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A Japanese woman with familial adenomatous polyposis in whom a duodenal ampullary adenoma underwent malignant change during a 10-year follow-up period is reported. After restorative proctocolectomy in 1989, and extensive small bowel resection for desmoid disease in 1991, regular surveillance duodenoscopies, including three to nine biopsies (mean, 4.8) were performed annually or biannually. Until 1995, the endoscopic findings of duodenal polyposis (including an ampullary polyp) did not progress and the histopathology did not worsen. In 1996, there was an increase in the number and size of the duodenal polyps, and the ampulla of Vater looked enlarged. Open surgery was discussed but not proceeded with because of the risk for short bowel syndrome. In January 1998, she was admitted with a diagnosis of acute pancreatitis. Duodenoscopy and radiological examination revealed that an advanced ampullary cancer had developed, and histopathology revealed a well-differentiated adenocarcinoma. Multiple hepatic metastases and ascites led to her death, in June, 1998. This in-vivo demonstration of the adenoma-carcinoma sequence highlights current limitations in the surveillance and treatment of duodenal lesions. [ABSTRACT FROM AUTHOR]

Background: A multiseptate gallbladder is a very rare congenital malformation in which the lumen is divided into variously sized multiseptal compartments. The pathogenesis and natural history of this disease remain uncertain. We herein describe a pediatric case of a multiseptate gallbladder with pancreaticobiliary maljunction (PBM), which was treated by laparoscopic cholecystectomy., Case Presentation: A 5-year-old girl was referred to our hospital, because a multiseptate gallbladder had been incidentally detected on abdominal ultrasonography when she presented for transient abdominal pain. Ultrasonography showed hyperechoic septa throughout the lumen of the gallbladder, giving it a honeycomb appearance. The atrophied gallbladder had weak or no contractility. Magnetic resonance cholangiopancreatography performed to detect other coexisting biliary disorders revealed PBM without dilatation of the common bile duct. Although physical examination and laboratory tests revealed no abnormalities, we performed laparoscopic cholecystectomy to prevent cholecystitis and reduce the risk of cancer secondary to the PBM., Conclusions: In recent pediatric case reports, the indication and timing of cholecystectomy has tended to be determined by the patient's symptoms and the presence of biliary complications. In the present case, however, the combination of a multiseptate gallbladder and PBM may become problematic in the future. Surgical treatment without delay was appropriate even in this pediatric patient., (© 2022. The Author(s).)

Introduction: Gastric outlet obstruction is characterized by the retention of gastric contents. Removal of gastric contents is an important part of the treatment strategy. The use of a nasogastric tube alone can result in inadequate removal of gastric contents. We treated a patient with advanced gastric cancer and gastric outlet obstruction with pancrelipase to aid in the removal of gastric contents., Presentation of Case: The patient is an 81-year-old man with a Type 3 gastric cancer nearly circumferentially involving the antrum, resulting in gastric outlet obstruction. A nasogastric tube was placed for four days, but drainage of gastric contents was inadequate. Pancrelipase was then given orally for four days, and gastric contents were evacuated. The patient underwent distal gastrectomy with Roux-en-Y reconstruction and was discharged from the hospital on postoperative day 14., Discussion: This report suggests that pancrelipase may be beneficial in the treatment of patients with gastric outlet obstruction., Conclusion: Pancrelipase allowed gastric contents to be evacuated in a short period of time in a patient with gastric outlet obstruction., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Activated neutrophils and monocytes produce interleukin (IL)-8, a pro-inflammatory chemokine, but also IL-1 receptor antagonist (IL-1ra), which is an anti-inflammatory cytokine. We were interested to see the profiles of IL-8 and IL-1ra in the colonic tissue and in the peripheral blood leukocytes (PBL) during the development of immune complex induced colitis in rabbits. IL-1ra and IL-8 in PBL were measured in 26 rabbits at time 0 h, 24 h, and 48 h after induction of colitis. The colons were removed at 48 h for measuring myeloperoxidase (MPO), ulcer area, IL-1ra and IL-8. Epithelial damage, crypt abscess formation and leukocyte infiltration of the colonic tissue were major features of this colitis model. During the development of colitis, there was an increase in circulating neutrophils and monocytes (P<0.0001), but not lymphocytes. Likewise, elevated amounts of IL-1ra (P=0.0001) and IL-8 (P=0.0219) production by PBL were observed following induction of colitis. Flow cytometry revealed major source of IL-1ra was monocytes, while the main sources of IL-8 were neutrophils and monocytes. There was correlation between MPO and ulcer area (Rs=0.6327, P<0.0001). At 24 h, PBL from MPOHigh group (n=11) showed increased IL-1ra (P=0.027) and IL-8 (P=0.0128) levels vs MPOLow group (n=15). IL-8 production by PBL showed correlation with tissue MPO (Rs=0.4273, P=0.0295). The colitis in this model was associated with an increase in circulating monocytes and neutrophils, which released increased amounts of IL-8 and IL-1ra. Further, IL-8 and IL-1ra showed correlation with the severity of colitis. These observations should significantly further understandings on the role of neutrophils and monocytes in the immunopathogenesis of ulcerative colitis., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: The endoscopic resection of early gastric cancers (EGC) is a standard technique in Japan and is increasingly used throughout the world. Further experience in the treatment of EGC and a clearer delineation of the factors related to lymph-node metastasis would permit a more accurate assessment of endoscopic resection., Methods: The study group comprised 1,389 patients with EGC who underwent gastrectomy with lymph-node dissection. We evaluated the relations of lymph-node metastasis to clinicopathological factors., Results: Of the 718 patients with intramucosal carcinomas, 14 (1.9%) had lymph-node metastasis. All cases of lymph-node metastasis were associated with ulceration. No lymph-node metastasis was found in patients with intramucosal carcinomas without ulceration, irrespective of tumor size and histological type. Lymph-node metastasis was present in 14 (4.7%) of the 296 patients who had cancer with a submucosal invasion depth of less than 500 microm (sm1). Significantly increased rates of lymph-node metastasis were associated with undifferentiated types, ulcerated lesions and lymphatic invasion. No lymph-node metastasis was found in patients with differentiated sm1 carcinomas 30 mm or less in diameter without ulceration. Lymph-node metastasis occurred in 29% of the patients who had cancer with a submucosal invasion depth of 500 microm or more (sm2)., Conclusion: This large series of patients with EGC provides further evidence supporting the expansion of indications for endoscopic treatment, as well as warns against potential risks.

