Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report

<p>Abstract</p> <p>Introduction</p> <p>The management of intestinal injury can be challenging, because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries.</p> <p>Case presentation</p> <p>A 78-year-old Japanese woman had undergone several abdominal surgeries including urinary cystectomy for bladder cancer. After this operation, she developed peritonitis as a result of a small bowel perforation thought to be due to an injury sustained during the operation, with signs consistent with systemic inflammatory response syndrome: body temperature 38.5°C, heart rate 92 beats/minute, respiratory rate 23 breaths/minute, white blood cell count 11.7 × 10⁹/L (normal range 4-11 × 10⁹/μL). Two further surgical interventions failed to control the leak, and our patient's clinical condition and nutritional status continued to deteriorate. We then performed percutaneous endoscopic gastrojejunostomy, and continuous suction was applied as an alternative to a third surgical intervention. With this endoscopic intervention, the intestinal leak gradually closed and oral feeding became possible.</p> <p>Conclusion</p> <p>We suggest that the technique of percutaneous endoscopic gastrojejunostomy combined with a somatostatin analog is a feasible alternative to surgical treatment for small bowel leakage, and is less invasive than a nasojejunal tube.</p

Relationship between inflammation and cancer progression: Recent advances in interleukin-6 signaling and its blockage in cancer therapy

Interleukin-6 (IL-6) is a well-known pro-inflammatory cytokine with pleiotropic bioactivity and is mainly produced by inflammatory cells. Several diseases are influenced by IL-6; thus, the anti-IL-6 receptor antibody has been used clinically e.g., in the treatment of rheumatoid disease and Castleman disease. Signal transduction through gp130 occurs primarily via the JAK/STAT pathway and secondarily via the PI3K and MAPK pathways. Activation of STAT3 is an important step for the expression of various genes associated with carcinogenesis and cancer progression. Experiments using STAT3 inhibitor and IL-6 shRNA have shown that the activation of STAT3 is necessary for cancer cell proliferation and survival. Several studies have also demonstrated that IL-6 exhibits characteristics associated with both inflammatory cytokines and proangiogenic factors. These studies have demonstrated that IL-6 contributes to angiogenesis as a potent inducer of VEGF, which is one of the most important angiogenic factors. Recently, it has also been reported that cancer–stromal interactions are necessary steps during cancer progression, such as during angiogenesis. These mechanisms of IL-6, which affect cancer cells directly and through cancer–stromal interactions are essential for cancer progression and are of various types. Therefore, increasing attention is being paid to IL-6 signaling as a novel cancer therapeutic approach. This review summarizes the role of IL-6 signaling from the viewpoint of cancer progression and the potency of the anti-IL-6 signaling antibody during cancer therapy

Cancer-Associated Fibroblasts: Their Characteristics and Their Roles in Tumor Growth

Cancer tissues are composed of cancer cells and the surrounding stromal cells (e.g., fibroblasts, vascular endothelial cells, and immune cells), in addition to the extracellular matrix. Most studies investigating carcinogenesis and the progression, invasion, metastasis, and angiogenesis of cancer have focused on alterations in cancer cells, including genetic and epigenetic changes. Recently, interactions between cancer cells and the stroma have attracted considerable attention, and increasing evidence has accumulated on this. Several researchers have gradually clarified the origins, features, and roles of cancer-associated fibroblasts (CAFs), a major component of the cancer stroma. CAFs function in a similar manner to myofibroblasts during wound healing. We previously reported the relationship between CAFs and angiogenesis. Interleukin-6 (IL-6), a multifunctional cytokine, plays a central role in regulating inflammatory and immune responses, and important roles in the progression, including proliferation, migration, and angiogenesis, of several cancers. We showed that CAFs are an important IL-6 source and that anti-IL-6 receptor antibody suppressed angiogenesis and inhibited tumor-stroma interactions. Furthermore, CAFs contribute to drug-resistance acquisition in cancer cells. The interaction between cancer cells and the stroma could be a potential target for anti-cancer therapy

Preoperative Serum Interleukin-6 Is a Potential Prognostic Factor for Colorectal Cancer, including Stage II Patients

Aims. To evaluate the prognostic significance of serum interleukin-6 (IL-6) in colorectal cancer (CRC). Patients and Methods. Preoperative serum IL-6 was measured in 233 CRC patients and 13 healthy controls. Relationships between IL-6 and various clinicopathological factors were evaluated, and the overall survival (OS) and disease-free survival (DFS) rates according to IL-6 status were calculated for all patients and according to disease stage. Results. The mean IL-6 level was 6.6 pg/mL in CRC patients and 2.6 pg/mL in healthy controls. Using a cutoff of 6.3 pg/mL, obtained using receiver operating characteristic curve analysis, 57 patients had a high IL-6 level. The mean value was higher for stage II disease than for stage III disease. IL-6 status correlated with C-reactive protein (CRP) and carcinoembryonic antigen levels, obstruction, and pT4 disease. The OS differed according to the IL-6 status for all patients, whereas the DFS differed for all patients and for those with stage II disease. The Cox proportional hazards model showed that pT4 disease was an independent risk factor for recurrence in all CRC patients; IL-6, CRP, and pT4 were significant risk factors in stage II patients. Conclusions. The preoperative IL-6 level influences the risk of CRC recurrence

Effect of the Size of Glare Source on the Position Index

The objective of this study is to investigate the effect of the size of glare source on the Position Index. The Guth Position Index has an issue that it is not defined for the glare sources having various sizes but for the glare source of 0.0011sr. It should be probed that the Guth Position Index is still valid for smaller or larger glare sources. Experiments were conducted using a Glare Testing Instmment made for this study. The experiments consisted of two kinds of test. One was carried out to assess discomfort glare from glare sources of 0.00018sr, 0.00072sr, 0.0029sr and 0.012sr under various adaptation conditions. Luminance for discomfort glare was measured at six positions along the horizontal line in the visual field of the right eye. The other test was carried out to investigate the difference in the sensitivity to glare between seeing by the two eyes and by one eye. The results show that the position index hardly varies for the size of glare source and the background luminance. And there is little difference in the sensitivity to glare between seeing by the two eyes and by one eye