WorldWideScience

Sample records for radical gastrectomy combined

  1. Bursectomy at radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cuneyt; Kayaalp

    2015-01-01

    Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursaomentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.

  2. Control study of arterial interventional chemotherapy before radical gastrectomy for gastric cancer and simple radical gastrectomy for gastric cancer in treatment of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Bin Liu

    2016-01-01

    Objective: To analyze the differences in effect of arterial interventional chemotherapy before radical gastrectomy for gastric cancer and simple radical gastrectomy for gastric cancer in treatment of advanced gastric cancer.Methods:A total of 86 cases of patients with advanced gastric cancer treated in our hospital were selected as research subjects and randomly divided into two groups, observation group received arterial interventional chemotherapy combined with radical gastrectomy for gastric cancer, control group received simple radical gastrectomy for gastric cancer, and then differences in prognosis-associated factors, MMP and Leptin contents as well as tumor marker and telomerase activity levels of two groups were compared.Results:Serum HER-2/neu ECD level of observation group was lower than that of control group, and serum DKK-1, TS and TP levels were higher than those of control group; at each point in time after treatment, serum CA72-4 and CA50 contents of observation group were lower than those of control group; intraoperative MMP-2, MMP-7, MMP-9 and Leptin levels in gastric cancer tissue of observation group were lower than those of control group; telomerase activity value in gastric cancer tissue of observation group after treatment was lower than that of control group, and both PGⅠ positive expression rate and PGⅠ/ PGⅡ ratio were higher than those of control group.Conclusion: Arterial interventional chemotherapy before radical gastrectomy for gastric cancer can lower tumor malignancy, promote the curative effect of radical gastrectomy for gastric cancer and improve long-term prognosis.

  3. Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Dong Yi Kim; Jae Kyoon Joo; Seong Yeob Ryu; Young Jin Kim; Shin Kon Kim; Yong Yeon Jung

    2003-01-01

    We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

  4. Treatment of cancerous ascites and radical gastrectomy with intraperitoneal hyperthermic double-distilled water and cis-diaminodichloro-platinum perfusion

    Science.gov (United States)

    Chen, Zhi-Xing; Chen, Jia-Ping; Chen, Zhong; Peng, De-Shu; Zhen, Ji-Xiang; Tan, Jian-San

    1997-01-01

    AIM: To study the therapeutic effect of intraperitoneal hyperthermic double-distilled water and cis-diaminodichloro-platinum (DDP) perfusion for cancerous ascites and radical gastrectomy. METHODS: LACA mice were injected peritoneally with H22 cancer cells (2 × 107 tumor cells). Five days later, the mice received treatments with either intraperitoneal perfusion of 37 °C isotonic fluid (group I), or 43 °C simple hyperthermic double-distilled water (group II), isotonic fluid (group III), DDP (group IV) or a combination of the hyperthermic double-distilled water with DDP (group V). A clinical experiment with intraperitoneal hyperthermic double-distilled water perfusion with DDP was carried out from September 1991 through September 1993 with 32 advanced gastric cancer patients who had undergone radical gastrectomy. RESULTS: In comparison with the untreated control group of cancer cell-bearing LACA mice, the mice in all treatment groups showed near complete obliteration of cancer cells in the peritoneal cavity, markedly reduced ascites, prolonged survival times, and reduced growth of peritoneal cancerous nodes. In the clinical experiment, all 32 patients with advanced carcinoma had achieved satisfactory results at the 1-year follow-up, but had unsatisfactory results at the 2-year follow-up. CONCLUSION: The intraperitoneal hyperthermic double-distilled water perfusion with DDP inhibited the occurrence of ascites in LACA mice bearing cancer cells, and prolonged the lifetime of patients with gastric cancer who had undergone radical gastrectomy. PMID:27053879

  5. 胃癌根治术联合改良胃旁路术在胃癌合并2型糖尿病患者中的应用%Radical Gastrectomy Combined with Modified Gastric Bypass in Treatment of Gastric Cancer Patients with Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    焦喜林; 王振全; 陈金辉; 申立中; 吴劲松; 陈芸; 蒋志斌; 贺屹巍; 苗玲玲

