer than that in the non-recovered group (12 months, p=0.003). The multivariate overall analysis demonstrated that good recovery of the postoperative PNI was strongly correlated with a better prognosis. CONCLUSIONS: Effective postoperative nutrition may have a prognostic benefit for patients with operable PDAC.

Median arcuate ligament syndrome and aneurysm in the pancreaticoduodenal artery detected by retroperitoneal hemorrhage: A case report.

Here, we report a case with successful treatment of inferior pancreaticoduodenal artery aneurysm rupture due to celiac artery trunk compression caused by the median arcuate ligament. When clinicians see visceral aneurysms, the possibility of arcuate midline ligament compression syndrome (MALS) and ligamentectomy for MALS should be considered.

WNT/ß-Catenin Signaling Inhibitor IC-2 Suppresses Sphere Formation and Sensitizes Colorectal Cancer Cells to 5-Fluorouracil.

BACKGROUND/AIM: Colorectal cancer (CRC) is one of the most malignant types of cancer worldwide. Recent studies suggest that a small subpopulation of cells, so-called cancer stem cells (CSCs), promote the high metastasis and relapse associated with CRC. WNT/ß-catenin signaling plays a critical role in CSC maintenance. Therefore, its inhibitor may suppress CSCs and improve therapeutic effects on CRC. MATERIALS AND METHODS: The effects of a derivative of WNT/ß-catenin signaling inhibitor, IC-2, which we recently developed, on the CRC cell line DLD-1, were examined by luciferase reporter assay, WST assay, western blot, and sphere assay. RESULTS: The reporter assay showed that IC-2 reduced WNT/ß-catenin transcriptional activity in DLD-1 cells. Notably, IC-2 reduced expression levels of CSC marker proteins, as well as sphere formation. In addition, IC-2 increasesd cytotoxicity of 5-fluorouracil (5-FU) in DLD-1 cells. CONCLUSION: These results suggest that the combination treatment of IC-2 and 5-FU can stimulate tumor-suppressive effects on CRC.

Inflammation-based prognostic scores and nutritional prognostic index in patients with locally-advanced unresectable colorectal cancer.

BACKGROUND: Unresectable colorectal cancer has a poor prognosis. However, some patients survive intensive chemotherapy, and complete resection of primary and metastatic tumors may even be possible. In the present study, we examined the prognostic factors associated with survival after intensive chemotherapy in patients with unresectable colorectal cancer. METHODS: This retrospective study enrolled 61 patients diagnosed with unresectable locally advanced colorectal cancer between January 2004 and December 2013. Among the prognostic parameters, we found that the prognoses of patients with abnormal performance status (PS) of 2 or 3, high Glasgow Prognostic Score (GPS) of 1 or 2, high neutrophil/lymphocyte ratio (NLR) >5, and low prognostic nutritional index (PNI) <40 were poor. Thus, we scored each patient according to our scoring system (abnormal PS, 2 or 3 = +1; high GPS, 1 or 2 = +1; high NLR, >5 = +1; and low PNI, <40 = +1). If the patient showed abnormalities in every parameter, the score would be +4. RESULTS: Sixteen patients had a score of 0, 17 scored +1, 10 scored +2, 17 scored +3, and one scored +4. The median survival time (MST) of the 61 patients was 9 months. Patients were divided into two groups, a low-score group (0 and +1) and a high-score group (+2, +3, and +4). The MST of the 33 patients in the low-score group was significantly longer than that of the 28 patients in the high-score group (15 months versus 4 months, P < 0.001). Also, conversion chemotherapy was performed in 4.9% (3/61) of patients. And these 3 patients were in a low-score group. CONCLUSIONS: This new prognostic scoring system may help to select patients with unresectable advanced colorectal cancer who are able to survive through intensive chemotherapy.

Surgical treatment of retroperitoneal liposarcoma.

BACKGROUND: Retroperitoneal liposarcoma (RL) is a relatively rare tumor and is usually found at the advanced stage. Chemotherapy or radiotherapy for this tumor is not yet defined, and if operable, surgery is the treatment of choice. Complete resection of tumor with wide margins including excision of other organs has been recommended. However, many patients suffer from deterioration of the quality of a postoperative life. In the present study, we retrospectively analyzed the ideal surgical procedures for treating RL. METHODS: RL patients treated at our institute between 2003 and 2013 amounted to 10. RL was primary in 5 patients and recurrent in the rest 5. We analyzed cases of the 10 patients retrospectively. RESULTS: Tumor resection was performed for 9 patients, 7 of whom underwent complete tumor resection. RL was well-differentiated in 6 patients and dedifferentiated in 4. We analyzed the overall survival of 10 patients, and the relapse free survival of the operated 9 patients. Patients with well-differentiated RL showed better survival than those with dedifferentiated RL. Even the recurrent RL was huge, complete tumor resection could be performed in the well-differentiated type, but it was difficult in the dedifferentiated type. CONCLUSION: In the recurrent huge RL, the chance of a margin-negative resection remains low, but surgery remains the treatment of choice. Tumor resection with preserving important organs may improve patients' quality of postoperative life and survival.