Histological study of the elongated esophagus in a rat model

Background Esophageal elongation by traction suture is used in pediatric patients to manage long-gap esophageal atresia (EA). There was no histological evidence of the esophageal elongation. Here, we sought to clarify the histologic effects of traction on the esophagus by using a rat EA model simulating Foker\u27s method. Materials and methods Rats were randomly assigned into three groups (n = 5 each). The traction group underwent daily stretching of the distal segment of the esophagus. The nontraction group underwent a sham operation, and the normal group served as controls. Seven days after the operation, the distal segments of the esophagus were removed. The length and thickness were measured, and samples were stained with Ki-67, nNOS, and S-100. Results The whole length of the esophagus in the traction group was significantly longer than that in the nontraction group (P < 0.01). The thickness of esophageal mucosa and muscle tended to become thin by traction, but not significantly. The Ki-67-positive ratio of mucosa and muscle was significantly higher in the traction group (P < 0.05). There were no significant differences in Ki-67 between two segments (cardia-middle and middle-stump) in any group. Auerbach\u27s plexus was identified at all sites of elongated esophagus by nNOS and S-100 staining. Conclusions By traction, the esophagus was elongated uniformly and cell proliferation activity was promoted in all parts of the elongated esophagus in the rat EA model

Ex vivo hepatic venography for hepatocellular carcinoma in livers explanted for liver transplantation

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) is supposed to have a venous drainage system to a portal vein, which makes intrahepatic metastasis possible. However, the mechanism of extrahepatic recurrence, including the possibility of a direct route to the systemic circulation from the HCC nodules, remains unclear. Therefore, we performed retrograde hepatic venography for HCC in livers that had been explanted for liver transplantation in order to explore the possible direct connection between the hepatic vein and HCC nodules.</p> <p>Methods</p> <p>Of 105 living-donor liver transplantations (LDLT) performed up to July, 2009 at the Department of Surgery, Nagasaki University Hospital, dynamic hepatic venography was performed with contrast media under fluoroscopy for the most recent 13 cases with HCC. The presence of a tumor stain for each HCC case was evaluated and compared with the histological findings of HCC.</p> <p>Results</p> <p>Hepatic venography revealed a tumor stain in 2 of 13 cases (15%). Neither showed any microscopic tumor invasion of HCC into the hepatic vein. In the other 11 cases, there were 4 microscopic portal venous invasions and 2 microscopic hepatic venous invasions. No patients have shown HCC recurrence in follow-up (median period, 13 months).</p> <p>Conclusion</p> <p>Using <it>ex vivo </it>hepatic venography, a direct connection to the hepatic vein from HCC in whole liver was revealed in 2 cases without demonstrated histopathological invasion to hepatic vein for the first time in the literature. The finding suggests that there is direct spillage of HCC cells into the systemic circulation via hepatic vein.</p

A secure taping technique for a liver hanging maneuver using a surgical probe.

A liver hanging maneuver is currently being applied for various types of hepatectomies. The most difficult and important step of this technique is to encircle the liver with tape that is passed between the liver and the inferior vena cava, using a blind dissection. This report describes a secure technique for taping utilizing a surgical probe

The impact of no placement of drains in hemithyroidectomy on the postoperative course: A single-institutional study in Japanese patients

Background: Recently, the placement of drains in thyroidectomy has been debated. In this study, we evaluated the efficacy and safety of no placement of drains in hemithyroidectomy. Methods: After obtaining approval from the Institutional Review Board, we started not placing drains during surgery in adult patients who underwent hemithyroidectomy with or without central neck lymph node dissection for benign thyroid nodules or well-differentiated thyroid cancer, with informed consent being obtained. We compared the clinical data of the patients without drain placement (n=19) to the historical data of consecutive patients with a suction drain (n=20). Results: The operative wound and amount and characteristics of the drainage fluid were monitored every 2 h after the operation until the following morning, in addition to monitoring the oxygen saturation and an electrocardiogram. The proportion of patients undergoing cervical lymph node dissection was identical between the groups. The drain was removed on Day 1 after surgery in 19 patients and on Day 2 after surgery in 1 patient. The patients without a drain showed a significantly shorter postoperative hospital stay than those with a drain (4.0 vs. 4.5 days, respectively, p=0.03). No patients in either group experienced postoperativebleeding or seroma or wound infection. Conclusion: The hemithyroidectomy patients without a drain were able to be discharged earlier than those with a drain and without any adverse events, provided they received close monitoring after surgery

Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation. A prospective randomized study.

