Usefulness of endoscope guided transabdominal ultrasonography in T staging of colorectal cancer.

BACKGROUND/AIMS: We investigated the efficacy of endoscope guided transabdominal ultrasonography (EGTUS) for the evaluating the depth of colorectal cancer invasion. METHODOLOGY: The subjects were 52 patients with colon cancer and 30 patients with rectal cancer who underwent transabdominal US and curative surgery. During endoscopy, we applied transabdominal US by filling the area around the tumor with de-gassed water. The accuracy of depth invasion assessment using EGTUS was compared with that using endoscopic, computed tomography (CT), surgical or histological findings. RESULTS: The tumor detection rate was 75.6% (62/82), 88.5% (46/52) for colon cancer and 53.3% (16/30) for rectal cancer. The diagnostic accuracies of EGTUS, endoscopic, CT and surgical findings were 87.1% (54/62), 73.2% (60/82), 66.7% (46/69), 65.9% (54/82), respectively. The diagnostic accuracy of EGTUS was 100% (2/2), 66.7% (4/6), and 90.0% (44/49) for T1, T2 and T3 cancer, respectively. CONCLUSION: The results suggest that EGTUS is useful for evaluating preoperative T staging of colorectal cancer.

Clinical improvement of membranous nephropathy after endoscopic resection of double early gastrointestinal cancers.

A-52-year-old man presented to our hospital with nephrotic syndrome caused by membranous nephropathy. Early gastric adenocarcinoma confined to the submucosa, and well-differentiated adenocarcinoma in a sigmoid adenoma were detected by screening endoscopy. Two years after complete endoscopic resection of these tumors, the estimated 24-h urinary protein excretion decreased, and serum total protein and albumin returned to their normal levels although he had no immunosuppressive therapy. Thus, this case was considered to be a case of secondary membranous nephropathy to cancer, although whether the pathogenesis was due to circulating or in situ immune complexes is unknown. The suspected antigen component of this immune complex can include carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). In our patient, however, serum CEA and CA19-9 were within normal values during the clinical course, and detected cancers were early stage and very small. Recently, the existence of anti-mucin 1 (MUC1) antibodies before carcinogenesis and their usefulness for early detection of cancer were reported. We tried to stain tumors and glomeruli for MUC1 but, although we had positive findings in both tumors but not in glomeruli, the role of MUC1 in the pathogenesis of membranous nephropathy is unknown. To the best of our knowledge, paraneoplastic nephrosis caused by double early cancers expressing MUC1 in the gastrointestinal tract has not been previously reported.

[Case of ruptured gastroduodenal arterial pseudoaneurysm with penetration to the duodenum, successfully treated with transcatheter arterial embolization].

A 77-year-old man, who underwent segmental pancreatectomy for intraductal papillary mucinous adenoma in 2001, was referred to our hospital with complaints of hematemesis and melena on January, 2004. Emergency upper gastrointestinal endoscopy showed a pulsating submucosal protrusion in the duodenal bulb, which was identified as a gastroduodenal arterial aneurysm measuring 1.5cm on abdominal CT imaging. Transcatheter arterial embolization of the aneurysm with metallic coils was successfully performed. Periodically repeated endoscopic examination has revealed the coils protruding into the duodenal lumen without any serious complication.

De novo liver tissue formation in rats using a novel collagen-polypropylene scaffold.

In experimental and clinical settings hepatocyte transplantation has provided limited benefit to patients with chronic liver disease because the transplanted hepatocytes were short-lived and were merely maintained for a brief period within the body. Except for whole-liver transplantation, creation of de novo liver tissue is necessary to treat this condition on a long-term basis. The aim of this study was to facilitate the formation of new tissue by actual self-regeneration, rather than by compensatory hypertrophy, or scar formation, with our collagen-polypropylene composite scaffold. Collagen-polypropylene composite scaffolds, not containing hepatocytes, were implanted into the median liver lobe and the dynamics of new liver tissue formation was analyzed immunohistochemically over a 6-month period. Control scaffolds consisted of polypropylene scaffolds without collagen matrix. The control scaffold implants remained hollow throughout the study period and became encapsulated with a hard connective tissue capsule 1 week after implantation. In contrast, the collagen-polypropylene composite scaffold was filled with regenerating tissue structures 3 weeks after implantation. At this time, the predominant cell type within the scaffold was sesmin-positive stellate cells. A week earlier, oval cells were identified using monoclonal antibody staining (OV-6). Subsequently, these cells differentiated into alpha-fetoprotein-positive immature hepatocytes. After 6 months, mature liver tissue, juxtaposed with bile ducts and blood vessels, was seen within the polypropylene scaffolds. We report the first evidence of de novo formation of liver tissue within a polypropylene scaffold, following implantation in the liver. This scaffold may play a role in treating chronic liver diseases requiring organ replacement therapy.

Regeneration of serous membrane on gelatin-processed polyglycolic acid (PGA)-human collagen membrane and its efficacy on the prevention of adhesion.

We prepared a complex membrane consisting of human amnion-derived collagen membrane and polyglycolic acid (PGA), and then gelatin was crosslinked using heat on one side of the complex membrane to prepare a membrane that can prevent adhesion (gelatin-processed PGA-human collagen membrane). Applying this membrane to a rabbit cecum-abdominal-wall-adhesion model, the prevention of adhesion and tissue regeneration were investigated. The animals were sacrificed 2 and 12 weeks after surgery and then examined. The adhesion scores in the short-term observation group (2 weeks after surgery) and long-term observation group (12 weeks after surgery) were 1.0 +/- 2.4 and 0.8 +/- 2.0, respectively, showing a significant prevention of adhesion compared to the control value of 6.3 +/- 2.5 (p < 0.01). Histologically, gelatin was not absorbed, and outgrowth of connective tissue accompanied by capillary blood vessels was observed between the sample and the cecum in the short-term observation group. In the long-term observation group, the sample was completely absorbed, and serous membrane was regenerated on the surface of connective tissue. Based on these findings, it is possible to use gelatin-processed PGA-human collagen membrane as a filling material with both an adhesion-preventing effect and tissue-regenerating function.