PURPOSE: Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. MATERIALS AND METHODS: Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. RESULTS: Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). CONCLUSION: TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.
Asian Continental Ancestry Group ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Emergencies ; Humans ; Propensity Score ; Retrospective Studies

No abstract available.
Heart ; Korea ; Thoracic Surgery

Prostate stem cell antigen (PSCA) is a glycosylphosphatidylinositol-anchored cell surface antigen with an organ-dependent expression pattern in cancers; e.g., up-regulated in prostate cancer and down-regulated in gastric cancer. Previously it was reported that PSCA is not expressed in the normal pancreas but aberrantly expressed in pancreatic cancer. In this present study, we identified PSCA expression in islets of the pancreas by immunohistochemistry, which was co-localized with four islet-cell markers: insulin, glucagon, somatostatin and pancreatic polypeptide. In our investigation of the transcription start site of PSCA, we found a non-coding splicing variant of PSCA as well as authentic PSCA transcripts in mRNA samples from a normal pancreas. Both the transcripts were also identified in several pancreatic cancer cell lines. We previously reported that PSCA expression is correlated to the methylation status of the enhancer region in gastric and gallbladder cancer cell lines but not in pancreatic cancer cell lines, suggesting that PSCA expression is regulated in a diff erent mode in pancreatic cancer from that in gastric and gallbladder cancers.
Antigens, Surface ; Cell Line ; Gallbladder Neoplasms ; Glucagon ; Immunohistochemistry ; Insulin ; Islets of Langerhans ; Methylation ; Pancreas ; Pancreatic Neoplasms ; Pancreatic Polypeptide ; Prostate ; Prostatic Neoplasms ; RNA, Messenger ; Somatostatin ; Stem Cells ; Stomach Neoplasms ; Transcription Initiation Site

Prosthetic and bioprosthetic materials currently in use lack growth potential and therefore must be repeatedly replaced in pediatric patients as they grow. Tissue engineering is a new discipline that offers the potential for creating replacement structures from autologous cells and biodegradable polymer scaffolds. In May 2000, we initiated clinical application of tissue-engineered vascular grafts seeded with cultured cells. However, cell culturing is time-consuming, and xenoserum must be used. To overcome these disadvantages, we began to use bone marrow cells, readily available on the day of surgery, as a cell source. Since September 2001, tissue-engineered grafts seeded with autologous bone marrow cells have been implanted in 44 patients. The patients or their parents were fully informed and had given consent to the procedure. A 3 to 10ml/kg specimen of bone marrow was aspirated with the patient under general anesthesia before the skin incision. The polymer tube serving as a scaffold for the cells was composed of a copolymer of lactide and ε-caprolactone (50: 50) which degrades by hydrolysis. Polyglycolic or poly-l-lactic acid woven fabric was used for reinforcement. Twenty-six tissue-engineered conduits and 19 tissue-engineered patches were used for the repair of congenital heart defects. The patients' ages ranged from 1 to 24 years (median 7.4 years). All patients underwent a catheterization study, CT scan, or both, for evaluation after the operation. There were 4 late deaths due to heart failure with or without multiple organ failure or brain bleeding in this series; these were unrelated to the tissue-engineered graft function. One patient required percutaneous balloon angioplasty for tubular graft-stenosis and 4 patients for the stenosis of the patch-shaped tissue engineered material. Two patients required re-do operation; one for recurrent pulmonary stenosis and another for a resulting R-L shunt after the lateral tunnel method. Kaplan-Meier analysis in relation to patients' survival was 95% within 3 years. There was only 1 patient (who underwent a total cavo-pulmonary connection procedure) requiring re-intervention in the tubular graft group and the material-related event-free rate was 96% within 3 years. This tissueengineering approach may provide an important alternative to the use of prosthetic materials in the field of pediatric cardiovascular surgery. As it is living tissue, these vascular structures may have the potential for growth, repair, and remodeling. However, this approach is still in its infancy, further studies to resolve the problems presented, and longer follow-up in patients are necessary to confirm the durability of this approach.