BACKGROUND: Although the effect of synbiotic therapy using prebiotics and probiotics has been reported in hepatobiliary surgery, there are no reports of the effect on elective living-donor liver transplantation (LDLT). METHODS: Fifty adult patients undergoing LDLT between September 2005 and June 2009 were randomized into a group receiving 2 days of preoperative and 2 weeks of postoperative synbiotic therapy (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides [the BLO group]) and a group without synbiotic therapy (the control group). Postoperative infectious complications were recorded as well as fecal microflora before and after LDLT in each group. RESULTS: Only 1 systemic infection occurred in the BLO group (4%), whereas the control group showed 6 infectious complications (24%), with 3 cases of sepsis and 3 urinary tract infections with Enterococcus spp (P = .033 vs BLO group). No other type of complication showed any difference between the groups. CONCLUSIONS: Infectious complications after elective LDLT significantly decreased with the perioperative administration of synbiotic therapy

Positivity for cancer stem cell markers, CD44 and CD133, is a useful biomarker for predicting the outcomes of patients with advanced gastric cancer

Background; The CD44 and CD133 expressions have been identified to be putative cancer stem cell (CSC) markers. Some reports have revealed a correlation between these CSC markers and a poor prognosis in the clinical setting. However, clinical impact of combined use of these markers has not been determinated in advanced gastric cancer.Methods; Specimens were obtained from 73 patients with gastric cancer with invasion beyond the muscularis (T3/4a) who underwent curative gastrectomy. Immunohistochemically, tumors with more than 5% CD44-positive cells or at least one CD133-positive cancer cell were regard as being CSC marker-positive.Results; Forty patients were CSC marker-positive. There were significant correlations between the CSC marker expression and the extent of lymphatic (p=0.04) and vessel invasion (p<0.001). The CSC marker-positive patients exhibitedpoor prognoses in both the overall (p=0.006) and disease-free survival analyses (p=0.019). Based on the results of the univariate analysis, the peritoneal CEA value, the extent of lymph node metastasis and CSC marker positivity were analyzed in the multivariate analysis. The results revealed that the extent of lymph node metastasis (p<0.001) and CSC marker positivity (p=0.04) were significant risk factors.Conclusion; CSC marker positivity is an independent prognostic factor in patients with T3/4a gastric cancer

Transition of Serum Alkaline Phosphatase Isoenzymes during Liver Regeneration in Humans

Background/Aims: Serum alkaline phosphatase (ALP) levels tend to increase after hepatectomy, however, no previous examinations have yet focused on the relationship between liver regeneration and the individual ALP isoenzymes levels. Methodology: Forty living liver transplantation donors who underwent hemi-hepatectomy were herein investigated. We evaluated the serum ALP levels and ALP isoenzyme levels preoperatively and postoperatively. The liver regeneration rate (LRR) was calculated using volumetry. According to the LRR, we divided the donors into two groups, consisting of a high regeneration group (HG) and a low regeneration group (LG). Results: The total serum ALP levels increased gradually after hepatectomy and peaked on postoperative days (POD) 14. ALP-1 was not detected in any donor preoperatively; however it was detected after hepatectomy, peaking on POD 7. The serum ALP-2 level increased after hepatectomy, reaching a peak level on POD 14. The ALP-2 levels gradually increased after hepatectomy and reached peak levels on POD 14 in both groups. However, the ALP-2 level on POD 14 was significantly higher in HG than LG. Conclusions: The serum ALP- 2 levels after POD 14 might therefore be a useful indicator of favorable liver regeneration following hepatectomy, especially in patients who have a normal liver function

