IRIS U kit usefulness in transanal total mesorectal excision for lower rectal cancer to avoid urethral injury.

Transanal total mesorectal excision (taTME) has improved the laparoscopic dissection for rectal cancer in the narrow pelvis. Although taTME has more clinical benefits than laparoscopic surgery, such as a better view of the distal rectum and direct determination of distal resection margin, an intraoperative urethral injury could occur in excision ta-TME. This study aimed to determine the feasibility and efficacy of the ta-TME with IRIS U kit surgery. This retrospective study enrolled 10 rectal cancer patients who underwent a taTME with an IRIS U kit. The study endpoints were the safety of access (intra- or postoperative morbidity). The detectability of the IRIS U kit catheter was investigated by using a laparoscope-ICG fluorescence camera system. Their mean age was 71.4±6.4 (58-78) years; 80 were men, and 2 were women. The mean operative time was 534.6 ± 94.5 min. The coloanal anastomosis was performed in 80%, and 20% underwent abdominal peritoneal resection. Two patients encountered postoperative complications graded as Clavien-Dindo grade 2. The transanal approach with IRIS U kit assistance is feasible, safe for patients with lower rectal cancer, and may prevent intraoperative urethral injury.

Commercial Production of Astaxanthin with Paracoccus carotinifaciens.

Paracoccus carotinifaciens is an aerobic Gram-negative bacterium that exhibits motility by a peritrichous flagellum. It produces a carotenoid mixture containing astaxanthin as the main component. Selective breeding of P. carotinifaciens has been performed using classical techniques for mutation induction, such as chemical treatment and ultraviolet irradiation, and not using genetic engineering technology. The commercial production of astaxanthin with P. carotinifaciens has been established by optimizing fermentation medium and conditions in the process. Dehydrated P. carotinifaciens is used as a coloring agent for farmed fish and egg yolks. Compared with the administration of chemically synthesized astaxanthin, dehydrated P. carotinifaciens imparts more natural coloration, which is favored by consumers. In addition, astaxanthin-rich carotenoid extracts (ARE) derived from P. carotinifaciens are developed for human nutrition. Animal and clinical studies with ARE for evaluating its efficacy have been conducted and suggested that ARE would be useful for preventing anxiety, stomach ulcer, and retinal damage, as well as improving cognitive function. The efficacy is anticipated to result from not only astaxanthin but also other carotenoids in ARE, such as adonirubin and adonixanthin, in some studies. Hence, astaxanthin commercially produced with P. carotinifaciens has been applied widely in animals and humans.

Laparoscopic Total Devascularization of the Upper Stomach and Splenectomy (Hassab's Procedure) Under Indocyanine Green Fluorescence Imaging: Initial Experience.

The use of surgical treatment for refractory isolated gastric varices has decreased owing to the development of endoscopic and radiologic procedures, although surgeries are sometimes required as the final method. A 75-year-old Japanese woman was diagnosed with solitary gastric varices. Initially, intraoperative splenic artery embolization was performed using the balloon transcatheter technique under general anesthesia. Laparoscopic splenectomy was performed safely owing to preoperative splenic artery embolization. Intraoperative indocyanine green (ICG) fluorescence angiography was performed following the injection of 5 mL of ICG; the remnant stomach was observed using laparoscopic equipment with an ICG imaging system, and blood flow from the remnant gastric artery was confirmed. The blood did not pool or wash out immediately, which confirmed successful devascularization of the stomach. The total operative time was 269 minutes, and the intraoperative blood loss was 500 mL. The patient's postoperative course was good, and at 21 days after the last operation, she was discharged from our hospital in remission. Real-time fluorescence angiography with ICG is a reliable and objective technique of assessing blood flow of the stomach. Accurate, extensive devascularization in the lower esophagus and upper stomach was performed using Hassab's procedure in combination with ICG imaging.

[Malignant gastrointestinal lymphoma with cicatricial stenosis after complete response to chemotherapy].