    2015-01-01

    目的 探讨胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病患者的临床效果.方法 回顾性分析我科2007年10月-2014年10月收治的72例胃癌合并2型糖尿病患者的临床资料,根据胃肿瘤部位选择手术方法的不同分为远端胃组30例,近端胃组14例和全胃组28例,分别予远端胃癌根治术、近端胃癌根治术、根治性全胃切除术联合改良式残胃空肠Roux-en-y吻合术. 术后观察各组手术并发症,术前及术后1、6个月空腹血糖( FPG)、餐后2 h血糖(2h PG)及糖化血红蛋白(HbA1C)水平,以及手术后1年癌转移情况. 结果 本组手术均获成功,术后住院时间9~25 d,进食及营养情况良好,术后恢复顺利. 术后无严重手术并发症发生. 术后1个月、6个月3组FPG、2h PG及HbA1c均明显下降(P<0. 01或P<0. 05). 术后1年各组无死亡病例,远端胃组发生肝脏转移2例,近端胃组发生肝脏转移、肺转移各1例,全胃组发生腹腔转移2例、肝脏转移1例. 结论 胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病患者操作简单,安全可行,有很好的临床应用前景.%Objective To investigate the clinical effect of radical gastrectomy combined with modified gastric by-pass in treatment of gastric cancer patients with type 2 diabetes mellitus. Methods Clinical data of 72 gastric cancer pa-tients with type 2 diabetes mellitus during October 2007 and October 2014 was retrospectively analyzed. The 72 patients were divided into distal gastrectomy group ( n=30 ) , proximal gastrectomy group ( n=14 ) and total gastrectomy group ( n=28) according to different operative methods, and the three groups were respectively treated with operations of distal radical gastrectomy, proximal radical gastrectomy and radical total gastrectomy combined with modified Roux-en-Y anas-tomosis of remnant stomach and jejunum. The postoperative complications, fasting plasma glucose ( FBG) levels before and 1 and 6

  6. Risk factors for hospital readmission after radical gastrectomy for gastric cancer:a prospective study

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:hTe purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.Methods: We conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. hTe incidence, cause and risk factors for 30-day readmission were determined.Results:A total of 376 patients were included in our analysis without loss in follow-up. hTe 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27 of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Conclusion:Readmission within 30 days of discharge atfer radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission.

  7. [Efficacy evaluation of laparoscopy-assisted radical gastrectomy in obese patients with gastric cancer].

    Science.gov (United States)

    Yang, Hong; Xing, Jiadi; Cui, Ming; Zhang, Chenghai; Yao, Zhendan; Zhang, Nan; Su, Xiangqian

    2014-08-01

    To investigate the influence of obesity on short-term outcomes after laparoscopy-assisted radical gastrectomy. Clinical data of 214 patients with gastric cancer, who underwent laparoscopy-assisted radical gastrectomy between May 2009 and December 2012 were analyzed retrospectively. Patients were divided into two groups, consisting of obese and non-obese patients. In the obese group, the BMI was ≥ 25.0 kg/m² (n=66), and in the non-obese group was obese group than that in non-obese group [(271.5 ± 51.2) min vs. (252.1 ± 53.6) min, Pobese group was less than that in non-obese group (26.2 ± 10.3 vs. 30.3 ± 12.4, P0.05). There were no significant differences between the two groups with respect to postoperative complications rate (25.8% vs. 20.9%, P>0.05) and perioperative mortality (1.5% vs. 0.7%, P>0.05). However, minor surgery-related complication rate was higher in obese group(16.7% vs. 6.8%, Pgastric emptying. There was no difference in perioperative mortality between the two groups (1.5% vs. 0.7%, P>0.05). Although obesity prolongs the duration of laparoscopy-assisted radical gastrectomy, and increases the risk of minor surgery-related complications, it has no influence on the surgical safety.

  8. The Effect of Thermal Double Distilled Water on Gastric Cancer Cell Line and Its Effect in Peritoneal Lavage During Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    CHENJunqing; XUHuimian; 等

    2002-01-01

    Objective:To evaluate the effect andindications of radical gastrectomy combined with peritoneal lavage with thermal double distilled water(DDW)or DDW plus chlorthexidine acetate.Methods:On the bases of the study on the killing effect of 43℃ DDW on human gastric cancer cell line MGC-803 and its inhibiting effect on ascitic tumor of SY86B morse,500 cases of gastric cancer who underwent radical gastectomy from January 1986 to December 1995 were divided into three groups:group A(n=198) subject to radical gastrectomy and peritoneal lavage for 10min with 4000ml DDW at 43℃ ;group B(n=89)subject to radical gastrectomy and peritoneal lavage for 4min with 4000ml DDW plus 0.6g chlorthexidine acetate,and grup C(n=213) subject to radical gastrectomy and peritoneal lavage for 4 min with 4000ml normal saline at room temperature as control.Results Human gastric cancer cells MGC-803 could be completely killed by treatment of either 43℃ DDW for 10min or DDW plus 0.015ml/L chlorhexidine acetate for 4 min.Clinical trials proved group A and group B(called lavage group as a whole)had almost the same curative effects.The 1-year survival rate and 3-year survival rate were similar in different stages among the groups.The 5-year survival rate was 63.8% in the lavage group and 51.2% in the control group respectively.Most of the cases with good effect were at the mid-stage (Ⅱand Ⅲ stage).Conclusion Radical gastrectom combined with peritoneal peritoneal lavage before closing the abdomen has satisfying effect on patients with gastric cancer at stage Ⅱ and stage ⅢA.

  9. [Impact of obesity on laparoscopic-assisted radical gastrectomy for gastric cancer].

