Perioperative immune responses in cancer patients undergoing digestive surgeries

<p>Abstract</p> <p>Background</p> <p>Th1/Th2 cell balance is thought to be shifted toward a Th2-type immune response not only by malignancy but also by surgical stress. The aim of this study was to estimate perioperative immune responses with respect to the Th1/Th2 balance in patients with gastrointestinal cancer.</p> <p>Methods</p> <p>Ninety-four patients who underwent abdominal surgeries were divided into three groups: gastric resection (n = 40), colorectal resection (n = 34) and hepatic resection (n = 20). Twelve patients undergoing laparoscopic cholecystectomy and 20 healthy subjects were served as control groups. Intracellular cytokine staining in CD4+ T lymphocytes was identified to characterize Th1/Th2 balance. Th1/Th2 balance was evaluated before operation and until postoperative days (POD) 14.</p> <p>Results</p> <p>The preoperative Th1/Th2 ratio was significantly lower in patients with malignancy compared with control. The Th1/Th2 ratio of patients in all groups decreased significantly postoperatively. Th1/Th2 balance on POD 2 in patients with malignancy was significantly decreased compared to patients with laparoscopic cholecystectomy, but there were no significant differences among the four groups on POD 14.</p> <p>Conclusion</p> <p>Patients with malignancy showed an abnormal perioperative Th1/Th2 balance suggesting predominance of a type-2 immune response. Major abdominal surgeries induce a marked shift in Th1/Th2 balance toward Th2 in the early postoperative stage.</p

カン focal nodular hyperplasia ニ タイスル フククウキョウカ カン セツジョジュツ

Recently, laparoscopic hepatectomy of the liver has been reported to be safe, with possible advantages to the patients such as reduced postoperative pain and shorter hospital stay. We report successful laparoscopic partial liver resections for two cases of focal nodular hyperplasia. Two cases of 43-year-old male and 69-year-old male, with chronic hepatitis C and without any symptoms, presented in each other a solitary mass 1.5 and 1.0 cm in size at the edge of the liver on diagnostic imagings. The patients underwent laparoscopic partial hepatectomy to rule out well differentiated hepatocellular carcinoma. The histopathological diagnosis was focal nodular hyperplasia. Each patient had an uneventful postoperative recovery and had been free from recurrence during the 6 years follow-up period. Laparoscopic partial hepatectomy is indicated in patients with benign solid mass located at the edge of the liver

ジコ メンエキセイ スイエン ニ タイスル ステロイド チリョウ コウカ ハンテイ ニ Ga scintigraphy ガ ユウヨウ デアッタ 1レイ

Some cases of chronic idiopathic pancreatitis associated with autoimmune disease havebeen reported. The autoimmune pancreatitis revealed a diffusely irregular and narrowedpancreatic duct and responded well to steroid treatment. We report a case of autoimmunepancreatitis with a significant role of Gallium scintigraphy in response to steroid therapy.A sixty seven-year-old male, with upper abdominal pain, appetite loss and thirst, presenteddiffuse pancreatic swelling on abdominal ultrasonography, and diffuse irregular narrowingof the pancreatic duct and stenosis of the distal common bile duct. Gallium-67 scitigraphyrevealed high uptake in the whole pancreas. The patient underwent pancreatic biopsy torule out pancreatic cancer and malignant lymphoma. The definitive diagnosis was autoimmunepancreatitis. The patient recovered quickly with steroid therapy after the biopsy

スイ カセイ ノウホウ ニ タイスル フククウキョウカ ノホウ イ フンゴウジュツ : イヘキ トノ ユチャク オ ゼンテイ ト シナイ アンゼンナ ジュツシキ

A forty seven-year-old male who had been in clinical follow-up for a pancreatic pseudocystunderwent a laparoscopic cystogastrostomy through the lesser peritoneal sac in 1996. Thisprocedure is performed by creating a cystotomy and posterior gastrotomy through whichan Endo GIATM is applied. The mouth of cystogastrostomy is closed using continuous suturesby Endo STITCHTM. This approach does not rely on adhesions between the pseudocyst andposterior wall of the stomach, and offers clear advantages over previously described techniquesin the management of pancreatic pseudocyst

Crystalline Inclusions in Hepatocyte Mitochondria of a Patient with Porphyria Cutanea Tarda

Intramitochondrial crystalline inclusions were found in hepatocytes of a patient with porphyria cutanea tarda (PCT). They were composed of parallel filamentous structures which measured approximately 12 nm in diameter. Each filament was separated from an adjacent filament by a space measuring approximately 5 nm. The mitochondria containing such inclusions were usually elongated and enlarged. It seemed likely that these changes are not particular in PCT, but indicate one reversible pathological finding in the liver

