Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

Purpose & Methods :In order to examine the enhanced effect of nitric oxide (NO) for the induction of polyethyleneglycol (PEG) -liposome containing adriamycin (ADM) into tumor, NO-producing substance (L-arginine), NO scavenger (PTIO) and NOS inhibitor (L-NAME) were administered into subcutaneous tumor model of mouse.
Results : The percentage of injected dose of [³H] labeled PEG-liposome was highest in the liver, next highest in the blood and then in the spleen. Levels were low and approximately equal in the kidney, heart and lung. For each tissue, no significant differences were recognized in the percentages of injected dose in each group. The percentages of injected dose/g tumor after administration of [³H] labeled PEG-liposome in tumor showed that a significantly higher value was found in the L-arginine group than in controls, and in the PTIO group, the value was significantly lower. No significant difference was noted between the L-NAME group and the control group. The tumor doubling time in the L-arginine group was similar to the control, but the doubling times were significantly longer in the Lip-ADM group and the Lip-ADM with L -arginine group. That of the Lip-ADM with L-arginine group was also significantly longer than that of the Lip-ADM group.
Conclusion : These results revealed that NO could enhance tumor vascular permeability and the accumulation of PEG-liposome containing ADM, with anti-tumor effect.

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Background/Aims :The role of rebamipide administration in reducing remnant gastritis after distal gastrectomy was studied.
Patients :Among patients with gastric cancer who underwent macroscopically curative distal gastrectomy with Roux-Y reconstruction in our department between July 1999 and September 2001, 22 subjects without particular complications were analyzed in the study. The patients were randomly divided into two groups. Eleven patients (Group A) were orally administered 300 mg/day of a gastroprotective agent, rebamipide (Mucosta) for 12 weeks starting at one week postoperatively. Treatment by administration of anti-acids or any agent possibly affecting the gastric mucosa or gastric emptying was prohibited in the other 11 patients (Group B).
Methods :All patients underwent endoscopic biopsy within 2 weeks before the operation and 13 weeks after the operation. Histological gastritis and IL-8 concentration in the gastric mucosa was also examined.
Results :The degree of neutrophil infiltration decreased after operation in both groups. The decrease was more remarkable in Group A than in Group B (p=0.02). IL-8 concentration in the gastric mucosa was reduced by administration of rebamipide, and its manifestation was significantly accelerated by H. pylori infection (p=0.03).
Conclusions :Administration of the gastroprotective agent, rebamipide appears to be histochemically effective in suppressing remnant gastritis after distal gastrectomy.

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The mortality and morbidity rates associated with spontaneous esophageal perforation remain high because of the difficulty in diagnosis and thus treatment of the disease are frequently delayed. The disorder's presentation is non-specific, and its management remains controversial. We report a case ofspontaneous esophageal perforation, in which the patient was successfully treated by T-tube drainage of the esophagus. The patient was initially diagnosed by thoracocentesis as having hemopneumothorax, but after admission, the correct diagnosis was made by esophagography. He underwent an emergency operation 12 hours after the onset of symptoms. The tissue surrounding the perforation was dirty, edematous, and not well-vascularized, so T-tube drainage of the esophagus, mediastinal and left thoracic drainage, and gastrostomy were performed. The T-tube was removed 2 months after surgery. T-tube drainage is useful for the management of spontaneous esophageal perforation, especially when primary closure is not suitable.

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The patient was a 73-year-old woman who had tested positive for occult fecal blood and had undergone colonoscopy at a nearby hospital.The colonoscopy revealed a submucosal tumor in the terminal ileum, and the patient was admitted to our hospital for further detailed examinations.Double contrast barium enema and colonoscopy revealed a 2.7×2.0cm protrusive lesion in the terminal ileum. Endoscopic ultrasonography revealed a homogenous highly echoic submucosal tumor in the terminal ileum.Abdominal CT scan showed a mass of pure fat density with no contrast enhancement in the right lower abdomen.Based on these findings, the patient was diagnosed as having an ileal lipoma and the tumor underwent surgery.Histopathological examination of the resected specimen showed the tumor to be located submucosally and to consist of mature adipose tissue.No cellular atypia was seen.Ileal lipoma is a relatively rare tumor, and it is extremely rare for an ileal lipoma without concomitant intussusception to be diagnosed preoperatively by endoscopy and endoscopic ultrasonography.

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