Assessment of spleen size using the ultrasonography has become a standard practice in human. However, the assessment is not established method in experimental animals. To establish the index to assess the spleen size using ultrasonography, we measured the cross-section image of rabbit spleen during endotoxin shock. The image of the cross-section was appeared as triangle, and the height of the triangular image was defined as the spleen index. This spleen index showed strong correlation with the spleen weight. In conclusion, this method is suitable for observation of changes in rabbit spleen size and may reduce the number of rabbit in the longitudinal studies.

Intraoperative Tumor site recognition is extremely difficult during laparoscopic surgical treatment of early-stage gastrointestinal carcinoma. A novel marking method that uses both metallic clips and a marking clip detector system (MCDS, Olympus Optical Co., Tokyo, Japan) modified from a metal detector system, was designed by the authors. Metallic clips were applied to the tumor site during preoperative endoscopy, and the clip site was identified intraoperatively using the MCDS. In a basic ex vivo study, three metallic clips were detected easily (100% detection). In a clinical study, the marking site was detected in all gastric cancer patients who underwent laparoscopic subtotal gastrectomy. The mean distance between detected site and clip along the longitudinal bowel axis was 6.4 +/- 2.9 mm. Mean detection time was 18.1 +/- 5.7 seconds. None of the patients in this study experienced complications from this marking technique. MCDS allows accurate identification of tumor sites. This method may be useful for tumor-site identification during laparoscopic gastrectomy.

Granulocyte and monocyte adsorptive apheresis (GMA) using a column filled with cellulose acetate (CA) beads (carriers) has been associated with a significant clinical efficacy in patients with rheumatoid arthritis and ulcerative colitis. To obtain further understanding on the mechanisms of disease modification by cellulose acetate-carrier-based GMA, in the present study, we investigated the mechanisms of granulocyte and monocyte adhesion to CA beads following exposure of human peripheral blood to the carriers at 37 degrees C for up to 60 min under controlled conditions. Cellulose acetate beads selectively adsorbed granulocytes, monocytes. CD19+ (B cells) and CD56+ (NK cells) lymphocyte subpopulations. The granulocyte and monocyte adsorption was inhibited by heat-inactivated plasma and EDTA, indicating that the adsorption was plasma protein (immunoglobulin, complement) and calcium dependent. Accordingly, granulocyte and monocyte adsorption was markedly enhanced by coating the carriers with IgG. Similarly, C3b was adsorbed onto the CA beads as a marker of complement activation. The results indicated that IgG and active complement fragments mediated leukocyte adhesion to CA beads via the FcgammaR and/or leukocyte complement receptor like CR3. Additionally, CA beads induced loss of expression of TNF receptors on CD16- granulocytes and CD14+ monocytes, but not on CD3+ lymphocytes In conclusion, CA beads might be an appropriate biomaterial for inducing extracorporeal immunomodulation as a treatment for auto-immune diseases which are associated with pathological leukocyte activity.

