Cross-phylum functional equivalence of Otx genes and the origin of brain patterning

Molecular mechanisms of cephalic development is an intriguing question in evolutionary and developmental biology. Otx gene plays important roles in animal brain and head development and Otx genes are found in all major animal groups: cnidarians, lophotrochozoans, ecdysozoans, anddeuterostomes. Ascidians, positioned near the origin of the phylum Chordata, share a conserved set of anteroposterior patterning genes withthat of vertebrates. Here I report the cross-phylum regulatory potential of the ascidian Otx gene in the development of the Drosophila brain and the head vertex structures. The ascidian Otx gene rescued the embryonic brain defect of Drosophila caused by null mutation of the orthodenticle (otd) gene and enhanced rostral brain development while it suppressed trunknerve cord formation. Furthermore, the ascidian Otx gene restored the head vertex defects caused by a viable otd mutation, ocelliless, via specificactivation and repression of downstream regulatory genes. The crossphylum regulatory potentials of the ascidian Otx gene are equivalent to the activities of the Drosophila and human otd/Otx genes in these developmental processes. In contrast to these results, cnidarian Otx gene showed little functional equivalence in Drosophila. In addition, planarianOtx gene had failed to rescue Drosophila embryonic brain development. The results with ascidian Otx gene function support the notion thatbasal chordates such as ascidians have the similar molecular patterningmechanism for the anterior structures found in higher chordates, andsuggest a common genetic program of cephalic development among invertebrate, protochordate and vertebrate. ･･･Thesis (Ph. D. in Science)--University of Tsukuba, (A), no. 3328, 2004.3.25Includes bibliographical reference

Combined pancreatic resection and pancreatic duct-navigation surgery for multiple lesions of the pancreas: intraductal papillary mucinous neoplasm of the pancreas concomitant with ductal carcinoma of the pancreas.

When a branch-type IPMN of the uncinate process is concomitant with ductal carcinoma of the body of the pancreas, total pancreatectomy may be recommended. However, a decrease in quality of life becomes a serious problem after total pancreatectomy because of the abolition of endocrine and exocrine pancreatic function. We proposed the combined resection, which consists of resection of the uncinate process of the pancreas with distal pancreatectomy. This surgical procedure of combined resection is most suitable for preservation of the pancreatic functions. In addition, we recommend the pancreatic duct-navigation surgery to enable us to prevent injury to the main pancreatic duct, and to dissect at the optimal cutting point of the pancreatic branch duct

Gastric wall-covering method prevents pancreatic fistula after distal pancreatectomy

Background/Aims: Pancreatic fistula is the most common complication after distal pancreatectomy. The aim of this study was to evaluate retrospectively the usefulness of a new surgical technique, the gastric wall-covering method, after distal pancreatectomy. Methodology: The study group consisted of 53 patients who underwent distal pancreatectomy. The management of the stump of the remnant pancreas was accomplished by the gastric wall-covering method (GWC group, n=20) or by conventional surgery (CS group, n=33). In the gastric wall-covering method, the cut surface of the pancreas is fixed to the posterior wall of the gastric body. Results: There were no significant differences in operating time, intraoperative blood loss, or texture of the remnant stump between the two groups. Postoperative pancreatic fistula was diagnosed in 1 patient (5.0%) in the GWC group and in 12 patients (36.4%) in the CS group (P=0.01). Conclusions: The gastric wall-covering method for the management of the pancreatic stump after distal pancreatectomy reduces the incidence of postoperative pancreatic fistula

Intraoperative pancreatography using an endoscopic naso-pancreatic drainage tube for the prevention of pancreatic fistula after local pancreatic resection

Background: Local pancreatic resections can avoid the unnecessary resection of the normal pancreatic parenchyma in comparison with standard pancreatic resection. However, the incidence of pancreatic fistula after local pancreatic resection is high, and still responsible for most morbidity and mortality. Methods: We reviewed 6 patients who underwent intraoperative pancreatography using an endoscopic naso-pancreatic drainage (ENPD) tube during local pancreatic resection for the prevention of postoperative pancreatic fistula. Results: One patient had injury to the main pancreatic duct during surgery, and transient pancreatic fistula of grade B occurred. In this patient, ENPD tube was left in place for the management the pancreatic fistula, resulted in a favorable outcome. Other 5 patients showed no postoperative complications including pancreatic fistula. Conclusions: Intraoperative pancreatography using ENPD tube is a simple technique and useful for the prevention of pancreatic fistula after local pancreatic resection

Marionette method for transumbilical single-incision, two-trocar laparoscopic cholecystectomy: a new, simple technique.

Single-incision laparoscopic cholecystectomy (SILC) has recently become a topic of interest among types of minimally invasive surgery

Long-term Outcome of Percutaneous Treatment and Surgery for Postoperative Benign Biliary Stricture

The aim of this study was to assess the therapeutic efficacy and long-term outcome of percutaneous and surgical treatment in patients with postoperative biliary stricture. The subjects consisted of 19 patients with postoperative benign biliary stricture secondary to bile duct injury or fibrosis at the bilioenterostomy. All of the patients were initially managed by percutaneous transhepatic biliary drainage. Five patients failed to achieve internalization across the stricture and then underwent a wide hilar hepaticojejunostomy. An additional 4 patients required surgery because of a complex injury involving the right hepatic artery in one and the occurrence of so-called "blind-loop syndrome&rdquo in 3. Hepatobiliary scintigraphy clearly demonstrated a functional obstacle in the bile flow in these patients. Percutaneous management with an internal/external catheter placement was accomplished in 10 patients. A successful outcome was achieved in all patients with a mean follow-up 6.7 (range 2-12) and 5.2 (range 1-12) years for the surgical and percutaneous treatment, respectively. Conclusively, postoperative biliary stricture requires multidisciplinary management. The surgical repair should therefore be carefully considered for cases with tight stricture, a complex injury, or blind-loop syndrome. In order to accurately characterize the biliary flow and to select the optimal treatment, hepatobiliary scintigraphy may thus provide us with helpful information

A jejunal wall-covering method following central pancreatectomy for prevention of a pancreatic fistula: a novel technique.

