Intraoperative Identification of Colonic Tumor Sites Using a Near-Infrared Fluorescence Endoscopic Imaging System and Indocyanine Green.

BACKGROUND: This study aimed to investigate the feasibility of the PINPOINT® Endoscopic Fluorescence Imaging System (PINPOINT) for intraoperative identification of colonic tumor sites during laparoscopic colorectal surgery. METHODS: Eighty consecutive patients with colorectal cancer were prospectively enrolled. Preoperatively, 0.5 mL of indocyanine green (ICG; 2.5 mg/mL) was injected into the submucosal space only at the distal side of the tumor under colonoscopy. Intraoperatively, we identified the tumor site on a PINPOINT image in which near-infrared fluorescence was superimposed in pseudocolor on a white light image. We estimated the intraoperative visibility rate of the tumor site and safety of ICG injection and assessed the interobserver variability of visibility grade between 2 surgeons. RESULTS: The intraoperative visibility rate of the tumor site was 93.8% (75/80). The visibility rate at an interval between injection and surgery of <7 days was significantly better than that at an interval of ≥10 days (p < 0.001). The kappa value between 2 observers was 0.827 (95% CI 0.635-1.019) with an agreement rate of 92.5%. There were no preoperative adverse reactions to ICG or intraoperative complications. CONCLUSIONS: Using ICG with the PINPOINT for identifying colonic tumor sites was feasible without any adverse effects during laparoscopic colorectal surgery.

The modified Altemeier procedure for a loop colostomy prolapse.

Loop colostomy prolapse is associated with an impaired quality of life. Surgical treatment may sometimes be required for cases that cannot be closed by colon colostomy because of high-risk morbidities or advanced disease. We applied the Altimeter operation for patients with transverse loop colostomy. The Altemeier operation is therefore indicated for rectal prolapse. This technique involves a simple operation, which includes a circumferential incision through the full thickness of the outer and inner cylinder of the prolapsed limb, without incising the abdominal wall, and anastomosis with sutures using absorbable thread. We performed the Altemeier operation for three cases of loop stomal prolapse. Those patients demonstrated no postoperative complications (including obstruction, prolapse recurrence, or hernia). Our findings suggest that this procedure is useful as an optional surgical treatment for cases of transverse loop colostomy prolapse as a permanent measure in patients with high-risk morbidities or advanced disease.

A rare case of synchronous appendiceal and cecal cancer.

Primary appendiceal cancer is rare, and difficult to diagnose pre-operatively because lack of specific symptoms. This report presents a rare case of synchronous colon and appendiceal cancer. A 50-year-old man was referred to our hospital due to endoscopic submucosal resection (ESD) for early cecal cancer. ESD was performed, and the pathological examination revealed tubular adenocarcinoma with deep submucosal invasion. Laparoscopic ileocecal resection was performed as additional resection after ESD of cecal cancer. There were no obvious abnormalities around the ileocecal region in the preoperative examination. Postoperative pathological examination incidentally revealed a mucosal papillary adenocarcinoma of the appendix, with no residual lesion in the ESD scar. The patient was discharged on the seventh postoperative day. Synchronous appendiceal and colon cancer is extremely rare in past reports. Here, we report the case details and review previous case reports.

Development of the Rope-Climbing Ergometer for Physical Training and Testing.

The purpose of this study was to develop and characterize a rope-climbing ergometer. A custom-made loading device that has an eddy current brake with an electrical current control circuit was developed to impose resistive load on the rope. A calibration test was first performed using a three-phase induction motor to associate the scale of the load-level setting (100 levels) with the resultant traction force. The calibration test yielded criteria values of loads (123 N at Level 0 and 1064 N at Level 100). The human test was carried out by 14 male subjects. The participants performed eight sets of 10-second maximal-effort exercises at different levels. Presumable trajectories of force, velocity, and power were obtained. The mean force increased by 161% (from 147.5 N at Level 0 to 383.7 N at Level 18), whereas the mean velocity decreased by 64.7% (from 1.87 m/s at Level 0 to 0.66 m/s at Level 18). The mean power reached its peak at Level 9 (320 W). The new rope ergometer for physical training and testing was successfully developed and characterized in this study. However, it remains to be seen whether its concurrent validity and reliability are qualifiable.

One-stage laparoscopy-assisted colectomy for synchronous double colorectal cancers.

Synchronous multiple malignant colorectal lesions are rare, and there have been very few studies about one-stage laparoscopic operations in these cases. Here, we evaluated the short-term outcomes of laparoscopy-assisted colectomy (LAC) for synchronous double colorectal cancers. Seven patients underwent one-stage LAC that required two resections and anastomoses in our hospital from 2010 to 2014. We retrospectively examined each patient's background and subsequent surgical outcomes. The median age of patients was 78 years, and the median BMI was 19.8 kg/m2 . The median operative time was 190 min, and blood loss was minimal. All resected specimens were extracted through a transumbilical incision. A radical operation was performed safely without procedural accidents or postoperative complications in all cases. The median postoperative hospital stay was 12.5 days. One-stage LAC is considered a safe and viable procedure for resecting synchronous double colorectal cancers. It involves minimal invasiveness and is similar to standard LAC.

Preoperative colonic cancer tattooing using the near-infrared fluorescence laparoscopic imaging system.