A 75-year-old woman presented complaining of anorexia. A malignant gastrointestinal lymphoma was diagnosed, and chemotherapy was initiated. After 2 months, she developed vomiting. Computed tomography (CT) revealed thickening of the jejunal wall and dilatation of the intestine proximal to that area. Positron emission tomography-CT showed no uptake. Small bowel stenosis due to cicatricial stenosis after chemotherapy was suspected. Laparoscopic partial resection of the stenotic small bowel segment was performed. Histopathologically, only granulation tissue was seen with no evidence of tumor. Occasionally, cicatricial stenosis can develop after chemotherapy for malignant gastrointestinal lymphoma. Therefore, this condition must be considered an important complication of treatment for this disease.

Effect of astaxanthin-rich extract derived from Paracoccus carotinifaciens on cognitive function in middle-aged and older individuals.

This study was conducted to investigate the effect of dietary supplement containing astaxanthin-rich extract derived from Paracoccus carotinifaciens (astaxanthin supplement) on cognitive function of subjects aged 45-64 years. Cognitive functions of 28 subjects orally administered 8 mg astaxanthin/day of astaxanthin supplement for 8 weeks (astaxanthin group) and 26 subjects given a placebo (placebo group) were compared by word memory test, verbal fluency test, and Stroop test. The astaxanthin group experienced significantly larger increase in blood astaxanthin level than the placebo group. However, there were no significant intergroup differences in the results of the tests. A subgroup analysis was performed after dividing subjects into the <55 years old and ≥55 years old age groups. The result of "words recalled after 5 minutes" in word memory test in <55 years old subjects showed significant improvement in the astaxanthin group than in the placebo group, which was not found in ≥55 years old subjects. Our results indicate that people aged 45-54 years may experience improved cognitive function after ingesting astaxanthin supplement for 8 weeks. On the basis of the parameters tested, administration of astaxanthin supplement was not associated with any problems related to safety.

[A case of adult gastric volvulus treated using upper gastrointestinal series].

Here, we report a case of adult gastric volvulus that was treated using an upper gastrointestinal series and provide a review of relevant reports. A 55-year-old woman presented with upper abdominal pain. Abdominal computed tomography revealed mesenteroaxial gastric volvulus. We performed an upper gastrointestinal series after the placement of a nasogastric tube. We successfully performed detorsion by repositioning. There was no recurrence of gastric volvulus after the detorsion. However, considering the risk of recurrence, we also performed laparoscopic gastropexy. The postoperative course was uneventful, and she was discharged from the hospital on postoperative day 3. No recurrence of symptoms has been observed to date.

Astaxanthin analogs, adonixanthin and lycopene, activate Nrf2 to prevent light-induced photoreceptor degeneration.

Carotenoids, in particular astaxanthin, possess potent antioxidant capabilities. Astaxanthin also induces NF-E2-related factor 2 (Nrf2), which plays a major regulatory role in the antioxidative response. However, little is known whether the carotenoid, by-products of astaxanthin, activate Nrf2. Toward this end, we screened eight astaxanthin analogs for Nrf2 activation in murine photoreceptor cell line, 661 W, by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). In addition, we monitored cell death in 661 W cells pretreated with astaxanthin analogs or only pretreated for 6 h with astaxanthin analogs and then exposed to light. Furthermore, we quantified the reactive oxygen species (ROS) production. Cell death was quantified after light exposure by nuclear staining. Nrf2-controlled genes Ho-1, Nqo-1, and Gclm by qRT-PCR and Nrf2 in the nucleus were upregulated in 661 W cells exposed astaxanthin, adonixanthin, echinenone, and lycopene. Moreover, astaxanthin, adonixanthin, echinenone, ß-carotene, adonirubin, and lycopene, but not canthaxanthin, suppressed ROS production and protected cells against light-induced damage. Moreover, pretreatment with adonixanthin or lycopene only before light exposure protected against light-induced cell damage and Nrf2 silencing canceled these effects. These findings indicate that the more potent astaxanthin analogs, adonixanthin and lycopene, protect against light-induced cell damage through not only an anti-oxidative response but also through Nrf2 activation.

[Maintenance of Long-Term Stable Disease(SD)in Metastatic Breast Cancer with Eribulin - A Case Report of Long-Term SD in Japan].

