Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study

BACKGROUND AND STUDY AIMS

Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES.

METHODS

Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture.

RESULTS

Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth.

CONCLUSIONS

The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

Correlation between docetaxel-induced skin toxicity and the use of steroids and H2 blockers: A multi-institution survey

9536

Background: Docetaxel is a standard drug used for adjuvant or neoadjuvant chemotherapeutic treatment of early breast cancer. With appropriate management of chemotherapy-induced bone marrow toxicity, skin toxicities such as hand-foot syndrome (HFS) and facial erythema (FE) have become dose-limiting. Steroids and H2 blockers are commonly used to provide supportive care to patients being treated with taxane-containing chemotherapeutic regimens, but their effects on skin toxicity are poorly understood. Methods: We asked institutions belonging to the JBCRG to complete a questionnaire regarding the occurrence of grade 2 or higher HFS and FE among patients treated with docetaxel as an adjuvant or neoadjuvant chemotherapeutic treatment for breast cancer between April 2007 and March 2008. Data collected were docetaxel dose, other chemotherapeutic agents administered, dosage regimens for the steroids and H2 blockers (if used), and incidences of grade 2 or higher HFS or FE. Statistical analyses were performed using the chi-squared test. Results: We obtained data for 989 patients from 22 institutions. Most patients received docetaxel at a dose of 75 mg/m2 and 852 patients were treated with docetaxel monotherapy. HFS and FE occurred in 18% and 13% of patients, respectively. The relationships between the incidence of skin toxicity and (i) chemotherapy regimen and (ii) use of H2 blockers are shown below ( Table ). Conclusions: Our data suggest that use of H2 blockers as premedication in breast cancer patients treated with docetaxel significantly increases the risk of both HFS and FE.

[Table: see text]

[Table: see text]

Robotic radiosurgery for severe recurrent and primary head and neck cancer

e17038

Background: We considered the functional reconstruction following head and neck tumor ablation, however, it was impossible to recover completely the function against the severe postoperative status. Here we describe our aim to improve local control and to obtain organ preservation by using the non-surgical outpatient procedure the CyberKnife frameless radiosurgery (CK). Methods: Between March 2006 and January 2008, 22 patients with severe recurrent, previously treated with conventional methods, and 14 patients with primary lesions were treated with CK in the management of head and neck cancer. All the patients had biopsy confirmation of disease prior to radiation therapy; rT2 (3 patients), rT3 (8), rT4 (9), T2 (5), T3 (3), T4 (6), N1 (4), N2b (3), M1 (1), tongue (11), mandibule (11), maxilla (6), maxillary sinus (4), soft palate (2), with sq. cell ca.(34), adenoid cystic ca.(1), fibrosarcoma (1). The treatment plan was set up based on CT, MRI and PET-CT in Yokohama CyberKnife Center. CK's lightweight linear accelerator always irradiates toward the target from 120 directions with image-guided computer based on CT. Marginal Doses were 2000–4200cGy in 3–5 fractions. Curative effects were evaluated assessed by RECIST included PET. Results: 11/22 (50.0%) of the severe recurrent cases were controlled from 6 to 25 months at follow-up range. The local recurrent cases with non-lymph node metastases were excellently controlled as 10/12 (83.3%). For the primary cases, significant tumor reduction were noted at the third-month follow-up, all the 14 patients went into remission with 5 cases in CR, and 9 cases in PR. Between the 4–6 month follow-up, 4 cases were performed additional CK treatment for the recurrent lesions, however, 3 patients with T4 tongue cancer were not cured. Finally, the total control rate of the primary cases was 10/14 (71.4%), however, 8/9 (88.9%) primary cases except tongue cancer has been controlled treated by CK with chemotherapy. The cases of non-lymph node metastases were cured 8/8 (100.0%) by CK. There have been no seriously complications of treatment caused by CK except severe osteoradionecrosis of the 4 patients irradiated with maximum dose. Conclusions: It is now possible with the development of CyberKnife Radiosurgery to improve our treatments of the local control in head and neck cancer.

No significant financial relationships to disclose.

Immediate and chronic results of cutting balloon angioplasty: a matched comparison with conventional angioplasty

BACKGROUND

At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique.

HYPOTHESIS

This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty.

METHODS

This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 +/- 9.3 years).

RESULTS

The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre- and/or postdilatation was 76.4% (91 lesions). There was one major in-hospital complication (Q-wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (> or = grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre- and/or postdilatation-treated lesions was 19.7%.

CONCLUSIONS

(1) Cutting balloon angioplasty procedures can be performed with high success rates with few major inhospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.

Prevalence of Helicobacter and Acanthamoeba in natural environment

AIMS

We examined whether the presence of Helicobacter is related to that of Acanthamoeba in river and soil environments.

