How to do noninflated intracorporeal anastomosis.

We present a modified technique called noninflated intracorporeal ileocolic anastomosis, which maintains the benefits of the intracorporeal technique, but has the advantages of no requirement for laparoscopic suturing.

Hepatic hydrothorax after blunt chest trauma.

We report a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. This was a female patient with liver cirrhosis, Child-Turcotte-Pugh class A, without ascites before injury. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually. We inserted a chest tube to relieve the patient's symptoms, and the daily drainage amount remained consistent. Hepatic hydrothorax was confirmed by the intraperitoneal injection of radioisotope 99mTc-sulfur colloid that demonstrated one-way transdiaphragmatic flow of fluid from the peritoneal cavity to pleural cavities. Finally, the hydrothorax was treated successfully by minocycline-induced pleural symphysis. To the best of our knowledge, this is the first case of hepatic hydrothorax developed after thoracoabdominal trauma.

Spleen artery embolization increases the success of nonoperative management following blunt splenic injury.

BACKGROUND: Spleen artery embolization (SAE) may increase the success rate of nonoperative management (NOM). The present study investigated the clinical outcome after the installation of SAE in the management of blunt splenic injury. METHODS: A retrospective review of hospital records was performed to enroll patients with blunt injury of the spleen. Demographic data and information about the injury severity score, organ injury scale, hospitalization days, management and final outcomes were evaluated. Patients were separated into early and late groups according to the year that SAE was selectively used (2003-2004 and 2005-2008). RESULTS: Six of eleven (55%) patients in the early group were successfully managed without surgery for blunt splenic injury, whereas all of the 38 patients (100%) in the late group were successfully managed without surgery. Eleven patients (11 of 38; 28.9%) received SAE in the late group. The rate of NOM increased from 55% in the early group to 100% in the late group (p < 0.001). Both early and late groups had similar injury severity score, length of hospitalization, blood transfusion, and complications, and there was no mortality. CONCLUSION: Performance of SAE for the patients with blunt splenic injury could increase the successful rate of NOM significantly and safely. An algorithm including the angioembolization might be beneficial in the management of patients with blunt spleen trauma.

Nuclear expression of CXCR4 is associated with advanced colorectal cancer.

BACKGROUND AND OBJECTIVES: CXCR4 and its ligand, SDF-1alpha, play an important role in the targeted metastasis of colon cancer. In this study, we analyzed an expression of CXCR4 in clinical samples and showed that SDF-1alpha affected the expression of CXCR4 in colon cancer cells. MATERIALS AND METHODS: A total of 388 patients with colorectal cancer (CRC) who underwent surgery in Taipei Veterans General Hospital from 2000 to 2004 were included. The expression of CXCR4 in CRC was visualized by immunohistochemistry (anti-CXCR4 mAb, R&D 12G5). HCT116, SW480, and SW620 cells were treated with SDF-1alpha in vitro and the CXCR4 proteins located in the cytoplasmic and nuclear compartments were separated and analyzed with western blotting. RESULTS: The frequency of cytoplasmic and nuclear expression of CXCR4 in colorectal cancers was 35.6% and 36.9%, respectively. Nuclear but not cytoplasmic expression of CXCR4 was associated with advanced CRC (p < 0.001) and lymphovascular invasion. However, in multivariate analysis, nuclear expression of CXCR4 did not correlate with patients' outcome. In the in vitro study, SDF-1alpha, stimulation of three colorectal carcinoma lines enhanced the CXCR4 nuclear expression. CONCLUSION: Expression of the CXCR4 plays a role in CRC progression and may be associated with SDF-1alpha stimulation.