Direct percutaneous access to a mesenteric vein for antegrade embolization of esophageal varices: A case report

A 79-year-old woman with a history of advanced gastric cancer and portal vein tumor thrombus, treated with surgery and chemoradiotherapy, presented with hematemesis due to esophageal variceal bleeding around the esophagojejunal anastomosis. Endoscopic treatment was unsuccessful. Due to portal vein occlusion, percutaneous transhepatic access was difficult. Thus, the middle colic vein, which was dilated due to portal vein occlusion, was percutaneously punctured, and antegrade embolization of a jejunal vein feeding the varices was performed using a microcatheter through a 4-F dilator placed as a sheath. After embolization, the sheath was removed, and ultrasound-guided compression of the puncture site was performed. No bleeding complication occurred. Therefore, direct percutaneous access to a mesenteric vein is a viable alternative to transhepatic access

McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis

[Background] The celiac artery stenosis due to compression by median arcuate ligament (MAL) has been reported in many cases of pancreaticoduodenectomy, but not in cases of esophagectomy. Recently, the celiac artery stenosis due to MAL or arteriosclerosis has been reported to be associated with the gastric tube necrosis or anastomotic leakage following Ivor–Lewis esophagectomy. Herein, we present the first reported case of esophageal cancer with celiac artery stenosis due to compression by the MAL successfully treated by McKeown esophagectomy and gastric tube reconstruction following prophylactic MAL release. [Case presentation] A 72-year-old female patient was referred to our department for esophagectomy. The patient had received two courses of neoadjuvant chemotherapy with 5-FU and cisplatin for T2N0M0 squamous cell carcinoma of the middle esophagus. Preoperative contrast-enhanced computed tomography (CECT) showed celiac artery stenosis due to compression by the MAL. The development of collateral arteries around the pancreatic head was observed without evidence of aneurysm formation. The patient reported no abdominal symptoms. After robot-assisted esophagectomy with mediastinal lymphadenectomy, gastric mobilization, supra-pancreatic lymphadenectomy, and preparation of the gastric tube were performed under laparotomy. Subsequently, the MAL was cut, and released to expose the celiac artery. Improved celiac artery blood flow was confirmed by decreased pulsatility index on intraoperative Doppler sonography. The operation was completed with the cervical esophagogastric anastomosis following cervical lymphadenectomy. Postoperative CECT on postoperative day 7 demonstrated increased celiac artery patency. The patient had an uncomplicated postoperative course thereafter. [Conclusions] Prophylactic MAL release may be considered in patients with celiac artery stenosis due to compression by the MAL on preoperative CECT for esophagectomy

INTRAOPERATIVE ANGIOGRAPHIC ASSESSMENT OF RECONSTRUCTED ARTERY AND USEFULNESS OF SAPHENOUS VEIN GRAFT BRIDGING IN EARLY THROMBOSIS OCCLUSION AFTER CAROTID ENDARTERECTOMY

Early postoperative thrombosis-occlusion of the internal carotid artery after carotid endarterectomy plays a major role in postoperative neurologic morbidity and mortality. To prevent this terrible complication, many surgeons are trying various prophylactic methods such as saphenous vein patch angioplasty, prolonged use of heparin, intraoperative Doppler ultrasound assessment, and so on. However, complete protection from postoperative thrombosis-occlusion is difficult. We have performed 47 carotid endarterectomies on 43 patients in the last three years. In 28 of these endarterectomies, primary closure for arteriotomy was performed, and in 19 cases, endarterectomies were reconstructed with saphenous vein patch angioplasty. An intraoperative angiographical assessment of the reconstructed segment was done in all endarterectomies after the reversing of heparin given during the carotid arterial surgical maneuver, and restenosis, or thrombosis-occlusion, was also checked. In three arteries, restenosis was demonstrated and repair was performed with vein graft angioplasty. Three of 28 arteries recontructed with primary closure and 1 of 19 arteries with vein patch angioplasty showed thrombosis-occlusion. Although vein patch angioplasty was done immediately for the primarily closured arteries, occlusion occurred again in two arteries. One artery with patch angioplasty also reoccluded. For these arteries, saphenous vein graft bridging between common carotid artery with an intact intima and internal carotid artery with an intact intima was performed. Postoperative angiogram showed good blood flow through the vein graft bridge. These results suggest that intraoperative angiography gives important imformation about the reconstructed arterial segment and that saphenous vein bridging is very useful in arteries with thrombosis-occlusion following carotid endarterectomy

Intrathoracic esophagogastric anastomosis using a linear stapler following minimally invasive esophagectomy in the prone position.