This case report discusses a 48-year-old woman with metastatic breast cancer: T4c(10.5 cm)N2bM1,(OSS, LYM), stage IV, estrogen receptor(ER)(+), progesterone receptor(PgR)(+), human epidermal growth factor receptor-2(HER2) (-), and Ki-67 17.2%. Administration of eribulin was initiated after treatment with anthracycline and taxane. Thereafter, 28 courses of eribulin maintained a SD state for over a year and improved the quality of life(QOL). Eribulin is effective for both prolonging life and improving QOL, which are the main goals in the treatment of metastatic or recurrent cancer. Therefore, this evidence suggests that eribulin can be effective in various clinical situations.

[A case of ruptured giant splenic artery aneurysm].

A 68-year-old woman presented with general malaise. Her vital signs were unstable, and abdominal computed tomography revealed giant (10 cm) splenic artery aneurysm with evidence of rupture. We first occluded the root of the splenic artery using a balloon catheter. Next, we resected the distal pancreas and spleen because of the aneurysm size and destruction of the related vasculature. After surgery, the patient's condition improved, and she was discharged from the hospital on postoperative day 18. Because ruptured giant splenic artery aneurysms are very rare, we report this case with a review of the literature.

Multiple calcifying fibrous tumors from gastric and retroperitoneal tissue: A case report.

INTRODUCTION AND IMPORTANCE: Calcifying fibrous tumor (CFT) is a rare benign mesenchymal lesion that has been occurred in the gastrointestinal tract, especially occurs most commonly in the stomach and the small and large intestines. CASE PRESENTATION: 74-year-old woman was admitted to our hospital with complaints of epigastric discomfort. Whole-body computed tomography (CT) revealed a 2.2-cm mass with a 1.2-cm low-density area at the anterior wall in the gastric cardia and lesser omentum; however, no abnormal uptake at the same site was noted on positron emission tomography (PET). We performed laparoscopic tumor resection of the two sites. The postoperative course was good without complications. Histopathological findings revealed collagen fibrous granulation connective tissue and psammomatous calcification. Subsequently, the patient has been relapse-free for 6 months. CLINICAL DISCUSSION: CFT is a rare benign tumor that commonly occurs in soft tissues, such as the subcutaneous extremities and neck. In particular, development from the stomach and lesser omentum has never been reported. Our case was incidentally found on a general examination. In our case, CT showed a low-density area, MRI showed a low-intensity area, and PET examination showed no uptake; it was difficult to establish a preoperative diagnosis. Therefore, in our case, laparoscopic tumor resection was performed, with GIST as the differential diagnosis. CONCLUSIONS: We herein reported a rare gastric and lesser omentum CFT that was successfully treated by laparoscopic surgery. For curative treatment of CFT, complete surgical resection is necessary.

Robotic transabdominal preperitoneal repair for recurrent inguinal hernia after Kugel hernioplasty: A case report.

INTRODUCTION AND IMPORTANCE: The laparoscopic posterior approach adapts the advantages of Kugel hernioplasty, making it possible to perform it at the new layer even if the inguinal hernia is recurrent following the anterior approach, producing a high level of completion. However, in laparoscopic surgery for recurrent inguinal hernia using posterior approaches, dissecting the extraperitoneal space is difficult. Robotic surgery may enable precise dissection, even if the space is severely adhered. Here, we report a robotic approach after extraperitoneal approach for recurrent inguinal hernia, which developed after Kugel hernioplasty. CASE PRESENTATION: A 78-year-old Japanese man, who underwent left inguinal hernia repair (Kugel hernioplasty) 2 years ago, presented with recurrent reducible left inguinal swelling. A peritoneal incision was created above the deep inguinal ring to treat the primary right inguinal hernia. The pressure in the left inguinal region revealed a spermatic cord lipoma protruding from the internal inguinal ring as a recurrent inguinal hernia of the abdominal cavity. CLINICAL DISCUSSION: Robotic transabdominal preperitoneal repair for recurrent inguinal hernia is effective, especially after posterior approach Kugel hernioplasty, in which dissection of the extraperitoneal space is difficult. In the present case, the peritoneal flap was conserved without removing the direct Kugel patch. CONCLUSION: Kugel hernioplasty, which is a posterior approach, would result in severe extraperitoneal space adhesion. Essentially, a new and previously unused approach is preferable to the previous approach in patients with recurrent inguinal hernias. Robotic approach is effective for recurrent inguinal hernias even if the space was severe adhesion.

Protective effects of a dietary carotenoid, astaxanthin, against light-induced retinal damage.

