Using the uterus to close a pelvic defect after primary perineal posterior hernia repair: report of a case.

Perineal hernias rarely develop spontaneously, and their treatment is controversial. We report a case of a primary perineal posterior hernia in an 81-year-old woman, who presented with progressive bulging in the perineal area, preventing comfortable excretion. The diagnosis was established by herniography. We operated via an abdominal approach and repaired the hernia by reconstructing the pelvic floor using the uterus. To our knowledge, reconstruction using the uterus to repair a pelvic defect has not been reported before.

[A case of recurrent gastric cancer patient with peritoneal dissemination who obtained a long-term survival and QOL by multi-modality therapy].

We report a case of recurrent gastric cancer patient with peritoneal dissemination who obtained a long-term survival and QOL by multi-modality therapy. A 54-year-old woman underwent a total gastrectomy against type 4 gastric cancer (por 2 ss ly1 v1 n0, pT2 pN0 sH0 sP0 sCY0 sM0, fStage IB). After two years, multiple stenoses due to peritoneal dissemination occurred consecutively. Multi-modality therapy combining operation, chemotherapy, and IVR was applied. Symptoms due to stenoses were decreased and a long-term survival was successfully acquired.

[A case of advanced gastric cancer patient who died from meningitis carcinomatosa after S-1 + CDDP therapy with good response].

A 68-year-old male who had undergone a distal gastrectomy for gastric cancer in 1996 visited our hospital. Gastroscopy revealed a type 2 tumor at upper corpus, and its biopsy showed poorly differentiated adenocarcinoma. Because enhanced CT showed lymph node swelling at para aorta, S-1 (100 mg/day) was administered for 14 days and CDDP (20 mg/day) was administered for 4 days as 1 course. After 2 courses, the main tumor and lymph node swelling reduced evidently. A total gastrectomy was performed and the pathology revealed no cancer cells in the stomach and dissected lymph nodes. Two months after the operation, speech disturbance and numbness of the left hand appeared. CT showed 3 metastatic brain tumors, and radiation therapy was administered. Four months after the operation, headache appeared and cerebrospinal fluid examination showed adenocarcinoma cells. Although MTX (10 mg) was administered intrathecally, he was died 5 months after the operation.

Reg IV expression and clinicopathologic features of gallbladder carcinoma.

Regenerating islet-derived family, member 4 (Reg IV) has been shown to be associated with colorectal carcinogenesis and gastric carcinogenesis through intestinal metaplasia. In this study, we examined Reg IV expression in the gallbladder and gallbladder carcinoma, and measured Reg IV levels in sera from patients with gallbladder carcinoma. Quantitative reverse transcription-polymerase chain reaction revealed that high Reg IV levels were identified in 17 of 31 gallbladder carcinomas, whereas there was no apparent amplification in normal gallbladders. Immunohistochemically, although only a small part of the epithelium with intestinal metaplasia in 2 of 4 cases with adenomyomatosis showed Reg IV expression, Reg IV was negative in all cases with normal gallbladder (n = 15) and cholelithiasis (n = 13). In contrast, 34 (56%) of 61 gallbladder carcinomas were positive. Expression was more frequently observed in well to moderately differentiated than in poorly differentiated adenocarcinomas and significantly correlated with expression of caudal-related homeobox transcription factor (a candidate for involvement in the induction of intestinal metaplasia). Multivariate analysis revealed negative Reg IV expression, as well as hepatic parenchymal invasion, to be independently associated with a poor prognosis in patients with advanced gallbladder carcinoma. Before surgical resection, 4 (33%) of 12 patients with gallbladder carcinoma had high serum Reg IV levels, whereas Reg IV was never elevated in 12 patients with benign diseases. The serum levels of Reg IV decreased after surgical resection of the tumors. These results suggest that Reg IV is involved in gallbladder carcinoma carcinogenesis through intestinal metaplasia and is associated with relatively favorable prognosis in patients after surgery. The serum level of Reg IV may be of use or indicative of neoplasia.

Upregulation of topoisomerase IIalpha expression in advanced gallbladder carcinoma: a potential chemotherapeutic target.

PURPOSE: The lack of treatment options other than surgical resection results in unfavourable prognosis of advanced gallbladder carcinoma. The aim of this study was to identify cancer-specific cellular targets that would form the basis for some therapeutic approaches for this disease. METHODS: Twelve advanced gallbladder carcinoma tissue samples and three samples of normal gallbladder epithelium were screened to identify differentially expressed genes by DNA microarray analysis. The results obtained were validated in an independent sample set by quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR). Among the genes picked-up, one molecule, topoisomerase IIalpha (TOPO IIalpha), was further assessed immunohistochemically as a potential chemotherapeutic target, and the growth inhibitory effects of etoposide, doxorubicin and idarubicin, representative TOPO IIalpha inhibitors, on two different gallbladder carcinoma cell lines were compared with that of gemcitabine and 5-fulorouracil. RESULTS: Five upregulated genes were identified: four cell cycle-related genes (TOPO IIalpha, cyclin B2, CDC28 protein kinase regulatory subunit 2, ubiquitin-conjugating enzyme E2C) and a metabolism-related gene (gamma-glutamyl hydrolase). Immunohistochemically, TOPO IIalpha was expressed in gallbladder cancer cells, and 16 of 35 cases (46%) had strong TOPO IIalpha expression defined as having a labeling index of >50%. In in vitro growth inhibition assay, etoposide, as well as doxorubicin and idarubicin, was the most effective for OCUG-1 cells that had strong TOPO IIalpha expression, while gemicitabine was the most effective for NOZ cells with weak TOPO IIalpha expression. Etoposide induced apoptosis of OCUG-1 cells. CONCLUSIONS: TOPO IIalpha might be an effective chemotherapeutic target in advanced gallbladder carcinoma, especially when it is expressed strongly.