Successful Treatment for Hepatic Encephalopathy Aggravated by Portal Vein Thrombosis with Balloon-Occluded Retrograde Transvenous Obliteration

This report presents the case of a 78-year-old female with hepatic encephalopathy due to an inferior mesenteric venous-inferior vena cava shunt. She developed hepatocellular carcinoma affected by hepatitis C virus-related cirrhosis and underwent posterior sectionectomy. Portal vein thrombosis developed and the portal trunk was narrowed after hepatectomy. Portal vein thrombosis resulted in high portal pressure and increased blood flow in an inferior mesenteric venous-inferior vena cava shunt, and hepatic encephalopathy with hyperammonemia was aggravated. The hepatic encephalopathy aggravated by portal vein thrombosis was successfully treated by balloon-occluded retrograde transvenous obliteration via a right transjugular venous approach without the development of other collateral vessels

A Novel Non-Gas Endospray for Applying Fibrin Glue in Laparoscopic Surgery

Purpose: Fibrin glue and polyglycolic acid felt are used for tissue repair in various surgical procedures. However, using a spray device to apply fibrin sealant during laparoscopic surgery can increase the intraperitoneal pressure, which can cause complications such as air embolism. We developed a novel non-gas endospray for use in laparoscopic surgery. This study aimed to evaluate the sealing effect of this non-gas endospray in comparison with a conventional gas-spray device and to evaluate the safety of its application in the clinical setting. Materials and Methods: An ex vivo pressure test model was used to assess the sealing effect of the non-gas endospray (method 1) versus conventional gas-spray (method 2). A bottle was sealed with a rabbit skin sample that had been pierced nine times by a 19G needle. Each skin sample was sealed using either method 1 or method 2 (n = 10 for each method). The non-gas endospray was then used in two patients undergoing laparoscopic splenectomy with CO2 pneumoperitoneum. Intra-abdominal pressure was measured throughout the surgery. Results: Bursting pressures were similar in method 1 (246.9 ± 123.2 mmHg) and method 2 (265.5 ± 93.6 mmHg; P = 0.7082). During laparoscopic splenectomy, the non-gas endospray was successfully used to apply fibrin glue without any increase in intra-abdominal pressure. Conclusions: The novel non-gas endospray produced a strong sealing effect similar to that of a conventional gas-spray device and has thus far proved feasible in the clinical setting

Biological significance of localized Type IV scirrhous gastric cancer

The prognosis of type IV scirrhous gastric cancer (SGC) is extremely poor. Linitis plastica (LP), the so-called ‘leather bottle stomach’, is believed to be a typical case of SGC, which is usually diagnosed as a far-advanced gastric cancer. The pathogenesis of this disease remains unclear. Although typical SGC often invades the entire stomach, atypical cases show SGC localized to one region of the stomach. The aim of the present study was to investigate localized SGC (LSGC) and its biological significance. A total of 509 patients with advanced gastric cancer who underwent gastrectomy were evaluated. These patients were divided into three groups as follows: 19 patients with type IV scirrhous lesions invading the whole stomach (defined as LP), 60 patients with type IV scirrhous lesions localized in less than two thirds of the stomach (defined as LSGC) and the remaining 430 patients with all other types of gastric cancer (OGC), and then clinicopathologically compared. Results showed that LP had deeper invasion (p=0.006), more frequent peritoneal dissemination including positive cytology (p=0.01 and p=0.018) and lower curability (p=0.03) compared with LSGC, whereas LSGC showed a higher malignant potential in a number of clinicopathological factors compared with OGC. Univariate analysis showed that survival in patients with LP was significantly poorer than in those with LSGC (p=0.002) whose survival was, in turn, inferior to those with OGC. By contrast, LSGC was not a prognostic factor in SGC according to the multivariate analysis. The findings of this study suggested that the malignant status of LSGC differs from that of LP, and that curative gastrectomy is effective in improving the outcome for LSGC but not for LP, as LSGC may represent the prelinitis condition

A Case of Laparoscopic Surgery for Early Gastric Cancer that Occurred after Coronary Artery Bypass Grafting using the Right Gastroepiploic Artery

We herein report a case involving a 70-year-old man who was diagnosed with early gastric cancer that occurred after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) for effort-induced angina. He was successfully treated by laparoscopic surgery. Preoperative cardiac three-dimensional computed tomography and coronary angiography showed an occlusion of the RGEA graft, which could lead to ligation of the RGEA to dissect the lymph nodes along the RGEA. The laparoscopic approach helps to identify and avoid injury to the RGEA graft because of its enlarged and precise viewing field compared with laparotomy followed by retractor placement. Laparoscopic surgery is a useful method in such cases to reduce perioperative complications risk