[Background] Minimally invasive esophagectomy (MIE) in the prone position typically includes thoracoscopic mediastinal dissection and laparoscopic gastric tube construction, followed by esophagogastric anastomosis in the neck. We introduced an intrathoracic esophagogastric anastomosis using linear staplers. [Technique] The lower mediastinal dissection and the gastric tube construction are done in the laparoscopic part of the operation. The esophagus is transected at the cranial level of the aortic arch after the completion of the upper mediastinal lymph node dissection in the prone position. The excess length of the gastric tube is sacrificed before making the anastomosis. Side-to-side esophagogastric anastomosis is performed using a 35-mm endoscopic linear stapler. The entry hole is closed with hand suturing using the posterior and the axillary port. [Results] Twenty-six patients with middle or lower esophageal tumor underwent MIE with an intrathoracic anastomosis. The mean thoracoscopic procedure time was 302 min. One patient had an anastomotic leakage, which was successfully managed with drainage. There has been no anastomotic stenosis. Pneumonia was observed in two patients. There was no mortality. [Conclusions] MIE with an intrathoracic linear-stapled anastomosis with the patient in the prone position is safe and feasible

CLINICOPATHOLOGICAL STUDY OF CEREBRAL SUBCORTICAL CAVERNOUS ANGIOMA AS EPILEPTOGENIC FOCUS

The authors conducted a comparative histological study of two groups of patients with cerebral subcortical cavernous angioma. One group was composed of 5 asymptomatic cases detected accidentally. The other group was composed of 4 patients presenting as epilepsy. The results obtained may be summarized as follows ; 1) Hemosiderin deposit and gliosis were seen in all cases examined ; 2) Granulomatous change was a histological finding associated with epileptogenesis ; 3) The histological changes, starting with proliferation of collagen fibers and leading to hyaline degeneration, calcification, and then hemangioma calcificans, seem to represent a course of spontaneous healing, when viewed from epileptogenesis

A NEW METHOD OF SURGICAL TREATMENT OF LUMBAR SPINAL STENOSIS

As the treatment of lumbar or lumbosacral stenosis, laminectomy with the preservation of tissues supporting the spine and the embracement of the exposed dura mater with thin silicone rubber to prevent the occurrence of restenosis due to exuberant fibrous tissue formation at the operative site have been performed over a period of seven years. Before the prevention of restenosis with silicone rubber, we had to reoperate in cases which developed recurrent symptoms resulting from restenosis of the lumbosacral canal. This operation that we describe is technically feasible and with practical benefit can be done routinely for spinal decompression not only in the lumbosaral, but also in cervical spinal region without requiring an extensive laminectomy

Microrna-9-5p-CDX2 axis: A useful prognostic biomarker for patients with stage II/III colorectal cancer

A lack of caudal-type homeobox transcription factor 2 (CDX2) protein expression has been proposed as a prognostic biomarker for colorectal cancer (CRC). However, the relationship between CDX2 levels and the survival of patients with stage II/III CRC along with the relationship between microRNAs (miRs) and CDX2 expression are unclear. Tissue samples were collected from patients with stage II/III CRC surgically treated at Kyoto University Hospital. CDX2 expression was semi-quantitatively evaluated by immunohistochemistry (IHC). The prognostic impacts of CDX2 expression on overall survival (OS) and relapse-free survival (RFS) were evaluated by multivariable statistical analysis. The expression of miRs regulating CDX2 expression and their prognostic impacts were analyzed using The Cancer Genome Atlas Program for CRC (TCGA-CRC). Eleven of 174 CRC tissues lacked CDX2 expression. The five-year OS and RFS rates of patients with CDX2-negative CRC were significantly lower than those of CDX2-positive patients. Multivariate analysis of clinicopathological features revealed that CDX2-negative status is an independent marker of poor prognosis in stage II/III CRC. miR-9-5p was shown to regulate CDX2 expression. TCGA-CRC analysis showed that high miR-9-5p expression was significantly associated with poor patient prognosis in stage II/III CRC. In conclusion, CDX2, the post-transcriptional target of microRNA-9-5p, is a useful prognostic biomarker in patients with stage II/III CRC

Neutrophil Depletion Exacerbates Pregnancy Complications, Including Placental Damage, Induced by Silica Nanoparticles in Mice

