Full-thickness resection closure using reopenable-clip over-the-line method inside a submucosal pocket.

Video 1Full-thickness defect resection closure using the reopenable-clip over-the-line method inside a submucosal pocket in the porcine stomach.

Suturing techniques with endoscopic clips and special devices after endoscopic resection.

Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large-teeth clips have also been developed. The over-the-scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip-line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O-ring closure, and the reopenable clip over-the-line method, have been developed. In recent years, techniques often utilized for full-thickness ER of submucosal tumors have been widely used in full-thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER.

Penile-preserving surgery for male distal urethral carcinoma followed by buccal mucosa urethroplasty.

INTRODUCTION: We report a case of distal urethral carcinoma treated with segmental urethral excision and reconstruction by staged buccal mucosa urethroplasty. CASE PRESENTATION: A 60-year-old man presented with difficulty urinating and a palpable mass on the ventral side of his penis. He was diagnosed as having localized distal urethral carcinoma (cT2N0M0) and underwent penile-preserving surgery with staged urethroplasty using buccal mucosa as substitute tissue. The pathological diagnosis was squamous cell carcinoma of the urethra (T2) with negative surgical margin. At 2 years of follow-up, there was no recurrence or metastasis, he could void in a standing position with an acceptable urinary stream, and he found the appearance of his external genitalia acceptable. CONCLUSION: In cases of distal primary urethral carcinoma, urethroplasty using buccal mucosa graft could be alternative treatment option providing a better postoperative quality of life.

A potential novel combination therapy targeting survivin in renal cancer cells: Inhibition of survivin expression by topotecan and hexamethylene bisacetamide.

Survivin is an inhibitor of apoptosis and, as it is found in many tumors but not in most normal differentiated tissues, is an attractive target for cancer therapy. Survivin expression has been associated with cell proliferation in renal cancer. We previously demonstrated the possibility of treating renal cancer by suppressing survivin expression using the topoisomerase I inhibitor topotecan and survivin-specific siRNA. In the present study, we used Caki-1 cells to investigate the possibility of treating renal cancer by combining topotecan and the hybrid polar compound hexamethylene bisacetamide (HMBA) to completely suppress survivin expression. HMBA is known to induce cell differentiation. This warrants the testing of the ability of HMBA to suppress survivin, which is associated not only with carcinogenesis but also with differentiation. Both topotecan and HMBA were shown to suppress survivin expression and cell proliferation. However, the combination of topotecan and HMBA suppressed survivin expression completely and more effectively inhibited cell proliferation, leading to apoptosis. Combination therapy using topotecan and HMBA might thus be effective treatment for advanced renal cancer.