Medical Library

Knowledge Helps, but Alone It Is Not Enough.

Brennan MF.

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, brennanm@mskcc.org.

Dendritic Cell Enumeration.

McCarter M.

Department of Surgery, University of Colorado, 4200 Ninth Avenue, C311, Denver, CO, 80262, USA, Martin.McCarter@UCHSC.edu.

Esophageal Cancers with Synchronous or Antecedent Head and Neck Cancers: A More Formidable Challenge?

BACKGROUND: The presence of synchronous or antecedent head and neck cancers may complicate management of patients with primary esophageal cancer. METHODS: From January 1982 to December 2004, by means of a prospectively collected database, we compared information from 119 patients with esophageal cancers who had synchronous or antecedent head and neck cancers with information from 1555 patients who only had squamous cell esophageal cancer in a tertiary referral academic hospital. RESULTS: There were far more men and younger patients in those who had head and neck cancers, and multicentric tumors were also more common. Hypopharyngeal tumors were the most frequently encountered head and neck cancer and were found in 36.1% of patients. Resection rates of the primary esophageal cancers were similar in those who had head and neck cancers and in those who only had esophageal cancer (60.7% vs. 61.7% P = .74). Overall postoperative complication rates were not different. Thirty-day mortality rates were 0% and 2.9% for those who did and did not have head and neck tumors, respectively (P = .25). The respective hospital mortality rates were 10.3% and 9.5% (P = .83). Median survival for resectable esophageal cancers was 9.2 months for the former group and 13.4 months for the latter (P = .02). CONCLUSIONS: Esophagectomy rates did not differ when synchronous or antecedent head and neck cancers were present. Similar postoperative morbidity and mortality rates could be achieved. The presence of additional head and neck tumors imparted a worse long-term prognosis.

Lo OS, Law S, Wei WI, Ng WM, Wong KH, Tong KH, Wong J.

Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong.

Modalities of Hyperthermic Intraperitoneal Chemotherapy.

Shigeki K, Baratti D, Deraco M.

IRCCS Istituto Nazionale Tumori, Milan, Italy.

Molecular Characterization and Expression Pattern of Two Pheromone-Binding Proteins from Spodoptera litura (Fabricius).

Pheromone perception is thought to be mediated by pheromone-binding proteins (PBPs) in the lymph surrounding the olfactory receptors. We cloned and characterized two PBP genes (SlitPBP1 and SlitPBP2) from the common cutworm, Spodoptera litura (F.; Lepidoptera: Noctuidae), which encode PBPs belonging to two different PBP groups. Western blot analysis of the crude antennal extracts with SexigPBP1 antibody revealed a single immunoreactive band (much stronger in male than in female) of approximately 16 kDa, in agreement with the calculated values for SlitPBPs. From genomic DNA, two introns and a similar exon/intron structural pattern were identified in each PBP genes, but the introns differed in length within and between PBP genes. The expression patterns of two SlitPBP genes, with respect to tissue distribution and sex, were further investigated by reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time PCR. Although the two PBP genes were expressed only in the antennae of both sexes, reflecting the antennal specificity of PBPs, the transcription levels of PBP genes differed between the sexes and the genes. The transcription levels of SlitPBP1 and SlitPBP2 in females were only 2.1% and 7.0%, respectively, relative to those in males, and the levels of PBP2 compared with PBP1 were 31.4% and 95.3% in males and females, respectively. These differential expression levels might suggest different roles played by the two SlitPBPs in the perception of sex pheromone both in males and females.

Xiu WM, Zhou YZ, Dong SL.

Key Laboratory of Monitoring and Management of Plant Diseases and Insects, Ministry of Agriculture, Nanjing Agricultural University, Nanjing, 210095, China.

Identification of Softness Syndrome-Associated Candidate Genes and DNA Sequence Variation in the Sea Squirt, Halocynthia roretzi.

