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To investigate the phenomenon of remnant gastric motility and emptying after local resection.Fifteen dogs were divided into three groups: a control (CONT) group, a group that underwent local resection of the greater (GREAT) curvature, and a group that underwent resection of the lesser (LESS) curvature. We conducted a strain gauge force transducer study, a [(13)C]octanoic acid breath test ((13)C-OBT), and a mosapride citrate effect test. Based on these results, we worked out the receptive relaxation (RR), motility index (MI), and postprandial period (PP) in the postprandial state, and the frequency, duration, and MI of phase III in the fasted state. The half emptying time (T (1/2)) of (13)C-OBT was also calculated. The MI was compared according to the mosapride effect test results.Postprandial RR, antro-pyloro-duodenal coordination, and fasting contractions were maintained in all three groups. Receptive relaxation was significantly shorter in the LESS group than in the other groups. Motility index was significantly lower in both treatment groups than in the CONT group. The PP was significantly longer in the GREAT group than in the other two groups. The (13)CO(2) excretion curves did not differ significantly among the groups. The duration of phase III was remarkably less in the treatment groups than in the CONT group, and MI was significantly lower in the LESS group than in the other groups in the fasted state. The MI increased remarkably after mosapride administration in the CONT group, showing no differences in other objective groups.Gastric function was maintained after gastric local resection, although its motility decreased.

The mechanisms of cellular cadmium uptake in mammalian cells remain obscure. To solve this problem, we established cadmium-resistant cells (A7 and B5) from metallothionein-null mouse cells, and found that cadmium accumulation was markedly suppressed in these cells. DNA microarray and real-time PCR analyses revealed that expressions of ZIP (Zrt-, Irt-related protein) 8 and ZIP14 were down-regulated in A7 and B5 cells. In particular, both mRNA and protein levels of ZIP8 were markedly suppressed in A7 and B5 cells. Introduction of short hairpin RNA (shRNA) of ZIP8 into parental cells reduced the accumulation of cadmium to about 35% of that of mock-transfected cells, whereas the introduction of shRNA of divalent metal transporter 1 hardly changed cadmium accumulation. Thus, the cadmium resistance in A7 and B5 cells may be conferred primarily by the down-regulation of ZIP8. In mouse tissues, high expression of ZIP8 was noted in the liver, kidney, lung and testis. These data suggest that ZIP8 plays an important role in cellular uptake of cadmium.

Endpolygalacturonase I from Stereum purpureum has been identified as a causative substance for the silver-leaf disease in apples. It possesses a unique pro-sequence in the C-terminal region that lacks endpolygalacturonases from any other origin. In this study, we analyzed and compared enzymatic characteristics between pro-form (pro-endoPG I) and mature form processed by V8 protease (endoPG I) and described the suppression activity of the pro-sequence. Of note, the optimal pH for pro-endoPG I activity shifted to pH 4.0 from pH 4.5-5.0 of endoPG I. The kinetic parameters indicated that the activity inhibition resulted from a pH-independent decrease of substrate affinity and pH-dependent deterioration of velocity by the pro-sequence. Analysis of site-directed mutations within pro-endoPG I showed that its α-helical structure includes two glutamates (E364 and E366) and alanine (A365), and its orientation by prolines (especially P348) in the pro-sequence played a significant role in its suppression activity. As for mutations in the mature domain, a marked reduction of suppression was observed for enzymes with mutations in H150, R220 and K253, indicating that the pro-sequence interacts with the active cleft by a few ionic bonds.

A 71-year-old man with a Helicobacter pylori infection-negative and API2-MALT1 translocation-negative extranodal marginal-zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type of the stomach has been followed conservatively for over 5 years. The lesion has shown no major morphological changes or malignant progression into a diffuse large-cell type during the time course. The absence of genetic translocation of API2-MALT1 was confirmed with fluorescence in situ hybridization (FISH). The prognosis of H. pylori-negative and API2-MALT1 translocation-negative low-grade MALT lymphoma is unknown, and a standard treatment for such lymphoma has yet to be defined. The case of MALT lymphoma negative for both of the above factors that we report has shown no obvious rapid progression or malignant change over the long-term course. Although curative operation and/or chemoradiotherapy should still be discussed as the treatment of choice, the treatment of this type of lymphoma must be carefully determined on a case-by-case basis, according to its biological status and prognosis.

The safety and effectiveness of laparoscopic treatment for incarcerated inguinal hernia have not been clarified. Six patients who underwent laparoscopic reduction and repair of incarcerated inguinal hernias were reviewed retrospectively. All operations were initiated within 1 h after establishment of the diagnosis. Laparoscopically, the incarcerated small-bowel segments could be easily returned to the abdominal cavity by a combination of pulling them with Babcock forceps while pushing back the bowels from outside the abdominal wall. The hernial portals were not cut in three patients, while they were dissected in the other three. All incarcerated bowels were congested and red immediately after reduction; however, their color returned to normal during hernia repair and unnecessary bowel resection was therefore avoided. The mean operation time was 88 min. Although one patient underwent laparotomy because of the suspicion of necrosis of the incarcerated inguinal hernia, which was finally found to be due to postoperative paralytic ileus, the postoperative courses of the remaining five were uneventful. Laparoscopic reduction and repair of incarcerated inguinal hernia was useful, and unnecessary bowel resection could be avoided.