Rat hepatocyte spheroids formed on temperature-responsive PIPAAm polymer-grafted surface maintain long-term differentiated hepatocyte function

Background.Although the development of a practicable culture method to maintain long-term hepatocyte function is highly desirable, hepatocytes lose their liver-specific functions rapidly on regular collagen-coated dishes. In this study, we evaluated the efficacy of a special cell culture dish coated with the temperature-responsive polymer poly(N-isopropylacrylamide) (PIPAAm), and observed the morphological and functional changes of hepatocytes on changing the amount of polymer.Methods.Culture plates with varying amounts of PIPAAm polymer (1.5～3.5 times that in the commercially available temperatureresponsive polymer-containing dish (UpCellR, CellSeed, Tokyo, Japan)) were prepared. All dishes were enhanced by adding a layer of rat tail collagen I at a dose of 600 μg/dish for 3 hours. Hepatocytes isolated from Sprague-Dawley rats were cultured in these static culture systems. Morphologic changes and liver-specific functions were evaluated.Results.On day 7 of culture, spheroid formation of hepatocytes was observed in the high-polymer group, with the presence of glycogen and albumin in the spheroid. In the high-polymer group, the rate of albumin production was significantly higher than in the low-polymer group until day 14 of culture (P<0.001).Conclusion.The spheroid formation of hepatocytes cultured in the presence of a high level of PIPAAm showed the long-term maintenance of liver-specific functions in vitro

Is preservation of middle hepatic vein tributaries during right hemi-hepatectomy beneficial for live donor liver transplantation?

Background/Aims: When right hemi-hepatectomy without middle hepatic vein (MHV) is performed in a living donor (LD), MHV tributaries such as V5 and V8 may be preserved during parenchymal transection to preserve liver function and reduce the damage of the graft. However, no study has so far investigated whether this preservation of MHV tributaries during parenchymal transection has impact on live donor operation or graft function. Methodology: Of 52 hepatectomies for right lobe LD, MHV tributaries were preserved during hepatic parenchymal transection in 11 cases, while, in the remaining 41 cases MHV tributaries were sacrificed when those were encountered during hepatic parenchymal transection. Results: There was no significant difference in blood loss, operative time, zenith liver enzyme level in a donor and rate of graft failure in a recipient. Conclusions: It was demonstrated that there was no significant effect of outflow preservation from MHV tributaries on LD hepatectomy for right lobe donation and subsequent liver transplantation

Transition of serum alkaline phosphatase isoenzymes during liver regeneration in humans

Background/Aims: Serum alkaline phosphatase (ALP) levels tend to increase after hepatectomy. However, no previous examinations have yet focused on the relationship between liver regeneration and the individual ALP isoenzymes level. Methodology: Forty living liver transplantation donors who underwent hemi-hepatectomy were herein investigated. We evaluated the serum ALP levels and ALP isoenzyme levels preoperatively and postoperatively. The liver regeneration rate (LRR) was calculated using volumetry. According to the LRR, we divided the donors into two groups, consisting of a high regeneration group (HG) and a low regeneration group (LG). Results: The total serum ALP levels increased gradually after hepatectomy and peaked on postoperative day (POD) 14. ALP-1 was not detected in any donor preoperatively. However, it was detected after hepatectomy, peaking on POD 7. The serum ALP-2 level increased after hepatectomy, reaching a peak level on POD 14. The ALP-2 levels gradually increased after hepatectomy and reached peak levels on POD 14 in both groups. However, the ALP-2 level on POD 14 was significantly higher in HG than LG. Conclusions: The serum ALP-2 levels after POD 14 might therefore be a useful indicator of favorable liver regeneration following hepatectomy, especially in patients who have a normal liver function