A new retractor system for thoracoscopic thymectomy using the anterior chest wall-lifting method.
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Cadaver↗
Biomedical subjects
G Watanabe
Publications and source records attributed to G Watanabe.
Ringed silicon rubber attachment prevents laparoscopic surgeon's thumb.
BACKGROUND: This investigation, using the nerve conduction study, aimed to quantify the degree of laparoscopic surgeon's thumb, and to evaluate the effect of the ringed silicon rubber attachment (RSRA) developed by the authors. METHODS: For the study, 26 residents or students performed surgical tasks (grasping and dissecting) using both the laparoscopic forceps with RSRA and the conventional instrument. The paresthesia was evaluated with a severity score obtained by interview and measurement of sensory nerve conduction velocity (SCV). RESULTS: The mean severity score was 2.57 +/- 0.58 m/s for the conventional forceps and 1.05 +/- 0.80 m/s for the forceps with RSRA (p < 0.01). For the grasping task with the conventional forceps, the mean SCV was 58.3 +/- 2.81 m/s before and 54.8 +/- 2.83 m/s after the task (p < 0.01), whereas for the dissecting task, the corresponding values were 57.5 +/- 2.46 m/s and 56.1 +/- 2.93 m/s (p < 0.01). For the grasping task with the RSRA, the mean SCV was 57.1 +/- 3.33 m/s before and 55.9 +/- 3.18 m/s after the task (p < 0.01), whereas for the dissecting task, the corresponding values were 55.7 +/- 4.59 m/s and 55.8 +/- 3.50 m/s (nonsignificant difference). CONCLUSIONS: Laparoscopic surgeon's thumb was induced by compression of the lateral digital nerve. The RSRA significantly reduced the degree of paresthesia.
Adult↗
Closed three-port anatomic lobectomy with systematic nodal dissection for lung cancer.
Closed three-port anatomic lobectomy of the lung with systematic nodal dissection was performed in 5 patients with clinical stage IA lung cancer. For removal of the resected specimen, a new technique was developed to avoid making an additional skin incision. No complications or deaths occurred after the operation, and all patients were alive longer than 27 months without recurrence, including 5-year survivors.
Adenocarcinoma↗
Significance of nerve growth factor overexpression and its autocrine loop in oesophageal squamous cell carcinoma.
Nerve growth factor (NGF) is overexpressed not only in nervous system, but also in several types of cancers. However, the role of NGF in oesophageal squamous cell carcinoma (OESCC) remains unclear. Here, we show the first evidence of NGF-TrkA autocrine loop and clinical significance of NGF overexpression in OESCC. Immunohistochemical study of 109 OESCC specimens revealed that NGF overexpression, found in 63 out of 109 patients (57.8%), was associated with lymph node metastasis, distant metastasis, higher TNM stage, poorer tumour differentiation, and poorer survival. NGF overexpression was also associated with strong expression of TrkA and negative expression of low-affinity neurotrophin receptor (p75NTR). Semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) of 19 surgical specimens showed upregulation of NGF mRNA in 17 out of 19 (89%) patients. All five OESCC cell lines tested in vitro secreted detectable NGF in enzyme-linked immunosorbent assay, and expressed TrkA and p75NTR on RT-PCR and Western blot. The motility of HSA/c, one of the OESCC cell lines overexpressing NGF, was significantly decreased by either neutralising anti-NGF antibody, an inhibitor of TrkA, or NGF-small interfering RNA in transwell migration assay. Our findings suggest that NGF is of potential interest not only as a prognostic factor, but also as a novel therapeutic target in OESCC.
Adult↗
DNA hypermethylation in the normal colonic mucosa of patients with colorectal cancer.
The CpG-island methylator phenotype (CIMP+) in colorectal cancer (CRC) is characterised by frequent hypermethylation of promoter regions in tumour suppressor genes. Low level methylation of some CpG islands is also seen in the normal colonic mucosa and increases with age; however, it is still unclear what other factors regulate this phenomenon. The first aim of our study was to determine whether the level of promoter methylation is elevated in the normal colonic mucosa of patients with CIMP+ tumours. The second aim was to investigate whether common, functional polymorphisms in genes involved in methyl group metabolism are associated with the level of methylation in this tissue. CpG islands within the ERalpha, MYOD, P16(INK4A), MLH1, APC, P14(ARF), DAPK and TIMP3 genes were quantitatively evaluated for methylation in normal colonic mucosa from a large series of CRC patients using the MethyLight assay. Genotyping was carried out for polymorphisms in the MTHFR, TS, MS, MTHFD1 and DNMT3b genes. Methylation of ERalpha and MYOD in normal colonic mucosa increased with age and was higher in female subjects. Methylation of P16(INK4A), MLH1, TIMP3 and DAPK in normal mucosa occurred at a lower level than ERalpha and MYOD but also increased with age and was significantly higher in patients with CIMP+ tumours. The DNMT3b C46359T polymorphism was associated with significantly less methylation of MYOD and MLH1 and with trends for lower methylation in each of the other CpG islands examined. Our results demonstrate that age, gender and genetic factors can influence the methylation level of CpG islands in gene promoter regions of normal colonic mucosa. Further work is required to determine whether such methylation is associated with the development of CIMP+ CRC.
