Interleukin-24 is a novel diagnostic biomarker for the severity of acute kidney injury.

There is a clinical need for sensitive acute kidney injury (AKI) biomarkers that enable early therapeutic interventions and prediction of disease prognosis. In this study, we monitored interleukin (IL)-24 expressed in kidneys with severe AKI that progresses to atrophic kidney in a mouse model of ischemia-reperfusion injury (IRI). Therefore, we evaluated IL-24 as a potential biomarker not only for early diagnosis of AKI, but also for predicting progression to chronic kidney disease (CKD). Serum IL-24 was detected earlier than the elevation of serum creatinine levels and urinary IL-24 was detected as early as neutrophil gelatinase associated lipocalin (NGAL) in severe AKI (60 min of IRI). In addition, serum and urine IL-24 levels tended to increase in relation to ischemia duration. In such kidneys, vascular smooth muscle cells expressed IL-24 in response to the injury in the renal tubular epithelial cell and its target was the renal tubular epithelial cell itself. IL-24 may play a pivotal role in the communication between tubular epithelial cells and vascular smooth muscle cells and, in conclusion, IL-24 can be used as a sensitive biomarker for AKI.

[A case of breast reconstruction surgery using flap of latissimus dorsi after neoadjuvant chemotherapy].

We performed breast reconstruction surgery with mastectomy after neoadjuvant chemotherapy(NAC)for a patient with NAC indication desiring breast conservation. The case was a 34-year-old single woman. In March, 2007, she was aware of a lump in her left breast and visited our hospital. The diagnosis was solid-tubular carcinoma 3 cm in diameter from close examination. We performed preoperative chemotherapy with EC(epirubicin 90 mg/m(2), cyclophosphamide 600 mg/m(2))x4, followed by 3w-paclitaxel 175 mg/m(2)x4, and then performed mastectomy with axillary dissection and breast reconstruction surgery using the flap of latissimus dorsi at the same time. Pathologically, pCR was provided. We thought that there are many advantages to both treatment of breast cancer and the cosmetic characteristics. The patient was very satisfied. But further cumulative examinations are awaited because there is not much evidence at present.

[A case of recurrent breast cancer with multiple lung, adrenal, inferior vena cava tumor thrombus and bone metastases successfully treated with 5'-DFUR and hormonal therapy].

A 42-year-old woman with multiple organ metastases from breast cancer was successfully treated with 5'-deoxy-5-fluorouridine (5'-DFUR) and hormonal therapy (leuprorelin+tamoxifen). She underwent radical mastectomy for advanced left breast cancer in June 1998. In September 2000, she was treated with docetaxel for multiple lung metastases, and the lesions were diagnosed as in complete remission. In June 2001, she received radiation for bone metastasis in left femoral and received a resection of subcutaneous metastases in the face. Then she received 2 courses of paclitaxel. In May 2002, she had multiple lung metastases, right adrenal metastasis, tumor thrombus in the inferior vena cava and multiple bone metastases, and was treated with cycrophosphamide, epirubicin, and 5-FU, however, they were abandoned due to severe leucopenia. Therefore, 600 mg/day of 5'-DFUR was administered from December 2002. The lesions of lung and adrenal decreased extendedly in March 2003. She was diagnosed as being in CR in March 2004, and this condition has continued to the present.

Pedicled ileal flap to repair large duodenal defect after right hemicolectomy for right colon cancer invading the duodenum.

Although right-sided colon cancer occasionally invades the second part of the duodenum, there is no standard procedure for reconstructing a large duodenal defect after resection. This report describes a new approach we recently devised. After resecting the right hemicolon and the involved duodenum, a segment of terminal ileum was isolated on the vascular pedicle, sacrificing the adjacent ileum. We created a flap by opening the segment along the antimesenteric border, and used this flap to cover the defect. This method does not create a nonanatomical bypass and fewer intestinal anastomoses are required than for Roux-en-Y reconstruction.

Continuous mattress suture for all hand-sewn anastomoses of the gastrointestinal tract.

BACKGROUND: The continuous vertical mattress technique for anastomoses in the gastrointestinal or colorectal surgery has not been well reported in literature. METHODS: We used the technique for all hand-sewn anastomoses with double-armed monofilament absorbable suture (Glycomer 631). RESULTS: In the 266 consecutive anastomoses in 242 cases, there were 4 anastomotic leakages (1.5%) and 1 anastomotic stenosis (0.4%). CONCLUSIONS: The technique was feasible, time-saving, economical and with satisfactory results.