Feasibility of laparoscopic resection of mesenteric cysts: two case reports.

INTRODUCTION: Mesenteric cysts (MC) are rare intra-abdominal tumors. The incidence has been estimated to be 1/100000 in the adult population and 1/20000 in children, with a male: female ratio of 1:1. The first successful laparoscopic resection of a MC was reported by MACKENZIE et al. in 1993. The malignant transformation appears in 3% of cases. In our study, we presented the feasibility and results of laparoscopic resection. CASE REPORTS: We report two cases of mesenteric cysts removed by a laparoscopic procedure. RESULTS: Laparoscopic approach in the two cases was successful. No conversion was observed. No complication occurred. The histopathological studies revealed no malignancy. After 18 months of follow-up the 2 patients remained free of disease. CONCLUSION: In selected cases, safe and complete resection of MC could be achieved by laparoscopic approach. Complete surgical resection of MC is the treatment of choice when the cyst becomes symptomatic or when complications occur.

[Gastric adenocarcinoma following "silastic vertical ring gastroplasty": case report]. / Survenue d'un adénocarcinome gastrique 10 ans après une "silastic ring vertical gastroplasty ": cas isolé ou lien de cause à effet?

OBJECTIVES: Bariatric surgery is considered as the most effective therapy for morbid obesity. But, each procedure carries both short-and long-term complications. And, it remains unclear if the late occurrence of gastric adenocarcinoma could be linked to bariatric surgery. We described a case of a female who developed a gastric adenocarcinoma after a silastic ring vertical gastroplasty (SRVG). METHODS: A 54-year-old female presented with postprandial vomiting, poor appetite, dysphagia and weight loss 10 year after a SRVG. A gastroscopy with biopsy disclosed a juxta-pyloric adenocarcinoma. No distant metastasis was found. After 3 cycles of neoadjuvant chemotherapy, a subtotal gastrectomy with Roux-en-Y anastomosis was performed. RESULTS: After the surgery, a minor anastomotic leak was treated conservatively and a parietal abscess was drained. The pathological studies demonstrated a T2bN1 adenocarcinoma with negative margins. Adjuvant chemotherapy was administered. At the last work up, the patient is disease-free. CONCLUSION: The association between a gastric adenocarcinoma and a bariatric procedure such as a SRVG is difficult to assess without a case-control or a cross-sectional study. Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be bear in mind.

The alphavbeta5 integrin functions as an endocytic receptor for vitronectin.

Endocytosis and degradation of vitronectin by human skin fibroblasts are regulated by the beta5 integrin. To determine whether the beta5 integrin is directly mediating the internalization of vitronectin, both vitronectin and the beta5 integrin were localized by indirect immunofluorescence during the endocytic process. This analysis showed that both vitronectin and beta5 were found in intracellular vesicles within 5 minutes of the addition of exogenous vitronectin to fibroblast cell layers. By 15 minutes, approximately 20% of the vitronectin-containing vesicles stained positively for beta5. In contrast, the beta3 integrin was not found in any intracellular vesicles. Within 30 minutes, more than 50% of vitronectin-containing vesicles also stained for lamp-1, indicating that internalized vitronectin traveled to lysosomes. Inhibition of clathrin assembly by either potassium depletion or hypertonic buffer inhibited vitronectin internalization, suggesting that vitronectin internalization occurred through coated pits. Confocal analysis confirmed the colocalization of vitronectin and alphavbeta5 in intracellular compartments and further demonstrated that the highest colocalization of the two proteins occurred within 1.8 microm from the ventral surface of the cell, suggesting endocytosis occurred at the substrate level. Pretreatment of cells with the PI-3 kinase inhibitor, wortmannin, resulted in a marked increase in the coincidence of vitronectin and beta5 staining within vesicles and prevented the accumulation of vitronectin within lysosomes. This suggests that following internalization, vitronectin and the alphavbeta5 integrin are segregated to different cellular compartments. This study provides the first evidence that the alphavbeta5 vitronectin receptor directly mediates the internalization of vitronectin.