A case of Dieulafoy's vascular malformation of the jejunum treated by laparoscopic surgery is described. The patient was a 31-year-old-woman who had complained of melena and had severe anemia needing ...blood transfusion. Angiography revealed microaneurysms and hypervascularity of the jejunum in the area between the first and second jejunal arterial fields. Laparoscopic partial resection of the jejunum was performed. The resected specimen was histologically diagnosed as Dieulafoy's vascular malformation. Since the operation, the patient has been free of melena and anemia. Small-intestinal Dieulafoy's vascular malformation is rare, as only 41 cases have been reported during the past three decades. Almost two-thirds of the patients were under 40 years old. Most of the patients complained of melena. The lesion was preoperatively identified in 14 of the 41 patients, while angiography was useful to define the lesion. Thirty-six of 37 patients for whom treatment methods were reported were surgically treated. While there are various treatment methods for intestinal bleeding, a surgical operation is often needed. When the disease location is obvious, treatment with laparoscopic surgery can reliably produce good results, in terms of its rate of cure, minimal invasiveness, and better cosmetic effect.
The ERBB proteins are cell membrane tyrosine kinase receptors. Among these receptors, ERBB1 (EGFR or HER1) and ERBB2 (HER2/Neu) have been reported to be the most important in terms of the development ...and progression of squamous cell carcinoma of the esophagus (SCC). Thus, targeting of ERBB1 and ERBB2 may become a promising strategy to treat SCC. In the present study, we examined ERBB1 and ERBB2 expression of SCC cell lines (TT, TE2, TE6 and TE10) and tumor samples. In addition, we evaluated the effect of the anti-ERBB1 antibody cetuximab and the anti-ERBB2 antibody trastuzumab for SCC in vitro and in vivo. Biological activities (receptor downregulation, the phosphorylation of MAPK and AKT) induced by the two agents were also investigated. Immunohistochemistry of SCC samples showed that ERBB1 was detected in 84%, while ERBB2 was detected in 30%. RT-PCR analysis revealed that ERBB1 and ERBB2 mRNA were detectable in all four cell lines. MTT cell proliferation analysis showed that cetuximab, but not trastuzumab, inhibited growth in each of the SCC cell lines in a dose-dependent manner. Further, cetuximab and trastuzumab used together produced stronger inhibition of growth compared to cetuximab alone. Cetuximab downregulated ERBB1, but not ERBB2, at the TE6 cell surface. However, neither ERBB1 nor ERBB2 showed any downregulation by trastuzumab at the TE6 cell surface. Cetuximab, not but trastuzumab, inhibited the phosphorylation of MAPK and Akt. When administered in combination, the two agents inhibited Akt phosphorylation to a greater degree compared to treatment with cetuximab alone. In the in vivo study, cetuximab, but not trastuzumab, significantly inhibited the TT tumors. Additionally, the combination of cetuximab with trastuzumab induced a synergistic inhibitory antitumor effect in the TT tumors. In conclusion, combination of cetuximab and trastuzumab revealed a synergistic antitumor effect for SCC in vitro and in vivo. The antitumor effect may be induced by the inhibition of the phosphorylation of Akt. These findings suggest that combination therapy including cetuximab and trastuzumab may be a promising strategy to treat SCC.
A RECURRENT CASE OF PRIMARY SMALL INTESTINAL VOLVULUS YAMAZAKI, Masanao; NITTA, Atsunori; YAMADA, Shinobu ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2006, Letnik:
67, Številka:
7
Journal Article
Odprti dostop
An 83-year-old woman was seen at the hospital for sudden vomiting and a sense of abdominal discomfort. The patient was diagnosed with primary small intestinal volvulus when abdominal computed ...tomography (CT) demonstrated a “whirl sign” in the small intestine loops around the superior mesenteric artery (SMA). In emergency surgery, the jejunum and ileum were twisted 360° counterclockwise around the SMA, and the intestine caused ischemic change. The blood flow recovered quickly after detorsion, eliminating the need for intestine resection. But three months later, the patient was seen at the hospital for the same symptom again. We diagnosed primary small intestinal volvulus recurrence because abdominal CT demonstrated the “whirl sign”. Again, the jejunum and ileum twisted 360° counterclockwise around the SMA. The blood flow recovered quickly after detorsion, but we added bowel fixation to prevent a recurrence. There are a few reports of recurrence, but the necessity of small intestine fixation was suggested in cases of primary small intestinal volvulus.
