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Introduction We report a case of a 1.8-kg infant who had laparoscopic Toupet fundoplication (LTF) using the AirSeal Intelligent Flow System and Anchor Port (AP). Materials and Surgical Technique Our case had severe gastroesophageal reflux in association with genetic and cardiac anomalies. Despite the patient being continuously fed, persistent vomiting caused failure to thrive, and LTF was performed at 4 months of age when he weighed 1.8 kg. The AirSeal Intelligent Flow System is a novel laparoscopic CO2 insufflation system that improves the visual field by constantly evacuating smoke and providing a more stable pneumoperitoneum. The AP is a recently developed, stretchable, elastomeric, low-profile cannula. Three 5-mm AP were inserted: one subumbilically for the scope and one in both the right and left upper abdomen for the surgeon. A 5-mm AirSeal trocar was inserted in the left lower abdomen for the assistant. The gastrosplenic ligament was dissected free, and the intra-abdominal esophagus was prepared. A posterior hiatoplasty was performed, followed by the 270° fundoplication. During the fundoplication, the esophagus was fixed to the crus and then the right and left wraps were fixed to the esophagus. Pneumoperitoneum was maintained stably throughout the LTF procedure, with optimal operative field. Total operating time for LTF was 90 min. Body temperature dropped from 37.4°C to 35.7°C during pneumoperitoneum but resolved once pneumoperitoneum was ceased. Postoperative progress was uneventful, and an upper gastrointestinal study on postoperative day 2 showed no residual gastroesophageal reflux. Discussion We believe the AirSeal Intelligent Flow System and AP contributed to the successful completion of LTF in a 1.8-kg infant.

To elucidate whether gene alterations of topoisomerase I (topo I) exist in untreated non‐small cell lung carcinomas (NSCLC), polymerase chain reaction‐single strand conformation polymorphism analysis was performed in forty‐four NSCLC tissue samples. Gene alterations of topo I were sought in three regions, near codons 361 and 363, 533, and 722 and 729, where point mutations have been found in resistant tumor cell lines selected by chronic camptothecin exposure. In addition, nuclear topo I contents were determined by immunoblotting. No mobility shifts were observed compared to the pattern observed in a normal control at any of the three regions in any sample, whereas topo I levels showed an approximately 12‐fold variation. The variation is remarkably large compared to those seen in previous in vitro and in vivo studies. The results suggest that mutations of topo I may not contribute to intrinsic resistance of NSCLC to camptothecins, but low topo I levels may account, at least in part, for the resistance.

To determine the expression of multidrug resistance‐associated protein (MRP) gene and its role in gastric and colon cancers, we analyzed 10 gastric and 10 colon non‐drug‐selected cell lines and a similar number of tissue samples of these cancers. We compared the expression of MRP and mdr1 mRNA in cell lines and tissues using reverse‐transcriptase polymerase chain reaction. In mdr1‐negative cells, the relationship between the level of MRP gene expression and sensitivity to anticancer drugs was examined. The effect of verapamil, an MRP‐modulating agent, was also examined in these cells. The expression of MRP gene in gastric cancer cell lines varied from a low to a high level, but mdr1 was not detected in any of these cell lines. Colon cancer cell lines expressed low to intermediate levels of MRP gene, and half of the cells co‐expressed low to high levels of mdr1. In tissue samples, the expression pattern of the two multidrug resistance (MDR) genes was broadly similar to that described for the cell lines, except that most of the gastric cancer tissue samples did express low levels of mdr1. No significant correlation was observed between the level of MRP gene expression and sensitivity to anticancer drugs in gastric and colon cell lines. However, verapamil significantly increased the sensitivity to etoposide, doxorubicin and vincristine in cells highly expressing MRP gene. Our results indicate that MRP gene may be important in conferring MDR in gastric and colon cancer cells.