Dietary carotenoids exhibit various biological activities, including antioxidative activity. In particular, astaxanthin, a type of carotenoid, is well known as a powerful antioxidant. We investigated whether astaxanthin would protect against light-induced retinal damage. In an in vivo study, ddY male mice were exposed to white light at 8,000 lux for 3 h to induce retinal damage. Five days after light exposure, retinal damage was evaluated by measuring electroretinogram (ERG) amplitude and outer nuclear layer (ONL) thickness. Furthermore, expression of apoptotic cells, 8-hydroxy-deoxyguanosine (8-OHdG), was measured. In an in vitro study, retinal damage was induced by white light exposure at 2,500 lux for 24 h, and propidium iodide (PI)-positive cells was measured and intracellular reactive oxygen species (ROS) activity was examined. Astaxanthin at 100 mg/kg inhibited the retinal dysfunction in terms of ERG and ONL loss and reduced the expression of apoptotic and 8-OHdG-positive cells induced by light exposure. Furthermore, astaxanthin protected against increases of PI-positive cells and intracellular reactive oxygen species (ROS) activity in 661W cells. These findings suggest that astaxanthin has protective effects against light-induced retinal damage via the mechanism of its antioxidative effect.

Bilateral laparosocopic lateral lymph node dissection by the totally extraperitoneal approach after intersphincteric resection of the lower rectum: report of a case.

Introduction and Importance: Lateral lymph node dissection (LLND) for recurrent lateral pelvic lymph node metastasis could be the only surgical treatment to improve its prognosis, but is difficult and challenging technically. Case Presentation: A 75-year-old Japanese man who underwent a radical laparoscopic intersphincteric resection to treat double lower rectal cancer. Computed tomography and MRI showed lower rectal wall thickening and bilateral lateral lymph node swelling. The authors scheduled and performed the LLND for recurrent lateral pelvic lymph nodes after ISR by the totally extraperitoneal (TEP) approach. The bottom of the obturators lymph node (#263D) were positive for metastasis histologically. Clinical Discussion: The TEP approach is an especially effective option for the treatment of bilateral LLND. Conclusion: Herein, the authors introduce our surgical technique: successful challenging treatment of the LLND by the TEP approach after intersphincteric resection of the lower rectum.

Protective effects of astaxanthin from Paracoccus carotinifaciens on murine gastric ulcer models.

The purpose of this study was to investigate the effect of astaxanthin extracted from Paracoccus carotinifaciens on gastric mucosal damage in murine gastric ulcer models. Mice were pretreated with astaxanthin for 1 h before ulcer induction. Gastric ulcers were induced in mice by oral administration of hydrochloride (HCl)/ethanol or acidified aspirin. The effect of astaxanthin on lipid peroxidation in murine stomach homogenates was also evaluated by measuring the level of thiobarbituric acid reactive substance (TBARS). The free radical scavenging activities of astaxanthin were also measured by electron spin resonance (ESR) measurements. Astaxanthin significantly decreased the extent of HCl/ethanol- and acidified aspirin-induced gastric ulcers. Astaxanthin also decreased the level of TBARS. The ESR measurement showed that astaxanthin had radical scavenging activities against the 1,1-diphenyl-2-picrylhydrazyl radical and the superoxide anion radical. These results suggest that astaxanthin has antioxidant properties and exerts a protective effect against ulcer formation in murine models.

A study of the effectiveness of the bilateral and contralateral occult inguinal hernia repair by total extraperitoneal repair with intraperitoneal examination.

