[Development of Dose Management Software Using Visual Basic for Applications and Dose Evaluation in the Field of Nuclear Medicine].

PURPOSE: The purpose of this study was to develop software for smooth dose management based on the Japan diagnostic reference levels (DRLs 2020) in the field of nuclear medicine. METHOD: Using the programming language Visual Basic for Applications (VBA), we implemented a function for calculating actual doses, a function for comparing doses at one's own facility with those of DRLs 2020, a function for calculating appropriate doses for pediatric nuclear medicine examinations, and so on. In addition, we evaluated actual doses before and after the software implementation. RESULT: The software enabled easy calculation of actual doses and comparison with DRLs 2020 for smooth dose management. Furthermore, we were able to use the results of dose evaluation to determine the dosage at our facility and to use them as a reference for optimization. CONCLUSION: In the field of nuclear medicine, it is possible to manage doses in accordance with DRLs 2020 by introducing own software into our clinical practice.

New insights into donor directionality of mating-type switching in Schizosaccharomyces pombe.

Mating-type switching in Schizosaccharomyces pombe entails programmed gene conversion events regulated by DNA replication, heterochromatin, and the HP1-like chromodomain protein Swi6. The whole mechanism remains to be fully understood. Using a gene deletion library, we screened ~ 3400 mutants for defects in the donor selection step where a heterochromatic locus, mat2-P or mat3-M, is chosen to convert the expressed mat1 locus. By measuring the biases in mat1 content that result from faulty directionality, we identified in total 20 factors required for donor selection. Unexpectedly, these included the histone H3 lysine 4 (H3K4) methyltransferase complex subunits Set1, Swd1, Swd2, Swd3, Spf1 and Ash2, the BRE1-like ubiquitin ligase Brl2 and the Elongator complex subunit Elp6. The mutant defects were investigated in strains with reversed donor loci (mat2-M mat3-P) or when the SRE2 and SRE3 recombination enhancers, adjacent to the donors, were deleted or transposed. Mutants in Set1C, Brl2 or Elp6 altered balanced donor usage away from mat2 and the SRE2 enhancer, towards mat3 and the SRE3 enhancer. The defects in these mutants were qualitatively similar to heterochromatin mutants lacking Swi6, the NAD+-dependent histone deacetylase Sir2, or the Clr4, Raf1 or Rik1 subunits of the histone H3 lysine 9 (H3K9) methyltransferase complex, albeit not as extreme. Other mutants showed clonal biases in switching. This was the case for mutants in the NAD+-independent deacetylase complex subunits Clr1, Clr2 and Clr3, the casein kinase CK2 subunit Ckb1, the ubiquitin ligase component Pof3, and the CENP-B homologue Cbp1, as well as for double mutants lacking Swi6 and Brl2, Pof3, or Cbp1. Thus, we propose that Set1C cooperates with Swi6 and heterochromatin to direct donor choice to mat2-P in M cells, perhaps by inhibiting the SRE3 recombination enhancer, and that in the absence of Swi6 other factors are still capable of imposing biases to donor choice.

Prospective randomized controlled study on the validity and safety of an absorbable adhesion barrier (Interceed®) made of oxidized regenerated cellulose for laparoscopic colorectal surgery.

INTRODUCTION: Clinical use of an adhesion barrier made of oxidized, regenerated cellulose, Interceed®, has been reported in the field of obstetrics and gynecology to help prevent adhesions between the peritoneum and the bowel in various types of operations. In gastrointestinal surgery, sodium hyaluronate/carboxymethylcellulose has been reported as an absorbable membrane to reduce postoperative adhesions. The present study was a prospective randomized controlled study to investigate the safety and usefulness of Interceed in laparoscopic colorectal surgery. METHODS: We analyzed 99 patients who underwent laparoscopic colorectal surgery from 2013 to 2014. The patients were randomly allocated to the group that used Interceed (Interceed group) or the group that did not (Non-Interceed group). RESULTS: Fifty cases used Interceed, and 49 cases did not. The incidence of adverse events was 12.0% in the Interceed group and 16.3% in the Non-Interceed group (P = 0.58). There were no significant differences, and no adhesive bowel obstructions were observed in the Interceed group. CONCLUSION: We have shown that using Interceed in laparoscopic colorectal surgery is valid and technically safe.