METHODS AND RESULTS

The samples (river n = 51, soil n = 75) were collected in Sapporo City, Japan. PCR with primers for Helicobacter genus-specific and standard culture techniques were used to detect helicobacter. Prevalence of acanthamoeba was also evaluated by genus-specific PCR. The prevalence of Helicobacter genus-specific DNA in river water samples and in soil samples was 88% and 0%, respectively. No successful culture of helicobacter was achieved. The prevalence of Acanthamoeba genus-specific DNA in river samples and in soil samples was 61% and 96%, respectively. No statistical correlation between the prevalence of helicobacter and either that of acanthamoeba or water quality parameters (pH, turbidity and coliform group) except for temperature was found.

CONCLUSIONS

We revealed the presence of helicobacter in river water and non-existence of helicobacter in soil. However, the distribution of helicobacter did not overlap with that of acanthamoeba in rivers. SIGNIFICANCE FOR IMPACT OF THE STUDY: The role of acanthamoeba on the survival of helicobacter might be limited as the both are coincidentally present in the environment.

FePt nanoparticles fabricated by pulsed laser ablation

Two unique laser processes of 'PLA in low vacuum (PLALV)' and 'PLA in liquid (PLAL)' have been examined to fabricate FePt nanoparticles and the magnetic and structural properties were investigated. The particles as prepared by PLALV showed a superparamagnetic behavior with an fcc structure. The annealing temperature dependence of the transformation from fcc to fct structure was studied by the structural and magnetic properties. A large coercivity of 3.6 kOe at 300 K was obtained by the low temperature (500 C) annealing. Composition deviation due to Fe dissolution in PLAL process was successfully suppressed by Ar bubbling.

Spectral tuning of photoactive yellow protein

We report a theoretical study on the optical properties of a small, water-soluble photosensory receptor, photoactive yellow protein (PYP). A hierarchical ab initio molecular orbital calculation accurately evaluated the optical absorption maximum of the wild-type, as well as the lambda(max) values of 12 mutants. Electronic excitation of the chromophore directly affects the electronic state of nearby atoms in the protein environment. This effect is explicitly considered in the present study. Furthermore, the spectral tuning mechanism of PYP was investigated at the atomic level. The static disorder of a protein molecule is intimately related to the complex nature of its energy landscape. By using molecular dynamics simulation and quantum mechanical structure optimization, we obtained multiple minimum energy conformations of PYP. The statistical distribution of electronic excitation energies of these minima was compared with the hole-burning experiment (Masciangioli, T. [2000] Photochem. Photobiol. 72, 639), a direct observation of the distribution of excitation energies.

A highly color-stability white organic light-emitting diode by color conversion within hole injection layer

We demonstrated a novel-structure white organic light-emitting devices (WOLEDs) composed of a greenish blue fluorescent emitting layer and a red fluorescent dye-doped hole injection layer. The spectra of WOLEDs show no change at a wide range current density operation and long-term continuous operation. We concluded that carriers recombined inside the emitting layer in the WOLEDs to produce a greenish blue electroluminescence (EL), and a part of the EL was absorbed by the red fluorescent guest doped hole injection layer and converted into red photoluminescence (PL); the whole white emission from the device was a mixture of the greenish blue EL and red PL.

Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow

BACKGROUND AND PURPOSE

Distal embolism during carotid angioplasty with stent (CAS) can be protected by a flow-reversal device. Diffusion-weighted MR imaging was used to evaluate this protective procedure and perform a comparison with the control.

METHODS

Cases of CAS with protection procedures were included in this study. Sixty-five men (68 procedures) and 5 women (5 procedures), with an average age of 68.8 years, having severe carotid stenosis were treated in our department between 2002 and 2004. Eleven cases were treated with the Parodi Anti-Emboli System, with which the internal carotid blood flow is reversed by simultaneous occlusion of the proximal common carotid artery and external carotid artery. Diffusion-weighted MR imaging was performed within 1-3 days after CAS. As controls, data from diffusion-weighted MR imaging in 26 patients who had diagnostic angiography were included.

RESULTS

Diffusion-weighted MR imaging in diagnostic angiography showed 11.5% appearance of ischemic spots after procedures. In the Parodi Anti-Emboli System, this value was 18.2%. In the CAS group, ischemic lesions appeared only in the hemisphere ipsilateral to carotid stenosis. There were no ischemic lesions in the opposite carotid or vertebrobasilar territory. The appearance rate of new ischemic spots was not significantly different between the control group and the group of CAS with Parodi Anti-Emboli System (chi2 test, P = .6227, Fisher exact method).

CONCLUSIONS

Protection results obtained with the Parodi system were excellent and comparable with conventional angiography.

Facial emphysema caused by cheek bite

Biting of the buccal mucosa is very frequent injury, whereas facial emphysema caused by cheek bite is rare. We report a case of facial emphysema causing puffing of the cheek through a self-inflicted bite of the buccal mucosa.