PURPOSE: Of the various methods used, the laparoscopic surgical repair of inguinal hernias is widely performed. We aimed to estimate the incidence of bilateral and contralateral occult inguinal hernias in our surgical population and to compare the results of total extraperitoneal repair (TEP) for bilateral and unilateral inguinal hernias, occult and non-occult hernias. METHODS: We retrospectively reviewed data of patients who underwent TEP for the repair of adult inguinal hernias from January 2012 to November 2018 in our hospital. RESULTS: Of the data of 259 patients included, 134 (51.7%) and 125 (48.3%) had unilateral and bilateral inguinal hernias, respectively, while 70 patients (27%) were found to have a contralateral occult inguinal hernia, intraoperatively. The mean operative time was 129 ± 48 minutes (range, 43-300 minutes) and 167 ± 55 minutes (range, 85-390 minutes) for the unilateral and bilateral groups, respectively, indicating a significantly longer duration of surgery for the bilateral group (P < .05). Recurrence occurred in 1.5% (5/134) and 0.4% (1/250) of the operated hernias in the unilateral and the bilateral groups, respectively, indicating a significantly lower rate of recurrence in the latter group (P < .05). The two groups showed no statistically significant differences with respect to the remaining perioperative data. The incidence of postoperative complications in occult hernias was not significantly different from that in non-occult hernias. CONCLUSIONS: Our TEP method, involving a laparoscopic exploration from the intraperitoneal side, can be safely and effectively utilized for the repair of both bilateral and contralateral occult inguinal hernias.

Successful treatment for sports hernia by total extraperitoneal repair with intraperitoneal examination: Report a case.

Introduction: and importance: TEP might be one of options for treating such a sports hernia. Case presentation: An 18-year-old Japanese male presented with right groin pain for approximately two years. The pain was initially felt on the right side only, especially on kicking. We assessed the patient using laparoscopic examination with an intra-abdominal scope and subsequently diagnosed a sports hernia with a bilateral internal inguinal hernia. We then performed total extraperitoneal repair (TEP) for its treatment. The patient had a good postoperative course and was discharged from our hospital in remission after 3 days. Finally, the patient was able to play soccer without groin pain. Clinical discussion: Chronic groin pain in athletes can be caused by a bulge in the posterior inguinal wall, consistent with an incipient direct inguinal hernia. Conclusion: We show that intraperitoneal examination with TEP might be one of options for treating such a sports hernia. Endoscopic placement of the retropubic mesh must be considered an important option for this type of hernia.

Laparoscopic intraperitoneal mesh repair of an incisional hernia after transverse rectus abdominis myocutaneous flap reconstruction for breast cancer.

Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is performed for the treatment of large defects of the breast. However, this may result in an abdominal wall hernia or bulging. A 53-year-old Japanese woman with left breast cancer underwent left skin-sparing mastectomy, sentinel node lymph node dissection, and immediate reconstruction with a contralateral pedicled TRAM flap. Thirty-two months following surgery, right lower abdominal wall hernia (15.5 × 12 cm) and bulging were observed at the suprapubic region. The patient was diagnosed with an incisional hernia and was scheduled for laparoscopic intraperitoneal mesh repair. The mesh was coated with an absorbable hydrogel barrier and was trimmed to 26 × 22 cm, with a 5 cm overlap around the defect. The patient demonstrated a good postoperative course. In conclusion, intraperitoneal onlay mesh with hernia repair closure (IPOM-Plus) is a simple and useful method for hernia repair following TRAM flap reconstruction.

A case report of the transanal lateral lymph node dissection with a combined abdominal assisted approach for the lower rectal cancer.

INTRODUCTION: Low and mid rectal cancer cells have the tendency to spread in the lateral pelvic lymph node (LPLN). The Japanese guidelines recommend systematic lymph node dissection when a positive LPLN is suspected or in stages II-III rectal cancer. However, laparoscopic lymph node dissection is complex and challenging. We introduce transanal LPLN dissection using an abdominal approach. PRESENTATION OF CASE: A 78-year-old man was diagnosed with advanced rectal cancer. Computed tomography and magnetic resonance imaging showed lower rectal wall thickening and bilateral lateral lymph node swelling. We performed laparoscopic abdominal peritoneal resection with combined bilateral LPLN dissection using abdominal and transanal approaches. He had an uneventful postoperative course with no signs of recurrence at the 5-month follow-up. DISCUSSION: LPLN metastases for low rectal cancer especially occur at the bottom of the deep pelvic spaces. As laparoscopic LPLND for low rectal cancer can be complicated, we adopted abdominal and transanal approaches, which provide the advantage of an anatomical view. This procedure may improve lateral pelvic anatomical structure viewing, and may offer advantages over laparoscopic abdominal approaches for visualizing and dissecting LPLNs. CONCLUSION: Curative resection has become available for rectal cancer with transanal LPLN dissection. LPLN dissection with combined abdominal and transanal approaches is a feasible treatment for advanced rectal cancer.