Background: Recurrent small bowel obstruction caused by postoperative adhesions has traditionally been treated by conventional laparotomy, but laparoscopic management of acute small bowel obstruction has been reported. The aim of this study was to assess the long-term efficacy and clinical outcome of laparoscopic adhesiolysis for recurrent small bowel obstruction., Methods: After conservative treatment, elective laparoscopic treatment was attempted in 17 patients hospitalized for recurrent small bowel obstruction after abdominal or pelvic surgery., Results: Postoperative adhesions were identified laparoscopically in all patients. Laparoscopic treatment was possible in 14 patients (82.4%). Conversion to laparotomy was required for 3 patients (17.6%) because of intestinal perforation (n = 1) or a convoluted mass of adherent bowel (n = 2). Long-term follow-up was possible in 16 patients. Two recurrences of small bowel obstructions were noted over a mean follow-up period of 61.7 months., Conclusions: Laparoscopic adhesiolysis is a safe and effective treatment for recurrent small bowel obstruction. Conversion to laparotomy should be considered in patients with dense adhesions.

The results of surgical treatment for advanced esophageal cancer remain extremely poor. Irradiation and chemotherapy are not superior to surgery. Perioperative morbidity and the influence on long-term survival of a combination of surgery and preoperative chemotherapy were investigated in patients with advanced esophageal cancer. Forty-nine patients with advanced esophageal squamous cell carcinoma were subjected to preoperative chemotherapy of cisplatin-5-fluorouracil. Fifty-seven patients were chosen as a historical control group who had not undergone chemotherapy before surgery but had the same histological stages as the chemotherapy group. The response to chemotherapy was assessed by histological studies of surgical specimens. The survival rates noted no significant difference between preoperative chemotherapy plus surgery and a resection alone. However, subclassification according to the grading of chemotherapeutic effectiveness showed that, compared with control, preoperative chemotherapy was beneficial to high responders (P = 0.01), ineffective in low responders (P = 0.61), and detrimental to nonresponders (P = 0.03). Postoperative morbidity was significantly higher in the chemotherapy group than in the control group (P = 0.02). These findings suggest that preoperative chemotherapy is necessary only for high responders and we therefore need to reliably identify non-, low, and high responders before chemotherapy to improve the survival and quality of life of patients with advanced esophageal cancer.

The effects of recombinant insulin-like growth factor I (rIGF-I) on wound healing were tested using senescent and young BDF-1 mice, aged 108 weeks and 10 weeks, respectively. After inflicting a full thickness dermal burn encompassing 15% of the body surface, a skin incision, 2 cm in length, was made in the back. A silicone tube containing a piece of polyvinyl sponge was then implanted into a subcutaneous pocket in the flank to collect body fluid. An osmotic pump was buried in the abdominal subcutaneous tissue for the continuous infusion of rIGF-I, the control being treated with the solvent of IGF-I, physiological saline, only. The administration of IGF-I produced favorable effects on wound healing in the senescent mice, shown by enhanced tensile strength and an elevated concentration in the hydroxyproline of the polyvinyl sponge content. The IGF-I-treated severely wounded senescent mice healed better than their counterparts and their skeletal muscles contained more glutamine. Furthermore, they showed more enhanced cutaneous hypersensitivity towards dinitrofluorobenzene than the controls, suggesting an enhanced grade of cellular immunity. There were no conspicuous differences between the two groups of young mice. These data may suggest the beneficial effects of rIGF-I on wound healing, especially in geriatric surgery.

Background: After radical ablation of tumors, colon or jejunum is pulled up for reconstruction of the thoracic esophagus when stomach is unusable. However, esophagocolonic or esophagojejunal anastomotic leak is relatively frequent because of the potential for vascular insufficiency of conduit extended upward., Methods: To overcome this disadvantage, 14 consecutive patients with esophageal or gastric carcinomas whose stomachs were unusable were subjected to thoracoesophageal reconstruction through upward extension of the jejunum with microvascular anastomosis. Jejunal vessels were used as graft vessels, and internal thoracic vessels were used as recipient vessels. If needed, arcade vessels were severed to ease extension., Results: All extended jejunums survived, and there were no operative deaths. Two of four initial series of patients, whose arcade vessels were not severed despite undue tension at the anastomotic site, had esophagojejunal anastomotic leaks that healed spontaneously., Conclusions: Some clinical functional problems still exist, but we believe this a safe and useful method for reconstruction of the esophagus where stomach cannot be used.