Colorectal mucinous carcinomas are considered to have a worse prognosis than typical adenocarcinomas. To evaluate the prognostic relevance of a series of clinical and pathological variables, patients with colorectal mucinous carcinomas were studied retrospectively.Ninety-eight patients who underwent surgery for colorectal mucinous carcinomas were included in this study. We firstly examined whether signet-ring cell carcinomas exhibited worse prognosis than the other mucinous carcinomas. Prognostic factors were then analyzed by both univariate and multivariate analysis for 70 patients who underwent complete resection.The overall five-year survival rate was 44%. Amount of signet-ring cells was a non-significant indicator of poor prognosis. For the cases whose cancers were completely resected, four parameters (liver metastasis, lymph node involvement, vessel involvement, spread beyond the bowel wall) were significantly related to prognosis on univariate analysis. With the multivariate analysis, liver metastasis and spread beyond the bowel wall were independent variables.This study reaffirmed the importance of liver metastasis and spread beyond the bowel wall for prediction of prognosis with colorectal mucinous carcinomas for cases who undergo complete resection. In addition, the presence of signet-ring cells is a non-significant indicator of a poor prognosis.

Many of the reports on the diagnostic efficacy of the 13C-urea breath test (13C-UBT) for the detection of Helicobacter pylori in the residual stomach have shown negative results. We conducted an evaluation to establish a standardized protocol and an appropriate cutoff value for 13C-UBT in partial gastrectomy patients.Forty-two patients undergoing partial gastrectomy were included. Three gastric biopsies from the anastomotic site and mid-to-high body were taken at panendoscopy for histology, culture and rapid urease test (RUT). The 13C-UBT protocol included ingestion of 100 mg 13C-urea, use of mouthwash, and the body in a horizontal position on the left side. Six breath samples were taken after ingestion.The Delta 13CO2 values were significantly elevated in infected patients at all time points, and values were higher at 20 min and thereafter than at an earlier time point. The sensitivity of 13C-UBT was 96.3% with the cutoff of 2.0 per thousand at 40 min. The accuracy rates were highest with 13C-UBT, culture, RUT and histological tests, in that order.Forty minutes and a cutoff of 2.0 per thousand were found to be optimal for the test, with the body position horizontal on the left side. In the present protocol 13C-UBT appears to be a reliable tool with the same accuracy rate as other routine tests in patients with a remnant stomach.

e15088 Background: The neutrophil-lymphocyte ratio (NLR) is related to inflammatory status and/or cellular immunity status of patients with some cancers. We hypothesize that preoperative NLR is ass...

LIVING-related partial liver transplantation (LRLT) produced encouraging results, with a more than 80% 5-year patient survival rate despite the complicated and elaborate procedure in comparison with cadaveric whole organ transplantation. However, the incidence of biliary complications after LRLT has been reported to be 4.3% to 35%. Avoiding biliary complications is important because these often lead to other infectious sequelae. Dilatation of bile ducts in the grafts after LRLT has been reported in the literature. One of the causes of this complication is an inadvertent suture or tie in the donor operation or bench surgery. If the patency of the bile ducts to each liver segment is confirmed during the recipient operation, this kind of complication can be avoided. We present a simple and useful technique to examine the patency of the segmental bile duct branches in the liver grafts using a surgical probe and ultrasonography.

LIVING-related liver transplantation (LRLT) produced encouraging results with more than an 80% 5-year patient survival rate. However, further efforts are needed to pursue better results. An important goal in hepatic venous reconstruction in LRLT using the piggyback method is to prevent outflow obstruction. We are adopting two types of venoplasty for recipient hepatic veins. One is venoplasty to make the common trunk using the middle and left hepatic veins for larger recipients; the other is venoplasty to make the common trunk using the right, middle, and left hepatic veins for smaller recipients. We present our hepatic venoplasty methods in recipients and their results.

HEPATIC arterial thrombosis (HAT) is a major cause of patient morbidity and graft loss in liver transplantation. HAT should be diagnosed before the development of liver parenchymal or bile duct damage. Early diagnosis and treatment are essential to salvage grafts. Doppler ultrasound (US) is a useful tool to diagnose HAT. HAT is diagnosed when arterial flow signals are not detected in the graft. However, waveforms on Doppler US predicting or suggesting HAT are not fully understood. In this study, we investigated whether the waveforms on Doppler US can predict or suggest HAT.