We present a case of gastrointestinal stromal tumor (GIST) of the rectum. A 55-year-old man was admitted to the hospital because of a rectal tumor detected at a medical checkup in April 2003. Digital ...examination revealed an about 3-cm sized elastic-hard mass with a smooth surface, locating about 3cm oral from the anal verge. Colonoscopic examination showed a submucosal tumor encircling about 1/4 of the lumer in the lower rectum which had the smooth surface without ulcer. A transanal core needle biopsy was performed. HE staining showed a solid growth of spindle-shaped cells, and immunohistochemically the tumor cells were positive for CD34 but negative for SMA and S100. GIST was thus diagnosed. Considering that lymph node dissection was unnecessary and the anal function was able to be preserved, we performed a transsacral partial resection of the rectum. No local recurrence or distant metastasis has occurred, as of 20 months after the operation.
The effects on esophageal cancer of monoclonal antibody trastuzumab, directed against the HER2 protein, were evaluated in this study. Immunohistochemical study showed that 90% (45/50) of esophageal ...cancer specimens expressed HER2 protein, and flow cytometric analysis showed that 4 kinds of human esophageal cancer cells (TT, TE2, TE6, TE10) expressed high levels of HER2 protein. Trastuzumab treatment (100-500 ng/ml) was not able to inhibit the growth of the all kinds of cancer cells, but the combination treatment of trastuzumab and peripheral mononuclear cells resulted in antibody dependent cell-mediated cytotoxicity (ADCC) against the cancer cells TE6 and TE10 in a dose dependent manner. Intraperitoneal injection of trastuzumab at 1 mg/body twice a week for 5 weeks significantly inhibited the growth of mice-bearing xenografts of TE6 and TE10. Our results suggest that trastuzumab therapy is useful in the treatment of human esophageal cancer.
While self-expandable metallic stents (EMS) have been reported to be useful for palliation of unresectable esophagogastric malignancies, complications accompanying such stenting also have been ...pointed out. Both advantages and disadvantages of EMS stenting are discussed on the basis of 25 cases of esophageal cancer and 5 cases of gastric cancer treated in our institute. Although dysphagia improved in 26 of the 30 patients with stenosis, only 14 of the patients who had been able to ingest more than 1,200 kcal of food could be discharged to their homes. Complications were noted in 12 (48%) of the esophageal cancer patients and 4 (80%) of the gastric cancer patients, including incomplete sealing of esophagorespiratory fistula in 6, tumor ingrown in 3, mucosal hyperplasia in 2, stent migration in 2 and reflux of digestive juice in 1. The patients with complications took food for shorter periods than those who had no complications. Successful patient outcomes can be achieved by the prevention of complications accompanying stenting and mastering the techniques to overcome those complications described above.
The current status and future prospects of chemoradiation therapy (CRT) for esophageal cancer are reviewed herein. In Western countries, CRT is performed for every stage of esophageal cancer and it ...has been reported that in definitive CRT series the complete response rate is 30 to 50%, the mean survival rate more than twelve months, and the in 2-year survival rate about 30%, while in neoadjuvant CRT series the pathological response rate is 20 to 50%, the mean survival period more than twenty months, and the 3-year survival 30 to 40%. On the other hand, as esophageal cancer is treated mainly by surgery in Japan, CRT is applied in patients with tumors invading adjacent organs, and a high pathological complete response rate is reported in some neoadjuvant studies. Although both definitive and neoadjuvant CRT increases the response rate and improves local tumor control, CRT is associated with substantial mortality and morbidity, especially in neoadjuvant series. More effective and less toxic CRT regimens, using new chemotherapeutic agents such as nedaplatin and paclitaxel and new irradiation protocol such as accelerated hyperfractionation, are needed to improve the prognosis of patients with advanced esophageal cancer.
The microporous polyacrylonitrile (PAN) nonwoven separators have been developed by using electrospun nano-fibers with homogeneous diameter of 380 and 250
nm. The physical, electrochemical and thermal ...properties of the PAN nonwovens were characterized. The PAN nonwovens possessed homogeneous pore size distribution with similar pore size to the conventional microporous membrane separator. Moreover, the PAN nonwovens showed higher porosities, lower gurley values and better wettabilities than the conventional polyolefin microporous separator. Cells with the PAN nonwovens showed better cycle lives and higher rate capabilities than that of a cell with conventional one. Any internal short circuit was not observed for the cells with the PAN nonwovens during charge–discharge test. Hot oven tests for the charged cells up to 4.2
V have revealed that the PAN nonwoven was thermally stable at 120
°C, but showed shrinkage of about 26% isotropically after the test at 150
°C for 1
h. The Celgard membrane showed uniaxial shrinkage of about 30% along the machine direction at 150
°C for 1
h.
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