The mortality of sea squirts, Halocynthia roretzi, with softness syndrome threatens the sea squirt aquaculture industry in Asian countries. The molecular approach to understanding the pathogenesis of softness syndrome began with differential gene expression analysis of tissues from normal and dying organisms. In the present study, we show that the expression of Halocynthia roretzi metalloproteinase (HrMMP) was significantly upregulated in the tissues of dying organisms through screening of differentially expressed genes, reverse transcription-polymerase chain reaction (RT-PCR), and real-time PCR. HrMMP is composed of 482 amino acids, contains a conserved domain found in the astacin family, and has typical metalloproteinase activity. To discriminate between the differential expression of the HrMMP gene in normal and dying organisms, we cloned the HrMMP gene promoter and identified a polymorphism in the HrMMP promoter region that resulted in distinct polymorphisms (G/T) at position - 308 bp. These results suggest that organisms with the GT genotype may have more resistance to softness syndrome than those with the TT genotype. These findings suggest that the HrMMP promoter polymorphism may be associated with an increased risk of softness syndrome in cultivated sea squirts and should be evaluated as a candidate molecular marker for the selective breeding of softness syndrome-resistant sea squirts.

Cho HK, Nam BH, Kong HJ, Han HS, Hur YB, Choi TJ, Choi YH, Kim WJ, Cheong J.

Department of Molecular Biology, Pusan National University, Busan, 609–735, Korea.

Presentation and management of Morgagni hernias in adults: a review of 298 cases.

BACKGROUND: Morgagni hernias are a very rare form of diaphragmatic hernias. No robust studies have been performed to show the true natural history of this disease process. This study aimed to summarize clinically relevant data with respect to Morgagni hernias in adults. These data should help surgeons workup, diagnose, and treat Morgagni hernias in adult patients. METHODS: A literature search was performed using PubMed, Google scholar, and the following key words: Morgagni, Larrey, retrosternal, retrocostoxiphal, retrochondrosternal, parasternal, substernal, anterior diaphragmatic, and subcostosternal. All case reports and series after 1951 that pertained to adults were included in the review. The following data points were queried: age, sex, presentation, studies used during workup, laterality, surgical approach, hernia sac management, specific laparoscopic techniques, and follow-up evaluation. RESULTS: These criteria were met by 135 articles representing 298 patients. Based on the data provided, several conclusions regarding this disease process can be drawn. Most patients (72%) present with symptoms related to their hernia. Pulmonary complaints are the most common symptoms (36%). Men present earlier in life than women. Thoracotomy is the most widely used surgical approach (49%). However, laparoscopic repair has gained popularity since its first report in 1992. Laparoscopic surgeons usually repair the defect with mesh (64%) and do not remove the hernia sac (69%). Laparoscopic repair can be performed with a low complication rate (5%) and a short hospital stay (3 days). Outcomes of other surgical approaches also are reported. CONCLUSIONS: Using modern surgical techniques including laparoscopy, repair of Morgagni hernia can be performed safely with a short hospital stay and with little morbidity or mortality.

Horton JD, Hofmann LJ, Hetz SP.

Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, Texas, 79920, USA, John.horton2@amedd.army.mil.

Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass.