We performed the Senning operation and pulmonary valvotomy in an 11-month-old baby with transposition of the great arteries (TGA) with an intact ventricular septum (IVS), and bicuspid pulmonary valvular stenosis associated with pulmonary hypertension (PH). Preoperative catheterization showed a pressure gradient (PG) between the left ventricle (LV) and main pulmonary artery (MPA) of 35mmHg, mean pulmonary artery pressure (MPAP) of 56mmHg, and pulmonary vascular resistance (PVR) of 11.2unit·m². The pure oxygen inhalation test showed a decrease in MPAP from 56 to 38mmHg, and a decrease in PVR from 11.2 to 5.5 unit·m². We could not perform lung biopsy to determine the surgical indications in terms of PH due to preoperative progressive congestive heart failure in this patient. Postoperative catheterization (28 days after the Senning operation) showed a decrease in PG between the LV and MPA to 8mmHg, and MPAP also decreased to 17mmHg. Two radical operations were possible in this patient. One was the arterial switch operation (ASO), and the other was the atrial switch operation, i. e. the Senning or the Mustard operation. We selected the Senning operation because there was the possibility that the new aortic valve might develop persistent stenosis and regurgitation after ASO and pulmonary valvotomy. The Senning operation may be an alternative in selected patients with TGA with IVS and pulmonary valvular stenosis.

We present a case in which nursing intervention could play a great role in improving the patients activity of daily living (ADL). A 81-years-old female with progressive Parkinsonian syndrome was admitted to our hospital with the chief complaint of dysphagia and weakness. As her dysphagia and weakness were very severe and drug treatment was totally in effective, tube feeding was begun. She was hardly expected to get out of the hospital. We tried to improve the ADL by helping her to conquer the difficulty in swallowing. First, oral hygiene and exercise of chewing were started to stimulate her to regain the will to eat. Second, we arranged her menu according to her ability of swallowing. The patient gradually had a desire for good, and her ADL was improved. Finally, she could eat gruel, and leave the hospital. Appetite is one of man's instinctive tendencies. We have learned that if patients got this kind of will, their ADL could be enhanced, and that nursing intervention could give the patients this will. We consider that nursing intervention is beneficial to patients with intractable neurological disease.

Ionescu-Shiley pericardial xenografts implanted in the mitral position between April 1980 and October 1984 were studied. In some cases the cusp was torn in a relatively early postoperative phase, thus requiring an emergency operation. Functional disorders, such as caused by the calcification of the cusp, advance at a relatively moderate pace, and the prognosis of a second operation in cases with valve dysfunction and a chronic course was favorable. The actuarial probability of freedom from reoperation was 88.5±8.7% at 5 years and 55.7±14.5% at 10 years. The structural deterioration of the pericardial valve increased about 5 years after replacement. This tendency was the same as in other bioprostheses. At 10 years the overall actuarial survival rate was 67.2±12.1%. Freedom at 10 years from thromboembolism was 84.6±9.8%. For cases whose the course is under observation at present, the strategy is to recommend an additional operation as far as possible, while continuously observing the function of the valve.

When we surgically treat cases for dissecting aortic aneurysm with an inheritable connective tissue disorder like Marfan's syndrome, we should choose the surgical procedure carefully, paying paticular attention to whether to extend the operation, because there is every possibility that the lesion might be progressive. A 41-year-old woman with Marfan's syndrome, type A chronic aortic dissection, rapidly dilating to 80mm in diameter, and with aortic valve regurgitation was operated on with a total aortic arch replacement and the modified Bentall procedure. In the procedure, the aortic root and valve were replaced with a composite graft with a prosthetic mechanical valve, and the coronary arteries were reconstructed by direct anastmosis. In this case, the infrarenal abdominal aorta had already dilated to 40mm in diameter. In many cases with Marfan's syndrome, it was reported that the lesion was progressive and the residual dissection or new aneurysm would usually dilate and eventually rupture postoperatively. Reoperation involve a high risk. With those factors in mind, we chose total aortic replacement, including the distal aortic arch, to where the dissection would not extend. The most important thing for patients with Marfan's syndrome is the development of new or reccurrent problems. We consider that the operation designed to dissect aortic aneurysm for those patients should be performed as extensively in the surgical field as possible.

We performed coronary artery bypass operation on 258 patients from July 1974 to February 1993, of whom 10 underwent a total of 11 reoperations. These 10 patients were not significantly different from the other patients with respect to gender, coronary risk factors and number of grafts used in the first operation, aside from older age and lower LVEF. The interval between the two operations was <1 year (early) or about 10 years (late) in most instances. The most common reasons for reoperation were graft failure from technical problems in early and time-related alterations in graft and progression of original disease in late cases. The outcome of reoperation was less than satisfactory, with 2 operative deaths, IABP required in 5, reoperation for bleeding needed in 3 and severe sternal wound infection of the patent vein graft postoperatively, of which atheromatous debris released from the atherosclerotic vein graft was strongly suspected to be the cause. The old vein graft should be immediately ligated at the beginning of CPB in cases with diffuse atherosclerotic vein graft in which more than several years have passed since initial operation. In reoperation, arterial graft is preferable, especially GEA graft can be used advantageously even with a left thoracotomy approach. Bypass reoperation for occlusion of LAD or Cx should be performed by a left thoracotomy approach.