Adaptor Proteins, Signal Transducing↗
Experimental study of aortic anastomosis using a circular stapling device in the porcine model.
OBJECTIVES: The aim of this study was to assess the strength (pressure resistance) and histological findings of aortic anastomoses performed using a circular stapling device. MATERIALS AND METHODS: A circular stapling device was used for anastomosing a porcine aorta and a Dacron graft. The maximum pressure resistance of the anastomotic site of a porcine aortic specimen and a Dacron graft was examined (n=10). A porcine aorta with Dacron graft was anastomosed to a beating heart, and pressure overload was induced by adrenaline (n=5). Specimens of the anastomotic sites were harvested after 14 days and examined histologically. RESULTS: The maximum pressure resistance of the anastomotic site was 427.3+/-34.4 (375-511) mmHg. No anastomotic sites leaked as a result of pressure overloading at 227.6+/-21.1 (201-260) mmHg. Histologically, good incorporation and cell coverage were observed, and the inner surfaces of the anastomotic sites were smooth and without stenoses. CONCLUSIONS: Aortic anastomosis using a circular stapling device is feasible and worthy of further investigation.
Anastomosis, Surgical↗
Thoracoscopic robot-assisted bronchoplasty.
BACKGROUND: In robotic surgery, the ideal position of the system, as well as the optimal working angles and the proper positioning of the thoraco ports position is very important. No robot-assisted bronchoplasty has been reported. Our study describes use of the da VinciTM surgical system (Intuitive Surgical, Inc.) for robotic sleeve upper lobectomy in a human fresh cadaver. METHODS: A male cadaver was placed in the left lateral decubitus position. After thoracoscopic upper lobectomy was performed through the working port and the two ports, the robotic system was then set up behind the cadaver. The working port allowed introduction of the optical scope and the robotic surgical arms were inserted into the thoraco ports. The right bronchus was dissected and wedge was cut out with the robotic scissors. After standard lymph node dissection, end-to-end bronchial anastomosis was performed with robotic instruments. Once the anastomosis was complete, air leakage was checked with saline solution placed in the pleural cavity. RESULTS: Thoracoscopic robot-assisted bronchoplasty was performed successfully. CONCLUSIONS: In evaluating various positions of the system we demonstrated that our technique is sufficient approaches to robotic bronchoplasty. This procedure offers specific advantages over conventional bronchoplasty with accuracy and safety.
Anastomosis, Surgical↗
Aldose reductase gene is associated with diabetic macroangiopathy in Japanese Type 2 diabetic patients.
AIMS: The aldose reductase (AR) gene, a rate-limiting enzyme of the polyol pathway, has been investigated as a candidate gene in determining susceptibility to diabetic microangiopathy. However, the association of the AR gene with diabetic macroangiopathy has not been investigated. Therefore, the present study was conducted to determine whether genetic variations of AR may determine susceptibility to diabetic macroangiopathy. METHODS: There were 378 Type 2 diabetic patients enrolled in this study. A single nucleotide polymorphism in the promoter region (C-106T) was genotyped and the AR protein content of erythrocytes measured by ELISA. RESULTS: There were no significant differences in genotypic or allelic distribution in patients with or without ischaemic heart diseases, but there was a significant increase in the frequency of the CT + TT genotype and T allele in patients with stroke (P = 0.019 and P = 0.012). The erythrocyte AR protein content was increased in patients with the CT and TT genotype compared with those with the CC genotype. After adjustment for age, duration of diabetes, body mass index, systolic blood pressure, HbA1c, and serum creatinine, triglycerides, and total cholesterol in multivariate logistic-regression models, the association between this AR genotype and stroke remained significant. CONCLUSIONS: Our results suggest that the CT or TT genotype of the AR gene might be a genetic marker of susceptibility to stroke in Type 2 diabetic patients. This observation might contribute to the development of strategies for the prevention of stroke in Type 2 diabetic patients.
Adult↗
Successful pregnancy following gonadotrophin-releasing hormone analogue treatment in a previously infertile bitch.
