Two Cases of Rectal Cancer with Retzius Shunt Treated with Robot-Assisted Surgery

The retroperitoneal intestinal vein-general circulation anastomotic pathway is referred to as a Retzius shunt; however, it is not a well-recognized condition. Here, we describe two patients with a Retzius shunt who underwent robot-assisted surgery for rectal cancer. The first case was an 81-year-old woman who had tested positive for fecal occult blood. A type 0-Is tumor was found in the middle rectum, and we used robot-assisted surgery for resection. Intraoperative findings included a dilated vein between the inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV); further, computed tomography (CT) revealed flow into the inferior vena cava (IVC). We clipped the vein without major bleeding and the tumor-specific mesorectal excision was completed. Thereafter, we reviewed relevant literature and identified the structure to be a Retzius shunt. The second case was 77-year-old man with type 1 advanced cancer in the middle rectum who underwent robot-assisted surgery. In this case, we recognized the Retzius shunt on preoperative CT due to our experience with the first case and surgery was completed without any problems. Preoperative recognition of vascular malformations, such as the Retzius shunt by CT is critical to ensure the safety of robot-assisted surgery

Inhibitory effects of adhesion oligopeptides on the invasion of squamous carcinoma cells with special reference to implication of αv integrins

金沢大学大学院医学系研究科保健学専攻We studied invasion-related adhesion events in vitro using three squamous carcinoma cell lines (HSC-3, poorly differentiated type; OSC-19, well-differentiated type; and KB cells, undifferentiated type). An in vitro invasion assay through matrigel in the transwell chamber revealed that HSC-3 cells were most invasive, OSC-19 cells moderately invasive and KB cells least invasive. Inhibition assay of invasion using synthetic peptides RGD, RGDV, RGDS, RGDT, IKVAV and YIGSR, showed that invasion of the three cell lines was significantly inhibited by RGDV. There were other peptides that inhibited invasion significantly including IKVAV for HSC-3, and RGDS and YIGSR for OSC-19. HSC-3 cells and OSC-19 cells adhered to fibronectin, laminin, vitronectin, and type IV collagen, and KB cells did not adhere to laminin but did to fibronectin, vitronectin and collagen type IV. Pretreatment of cells with RGDV peptide in the attachment assay reduced the ability of these cells to bind to vitronectin and fibronectin more efficiently than pretreatment with RGDS. Anti-αv antibodies inhibited adhesion of HSC-3, OSC-19 and KB cells to vitronectin, but anti-β1 antibodies did not inhibit adhesion. Immunofluorescent microscopic examinations showed that all cell lines were positive for anti-β5 and anti-αv antibodies, and only HSC-β3 cells were positive for antiβ-3 antibody. α5β1 was not clearly demonstrated in any of the cell lines. RGDV was the most effective inhibitor of squamous cell carcinoma invasion among the synthetic oligopeptides used in this experiment, and it is suggested that it affects αvβ3-and/or αvβ5-mediated carcinoma cell invasion

Inhibitory/Suppressive oligodeoxynucleotide nanocapsules as simple oral delivery devices for preventing atopic dermatitis in mice

Advance online publication 6 January 2015Here, we report a simple and low-cost oral oligodeoxynucleotide (ODN) delivery system targeted to the gut Peyer's patches (PPs). This system requires only Dulbecco's modified eagle's medium, calcium chloride, ODNs, and basic laboratory equipment. ODN nanocapsules (ODNcaps) were directly delivered to the PPs through oral administration and were taken up by macrophages in the PPs, where they induced an immune response. Long-term continuous oral dosing with inhibitory/suppressive ODNcaps (iODNcaps, "iSG3caps" in this study) was evaluated using an atopic dermatitis mouse model to visually monitor disease course. Administration of iSG3caps improved skin lesions and decreased epidermal thickness. Underlying this effect is the ability of iSG3 to bind to and prevent phosphorylation of signal transducer and activator of transcription 6, thereby blocking the interleukin-4 signaling cascade mediated by binding of allergens to type 2 helper T cells. The results of our iSG3cap oral delivery experiments suggest that iSG3 may be useful for treating allergic diseases.ArticleMOLECULAR THERAPY. 23(2):297-309 (2015)journal articl

Measurement of the muscle power of the toes in female marathon runners using a toe dynamometer.

The aim of this study was to investigate the relationship between the strength of the foot muscles that control the toes and disorders such as shin splint. In order to this, we designed and built a toe dynamometer to compare the muscle power exerted through the toes in top female marathon runners and age-matched women not involved in sports. The subjects were 12 top-level female marathon runners (Group A) and 37 student nurses who were not involved in sports (Group B). We devised a dynamometer to measure the total power exerted by the flexor muscles of the 5 toes of a single foot (total flexor power) and the combined power of the abductors of the big (1st) and little (5th) toes (abductor power). In Group A, the total flexor power was 14.3 +/- 5.3 kg in the right foot and 15.4 +/- 4.7 kg in the left foot. The abductor power was 1.9 +/- 1.8 kg in the right foot and 2.2 +/- 1.9 kg in the left foot. In Group B, total flexor power was 18.3 +/- 6.7 kg in the right foot, while the abductor power was 1.9 +/- 1.7 kg. The subjects from Group A with an arch index &#60; 1.0 (n = 8) or &#62; 1.0 (n = 4) were respectively classified as Group I and Group II. In Group I, total flexor power was 14.9 +/- 5.3 kg (right) and 15.5 +/- 5.2 kg (left), while the abductor power was 2.6 +/- 1.9 kg (right), and 3.1 +/- 1.7 kg (left). In Group II, the total flexor power was 13.2 +/- 5.8 kg (right) and 15.1 +/- 4.2 kg (left), while the abductor power was 0.7 +/- 0.6 kg (right) and 0.3 +/- 0.2 kg (left). The abductor power of toes was significantly lower in Group II than in Group I. The incidence of posteromedial shin pain was higher in Group II (75.0%) than in Group I (12.5%).</p

Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

[Background]?Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. [Methods]?We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. [Results]?The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P?< 0.001). Postoperative complications were more frequently observed in the early phase (P?= 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. [Conclusion]?Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for the Diagnosis of Intrathoracic Lesions : Experience of a Single Academic Medical Center

Article信州医学雑誌 60(5): 249-255(2012)journal articl