From April 1980 to April 1995 a total of 54 patients (53 women, 1 man) were hospitalized in our department for the surgical treatment of radiation enterocolitis. Two surgical protocols were applied for these patients: intestinal decompression procedures alone (intestinal bypass, colostomy, or both; n = 18) or an intestinal resection in addition to decompression (n = 36). The clinical factors contributing to survival after irradiation were retrospectively reviewed by a multiple variate proportional hazards model. As a result, patients treated with decompression procedures alone had an 11 times higher risk for death than those treated with the addition of intestinal resection. In the former group, 5 of 18 patients died of bleeding from the remaining intestine after operation. We concluded that surgical resection of the diseased intestine is a useful procedure for treating radiation enterocolitis to reduce intestinal bleeding from the irradiated intestine.

We herein report the first case of a single-incision laparoscopic access (SILA) adrenalectomy in Japan. A 74-year-old woman who was a hepatitis B virus carrier was referred to our hospital because of an abnormal screening result during a routine health checkup. Abdominal computed tomography and an endocrinologic workup revealed a 2-cm left adrenal tumor with primary aldosteronism. We prioritized the safety of the SILA adrenalectomy by choosing a left lower abdominal approach. A SILS port was inserted through a 2.5-cm incision. An ultrasonic coagulator was the main tool used during the surgical procedure. The duration of the surgery was 105 min and the blood loss was 1 ml. This result was comparable to that of a conventional laparoscopic adrenalectomy. Based on our experience, an SILA adrenalectomy is thus considered to be feasible and safe, with better cosmetic results and a greater overall patient satisfaction than that of a conventional laparoscopic adrenalectomy. However, further studies will be necessary before the universal adoption of this new technique can be considered.

The proliferation and activation of CD4 + T helper 1 (Th1) cells and CD8 + cytotoxic T lymphocytes (CTLs) that produce interferon-γ (IFN-γ) is an essential action of effective cancer vaccines. Recently, a novel Wilms' tumor 1 (WT1) helper peptide (WT1 HP 34-51 ; amino acid sequence, WAPVLDFAPPGASAYGSL) applicable for various human leukocyte antigen (HLA) subtypes (HLA-DR, HLA-DP and HLA-DQ) was reported to increase peptide immunogenicity; however, the function of WT1 HP 34-51 remains unclear. In the present study, mature dendritic cells (mDCs) pulsed with WT1 HP 34-51 (mDC/WT1 HP 34-51 ) activated not only WT1-specific CD4 + T cells but also CD8 + T cells that produced IFN-γ following stimulation with immature dendritic cells (imDCs) pulsed with WT1 killer peptide (imDC/WT1 KP 37-45 ) in an HLA-A*02:01-or HLA-A*02:06-restricted manner. Furthermore, the activated WT1-reactive CD4 + Th1 cells were predominantly effector memory (EM) T cells. In 5 of 12 (41.7%) patients with cancer carrying the HLA-A*02:01 or HLA-A*02:06 allele, WT1-reactive CD8 + T cells stimulated with mDC/WT1 HP 34-51 enhanced their levels of WT1 KP 37-45 -specific IFN-γ production, with an increase >10%. Simultaneous activation of CD4 + and CD8 + T cells occurred more often when stimulation with mDC/WT1 HP 34-51 was combined with imDC/WT1 KP 37-45 restimulation. These results indicated that the novel mDC/WT1 HP 34-51 combination induced responses by WT1-specific EM CD4 + Th1 cells and HLA-A*02:01-or HLA-A*02:06-restricted CD8 + CTLs, suggesting its potential as a WT1-targeting cancer vaccine.

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.

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