Laparoscopic Surgery is Useful for Preventing Recurrence of Small Bowel Obstruction After Surgery for Postoperative Small Bowel Obstruction.

INTRODUCTION: Risk factors for recurrence postoperative small bowel obstruction in patients who have postoperative abdominal surgery remain unclear. MATERIALS AND METHODS: The study group comprised 123 patients who underwent surgery for ileus that developed after abdominal surgery from 1999 through 2013. There were 58 men (47%) and 65 women (53%), with a mean age of 63 years (range, 17 to 92 y). The following surgical procedures were performed: lower gastrointestinal surgery in 47 patients (39%), gynecologic surgery in 39 (32%), upper gastrointestinal surgery in 15 (12%), appendectomy in 9 (7%), cholecystectomy in 5 (4%), urologic surgery in 5 (4%), and repair of injuries caused by traffic accidents in 3 (2%). Laparoscopic surgery was performed in 75 patients (61%), and open surgery was done in 48 (39%). We examined the following 11 potential risk factors for recurrence of small bowel obstruction after surgery for ileus: sex, age, body mass index, the number of episodes of ileus, the number of previously performed operations, the presence or absence of radiotherapy, the previously used surgical technique, the current surgical technique (laparoscopic surgery, open surgery), operation time, bleeding volume, and the presence or absence of enterectomy. RESULTS: The median follow-up was 57 months (range, 7 to 185 mo). Laparoscopic surgery was switched to open surgery in 11 patients (18%). The reason for surgery for postoperative small bowel obstruction was adhesion to the midline incision in 36 patients (29%), band formation in 30 (24%), intrapelvic adhesion in 23 (19%), internal hernia in 13 (11%), small bowel adhesion in 20 (16%), and others in 1 (1%). Postoperative complications developed in 35 patients (28%): wound infection in 12 (10%), recurrence of postoperative small bowel obstruction in 12 (10%), paralytic ileus in 4 (3%), intra-abdominal abscess in 3 (2%), suture failure in 1 (1%), anastomotic bleeding in 1 (1%), enteritis in 1 (1%), and dysuria in 1 (1%). Enterectomy was performed in 42 patients (38%). On univariate analysis, 2 risk factors were significantly related to the recurrence of small bowel obstruction: open surgery (P=0.017) and bleeding volume (P=0.031). On multivariate analysis, open surgery was an independent risk factor for the recurrence of small bowel obstruction (odds ratio, 5.621; P=0.015). CONCLUSIONS: Open surgery was an independent risk factor for the recurrence of small bowel obstruction after abdominal surgery. In the future, laparoscopic surgery should be performed to prevent the recurrence of small bowel obstruction.

Case report of a laparoscopically resected rectal villous tumor associated with electrolyte depletion syndrome.

A 70-year-old woman had been aware of lower extremity weakness and anal discomfort for 3 years. A soft, elastic, palm-sized mass covered by a large amount of mucus was found protruding from the anus. Biopsy revealed a villous adenoma. On the basis of these results, a villous adenoma associated with electrolyte depletion syndrome was diagnosed. After electrolyte abnormalities were improved by fluid replacement therapy, laparoscopic abdominoperineal resection was performed. The surgically resected specimen was a circumferential villous tumor measuring 210 × 140 mm. The histopathological diagnosis was an intramucosal papillary adenocarcinoma. The patient recovered uneventfully after surgery, and the electrolyte abnormalities gradually improved. She was discharged on the 28th postoperative day. The electrolyte levels normalized about 3 months after surgery.