To preserve pancreatic endocrine and exocrine function, various types of pancreatic resection, including central pancreatectomy, have been introduced as less invasive surgeries. However, postoperative pancreatic leakage has been demonstrated to be the most frequent complication following pancreas-preserving surgery. The authors\u27 new surgical technique, a jejunal wall-covering method, helps to prevent pancreatic leakage following central pancreatectomy

Chemopreventive effects of a selective cyclooxygenase-2 inhibitor (etodolac) on chemically induced intraductal papillary carcinoma of the pancreas in hamsters.

The present study was designed to determine whether etodolac, a selective cyclooxygenase-2 inhibitor, prevents chemically induced intraductal papillary carcinoma (IPC) in the main pancreatic duct of hamsters. Hamsters were subjected to cholecystoduodenostomy with dissection of the distal end of the common duct. Four weeks after surgery, the surviving hamsters received subcutaneous injections of N-nitrosobis(2-oxopropyl)amine four times at a dose of 10 mg/kg body wt, every 2 weeks. The animals were divided into three groups according to the simultaneous oral intake of a standard pelleted diet containing etodolac at 0% (group CE, n = 30), 0.01% (group ET, n = 21) and 0.04% (group ET4, n = 25), respectively. Hamsters were killed for pathological examination at 36 weeks after the operation. The incidence of induced pancreatic carcinoma was 93, 81 and 72% in groups CE, ET and ET4, respectively. The pancreatic carcinomas were histologically classified into four types, i.e. tubular, papillary, cyst adenocarcinoma and IPC. The incidence of IPC and the number of IPCs per animal were significantly lower in groups ET4 (36% and 0.48) and ET (48% and 0.62) when compared with group CE (67% and 1.30). The proliferating cell nuclear antigen labeling indices in the non-cancerous epithelial cells of the main pancreatic duct were 2.8 and 6.8% in groups ET4 and ET, respectively, and were significantly lower than that in group CE (10.8%). In conclusion, etodolac inhibited N-nitrosobis(2-oxopropyl)amine-induced IPC in hamsters. Suppression of epithelial cell proliferation of the main pancreatic duct was considered as a possible mechanism of cancer prevention in this hamster model

Limited pancreatectomy for metastatic pancreatic tumors from renal cell carcinoma

Background/Aims: Metastasis of renal cell carcinoma (RCC) to distant organs occurs commonly, even after radical nephrectomy, but metastatic lesions are rarely detected in the pancreas. The present study aim was to improve the postoperative quality of life of a patient with pancreatic metastasis of RCC through limited resection of the pancreas. Methodology: Since therapeutic modalities including chemotherapy or radiation are ineffective for metastatic tumors, surgical intervention is a treatment of choice in selected patients. In patients with multiple pancreatic metastases, however, near-total or total pancreatectomy may result in a lower quality of life postoperatively due to endocrine and exocrine pancreatic insufficiency. Results: We used limited resection of the pancreas combined with removal of the uncinate process and distal pancreatectomy for a 65-year-old woman with multifocal pancreatic metastases located in the uncinate process, body, and tail of the pancreas, which were detected 6 years after radical nephrectomy for RCC. This surgical procedure allowed preservation of about 40% of the pancreatic parenchyma, with complete excision of metastatic tumors in the pancreas. Conclusions: The patient has had an excellent quality of life with well-preserved pancreatic function and no evidence of tumor recurrence for 31 months after pancreatic surgery

Radical surgery for advanced pure squamous cell carcinoma of the gallbladder: report of a case.

Squamous cell carcinoma (SCC) of the gallbladder is frequently detected at an advanced stage because of its tendency to infiltrate adjacent organs. In addition, more rapid growth of this type of carcinoma compared to that of adenocarcinoma, the most frequent subtype of gallbladder carcinoma, has been reported. Although it is not rare to find squamous cell carcinoma components in cases other than the usual adenocarcinoma of the gallbladder, these cases must be distinguished from those of pure squamous cell carcinoma, as diagnosed in the present case. Pure squamous cell carcinoma is characterized by a well-localized growth, no visceral metastasis, and a rarity or lack of lymph node metastasis, even when the tumor has grown to a large size locally. Prognosis of SCC of the gallbladder has generally been considered poor. Nevertheless, long-term survival after curative resection in patients with SCC of the gallbladder has been sporadically reported. We performed extended right hemihepatectomy with portal vein resection after portal vein embolization for a 55-year-old woman with advanced SCC of the gallbladder. The patient has not developed any signs of recurrence 40 months after the surgery. Although such radical surgery remains challenging, it may lead to a favorable outcome in selected patients with advanced SCC of the gallbladder