Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND

The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.

METHODS

A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.

RESULTS

The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.

CONCLUSION

Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.

A case of pericecal hernia with a hernial orifice located on the lateral side of the cecum

The patient was a female in her 70s without previous laparotomy who visited our hospital for right lower abdominal pain. Marked small intestinal gas was noted on plain abdominal X-ray radiography. The patient was diagnosed with ileus and admitted. On contrast imaging through an ileus tube inserted for decompression, the small intestine was obstructed in the right lower abdominal region, and emergency laparotomy was performed. A hernial orifice was present on the lateral side of the cecum, and the small intestine was partially incarcerated, based on which a pericecal hernia was diagnosed. Since no circulatory disorder was noted in the incarcerated intestine, only reduction was performed without enterectomy. The hernial orifice was left open, considering that there was no possibility of re-incarceration. The postoperative course was favorable, and the patient was discharged on the 7th hospital day. Since this was a rare pericecal hernia case of internal hernia, we searched for and reviewed cases reported in Japan. This was a very rare case with a hernial orifice located on the lateral side of the cecum, not included in the current classification of pericecal hernia.

Characterization of nanoscale mechanical heterogeneity in a metallic glass by dynamic force microscopy

We report nanoscale mechanical heterogeneity of a metallic glass characterized by dynamic force microscopy. Apparent energy dissipation with a variation of ~12%, originating from nonuniform distribution of local viscoelasticity, was observed. The correlation length of the heterogeneity was measured to be ~2.5 nm, consistent with the dimension of shear transformation zones for plastic flow. This study provides the first experimental evidence on the nanoscale viscoelastic heterogeneity in metallic glasses and may fill the gap between atomic models and macroscopic glass properties.

[Recent advances in endoscopic resection for esophageal cancer]

The indications for endoscopic resection (ER) in esophageal cancer are limited to cases without lymph node metastasis because it is a local therapy. The relationship between cancer depth and lymph node metastasis has been clarified according to the pathologic analysis of lymph nodes removed during esophagectomy for early esophageal cancer. Cancer invasion remaining in the lamina propria mucosa rarely metastasizes to the lymph nodes, and ER is thus indicated. ER allows the esophagus to be preserved and is less invasive, enabling the specimen to be examined pathologically. Lesions extending to a large area can be resected by repeated endoscopic mucosal resection (EMR), but have recently been resected en bloc in the endoscopic submucosal dissection (ESD) procedure, which is also indicated for the treatment of gastric cancer. The selection of EMR or ESD depends on the size of the lesion, the technique of the surgeon, the time the patient can safely spend under anesthesia, and economic management. ER is now employed in T1a-MM, SM1 cases without lymph node metastasis, although some require additional treatment including surgery after pathologic examination of the resected lesions.

Cloning and expression of cDNA for salmon growth hormone in Escherichia coli

cDNA clones encoding chum salmon (Oncorhynchus keta) growth hormone (sGH) have been isolated from a cDNA library prepared from chum salmon pituitary gland poly(A)(+) RNA. Synthetic oligodeoxynucleotide mixtures based on amino acid residues 23-28 of sGH were used as hybridization probes to select recombinant plasmids carrying the sGH coding sequence. The complete nucleotide sequence of sGH cDNA has been determined. The cDNA sequence codes for a polypeptide of 210 amino acids, including a putative signal sequence of 22 amino acids. The 5' and 3' untranslated regions of the message were 64 and 426 bases long, respectively. Mature sGH was efficiently expressed in Escherichia coli carrying a plasmid in which the sGH cDNA was under control of the E. coli trp promoter; sGH comprised about 15% of the total cellular protein in such bacteria. The partially purified sGH from E. coli stimulated the growth of rainbow trout and the activity was indistinguishable from that of natural sGH.

Polyassembly formation of complementary half-sliding oligo-DNAs and atomic force microscopic observation

Oligonucleotides, especially oligo-DNAs, are useful building blocks for construction nanometer scale ordered architectures. Many researchers have been carried out to construct nano-architectures using complementary hydrogen bonding of DNAs. However, in order to achieve rational and robust design of various functional nano-architectures using DNAs, it is extremely important to establish basic principles of assembly patterns of oligo-DNAs based on their complementarity. In this study, to obtain basic information of polyassembly for simple oligo-DNA systems, formation of multiple assemblies of complementary half-sliding oligo-DNAs (cHSOs) was investigated with varying the length and sequence (GC content). A pairs of cHSOs were mixed in combination of complementary each other, and then the formation of high-molecular-weight polyassembly was evaluated by polyacrylamide gel electrophoresis (PAGE) and size exclusion chromatography (SEC). Moreover, the morphology and shape of the polyassembly was investigated by atomic force microscope (AFM) observation on mica. The obtained polyassembly displayed linear and networked morphology, and the continuous length and patterns of the assembly was depend on the length, GC contents and the concentration of the cHSOs.

Intra-operative natural sound decreases salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia

BACKGROUND

The perioperative period is psychologically as well as physically stressful for patients. Although music and sound are known to reduce patients' psychological stress, a few previous studies showed an objective outcome of music. The aim of the present study was to evaluate the relaxing effect of music during epidural anesthesia, using patients' salivary amylase activity.

METHODS

Thirty-two American Society of Anesthesiologists (ASA) I or II patients presenting for inguinal hernia repair under epidural anesthesia were randomly assigned to listen to sounds of a soft wind and a twitter (S group) or to have no sounds (N group). Patients' salivary amylase activity was evaluated on arrival to the operating room and at wound closure.

RESULTS

Intra-operative music significantly decreased salivary amylase activity at wound closure in the S group and the activity at wound closure of the S group was significantly smaller than that of the N group.

CONCLUSION

Intra-operative natural sound significantly decreased salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.