Clinical usefulness of laparoscopic surgery for clinical stage 0/I cancer in the rectum: a single-center experience in 137 patients.

PURPOSE: Laparoscopic surgery has yet to achieve widespread acceptance for the treatment of rectal cancer because of technical difficulty caused by anatomical features and the lack of sufficient evidence supporting effectiveness. Consequently, the safety and long-term outcomes of laparoscopic surgery for rectal cancer remain to be established in Japan. We evaluated the feasibility, safety, and effectiveness of laparoscopic surgery in patients with up to clinical stage 0/I rectal cancer. MATERIALS AND METHODS: From February 1998 through December 2010, we studied 137 patients with up to clinical stage 0/I rectal cancer treated by laparoscopic surgery. Surgical outcomes, invasiveness, safety, recurrence rates and patterns, and medium-term outcomes were examined. Four patients were converted to open surgery and excluded from analysis. RESULTS: The median follow-up was 64 months (range, 9 to 156 mo), and the rate of conversion to open surgery was 2.8% (4/141). Postoperative complications occurred in 37 patients (27%) and included anastomotic leakage in 10 patients (10/125, 7.9%) and ileus in 10 patients (10/37, 7.3%). The recurrence rate was 6.6%. Lung metastasis and liver metastasis were frequent, but no patient had port-site recurrence. The 5-year disease-free survival rate and the cumulative survival rate were 94.2% and 96.9%, respectively, in patients with stage I disease and 80.2% and 94.7% in those with stage III disease. DISCUSSION: Laparoscopic resection had good surgical outcomes, minimal invasiveness, high safety, and high rates of disease-free survival and overall survival in patients with up to clinical stage 0/I rectal cancer. These results suggest that laparoscopic surgery is a safe and effective procedure for the management of rectal cancer with clinical stage 0/I.

Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer.

PURPOSE: Short-term and midterm outcomes of surgery remain unclear in very elderly patients (≥85 y) with colorectal cancer. This study was designed to clarify the safety and therapeutic usefulness of surgery for colorectal cancer in this subgroup of patients. We compared postoperative short-term and midterm outcomes between laparoscopic surgery and open surgery to evaluate the feasibility of laparoscopic surgery in very elderly patients. MATERIALS AND METHODS: The study group comprised 80 patients [38 men (48%) and 42 women (52%)] aged 85 years or older who had colorectal cancer and were treated in our department from 1987 to 2010. The mean age was 87.3±2.3 years, and the median follow-up was 45 months (range, 4 to 252 mo). Sixty-nine patients (86%) were 85 to 89 years old, and 11 (14%) were aged 90 years or older. The American Society of Anesthesiologists' (ASA) risk class was I in 2 patients (2%), II in 44 (55%), and III in 34 (43%). Open surgery was performed in 46 patients (58%), and laparoscopic surgery was performed in 34 patients (42%). RESULTS: The ASA risk class was II or III in 78 patients (98%). Postoperative complications occurred in 21 patients (26%), including ileus in 8 patients (10%), wound infection in 7 (9%), and anastomotic leakage in 3 (4%). As compared with open surgery, laparoscopic surgery had significantly lower intraoperative blood loss (P<0.0001) and a significantly shorter postoperative hospital stay (P=0.0001) but required a significantly longer operation time (P=0.0017). Clinicopathologically, laparoscopic surgery was associated with a significantly smaller tumor size (P=0.0371), significantly fewer dissected lymph nodes (P=0.0181), and significantly fewer patients with stage II or III disease (P=0.0090). Postoperative complications occurred in 14 patients (30%) in the open surgery group and 6 (18%) in the laparoscopic surgery group, but this difference was not significant. As for midterm outcomes, the disease-free survival rate and the overall survival rate were, respectively, 90.9% and 100% in stage I disease, 89.7% and 100% in stage II disease, and 68.4% and 75.9% in stage III disease. CONCLUSIONS: Colorectal surgery was safe, therapeutically useful, and had good short-term and midterm outcomes in very elderly patients with colorectal cancer. As compared with open surgery, laparoscopic surgery was associated with lower intraoperative blood loss and a shorter postoperative hospital stay. These results suggest that laparoscopic surgery is suitable for very elderly patients with colorectal cancer because it is less invasive than open surgery.