[Surgical treatment for adrenal metastasis from lung cancer]

Several long-term survivors after surgical resection for a solitary adrenal metastasis from non-small cell lung cancer (NSCLC) have been reported in case reports and case series with a small number of patients. We have experienced 6 cases of patients who had adrenalectomy (ADR) for a metastasis from NSCLC. The median survival time (MST) after ADR was 24 months, and there was only 1 case of 3-year survivor. To elucidate the surgical indication and the prognostic factors of patients with a solitary adrenal metastasis from NSCLC, we analyzed 104 patients including our 6 patients who had ADR for a metastasis from NSCLC. The MST after ADR and 5-year survival were 24 months and 31%, respectively. Univariate and multivariate analysis demonstrated that lymph node metastasis at the surgery for primary lung cancer was the only significant and independent predictor of poor survival in patients after ADR. The results suggest that aggressive surgical treatment of a solitary adrenal metastasis from NSCLC may be effective when a patient have N0 disease.

Portal venous tumor thrombus associated with hepatic metastasis of renal cell carcinoma: case report

We report a case of liver metastasis of renal cell carcinoma with portal venous tumor thrombus. Abdominal computed tomographic images showed a large hepatic mass that enhanced slightly during arterial phase. Multiple hypoattenuating lesions were seen in the intrahepatic portal venous branches and were traced directly from the mass. The histologic specimen confirmed metastatic liver tumor of renal cell carcinoma with portal venous tumor thrombus.

Mapping of QTL associated with chilling tolerance during reproductive growth in soybean

Low temperatures in summer bring about drastic reduction in seed yield of soybean [Glycine max (L.) Merr.]. To identify quantitative trait loci (QTL) associated with chilling tolerance during the reproductive growth in soybean, a recombinant inbred line (RIL) population consisting of 104 F(6)-derived lines was created from a cross between two cultivars, chilling-tolerant Hayahikari and chilling-sensitive Toyomusume. The RIL were genotyped with 181 molecular and phenotypic markers and were scored with regard to chilling tolerance, which was evaluated by comparison of seed-yielding abilities in two artificial climatic environments at chilling and usual temperatures. Three QTL were detected for chilling tolerance in seed-yielding ability. Two of them, qCTTSW 1 and qCTTSW 2, were mapped near QTL for flowering time, and the latter had an epistatic interaction with a marker locus located near another QTL for flowering time, where no significant QTL for chilling tolerance was detected. The analysis of an F(2) population derived from the cross between Hayahikari and an RIL of the Hayahikari genotype at all QTL for flowering time confirmed the effect of the third QTL, qCTTSW 3, on chilling tolerance and suggested that qCTTSW 1 was basically independent of the QTL for flowering time. The findings and QTL found in this study may provide useful information for marker-assisted selection (MAS) and further genetic studies on soybean chilling tolerance.

High resolution emission Fourier transform infrared spectra of the 4p-5s and 5p-6s bands of ArH

In the 2500-8500 cm(-1) region several strong emission bands of (40)ArH were observed by Fourier transform spectroscopy through a dc glow discharge in a mixture of argon and hydrogen. Rotational-electronic transitions of the two previously unstudied 4p-5s and 5p-6s,v = 0-0, bands of (40)ArH were measured and assigned in the 6060 and 3770 cm(-1) regions, respectively. A simultaneous fit of the emission transitions of the 4p-5s and 5p-6s bands and an extended set of transitions of the 6s-4p band observed by Dabrowski, Tokaryk, and Watson [J. Mol. Spectrosc. 189, 95 (1998)] and remeasured in the present work yielded consistent values of the spectroscopic parameters of the electronic states under investigation. In the branch of the 4p-5s band with transitions of type (Q)Q(f(3)e) we observed a narrowing in the linewidths with increasing rotational quantum number N. The rotational dependence of the linewidth is caused by predissociation of the 5s state by the repulsive ground 4s state through homogeneous coupling and changes in overlap integrals of the vibrational wave functions with the rotational level. Analysis was based on the Fermi's golden rule approximation model. In the 4p-5s band region a vibrational sequence ofv(')-v(")=1-1, 2-2, and 3-3 were recorded and a number of transitions belonging to the strongest (Q)Q(f(3)e) form branch of the 1-1 band were analyzed.

Treatment for intracranial cerebral artery stenosis

SUMMARY

Symptomatic intracranial cerebral artery stenosis is largely resistant to drug treatment. Regardless of their locations, lesions may cause cerebral infarction with a frequency of 7-10% in a year, but the natural history of asymptomatic intracranial cerebral artery stenosis remains unclear. Revascularization is indicated for symptomatic lesions which show resistance to drug treatment, while bypass surgery is the accepted therapeutic indication for haemodynamic ischemia. Endovascular treatment is effective in haemodynamic ischemia, and is also expected to be effective against embolic symptoms. Bypass surgery for anterior circulation cases is safe because of its low incidence of complications, whereas bypass surgery for posterior circulation cases is technically difficult and has a high associated complication rate. Hence, endovascular treatment is currently favored for posterior circulation cases, and has also been introduced for anterior circulation cases. Endovascular treatment has become a widespread modality for intracranial cerebral artery stenosis, but there are many unsolved problems associated with complications, technology and devices. Therefore, in practice, endovascular treatment should be used only with a strict indication, and should be performed only after considerable thought and with appropriate informed consent.