Single-incision laparoscopic-assisted surgery for colon cancer via a periumbilical approach using a surgical glove: Initial experience with 9 cases

AbstractOur initial experience of performing a single-incision laparoscopic-assisted (SILS) colectomy using a “home-made” multichannel port system is presented. Nine patients (5 women) with a median age of 67 years (range, 55–72 years) and a median body mass index of 21.2kg/m2 (range, 17.8–26.7kg/m2) underwent the SILS colectomy for colon cancer between September 2009 and March 2010. The sites of the primary tumor were the ascending colon (n=2), hepatic flexure (n=1), transverse colon (n=2), and sigmoid colon (n=4). Each trocar was introduced intraperitoneally through each finger of a surgical glove attached to the wound protector, which was applied to a midline fasciotomy made via a ¾-circular periumbilical incision. If necessary, one to three radial splits were added to the incision. The colon was mobilized intracorporeally, and the vessels were ligated intra- or extracorporeally. All the patients underwent a curative segmental colectomy without conversion to a standard multiport laparoscopy or open surgery. The median operative time and blood loss were 140min (range, 135–165min) and 50mL (range, 20–225mL), respectively. The median number of harvested lymph nodes was 18 (range, 6–31). The pathological stages included stage 0 (n=2), stage I (n=6), and stage III (n=1). The median number of postoperative analgesic use was one (range, 0–6). No intra- or postoperative complications occurred in this series. Our SILS colectomy procedure seems feasible and safe in selected patients with colon cancer

Distal gastrectomy via minilaparotomy for non-overweight patients with T1N0-1 gastric cancer: Initial experience of 30 cases

AbstractMinilaparotomy is considered to be a useful treatment alternative to laparoscopic-assisted surgery from the viewpoint of minimal invasiveness, although it has several limitations for the resection of malignant tumors. We evaluated the usefulness of distal gastrectomy via minilaparotomy for non-overweight patients with clinically diagnosed T1N0-1 gastric cancer. Clinicopathological and surgical data on 30 patients attempted to undergo distal gastrectomy via minilaparotomy (skin incision, ≤7cm) without laparoscopic assistance were analyzed. Inclusion criteria were clinically (preoperatively) diagnosed T1N0-1 gastric cancer that was not suitable for endoscopic mucosal resection located in the middle- or lower-third of the stomach and the patient body mass index ≤ 25.0 kg/m2. The minilaparotomy approach was successful in 27 patients (90%), while laparoscopic assistance was required to accomplish the procedures in three patients (10%). The type of lymph node dissection was D1 + α in 23 patients and D1 + β in 7 patients. The duration of surgery was 105–170 min (median, 143.5 min) and blood loss was 25–520 mL (median, 152.5 mL). Pathological stage was stage IA in 26 patients, IB in two patients, and stage II in two patients. Postoperative complications were wound infection in one patient, bleeding in one patient, and anastomotic ulcer in one patient. The length of postoperative stay was 7–41 (median, 11) days. With a median follow-up of 31 months, there was no recurrence. Distal gastrectomy via minilaparotomy seems feasible and safe in the majority of non-overweight patients with clinically diagnosed T1N0 gastric cancer

Neuroendocrine Carcinoma of the Stomach: A Case Study

Gastric neuroendocrine carcinomas are rare and have a poor prognosis, and the diagnostic criteria for this disease have recently changed. We herein report a case of sporadic gastric neuroendocrine carcinoma. A 75-year-old man was referred to our hospital with epigastric pain. Endoscopic examination revealed a localized ulcerative lesion (diameter, 4 cm) at the upper stomach. The diagnosis on biopsy was neuroendocrine carcinoma. Total gastrectomy with D2 lymphadenectomy, splenectomy, and cholecystectomy was performed. Pathologically, the tumor infiltrated the subserosal layer, and 6/49 lymph nodes were involved. The tumor was uniform in shape and arranged in a rosette-like structure to form solid nests, with medium-sized, round-to-cuboid-shaped tumor cells and intense mitosis 46/10 HPF. It was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 70–80%. The diagnosis of neuroendocrine carcinoma was made according to the WHO 2010 criteria. The patient was followed up for three years without recurrence

Role of the VEGF-Flt-1-FAK pathway in the pathogenesis of osteoclastic bone destruction of giant cell tumors of bone