A Labrador retriever bitch was presented with repeated unsuccessful breeding during both the third and fourth oestruses, even though accurate timing for natural mating was planned based on the results obtained using a semiquantitative luteinising hormone kit and a quantitative assay of progesterone. To identify the problem, serum luteinising hormone, follicle-stimulating hormone, progesterone, and oestradiol-17beta concentrations around the fourth oestrus stage were assayed by radioimmunoassay. Abnormal luteinising hormone fluctuations were detected during pro-oestrus and oestrus, and lower than normal progesterone concentrations were found during the mating period. In the fifth to seventh oestrus, the bitch was successfully treated with gonadotrophin-releasing hormone analogue at times based on the findings of the hormonal assays.
Animals↗
Management of malignant pleural effusion by multimodality treatment including the use of paclitaxel administered by 24-hour intrathoracic infusion for patients with carcinomatous pleuritis.
For successful intrapleural chemotherapy, intrapleural drug activity should be maintained for as long as possible. This interim report presents the results of treatment with paclitaxel administered by 24-hour intrathoracic infusion as an adjunct to selective surgical management and/or systemic chemotherapy for controlling malignant pleural effusion. Thirteen patients with carcinomatous pleuritis were enrolled in the study between October 2001 and September 2004. The sites of primary disease were the lung in 12 patients and the breast in one patient. Paclitaxel (120 mg/m2) was administered by 24-hour intrathoracic infusion. Seven patients underwent elective surgical treatment and 11 patients received adjuvant systemic chemotherapy. Mild toxicity occurred in 7 cases, and chest pain and neutropenia were dominant. During a median follow-up period of 9 months (range, 2-33 months), malignant effusion was controlled successfully in 11 patients (84.6%). The multimodality treatment, including the use of paclitaxel, in this manner merits further investigation for possible intervention for malignant pleural effusion originating in lung and breast neoplasms.
Adult↗
Evaluation of carcinomatous pleuritis on initial relapse in patients with lung cancer who underwent complete resection.
The purpose of this study was to evaluate the clinical characteristics and results of lung cancer patients with carcinomatous pleuritis on initial relapse. Over the past decade, seven patients out of 595 surgically treated lung cancer patients developed carcinomatous pleuritis as the initial sign of relapse. All patients had undergone complete resection of the primary peripheral type adenocarcinoma. Only 3 cases showed obvious visceral pleural invasion, while venous or lymphatic invasion were frequently found in the histological sections. The mean disease-free interval after surgery was 30.9 months. The median survival after the development of carcinomatous pleuritis was 14 months. The results showed the possible association of blood/lymphatic routes with the development of this type of recurrence. In some lung cancer patients with carcinomatous pleuritis on initial relapse, long-term survival can be expected by aggressive interventions consisting of intrathoracic and/or systemic chemotherapies.
Adenocarcinoma↗
Effect of active immunization against inhibin on hormonal concentrations and semen characteristics in Shiba bucks.
Active immunization against inhibin increased ovulation rate in females; in males, the effects of active immunization against inhibin on hormonal concentrations and sperm production need more investigation. To test the hypothesis that active immunization against inhibin increases FSH secretion and sperm output, the present study was undertaken to determine the effects of active immunization against inhibin on hormonal profile and sperm production in Shiba bucks. The bucks were actively immunized against inhibin alpha-subunit (immunized group, n=6) or Freund adjuvant (control group, n=5) four times, at 5-weeks intervals. Blood samples were collected twice-weekly and two successive ejaculates of semen were collected (with an artificial vagina) once-weekly. Plasma concentrations of FSH, LH and testosterone were measured by radioimmunoassay (RIA) and sperm motility characteristics were measured by computer-assisted sperm analysis (CASA). All inhibin-immunized bucks produced antibodies against inhibin. Relative to control bucks, in immunized bucks there were significant increases in plasma FSH concentrations and in sperm concentrations from 5 to 9 weeks and from 8 to 11 weeks, respectively, after primary immunization. However, plasma concentrations of LH and testosterone, semen volume, percentage of motile spermatozoa and motility parameters (straight-line velocity, curvilinear velocity and linearity index) were similar in both groups. In conclusion, active immunization against inhibin alpha-subunit increased FSH secretions and enhanced sperm production in bucks, whereas LH and testosterone concentrations, semen volume and sperm motility parameters were unaffected. Active immunization against inhibin could be used to improve fertility in Shiba bucks.
Animals↗
Headmount stereoscopic monitor for endoscopic surgery.
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Data Display↗
Bacteriological study of autologous cryoprecipitate-derived fibrin glue as the operative sealant.