A 58-year-old man was referred to us because of anal bleeding. Digital rectal examination revealed a 1.2 x 0.8 cm-sessile villous tumor located in the anal canal and lower rectum. Pruritus was lacking and there were no erythematous lesions or any skin lesion in the perianal region. Histologic examination of the excised lesion revealed the presence of an adenocarcinoma within a villous adenoma. The malignancy exhibited well, moderately and poorly differentiated areas with signet-ring cell elements. Because the carcinoma had massively invaded into the submucosa, additional abdominoperineal resection was performed. Microscopic examination of the obtained specimens showed incidental Paget's disease of the anal skin. Although perianal Paget's disease associated with rectal cancer is rare, cautious pathologic examination of the anal and perianal skin in cases with anorectal carcinoma is necessary, even if there are no suggestive clinical findings. If there is perianal Paget's disease, surgical resection with sufficient apparently normal skin and close follow-up are necessary.

A 51-year-old man with a traumatic diaphragmatic rupture is presented. Preoperatively, diaphragmatic rupture and herniation of the stomach into the left thoracic cavity were suspected. Under thoracoscopic guidance, the stomach and omentum were repositioned in the abdominal cavity using Babcock forceps, and then the rupture site was closed using an endoscopic hernia stapler. The postoperative course was uneventful and the patient was discharged from our hospital with no symptoms.

Since the application of laparoscopic cholecystectomy (Lap C) to gallbladder polyps has not yet been fully evaluated, we performed Lap C on 26 patients with gallbladder polyps. Pathological examinations showed adenocarcinoma in three patients, adenoma in two, and cholesterol polyp in 21. Preoperative diagnoses of the cases with adenocarcinoma were a cholesterol polyp in one patient and an adenoma in two. Adenocarcinoma was confirmed to reside in the mucosa without any invasion of lymphatic ducts or small vessels in the three patients. This procedure was considered to be sufficient for this grade of cancer, and, therefore, no additional operations were performed. At present, our policy is to resect by Lap C a gallbladder polyp having a maximum size larger than 10 mm and a tendency to grow or presenting with suspicion of adenoma. When cancer is suspected by preoperative examinations, however, traditional surgery may be recommended.

The outcome of the stomach-partitioning gastrojejunostomy (SPGJ) procedure is superior to that of stenting procedures.Data from patients who underwent an SPGJ were collected retrospectively from hospital medical records (body weight, hemoglobin and albumin levels, assessment of food intake, duration of hospitalization, complications, and survival rates), and we compared the results with those obtained from patients treated with stenting.Departments of Gastrointestinal Surgery and Gastroenterology, Tokyo University Hospital, Tokyo, Japan.A series of 16 consecutive patients with gastroduodenal outlet obstruction who underwent an SPGJ and 9 patients who were treated with stenting between January 5, 1998, and August 18, 2004.Mann-Whitney, Fisher exact, and generalized Wilcoxon tests were used for statistical analyses.There were no differences between the 2 groups concerning background data, physiological status, or laboratory data. The starting point of food intake by patients treated with stenting was significantly earlier (at 4.2 days in the stent group vs at 6.0 days in the SPGJ group, P.004). The numbers of patients taking a regular meal at 2 weeks after treatment were 12 of 16 patients in the SPGJ group and 1 of 9 patients in the stent group (P.001). There was no significant difference between the 2 groups regarding the duration of hospitalization. The complication rates were significantly different between the 2 groups (P = .48). The median survival was 7.3 months in the SPGJ group and 2.8 months in the stent group (P = .008), and the mean 6-month survival rates were 81% (13 of 16) and 33% (3 of 9), respectively (P.04).Stomach-partitioning gastrojejunostomy achieved improved quality of life and a better prognosis compared with stenting procedures, and it is the treatment of choice for gastroduodenal outlet obstruction.

14140 Background: We investigated the combination of docetaxel, 5-fluorouracil (5FU) and cisplatin analog, nedaplatin (CDGP) as second-line chemotherapy after esophagectomy. Methods: Eight patients with recurrent esophageal cancer who had undergone adjuvant 5FU/cisplatin after esophagectomy were included this study (7 male, 1 female; median ECOG performance status: 1). Histologic type of all esophageal cancer was squamous cell carcinoma. Patients received docetaxel 60 mg/m2 on day 1, 5FU 600 mg/m2 on days 1–5, and CDGP60 mg/m2 on day 4 every 3 weeks. A total of 17 chemotherapy cycles was administered. The median number of cycles was 2 (range 1–5). Results: The overall response rate was 62.5%. The median overall survival was 42 weeks, and the median progression-free survival was 26 weeks. Hematological and non-hematological toxicities were moderate (neutropenia WHO grade III/IV: 62.5%, alopecia grade II/III: 75%, nausea/vomiting grade II/III: 50%, neurotoxicity grade II: 12.5%). Conclusions: The combination of docetaxel, 5FU and CDGP is an active regimen with moderate toxicity in the treatment of patients with recurrent esophageal cancer. This pilot study suggests the feasibility of a combination treatment containing a taxan, 5FU and cisplatin or its analog in esophageal squmaous cell carcinoma. No significant financial relationships to disclose.