Adult primary gastric volvulus, a report of two cases.

Gastric volvulus is the medical situation that a stomach is twisted beyond the physiological range. It is a rare disease which is hard to experience in routine medical examination. Principally surgical treatment is essential for the acute type. However, the conservative therapy should be attempted in some cases, such as decompression of a stomach with a nasogastric tube, endoscopic reduction and so forth. Concerning surgical operation, the base is reduction of the torsion and immobilization of stomach. Recently, laparoscopic surgery is performed for the case that the general condition is stable or chronically progressive in the early stages. Percutaneous endoscopic gastrostomy (PEG) had also been performed for gastric immobilization. However, the recurrences and problems of twisting around the gastrostomy site were reported in addition to the problem of cosmetic outcomes. Therefore, the case is decreasing. In this paper, we present two cases on adult primary gastric volvulus. For the first case, endoscopic reduction was not good enough to release the torsion state. Then laparoscopic gastropexy was performed successfully. For the second case, we succeeded in endoscopic reduction. Since the patient had already experienced gastric volvulus, laparoscopic surgery was performed. The upper and middle gastric bodies were secured to the anterior abdominal wall, and gastric antrum to the ligamentum teres hepatis with interrupted absorbable sutures respectively. However, partial gastric volvulus recurred after ten and a several days postoperatively due to cutting off of the suture at the antrum secured to the ligamentum teres hepatis at previous surgery. Then, PEG for 2 points of lower body and antrum were performed to secure the antrum. The gastrostomies were removed 6 months after the surgery. Immobilization by laparoscopic gastropexy and PEG are useful for gastric volvulus due to their significant merit of minimum invasiveness. Concerning gastropexy, the number of sutures is very important for the secured part not to be torn off.

[An elderly case of recurrent colon cancer responding to weekly S-1 chemotherapy leading to partial response].

An 82-year-old female with unresectable colon cancer accompanied by multiple lung metastasis was treated with S-1. Our course consisted of S-1(80 mg/body)from day 1 to 5 followed by 2 days rest. After 14 courses, multiple lung metastasis decreased in size. After 20 courses, the multiple lung metastasis disappeared and local recurrence of colon cancer decreased. Weekly S-1 leads to a partial response. Our chemotherapy showed simple and good compliance for a patient over 80 years old.

Identification of cardiac myocytes as the target of interleukin 11, a cardioprotective cytokine.

Interleukin (IL)-6 family cytokines, which share glycoprotein 130 (gp130) as a signal-transducing receptor component, play important roles in the maintenance of cardiac homeostasis. IL-11, a member of IL-6 family cytokines, is expressed in cardiac myocytes, though it remains to be elucidated how IL-11 functions in the hearts. In the present study, first, we showed that IL-11 administration reduced the ischemia/reperfusion injury in the hearts. IL-11 receptor alpha was expressed in cardiomyocytes. IL-11 treatment rapidly activated signal transducer and activator of transcription 3 (STAT3) and extracellular signal-regulated kinase (ERK) 1/2 in cardiac myocytes. IL-11 stimulation resulted in the translocation of phosphorylated STAT3 into nuclei. Immunofluorescence microscopic analyses revealed that IL-11 treatment led to the cell elongation, as is the case with other cardiotrophic members of IL-6 family, such as leukemia inhibitory factor. Finally we showed that IL-11 treatment conferred the resistance to cell death induced by hydrogen peroxide, which was abrogated by adenoviral transfer of dominant negative STAT3, but not by the inhibition of ERK1/2 with U0126. These findings indicate that IL-11 mediates cytoprotective signals in cardiomyocytes, proposing that IL-11 has the potential to exhibit cardioprotection as a novel biological function.