Receptors for peanut agglutinin (PNA) were isolated from Lewis lung carcinoma cells (3LL) by detergent solubilization and affinity chromatography on PNA-agarose. The isolated receptors showed heterogeneous yet distinct molecular species when they were analyzed by SDS gel electrophoresis. In vivo inoculation of the isolated receptors could induce potent cytotoxic effector cells against 3LL cells, which were detected by Winn's tumor neutralization assay. The PNA receptors were also effective in preventing the settlement of the intravenously injected 3LL tumors in the lung. These findings suggest that PNA receptors can be used for immunological therapy of certain cancers.

Eleven incubations of minced human fetal adrenal tissue from two fetuses at midtrimester of pregnancy terminated for socio-economic reasons, were performed for different periods of time with labelled pregnenolone, progesterone, 17alpha-hydroxyprogesterone and deoxycorticosterone (DOC). The order of magnitudes of enzyme activity when progesterone was used as a substrate and incubated with midterm fetal adrenals was 17alpha-hydroxylase, 21-hydroxylase and 16alpha-hydroxylase. The activity of 3beta-hydroxysteroid dehydrogenase and delta5-4 isomerase was almost negligible as compared to other enzymic activities as mentioned above. Similar biosynthetic pathways for adrenal corticoids formation were observed in human fetal adrenals as reported in human adults and animals; once progesterone was converted into DOC, further 17alpha-hydroxylation did not take place.

The 16 alpha-hydroxylase system in fetal liver which used dehydroepiandrosterone (DHA) or pregnenolone as substrate, was apparently inhibited by various endogenous and synthetic steriods: DHA, pregnenolone, their sulfates, androstenediol, androstenetriol, estrone, estradiol-17 beta, ethynylestradiol and chlormadinone-acetate. The inhibition constants (Ki) towards DHA were as follows; pregnenolone 22 muM, DHA-sulfate 13 muM, pregnenolone-sulfate 21 muM, androstenediol 16 muM, androstenetriol 53 muM estrone 32 muM, estradiol-17 beta 74 muM, ethynylestradiol 22 muM and chlormadinone-acetate 27 muM. The Ki values towards pregnenolone were DHA 6.3 muM, DHA-sulfate 8.3 muM, pregnenolone-sulfate 3.9 muM, androstenediol 8.7 muM, androstenetriol 14.7 muM, estradiol-17 beta 15.4 muM and ethynylestradiol 16.0 muM, respectively. The reaction products, 16 alpha OH-DHA and 16 alpha OH-pregnenolone, showed little inhibitory effect upon the 16 alpha-hydroxylase.

A radioimmunoassay for plasma 16alpha-hydroxypregnenolone has been developed using anti-16alpha-hydroxypregnenolone antiserum produced in rabbits immunized with 16 alpha-hydroxypregnenolone-3-succinate-bovine serum albumin. Radioimmunoassay data were processed and analysed for its validity using a four parameter logistic curve fitting routine with use of the IBM call system. The assay system was satisfactory for a routine use. The 16alpha-hydroxypregnenolone concentrations in the umbilical cord blood at term ranged from 223 to 324 ng/ml. Gas liquid chromatographic analysis revealed a similar result, and also the presence of this steroid in the adrenal gland of the human fetus at midtrimester was confirmed. It is speculated that this steroid is secreted from fetal adrenals.

Inhibitory effects of naturally occurring steroids on 21-hydroxylase activity were determined by measuring the initial conversion rate of 17-hydroxyprogesterone (17alpha-hydroxy-4-pregnene-3, 20-dione) to 11-deoxycortisol (17alpha, 21-dihydroxy-4-pregnene-3, 20-dione) in incubation experiments with the microsomal fraction (10,000--105,000 X g percipitate) of the human fetal adrenal gland. The apparent Michaelis constant (Km) for conversion of 17-hydroxyprogesterone was 13.3 X 10(-6)M. Human fetal adrenal 21-hydroxylase was inhibited by some of the steroids produced in the feto-placental unit. The following steroids acted as competitive inhibitors of the reaction; progesterone (Ki = 20.0 X 10(-6)M), 11-deoxycortisol (Ki = 87.5 X 10(-6)M) and estradiol-17beta (Ki = 87.5 X 10(-6)M). The most potent inhibitor among the estrogens was estradiol-17beta.