Heterotopic mesenteric ossification (HMO) is a rare disease that results in intra-abdominal ossification of unknown origin. An 88-year-old man developed an intestinal obstruction 2 weeks after undergoing an operation for a ruptured abdominal aortic aneurysm, resulting in intestinal obstructions those did not improved concervatively. During relaparotomy performed 30 days after the first operation, hard adhesions of the small intestine and mesentery were found; these adhesions were difficult to separate without damaging the serosa of the small intestine. We removed 240 cm of the small intestine and performed a jejuno-ileo anastomosis. Microscopically, trabecular bone tissue had increased irregularly in the fat tissue of the nodules with fibrosis, which were partially lined with osteoblasts. Accordingly, we histopathologically diagnosed the patient as having HMO. The patient was treated with NSAIDs and cimetidine to prevent the recurrence of HMO. No signs of recurrence have occurred as of one year after the second operation.

We report a case of necrosis of a reconstructed gastric tube in a 77-year-old male patient who had undergone esophagectomy. At the time of admission, the patient had active gastric ulcers, but these were resolved by treatment with a proton pump inhibitor. Subtotal esophagectomy with gastric tube reconstruction was performed. Visually, the reconstructed gastric tube appeared to be well perfused with blood. Using indocyanine green (ICG) fluorescence imaging the gastroepiploic vessels were well enhanced and no enhancement was visable 3 to 4 cm from the tip of the gastric tube. Four days after esophagectomy, gastric tube necrosis was confirmed, necessitating a second operation. The necrosis of the gastric tube matched the area that had been shown to lack blood perfusion by ICG angiography imaging. It seems that ICG angiography is useful for the evaluation of perfusion in a reconstructed gastric tube.

Angiogenesis is essential for tumor growth and metastasis, therefore, inhibition of angiogenesis has emerged as a new therapy to treat cancers. Although vascular endothelial cell growth factor (VEGF) induces tumor growth and metastasis by its angiogenic property, the mechanism(s) of circadian rhythm in angiogenesis has not been fully analyzed. Here we revealed that VEGF mRNA expression level, protein expression level and its promoter activity belonged to circadian rhythm in human colon carcinoma cell line, HCT116 cells. HIF (hypoxia inducible factor)-1 also underwent circadian oscillation at levels of mRNA and promoter activity. Co-transfection of Bmal1 and Clock enhanced HIF-1 luciferase activity, but not VEGF luciferase activity, indicating that VEGF is not a direct target of Bmal1/Clock. However, inhibition of HIF-1 by chrysin resulted in disappearance of VEGF circadian oscillation, suggesting that HIF-1 is involved in the regulation of the VEGF expression. Moreover, circadian oscillation of VEGF and HIF-1 was induced by 100 nM of dexamethasone. These results suggest the link between the circadian oscillation between VEGF and HIF-1 , raising a possible strategy for chronotherapy in clinic.