EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

There is still an unresolved paradox with respect to the immunomodulating role of estrogens. On one side, we recognize inhibition of bone resorption and suppression of inflammation in several animal models of chronic inflammatory diseases. On the other hand, we realize the immunosupportive role of estrogens in trauma/sepsis and the proinflammatory effects in some chronic autoimmune diseases in humans. This review examines possible causes for this paradox. This review delineates how the effects of estrogens are dependent on criteria such as: 1) the immune stimulus (foreign antigens or autoantigens) and subsequent antigen-specific immune responses (e.g., T cell inhibited by estrogens vs. activation of B cell); 2) the cell types involved during different phases of the disease; 3) the target organ with its specific microenvironment; 4) timing of 17beta-estradiol administration in relation to the disease course (and the reproductive status of a woman); 5) the concentration of estrogens; 6) the variability in expression of estrogen receptor alpha and beta depending on the microenvironment and the cell type; and 7) intracellular metabolism of estrogens leading to important biologically active metabolites with quite different anti- and proinflammatory function. Also mentioned are systemic supersystems such as the hypothalamic-pituitary-adrenal axis, the sensory nervous system, and the sympathetic nervous system and how they are influenced by estrogens. This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned criteria. It also explains that a uniform concept as to the action of estrogens cannot be found for all inflammatory diseases due to the enormous variable responses of immune and repair systems.

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The complex role of estrogens in inflammation

This review is intended to stimulate interest in the effect of increased expression of heme oxygenase-1 (HO-1) protein and increased levels of HO activity on normal and pathological states. The HO system includes the heme catabolic pathway, comprising HO and biliverdin reductase, and the products of heme degradation, carbon monoxide (CO), iron, and biliverdin/bilirubin. The role of the HO system in diabetes, inflammation, heart disease, hypertension, neurological disorders, transplantation, endotoxemia and other pathologies is a burgeoning area of research. This review focuses on the clinical potential of increased levels of HO-1 protein and HO activity to ameliorate tissue injury. The use of pharmacological and genetic probes to manipulate HO, leading to new insights into the complex relationship of the HO system with biological and pathological phenomena under investigation, is reviewed. This information is critical in both drug development and the implementation of clinical approaches to moderate and to alleviate the numerous chronic disorders in humans affected by perturbations in the HO system.

Pharmacological and Clinical Aspects of Heme Oxygenase

To describe a technique for the treatment of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) using a hand-made T-tube. Reconstruction after PD was performed by a modified Child’s method. A 3-mm tube and a 2-mm tube were connected in a ‘T’ shape. This hand-made T-tube was inserted into both the pancreatic duct and the jejunal limb, using two guidewires through a sinus tract of POPF. After a few days, the external end of the T-tube was closed with a metallic tip, and the internal pancreatic drainage was completed. The indication criteria for the T-tube treatment are as follows: (1) the pancreatic drainage tube inserted during operation has been dislodged; and (2) either the main pancreatic duct or the jejunal limb can be demonstrated on fistulograms. In the 30 years between 1978 and 2007, 642 patients underwent PD (pylorus-preserving, n = 210; Whipple, n = 302; and hepatopancreatoduodenectomy, n = 130). The T-tube treatment was performed in 9 patients (pylorus-preserving, n = 5; Whipple, n = 1; and hepatopancreatoduodenectomy, n = 3). The median duration between surgery and the T-tube placement was 64 days (range, 22–107 days). The median hospital stay after the T-tube placement was 12 days (range, 7–54 days). Neither major nor minor complications associated with the T-tube treatment occurred. The T-tube was removed in 5 patients after a median of 2 months (range, 2–24 months). Of these patients, 4 are alive without recurrence of carcinoma, and 1 patient died of recurrence 56 months after surgery. The other 4 patients died of recurrence before removal of the T-tube, at 11 months after placement of the tube (range, 7–15 months) without any complications associated with the T-tube treatment. T-tube treatment is a minimally invasive, simple, safe, and reliable technique that can dramatically improve grade C POPF. This procedure should be considered as a first-line treatment of choice in selected patients with refractory grade C POPF.

Treatment of pancreatic fistula after pancreatoduodenectomy using a hand-made T-tube

Loss of trefoil factor 1 inhibits biliary regeneration but accelerates the hepatic differentiation of progenitor cells in mice

We report a case of internal supravesical hernia. A 74-year-old male with complaint of abdominal pain underwent an operation for small intestinal obstruction due to its incarceration into the internal supravesical hernia. Retrospectively, the preoperative abdominal CT film showed the relation of the incarcerated intestine, the urinary bladder, and the middle umbilical ligament. This is the first case of the internal supravesical hernia in which the preoperative CT had taken and it will contribute to the preoperative correct diagnosis in the future.

A case of internal supravesical hernia

233PReal-world experience with FOLFIRINOX and gemcitabine plus nab-paclitaxel in the treatment of pancreatic cancer in Japan

A combined ischiopubic rami resection is extremely rare in the field of gastroenterologic surgery. We report a case of a locally recurrent rectal cancer that was successfully treated by total pelvic exenteration with combined ischiopubic rami resection. A 58-year-old male with locally recurrent rectal cancer and liver metastases was referred to our hospital. Computed tomography and magnetic resonance imaging showed a perineal tumor, which had invaded the prostate, urethra, and obturator internus muscle, and two liver metastases. Because the perineal tumor was very close to the dorsal vein complex and the pubic symphysis, it was considered difficult to approach and divide the dorsal vein complex, and still retain oncologic safety. To achieve R0 resection, total pelvic exenteration with ischiopubic rami resection, total emasculation and partial liver resection were performed. Pathological examination revealed that surgical margins were negative for cancer cells. Although reconstruction of the pelvic ring was not performed, his ambulatory function had recovered to an almost normal status at 6 months after the operation.

/pdf/locally-recurrent-rectal-cancer-successfully-treated-by-133ujae264.pdf

Yukihiro Yokoyama

Papers

Treatment of pancreatic fistula after pancreatoduodenectomy using a hand-made T-tube

Loss of trefoil factor 1 inhibits biliary regeneration but accelerates the hepatic differentiation of progenitor cells in mice

A case of internal supravesical hernia

233PReal-world experience with FOLFIRINOX and gemcitabine plus nab-paclitaxel in the treatment of pancreatic cancer in Japan

Locally Recurrent Rectal Cancer Successfully Treated by Total Pelvic Exenteration with Combined Ischiopubic Rami Resection: Report of a Case