Recent advances in nanotechnology have led to the development of nanoparticles with innovative functions in various fields. However, the biological effects of nanoparticles—particularly those on the fetus—need to be investigated in detail, because several previous studies have shown that various nanoparticles induce pregnancy complications in mice. In this regard, our previous findings in mice suggested that the increase in peripheral neutrophil count induced by treatment with silica nanoparticles with a diameter of 70 nm (nSP70) may play a role in the associated pregnancy complications. Therefore, here, we sought to define the role of neutrophils in nSP70-induced pregnancy complications. The peripheral neutrophil count in pregnant BALB/c mice at 24 h after treatment with nSP70 was significantly higher than in saline-treated mice. In addition, maternal body weight, uterine weight, and the number of fetuses in nSP70-treated mice pretreated with anti-antibodies, which deplete neutrophils, were significantly lower than those in nSP70-treated mice pretreated with phosphate-buffered saline or isotype-matched control antibodies. Histology revealed that neutrophil depletion increased nSP70-induced placental damage from the decidua through the spongiotrophoblast layer and narrowed spiral arteries in the placentae. In addition, depletion of neutrophils augmented nSP70-induced cytotoxicity to fetal vessels, which were covered with endothelium. The rate of apoptotic cell death was significantly higher in the placentae of anti-nSP70-treated mice than in those from mice pretreated with isotype-matched control antibodies. Therefore, impairment of placental vessels and apoptotic cell death due to nSP70 exposure is exacerbated in the placentae of nSP70-treated mice pretreated with anti-antibodies. Depletion of neutrophils worsens nSP70-induced pregnancy complications in mice; this exacerbation was due to enhanced impairment of placental vessels and increased apoptotic cell death in maternal placentae. Our results provide basic information regarding the mechanism underlying silica-nanoparticle-induced pregnancy complications

Comparative Outcomes of Laparoscopic Gastrectomy and Open Gastrectomy for Scirrhous Gastric Cancer: A Multicenter Retrospective Cohort Study

Objective: A multicenter retrospective cohort study was performed to compare the outcomes of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for scirrhous gastric cancer (GC) as a unique subtype also known as type 4 gastric cancer or linitis plastica. Background: Although data on the efficacy and safety of LG as an alternative to OG are emerging, the applicability of LG to scirrhous GC remains unclear. Methods: Patients with clinical type 4 GC undergoing gastrectomy at 13 hospitals from 2005 to 2015 were retrospectively reviewed. As the primary endpoint, we compared overall survival (OS) between the LG and OG groups. To adjust for confounding factors, we used multivariate Cox regression analysis for the main analyses and propensity-score matching for sensitivity analysis. Short-term outcomes and recurrence-free survival were also compared. Results: A total of 288 patients (LG, 62; OG, 226) were included in the main analysis. Postoperative complications occurred in 25.8% and 30.1%, respectively (P = 0.44). No significant difference in recurrence-free survival was observed (P = 0.72). The 5-year OS rates were 32.4% and 31.6% in the LG and OG groups, respectively (P = 0.60). The hazard ratio (LG/OG) for OS was 0.98 (95% confidence interval [CI], 0.65–1.43) in the multivariate regression analysis. In the sensitivity analyses after propensity-score matching, the hazard ratio for OS was 0.92 (95% CI, 0.58–1.45). Conclusions: Considering the hazard ratios and 95% CIs for OS, LG for scirrhous GC was not associated with worse survival than that for OG

Management of Natural History collections: criteria and parameters of evaluation

[ES] Las colecciones de historia natural son una herramienta básica para la investigación científica y el estudio de la distribución en el pasado de muchas especies, así como de la propia historia de la ciencia. Además del uso científico de estas colecciones, destacan otros como el histórico, el divulgativo-pedagógico y el estético. De ahí la importancia que tiene una gestión eficaz de las mismas, la cual implica diversos aspectos, que van desde la conservación y su mantenimiento, su inventario, ordenación y procesamiento informático hasta las múltiples tareas relacionadas con su uso en consultas, visitas, préstamos científicos y participación en actividades de carácter divulgativo. En este artículo se examinan los criterios para evaluar la gestión de las colecciones de historia natural y se definen una serie de parámetros, útiles para medir el estado de una colección y su evolución en el tiempo, tanto en su crecimiento como en su uso, principalmente. Se ejemplifica todo ello en el grupo de los poliquetos, del que el Museo Nacional de Ciencias Naturales de Madrid (MNCN) cuenta con una estimable colección, y se comparan los resultados, según varios parámetros seleccionados, con los de otras colecciones de poliquetos de diversas instituciones de todo el mundo.[EN] Natural History collections are a basic and essential tool for scientific research, the study of the distribution in the past of many species of animals and plants and the History of Science. As well as the scientific aspect of these collections, stand outs other uses as the historic one, the educational and the aesthetic. All these are reasons that show the importance of an effective management of the Natural History collections as well as the several tasks related to it, as consults, visits, scientific loans and educational activities. In this article various criteria and useful parameters are provided for evaluating the curatorial state of a Natural History collection and its evolution, both in growth and use mainly. Finally, an example based on the Polychaeta, an estimable group in the Invertebrates Collection of the Museo Nacional de Ciencias Naturales of Madrid (MNCN), is provided. The results of several selected parameters are compared with other Polychaeta collections from several institutions around the world.Peer reviewe