Laparoscopic surgery for obese patients with colon cancer: a case-matched control study.

PURPOSE: This study compared the results of laparoscopic surgery for colon cancer in obese patients with a body-mass index (BMI) of 25 kg/m(2) or higher with those in nonobese patients (BMI <25 kg/m(2)) who were matched for clinicohistopathological factors. METHODS: The oncologic outcomes were compared between 140 patients with a BMI of 25 kg/m(2) or higher (obese group) and 140 patients with a BMI of <25 kg/m(2) (nonobese group) that were matched for sex, tumor location, date of operation, and pTNM stage. RESULTS: The proportion of patients with postoperative complications was significantly higher in the obese group (15 %) than in the nonobese group (6 %). The disease-free survival rate and overall survival rate in patients with stage I or II disease were similar in the obese group (98.6 and 98.8 %, respectively) and the nonobese group (97.8 and 97.8 %, respectively). The disease-free survival rate and overall survival rate in patients with stage III disease also did not differ significantly between the obese group (77.2 and 79.4 %, respectively) and the nonobese group (83.4 and 84.9 %, respectively). CONCLUSIONS: Postoperative complications and long-term oncologic outcomes were similar in obese and nonobese patients who underwent laparoscopic colectomy for colon cancer in this hospital.

[Neoadjuvant chemotherapy for colorectal cancer].

Surgery continues to play an important role in the curative treatment of gastrointestinal cancer. Recently, considerable progress has been made in chemotherapy and radiotherapy. In particular, chemotherapy with FOLFIRI and FOLFOX has prolonged survival in patients with colorectal cancer. Molecular-targeted agents have also enhanced the effectiveness of chemotherapy. However, radical resection offers the potential for a cure and is unsurpassed by any other treatments. Nonetheless, further improvement in survival is unlikely to be achieved by surgery alone. Studying how treatment regimens highly effective against unresectable or recurrent colorectal cancer can be adapted to patients with resectable disease is thus an important issue.

Benefits of a straight laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis: a retrospective case-matched study.

PURPOSES: The aim of this study was to evaluate the benefit of straight laparoscopic restorative proctocolectomy (sLRP) with ileal pouch anal anastomosis for ulcerative colitis (UC). METHODS: Twenty patients underwent sLRP or open restorative proctocolectomy. The 2 groups were retrospectively well matched with respect to sex, body mass index, and American Society of Anesthesiologists' score. RESULTS: The median operative time was longer in the sLRP group (P=0.0003). The median operative blood loss was significantly less in the sLRP group (P=0.0054). The median analgesic drug usage during the first 7 days after surgery was lower in the sLRP group (P=0.038). There were no differences in morbidity rates and long-term functional outcome measures between the groups. CONCLUSIONS: An sLRP for UC has the advantage over an open restorative proctocolectomy of better short-term outcomes, and both groups have similar long-term outcomes. This procedure is acceptable for minimally invasive surgery in patients with UC.

Laparoscopic resection of a gastrointestinal stromal tumor of the rectum after treatment with imatinib mesylate: report of a case.

This report describes the laparoscopic resection of a rectal GIST after treatment with imatinib mesylate. A 56-year-old male presented with a submucosal tumor (longest diameter, 8 cm) arising in the lower rectum. A core needle biopsy revealed that the tumor contained bundles of spindle-like cells. Immunostaining revealed that the tumor was positive for c-kit and CD34. Analysis of the c-kit gene revealed a substitution of ACA (threonine) by GCA (alanine) at codon 574 of exon 11. Imatinib mesylate (400 mg/day) was given as preoperative adjuvant therapy for 3 months, and the tumor shrank to 5 cm in diameter. Proctectomy with transanal anastomosis could be performed laparoscopically, while preserving the anus. There was no evidence of recurrence 2 years 6 months after surgery. Preoperative adjuvant chemotherapy with imatinib mesylate may permit the use of less invasive treatment procedures, allowing anal preservation.