OBJECTIVE: Stricture formation at the gastrojejunal anastomosis is a relatively common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to report the incidence of stomal strictures after LRYGB in our institution and report our experience with their management by endoscopic balloon dilatation. METHODS: This is a retrospective study of 1012 patients who underwent LRYGB from January 2001 to May 2004. Patients with nausea and vomiting after the surgery, suspected of having gastrojejunal (GJ) anastomotic stricture, had upper endoscopy. Stomas less than 10 mm in diameter, or those not allowing passage of the scope were considered significant strictures and were treated with balloon dilations. Dilations were performed with a through-the-scope (TTS) balloon, with sizes ranging from 6 to 18 mm. The following data were collected from these patients: age, sex, body mass index (BMI), comorbidities, size of balloon catheter, time from surgery until symptoms onset, number of endoscopies needed to relief symptoms, and complications of the procedure. RESULTS: Sixty-one patients (46 females and 15 males) were found to have anastomotic strictures, corresponding to an incidence of 6%. In total, 134 upper endoscopies were performed, with 128 dilatations. The average age was 41.7 years (range: 19-68 years); mean preoperative BMI was 45 kg/m(2) (range: 42-61 kg/m(2)). Mean time from surgery to symptoms onset was 2 months (range: 1-6 months). The number of dilations per patient was as follows: a single dilation in 28% of patients, two dilations in 33%, three dilations in 26%, four dilations in 11.5%, and five dilations in 1.5% of patients. All the patients responded to dilation without need for formal surgical revision. However, after balloon dilatation three patients (4.9%), all females, had bowel perforation by radiological criteria (free air on X-ray), which corresponded to 2.2% of all dilatations. The maximum balloon size used in this group was 13.5 mm. All three patients had exploratory laparoscopy without finding of perforation site. They were treated with bowel rest, intravenous antibiotics for 7 days, and drain placement. No factors were identified to predict a risk of perforation. CONCLUSION: This is the largest study to evaluate the outcome of endoscopic dilatations of GJ strictures after RYGB. Endoscopic balloon dilation is a safe and effective treatment for anastomotic strictures. However, it carries a small risk of perforation. Further case studies are needed to determine risk factors for perforation and if the patients can be managed conservatively in this setting.

Ukleja A, Afonso BB, Pimentel R, Szomstein S, Rosenthal R.

Department of Gastroenterology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA, uklejaa@ccf.org.

Evaluation of real-time infrared intraoperative cholangiography in a porcine model.

BACKGROUND: Intraoperative cholangiograms (IOCs) may increase cost, surgical time, and radiation exposure of staff and patients. The authors introduce the application of passive infrared imaging to intraoperative cholangiography as a feasible alternative to traditional fluoroscopic IOCs. METHODS: A porcine model was used in which the gallbladder, cystic duct, common bile duct (CBD), and duodenum were exposed and an 18-gauge angiocatheter was inserted into the cystic duct. Infrared emission was detected using a digital infrared camera positioned 30 to 60 cm above the abdomen. Infrared images were taken in real time ( approximately 1/s) during infusion of room-temperature saline. A thermoplastic polymer stone then was inserted into the CBD. Once the artificial stone was placed, room-temperature saline was again injected. A standard single-shot renograffin IOC was obtained to confirm the obstruction. The experiment was concluded by creation of a lateral 2-mm CBD injury immediately proximal to the duodenum followed by infusion of room-temperature saline. RESULTS: Six pigs were used in this study. Baseline infrared imaging was able to capture a visible temperature decrease, outlining the lumen of the CBD. With injection of room-temperature saline, a decrease in temperature was visualized as a dark area representing flow from the CBD to the duodenum. After placement of the synthetic stone, real-time infrared images displayed slowing of the injected bolus by the obstruction. The obstruction was correlated with fluoroscopic IOCs. Finally, after partial transection of the CBD, the infrared camera visualized saline flowing from the site of injury out into the peritoneal cavity. CONCLUSIONS: The CBD anatomy, obstruction, and injury can be clearly visualized with an infrared camera. Intraoperative infrared imaging is an emerging method already being used in several surgical fields. Ultimately, the integration of infrared and laparoscopic technology will be necessary to make infrared technology important in laparoscopic cholecystectomy.

Liu JJ, Alemozaffar M, McHone B, Dhanani N, Gage F, Pinto PA, Gorbach AM, Elster E.

Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA, jackjliu@gmail.com.

Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus.

BACKGROUND: Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35. METHODS: Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 +/- 6.4 years (range, 27-66 years) and a mean BMI of 30.1 +/- 2.7 (range, 23.6-34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 +/- 4.6 years (range, 3-22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG). RESULTS: The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3-19 months). The mean BMI was 23.8 +/- 4.1 kg/m(2), and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure. CONCLUSIONS: Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.

Depaula AL, Macedo AL, Rassi N, Vencio S, Machado CA, Mota BR, Silva LQ, Halpern A, Schraibman V.

, Av. 136, no. 961, 14° andar, Setor Marista, 74.093-250, Goiania, Goiás, Brazil, adepaula@uol.com.br.