Fibrin glue (FG) is frequently used to seal and cover the anastomoses in many operations such as cardiovascular surgery or orthopaedic surgery. However, in case of gastrointestinal surgery, anastomoses are potentially contaminated, and FG may promote bacterial growth, increasing the risk of leakage. The purpose of this study was to examine the effect of cryoprecipitate-derived FG (CryoFG) on bacterial growth. Bacterial growth on the CryoFG and on the commercial FG (Beriplast P) was evaluated and compared with that on control medium. In addition, the complement activities were evaluated by heat inactivation or addition of guinea-pig complement to the experimental settings. The CryoFG inhibited the growth of Escherichia coli, whereas the commercial FG had no effect. Heat inactivation of the CryoFG inhibited the bactericidal effect of CryoFG. Addition of guinea-pig complement to the heat-inactivated CryoFG could almost restore the bactericidal activity, suggesting the important role of complement. This study showed that the CryoFG preserved the complement activity, which inhibited the in vitro growth of E. coli. Therefore, we concluded that the application of the CryoFG for gastrointestinal surgical anastomoses not only would be safe but also has the advantage of reducing bacterial infection.
Bacteria↗
[Clinical experience with aortic connector system].
From April to December 2002, 40 patients underwent coronary artery bypass grafting (CABG) using the St. Jude Medical (Minneapolis) Symmetry bypass system (aortic connector system: ACS). 59 proximal anastomoses (51 saphenous vein grafts, 8 radial artery grafts) were performed with the ACS. One saphenous vein graft occluded during operation. Postoperative evaluation of the anastomotic patency was carried out by angiography in 45 grafts. Five of the saphenous vein grafts were occluded (5/38). One patient who was shock state before operation presented with postoperative unconsciousness. Another patient died at 8th postoperative day caused by ventricular fibrillation. We conclude that the ACS produces a simple, quick way of performing the proximal anastomosis without the need for clamping the aorta, allows reducing risk of embolization by aortic manipulation. However, it is necessary to discuss sufficiently using the ACS, because the graft patency with the ACS is lower than with standard suturing technique.
Aged↗
[Completion pneumonectomy after 4 times of resections for metastatic lung tumors from rectal carcinoma].
We report a case of completion pneumonectomy after 4 times of metastasectomy for metastatic lung tumors from rectal carcinoma. A 63-year-old man underwent Miles' operation for advanced rectal carcinoma. Forty-seven months after the operation, bilateral metastasis was appeared, and bilateral metastasectomy was performed. After the resection, 3 times of metastasectomy were performed during 40 months. Follow-up X-ray and computed tomography (CT) showed abnormal shadow in his left hilum of lung. Completion pneumonectomy with mediastinal lymph node sampling was performed. He is still alive without recurrence 4 years after first thoracotomy. Repeated pulmonary resection can lead to good outcome for selective patients with metastatic colorectal carcinoma, and repeated surgery can be useful for pulmonary recurrences after thoracotomy.
Humans↗
[Performing off-pump coronary artery bypass grafting in elderly patients safely].
The elderly patients of the ischemic heart disease have been increasing in recent years. From January 2001 to December 2004, 41 patients were aged 80 years or older underwent off-pump coronary artery bypass grafting (OPCAB) in our hospital. To perform OPCAB of elderly patient safely, we review presence of carotid artery stenosis and previous cerebral infarction preoperatively and use high thoracic epidural anesthesia (TEA) and coronary artery active perfusion system (CAPS) intraoperatively. TEA provides bradycardia and coronary vasodilatation which facilitate beating-heart surgery technically, and prevent intra- and postoperative arrhythmia. Comparing with before use of TEA, operating time and postoperative intubation time decreased significantly. Using CAPS anastomosis was performed under bloodless field and stable hemodynamics. There was no operative death and severe postoperative complication. In conclusion, with careful preoperative inspection and using TEA and CAPS, OPCAB can be performed safely in octogenarians.
Aged↗
[Surgical results of non-small cell lung cancer invading parietal pleura and chest wall].
This retrospective analysis was undertaken to review our results of treatment of lung cancers with invasion of non-apical and non-vertebral chest wall structures. In summary of our experience, although relatively good prognosis can be expected in N0M0 patients with the histological type of adenocarcinoma by initial operation, distant relapse remains a major problem of the disease. Furthermore, our results are in agreement with the idea that postoperative adjuvant therapy is of little value in patients with complete resection. To ameliorate surgical outcomes, induction treatment should be considered and preoperative staging assessment needs to be strictly done for proper selection of patients with this locally advanced disease. The indication of initial operation needs to be cautiously determined for patients with this disease.
Carcinoma, Non-Small-Cell Lung↗