BACKGROUND: Giant cell tumors (GCTs) of bone are primary benign bone tumors that are characterized by a high number of osteoclast-like multinuclear giant cells (MNCs). Recent studies suggest that the spindle-shaped stromal cells in GCTs are tumor cells, while monocyte-like cells and MNCs are reactive osteoclast precursor cells (OPCs) and osteoclasts (OCs), respectively. In this study, we investigated the pathogenesis of osteoclastic bone destruction in GCTs by focusing on the role of the vascular endothelial growth factor (VEGF)-Flt-1 (type-1 VEGF receptor)-focal adhesion kinase (FAK) pathway. METHODS: The motility of OPCs cells was assessed by a chemotaxis assay and the growth of OPCs was examined using a cell proliferation assay. The expression of VEGF and activation of Flt-1 and FAK in clinical GCT samples and in OPCs were detected by immunohistochemistry and immunoblotting. The correlation between the expression levels of activated Flt-1 and FAK and clinical stages of GCTs was investigated by immunohistochemistry. RESULTS: In GCT samples, CD68, a marker of OPCs and OCs, co-localized with Flt-1. Conditioned media from GCT tissue (GCT-CM) enhanced the chemotaxis and proliferation of OPCs. GCT-CM also stimulated FAK activation in OPCs in vitro. Moreover, there was a correlation between the clinical stage of GCTs and the expression of tyrosine-phosphorylated Flt-1 and FAK. CONCLUSIONS: Our results suggest that the VEGF-Flt-1-FAK pathway is involved in the pathogenesis of bone destruction of GCTs

Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation

Study DesignRetrospective case series.PurposeTo clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation.Overview of LiteratureThe biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI.MethodsTo obtain a relatively uniform background, patients non-surgically treated for an acute C3–4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed.ResultsThere were no significant relationships between sagittal diameter of the CSF column at the C3–4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3–4 segment and their neurological recovery during the following period.ConclusionsNo relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS

P-NETG2に対しPRRTを施行した4例に関する検討

In June 2021, 177Lu-oxodotreotide, a PRRT, was approved by insurance for unresectable or recurrent NETs. We investigated the efficacy and safety of PRRT in four patients with P-NETs at our hospital. All patients were confirmed to be positive for somatostatin receptors by using octreoscan. PRRT treatment was then performed and retrospectively evaluated for efficacy and safety. PRRT was administered as lutetium oxodotreotide（177Lu） at 7.4 GBq per dose over 30 - minutes for up to 1 - 4 doses at 8 - week intervals. Efficacy was evaluated using RECIST v1. 1. Adverse effects were evaluated by CTCAE（v5.0 JCOG）. The mean patient age was 60±12.0 years, and all patients were male. Three patients had a PS of 0, and one patient had a PS of 1 or higher. Metastatic organs were the liver in four patients and intra-abdominal lymph nodes in one patient, all of whom were Stage IV. Three patients underwent transarterial embolization. 177Lu-DOTATOC PRRT was administered every 8 weeks, and a total of four courses were administered in two patients, three courses in one patient, and one course in one patient. One patient had grade 2 thrombocytopenia after one course, and the second course was administered at a half dose（3.7 GBq）. The overall response rate（ORR） was 25%, with one PR and two SD. The median PFS was 9 months（95% Cl, 8-NA）, and the median overall survival from diagnosis was 119 months（95%Cl, 31 - NA）. Adverse events during PRRT included leukopenia in two patients（one G3, one G2）, lymphopenia in one patient（one G3）, thrombocytopenia in two patients（two G2, one G3）, creatinine increase in one patient（one G2）, and skin rash in one patient. In conclusion, PRRT is expected to be highly effective and safe compared with conventional therapy for neuroendocrine tumors with unresectable or distant metastases

HISTOLOGICAL AND ELECTRON MICROSCOPIC OBSERVATION ON THE ADENOMATOUS HYPERPLASIA OF THE ALVEOLAR EPITHELIAL CELL IN THE HUMAN LUNG

この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。Histological observation suggests that the cuboid cell of adenomatous hyperplasia originates from pre-existing lining cell of the healthy alveolus. The resemblance in the fine structure of the cuboid cell to that of the alveolar wall cell (type B epithelial cell) provides strong evidence that the alveolar wall cell proliferates in response to pathogenic stimuli and forms the adenomatous hyperplasia in the alveolar area. Furthermore, it is suggested that the alveolar wall cell might play an improtant role in the carcinogenesis of some peripheral lung cancer

variationalDCM: An R package for variational Bayesian inference in diagnostic classification models

This paper introduces variationalDCM, an R package that performs recently-developed variational Bayesian (VB) estimation methods for diagnostic classification models (DCMs). DCMs are a class of discrete latent variable models that reveal respondents’ current knowledge statuses and perform clustering based on these statuses mainly in educational measurements. This package enables computationally efficient Bayesian estimation for various DCMs in large-scale datasets. The paper describes the parsimonious and generalized DCMs that variationalDCM supports and provides the empirical illustration of the functions in this package