Short- and long-term outcomes of laparoscopic surgery in patients with pathological stage II and III colon cancer.

BACKGROUND/AIMS: In Japan, the safety and long-term outcomes of laparoscopic surgery for advanced colorectal cancer remains a matter of debate. We studied the safety and outcomes of laparoscopic surgery in patients with pathological stage II and III colon cancer. METHODOLOGY: The study group comprised 253 patients with colon cancer who underwent laparoscopic surgery from January 1998 through December 2006. We studied surgical outcomes, invasiveness, safety, recurrence rates, recurrence patterns, and long-term outcomes. RESULTS: Median follow-up was 67 months (range, 7-149). Laparoscopic surgery was converted to open surgery in 5 patients (2%). Postoperative complications occurred in 23 patients (9%); wound infections were most common (11 patients, 4.3%), followed by ileus (5 patients, 1.9%). Recurrence developed in 66 patients (26%). Liver and lung metastases were the most common types of recurrence; there was no port-site recurrence. The 10-year recurrence-free survival rate and the overall survival rate were respectively 92.9% and 93.3% in stage II disease, 82.7% and 82.9% in stage IIIA and IIIB disease, and 70.3% and 68.6% in stage IIIC disease. CONCLUSIONS: In patients with pathological stage II and III colon cancer, laparoscopic surgery is safe, minimally invasive, and has good surgical outcomes, overall survival rates and recurrence-free survival rates. Our results suggest that laparoscopic surgery is a viable treatment option for pathological stage II and III colon cancer.

Oncological outcomes of laparoscopic surgery in elderly patients with colon cancer: a comparison of patients 64 years or younger with those 75 years or older.

BACKGROUND/AIMS: We compared the results of laparoscopic resection of colon cancer between patients 75 years or older and those 64 years or younger, to confirm whether this procedure is warranted in elderly patients. METHODOLOGY: The study group was comprised of patients with stage I to III colon cancer treated by laparoscopic surgery from 1995 through 2006. Oncologic outcomes were compared between 74 patients 75 years or older (elderly group) and 74 patients 64 years or younger (younger group) who were matched for gender, tumor location and pathological tumor-node-metastasis (TNM) stage. RESULTS: In patients with stage I or II disease, the disease-free survival rate and overall survival rate were similar in the elderly group (100% and 100%, respectively) and the younger group (95.6% and 95.8%, respectively). In patients with stage III disease, the disease-free survival rate and overall survival rate were also similar in the elderly group (76.7% and 88.5%, respectively) and the younger group (88.5% and 88.5%, respectively). CONCLUSIONS: Postoperative complications and long-term oncologic outcomes were similar in elderly patients and younger patients with colon cancer who underwent laparoscopic colectomy in our hospital. These results demonstrate that laparoscopic resection of colon cancer is warranted in patients 75 years or older.

[Advances in laparoscopic surgery for colorectal cancer].

Laparoscopic surgery for colorectal cancer must follow the same basic principles as open surgery. However, the special approach used for laparoscopic surgery differs essentially from the one used for conventional open surgery. Within the narrow working space permitted by laparoscopy, precluding an understanding of the entire picture, it is most important to secure an adequate field of vision. Lymph-node dissection performed with a forceps providing no sense of touch requires extreme caution and a bloodless procedure. Recently, remarkable progress has been made in devices designed to overcome the shortcomings of laparoscopic surgery. We present the current status and problems of laparoscopic surgery for colorectal cancer and discuss future developments.