Since the discovery of small non-coding RNAs, the analyses of microRNA (miRNA) expression patterns in human cancer have provided new insights into cancer biology. miRNA-21 has been suggested to be one of the miRNAs that have an important role in the development or biological behavior of a variety of malignancies, including pancreatic cancer. This study was conducted to evaluate the relationship between the expression of miRNA-21 and that of its molecular targets, programmed cell death 4 (PDCD4) and tissue inhibitor of metalloproteinase (TIMP3), in pancreatic ductal adenocarcinoma. The study included 65 pancreatic ductal adenocarcinomas and 5 normal pancreatic tissue specimens for comparison. The miRNA expression profiling of five selected pancreatic ductal adenocarcinomas and five normal pancreatic specimens was performed using a microarray platform, and was evaluated by a hierarchical clustering analysis. The miRNA most highly expressed in pancreatic ductal adenocarcinomas (ie, miRNA-21) was further assessed by quantitative real-time reverse transcription PCR (RT-PCR) assays in the 65 pancreatic ductal adenocarcinoma cases. The expression pattern of its molecular targets (eg, PDCD4 and TIMP3) in pancreatic ductal adenocarcinoma was examined immunohistochemically. In the microarray analyses, 28 miRNAs were upregulated in pancreatic ductal adenocarcinoma compared with normal pancreatic tissue, whereas 48 miRNAs were downregulated. miRNA-21 was the most significantly overexpressed miRNA in the pancreatic ductal adenocarcinomas analyzed, and was also highly expressed in 75% of the 65 pancreatic ductal adenocarcinomas examined by real-time RT-PCR. High miRNA-21 expression was correlated with a worse prognosis in the pancreatic ductal adenocarcinoma patients (P ¼ 0.045). The immunohistochemical expression patterns of PDCD4 (reduced nuclear staining pattern) and TIMP3 (downregulated expression) were significantly associated with both the upregulated miR-21 expression (Po0.05) and the poor survival of the patients (Po0.001 and P ¼ 0.001, respectively). Our data suggest that an overexpression of miRNA-21 is, therefore, associated with the biological behavior of pancreatic ductal adenocarcinoma via the downregulation of the expression of tumor suppressors, PDCD4 and TIMP3, thus resulting in tumor progression and the adverse clinical course of pancreatic ductal adenocarcinoma.

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in Japan [1][2][3]. We and others have reported the advantages of the laparoscopic procedure compared to the conventional open method [4][5][6]. Distal gastrectomy is usually followed by Billroth I or Roux-en-Y anastomosis to restore continuity of the alimentary tract. When Billroth I reconstruction is diffi cult because of the physical status of the patient or because a large portion of the stomach has been resected, Roux-en-Y anastomosis is an alternative. Because intraabdominal anastomotic procedures are very complex, Billroth I or Roux-en-Y reconstruction is commonly performed extracorporeally through a minilaparotomy incision; thus, it is termed laparoscopy-assisted gastrectomy [7]. There have been only a few reports of intracorporeal Billroth I or Roux-en Y reconstruction after laparoscopic distal gastrectomy (LDG). Kanaya and colleagues [8] developed a method for Billroth I anastomosis after LDG that uses only endoscopic linear staplers. Takaori et al. [9] reported intracorporeal Roux-en-Y anastomosis with linear staplers, where the gastrojejunostomy was performed by "functional end-to-end anastomosis" between the residual stomach and the jejunum. In another type of intracorporeal side-to-side gastrojejunostomy, the outlet of the jejunum is arranged in a cranial-caudal straight direction [7]. In the case of a very small gastric remnant, the posterior wall of the greater curvature side near the transected stapler line becomes particularly susceptible to ischemia because the blood supply from the short gastric artery is interrupted by stapling for the gastrojejunostomy, as commonly performed using endoscopic linear staplers. To avoid this potentially dangerous condition, we have developed a new technique for intraabdominal Roux-en-Y reconstruction to allow the gastrojejunostomy to be made on the stomach transecting line.Herein we describe a unique but secure intraabdominal stapling technique that can be used even in patients with a very small residual stomach after LDG. AbstractLaparoscopic gastrectomy is widely used as minimally invasive surgery for gastric carcinoma. Billroth I or Roux-en-Y reconstruction is commonly performed after laparoscopic distal gastrectomy (LDG). Roux-en-Y reconstruction after LDG is one of the best methods for reconstruction of the alimentary tract when Billroth I reconstruction is diffi cult. There are few reports of intracorporeal Roux-en-Y reconstruction after LDG because of the technical diffi culties of such a procedure. In particular, in the case of a very small gastric remnant, gastrojejunostomy using endoscopic linear staplers becomes more complicated. We developed a new technique for intracorporeal Roux-en-Y reconstruction: a modifi ed stapling technique to allow the gastrojejunostomy to be made on the stomach transecting line that is applicable even when the residual stomach is very small. Roux-en-Y reconstruction with our modifi ed technique was performed in six patients. There was no intraoperative complication or conversion to minilaparotomy or conventional celiotomy...

We report a case of pancreatic melanotic schwannoma mimicking an epithelial cystic neoplasm of the pancreas. A 67-year-old Japanese woman underwent routine ultrasonography, which showed a large cystic mass in the head of the pancreas. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) showed an inhomogeneous, round cystic mass, which was encapsulated, in the head of the pancreas. We performed pyrolus-preserving pancreatoduodenectomy under the tentative diagnosis of a cystic neoplasm of the pancreas. The histopathologic diagnosis was benign melanotic schwannoma. The patient is now well after 43 months of follow-up. We describe the CT and MRI findings in detail, and review the literature on previously reported cases of pancreatic schwannoma.

Retrocolic RY with appropriate closure of defects can reduce IH incidence at Petersen's defect and at jejunojejunostomy mesenteric defect. Although the IH incidence at the transverse mesocolic defect is not particularly high, the possibility of herniation through this defect should be kept in mind.