シュヨウナイ シュッケツ ニヨリ ゾウダイ シタ イ GIST ノ 1レイ

Although there are a lot of case-reports of GIST （Gastrointestinal stromal tumor） with bleeding into the alimentary tract, cases of bleeding inside of the GIST are rare. We report a case in which a GIST increased its size associated with bleeding inside and was resected successfully. An ８２-year-old man was diagnosed as GIST （１．０×２．０ cm in size） and followed for ３ years. Its size increased to １１×８ cm in size, therefore, we performed an operation. During laparotomy, the tumor was elastic hard and located on the upper body and posterior wall of the stomach. The tumor size was approximately the head of child. A total gastrectomy with splenectomy was done. A case of sudden increasing of the tumor was histologically thought to bleed inside of it. The increased size of tumors revealed a malignant potential and/or hemorrage, the tumor should be resected as soon as possible

Reduction mammaplasty and mastopexy for the contralateral breast after reconstruction surgery following cancer resection : A report of 3 cases

Background : Breast reconstruction generally involves autologous tissue transplantation and placement of a mammary prosthesis. When the patient’s breasts are extremely large and ptotic, breast reconstruction often results in significantly asymmetrical appearance. However, a good aesthetic outcome after reconstruction surgery following cancer resection is an important quality-of-life factor. We evaluated the efficacy of touch-up surgery, either reduction mammaplasty or mastopexy, performed on the contralateral breast for symmetrization. Methods : Reduction mammaplasty was performed on the contralateral breast in 2 patients and mastopexy was performed on the contralateral breast in 1 patient after reconstruction surgery following cancer resection, between 2008 and 2014. We reviewed each patient’s medical record for general clinical information and for the methods of breast cancer resection and breast reconstruction used, wait time between breast cancer resection and touch-up surgery, preservation of the sensitivity of the nipple-areola complex after the touch-up surgery, and aesthetic outcome (based on visual analog scale score). Results : Wait times in the 3 cases were 4, 9, and 18 months. Nipple-areolar sensitivity was well preserved in all 3 cases. Aesthetic outcomes were judged “excellent” or “very good.” Conclusion : Revision surgery on the contralateral breast 4 to 18 months after breast reconstruction substantially improves the aesthetic outcome

Giant gastrointestinal stromal tumor, associated with esophageal hiatus hernia

An 85-year-old woman was admitted to our hospital because of vomiting. An upper gastrointestinal series what showed a large esophageal hiatus hernia, suggesting an association with extrinsic pressure in the middle portion of the stomach. An upper gastrointestinal endoscopic examination showed severe esophagitis and a prominent narrowing in the middle portion of the stomach, however, it showed normal gastric mucosa findings. CT and MRI revealed a large tumor extending from the region of the lower chest to the upper abdomen. From these findings, the tumor was diagnosed as gastrointestinal stromal tumor(GIST), which arose from the gastric wall and complicated with an esophageal hiatus hernia. We performed a laparotomy, however, the tumor showed severe invasion to the circumferential organs. Therefore, we abandoned the excision of the tumor. Histologically, the tumor was composed of spindle shaped cells with marked nuclear atypia and prominent mitosis. The tumor cells were strongly positive for CD34 and c-kit by immunohistochemical examination. From these findings, the tumor was definitely diagnosed as a malignant GIST. As palliative treatment, we implanted a self-expandable metallic stent in the narrow segment of the stomach. The patient could eat solid food and was discharged. In the treatment of esophageal hiatus hernia, the rare association of GIST should be considered

Impact of Ambulation Status in Patients with End-stage Renal Disease on Hemodialysis due to Diabetic Nephropathy : The PREDICT Study

Article信州医学雑誌 68(3): 131-138(2020)journal articl

Clinical implications of thymidylate synthetase, dihydropyrimidine dehydrogenase and orotate phosphoribosyl transferase activity levels in colorectal carcinoma following radical resection and administration of adjuvant 5-FU chemotherapy

<p>Abstract</p> <p>Bckground</p> <p>A number of studies have investigated whether the activity levels of enzymes involved in 5-fluorouracil (5-FU) metabolism are prognostic factors for survival in patients with colorectal carcinoma. Most reports have examined thymidylate synthetase (TS) and dihydropyrimidine dehydrogenase (DPD) in unresectable or metastatic cases, therefore it is unclear whether the activity of these enzymes is of prognostic value in colorectal cancer patients treated with radical resection and adjuvant chemotherapy with 5-FU.</p> <p>Methods</p> <p>This study examined fresh frozen specimens of colorectal carcinoma from 40 patients who had undergone curative operation and were orally administered adjuvant tegafur/uracil (UFT) chemotherapy. TS, DPD and orotate phosphoribosyl transferase (OPRT) activities were assayed in cancer tissue and adjacent normal tissue and their association with clinicopathological variables was investigated. In addition, the relationships between TS, DPD and OPRT activities and patient survival were examined to determine whether any of these enzymes could be useful prognostic factors.</p> <p>Results</p> <p>While there was no clear relationship between pathological findings and TS or DPD activity, OPRT activity was significantly lower in tumors with lymph node metastasis than in tumors lacking lymph node metastasis. Postoperative survival was significantly better in the groups with low TS activity and/or high OPRT activity.</p> <p>Conclusion</p> <p>TS and OPRT activity levels in tumor tissue may be important prognostic factors for survival in Dukes' B and C colorectal carcinoma with radical resection and adjuvant chemotherapy with UFT.</p