INTRODUCTION: To identify a colorectal cancer tumor site for surgery, preoperative endoscopic marking methods, such as India ink tattooing or clipping, are generally performed. However, India ink tattooing causes problems such as impaired surgical view because of adverse events, ink leakage into the peritoneal cavity, and peritonitis or adhesion ileus as a result of leakage. The clipping method requires checking by palpation, which is unsuitable for laparoscopic surgery. MATERIALS AND SURGICAL TECHNIQUES: We devised a preoperative marking method for colorectal cancer surgery (laparotomy) by applying the fluorescent dye indocyanine green. Herein, we report its usefulness. DISCUSSION: We report the application of fluorescent dye indocyanine green in laparoscopic surgery.

Clinical Aspects of IgG4-Related Orbital Inflammation in a Case Series of Ocular Adnexal Lymphoproliferative Disorders.

The most frequent ocular adnexal tumors and simulating lesions are lymphoproliferative disorders (LPDs), including malignant lymphomas and orbital inflammation with lymphoid hyperplasia or infiltration. IgG4-related orbital inflammation (IgG4-ROI) often involves lacrimal glands and other orbital tissues and is an important differential diagnosis. The present study evaluated clinical aspects of IgG4-ROI in a case series of orbital LPD. Sixty-two consecutive cases of orbital LPD, pathologically diagnosed from November, 2004, through March, 2011, were investigated. Histological types were 22 cases with MALT lymphoma, 11 cases with diffuse large B-cell lymphoma (DLBCL), 3 cases with other malignant lymphomas, 16 cases with IgG4-ROI, and 10 cases with non-IgG4-ROI. Ages of the IgG4-ROI group (56 ± 10 yrs) were significantly lower than the MALT lymphoma (71 ± 12 yrs) and DLBCL (75 ± 14 yrs) groups. Orbital lesions other than lacrimal glands were present in six cases including extraocular muscle swelling, mass lesions surrounding the optic nerve, and supraorbital and infraorbital nerves enlargements. Although none of the malignant lymphomas were related to IgG4, previous evidence suggested that malignant lymphomas can arise from IgG4-ROI. Based on this study (26%) and another report (33%), it is likely that nearly a quarter of orbital LPD are IgG4-ROI.

[Dynamics of cerebral circulation in patients with chronic cerebrovascular disease--analysis with multi-channel near infra-red spectroscopic topography plus hand grasp as the exercise task].

We used multi-channel near infra-red spectroscopic topography to evaluate the dynamics of cerebral circulation of patients with cerebrovascular disease (CVD). The subjects included 17 patients with chronic CVD, while 11 physically unimpaired persons served as controls. We used a spectroscopic topography device (Hitachi, ETG -100) to determine the topographic values of oxy-Hb, deoxy-Hb, and total-Hb in the right and left cerebral hemispheres. Hand grasp for 30 or 60 second duration was used as the exercise task, and each task was tried twice. In the control group, the oxy-Hb values of the left cerebral hemisphere were elevated by bilateral hand grasp, while those of the right cerebral hemisphere were elevated by left hand grasp. In patients with a lesion in the left cerebral hemisphere, oxy-Hb values of the left hemisphere were elevated by the bilateral hand grasp, while those of the right hemisphere were elevated only by the healthy left hand grasp. When the 30- and 60-second-duration grasp exercises were compared, it was found that the oxy-Hb values in the control group corresponded to the loading time. In patients with either right or left cerebral lesion, the oxy-Hb peak values were lower than those of the control group, while the peak values did not show any difference between the 30-and 60-seconds hand grip durations themselves. The latency from the start of the grasp to the maximum peak of the oxy-Hb value was significantly prolonged in CVD patients as compared with that in the control group. As for the relation between the degree of hemiparesis and the oxy-Hb values, the value of the oxy-Hb in the left cerebral hemisphere during right hand grasp decreases depending on the severity of paralysis induced by the left cerebral lesion. The determination of cerebral oxy-Hb values by near infra-red spectroscopic topography using exercise test appeared to be useful for the evaluation of the dynamic of cerebral circulation in stroke patients. Furthermore, the possibility of inducing recovery by the rehabilitation of stroke patients, who were in the chronic stage, should be studied.

Brain activation during manipulation of the myoelectric prosthetic hand: a functional magnetic resonance imaging study.

Neuroimaging data, particularly functional magnetic resonance imaging (fMRI) findings, have not been reported in users of the myoelectric or electromyographic (EMG) prosthetic hand. We developed a virtual EMG prosthetic hand system to eliminate mutual signal noise interference between fMRI imaging and the EMG prosthesis. We used fMRI to localize activation in the human brain during manipulation of the virtual EMG prosthetic hand. Fourteen right-handed normal subjects were instructed to perform repetitive grasping with the right hand with eyes closed (CEG); repetitive grasping with the right hand with eyes open to obtain visual feedback of their own hand movement (OEG); and repetitive grasping with the virtual EMG prosthetic hand with the eyes open to obtain visual feedback of the prosthetic hand movement (VRG). The specific site activated during manipulation of the EMG prosthetic hand was the right ventral premotor cortex. Both paradigms with visual feedback also (OEG and VRG) demonstrated activation in the right posterior parietal cortex. The center of activation of the right posterior parietal cortex shifted laterally for visual feedback with the virtual EMG prosthetic hand compared to a subject's own hand. The results suggest that the EMG prosthetic hand might be recognized in the brain as a high-performance alternative to a real hand, being controlled through a "mirror system" in the brain.