[A case of duodenal gastrointestinal stromal tumor treated by pancreas-sparing partial duodenectomy].

An 79-year-old man admitted our hospital for abdominal mass. Computed tomography showed a tumor measuring about 10 cm in diameter without any metastasis lesion and any sings of local infiltration. Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the third portion of the duodenum, and biopsy revealed tumor cells stained positive for c-kit. These findings were consistent with a GIST and we performed a partial resection of the duodenum sparing the pancreas. Gastrointestinal stromal tumors (GIST) were mainly located in the stomach and the small intestine. Duodenal localization is rare. Surgical approach for GISTs should basically be a partial resection. However, for GISTs located in the duodenum, the partial resection was sometimes difficult and pancreaticoduodenectomy (PD) may be needed, depending on the tumor size and the location of the tumor close to the papilla Vater. Since GIST grew expansively, rarely involving lymph nodes, PD may be an excessive procedure to treat the disease. For this reason pancreas-sparing partial duodenectomy has been introduced for the treatment of duodenal GIST.

Antithrombin reduces the ischemia/reperfusion-induced spinal cord injury in rats by attenuating inflammatory responses.

Antithrombin (AT) reveals its antiinflammatory activity by promoting endothelial release of prostacyclin (PGI(2)) in vivo. Since neuroinflammation is critically involved in the development of ischemia/reperfusion (I/R)-induced spinal cord injury (SCI), it is possible that AT reduces the I/R-induced SCI by attenuating the inflammatory responses. We examined this possibility using rat model of I/R-induced SCI in the present study. AT significantly reduced the mortality and motor disturbances by inhibiting reduction of the number of motor neurons in animals subjected to SCI. Microinfarctions of the spinal cord seen after reperfusion were markedly reduced by AT. AT significantly enhanced the I/R-induced increases in spinal cord tissue levels of 6-keto-PGFIalpha, a stable metabolite of PGI2. AT significantly inhibited the I/R-induced increases in spinal cord tissue levels of TNF-alpha, rat interleukin-8 and myeloperoxidase. In contrast,Trp(49) -modified AT did not show any protective effects. Pretreatment with indomethacin significantly reversed the protective effects of AT. An inactive derivative of factor Xa, which selectively inhibits thrombin generation, has been shown to fail to reduce SCI. Taken together, these observations strongly suggested that AT might reduce I/R-induced SCI mainly by the antiinflammatory effect through promotion of endothelial production of PGI(2). These findings also suggested that AT might be a potential neuroprotective agent.

All pathological T4 esophageal carcinomas should be categorized as stage IV.

BACKGROUND/AIMS: The prognosis of pathological T4 (pT4) esophageal carcinoma is still dismal, however, the current TNM classification categorizes some pT4 cancers (pT4M0) as stage III. The purpose of this study was to evaluate of the relevance of this classification. METHODOLOGY: One hundred and thirty-five patients who underwent esophagectomy for pathological stage III (n = 85) and IV (n = 50) esophageal tumors were enrolled in the study. The outcomes and prognostic factors for these patients were examined. After the reclassification that pT4M0 tumors were categorized as stage IV, the two survival curves were compared between new stage III and IV. RESULTS: The 5-year survival rates for stage III and IV were 14.6%, 19.1%, respectively (P = 0.9). The 5-year survival rates for pT3N1M0 and pT4M0 were 21.1%, 0%, respectively (P < 0.0001). After the reclassification, the overall 5-year survival rates for new stage III and IV were 24.0%, 14.2%, respectively (P = 0.004). Curative resection (P = 0.002), radiotherapy (P = 0.001), depth of tumor invasion (pT3; P = 0.0004, pT1; P = 0.04) were the significant prognostic factors for stage III and IV carcinomas. Thirty-one (83.8%) of 37 patients with pT4 tumor had received non-curative esophagectomy. CONCLUSIONS: All pathological T4 esophageal carcinomas should be categorized as stage IV in the TNM classification.