    Science.gov (United States)

    Chen, Jian-xin; Huang, Chang-ming; Zheng, Chao-hui; Li, Ping; Xie, Jian-wei; Wang, Jia-bin; Lin, Jian-xian

    2011-10-01

    To study the impact of obesity on the short-term outcomes after laparoscopic-assisted radical gastrectomy. A total of 531 gastric cancer patients underwent radical resection at the Fujian Medical University Union Hospital between May 2007 and June 2010. There were 83 patients with BMI ≥ 25 kg/m(2) (obese group) and 448 patients with BMIobese group). Intraoperative and postoperative parameters, and short-term survival rates between the two groups were compared. There was no significant difference between obese and non-obese patients in terms of conversion rate (2.4% vs. 1.8%, P>0.05). The operative time in obese group was (224.7 ± 57.3) min, which was significantly longer than that in non-obese group [(210.0 ± 57.9) min, Pobese and non-obese groups in terms of blood loss, blood transfusion rate, elevated leukocyte and granulocyte count on the first postoperative day, time to temperature recovery, first flatus, and postoperative hospital stays(P>0.05). The mean number of retrieved lymph nodes in obese group was (24.8 ± 8.4), and was significantly less than that of non-obese group[(29.9 ± 10.2), Pobese and non-obese groups in postoperative complication rate (16.8% vs. 10.2%, P>0.05), postoperative mortality(1.2% vs. 0.4%, P>0.05), and 3-year overall survival (68.8% vs. 74.0%, P>0.05). Obesity is associated with prolonged operative time for laparoscopic radical gastrectomy. However, the short-term outcomes after the laparoscopic radical gastrectomy is not influenced by obesity.

  10. Analysis of risk factors for the interval time, number and pattern of hepatic metastases from gastric cancer after radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Jing-Yu Deng; Han Liang; Dan Sun; Hong-Jie Zhan; Ru-Peng Zhang

    2008-01-01

    AIM: To analyze the risk factors for interval time,number and pattern of hepatic metastases from gastric cancer after radical gastrectomy, and provide evidence for predicting and preventing hepatic metastasis from gastric cancer after radical gastrectomy. METHODS: A retrospective study of 87 patients with hepatic metastasis who underwent radical gastrectomy for gastric cancer from 1996 to 2001. The data was analyzed to evaluate significant risk factors for interval time, number and pattern of hepatic metastases originating from gastric cancer after radical gastrectomy.RESULTS: The size of gastric cancer and lymph node metastases were independently correlated with the interval time of hepatic metastases; the depth of invasion was independently correlated with the number of hepatic metastases; while the depth of invasion and Lauren classification were independently correlated with the pattern of hepatic metastases.CONCLUSION: We evaluated the interval time of hepatic metastases with the size of gastric cancer and lymph node metastases. The depth of invasion could be used to evaluate the number of hepatic metastases, while the depth of invasion and the Lauren classification could be used to evaluate the pattern of hepatic metastases in patients who underwent radical gastrectomy.

  11. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. XbaⅠpolymorphisms of apolipoprotein B gene:Another risk factor of gallstone formation after radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To prospectively investigate the association between the XbaⅠpolymorphisms of apolipoprotein B (APOB)gene and gallstone formation following gastrectomy.METHODS:The study was conducted between January 2005 and December 2006.A total of 186 gastric cancer patients who had undergone radical gastrectomy were grouped according to XbaⅠpolymorphisms of APOB gene(X+X-group,n=24 and X-X-group,n =162)and compared.The XbaⅠpolymorphisms of APOB gene were detected by polymerase chain reaction-restriction fragment len...

  13. Quality of life of patients with carcinoma of stomach after radical gastrectomy%胃癌根治术后患者生活质量评价

    Institute of Scientific and Technical Information of China (English)

    李健; 马骏; 张晓云; 周璐

    2003-01-01

    @@ INTRODUCTION The radical gastrectomy gives a significant prolongation of survival for patients with gastric cancer.But the operation can cause weigh loss,malabsorption,disturbed eating habits, and psychological disturbances.In this study,food tolerance,body-weigh and performance status were determined in patients after radical gastrectomy for carcinoma.The purpose of the study is to evaluate the extent of gastric resection to assess their impact on quality of life(QOL).

  14. Roux-en-Y reconstruction does not require gastric decompression after radical distal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cheng-Jueng Chen; Tsang-Pai Liu; Jyh-Cherng Yu; Sheng-Der Hsua; Tsai-Yuan Hsieh; Heng-Cheng Chu; Chung-Bao Hsieh; Teng-Wei Chen; De-Chuan Chan

    2012-01-01

    AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery.METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy for gastric cancer were retrospectively divided into 2 time-period cohorts; those treated with Billroth Ⅱ (BⅡ) reconstruction in the first 6 years and those with Roux-en-Y (RY) reconstruction in the last 5 years. In the latter group, the patients were further divided into 2 subgroups; with and without nasogastric decompression.RESULTS: Postoperatively, there were no significant differences in the number of anastomotic leaks between the 3 groups. In the tubeless RY group, time to semi-liquid diet was significantly shorter than in the other 2 groups (4.4 d ± 1.4 d vs 7.2 d ± 1.3 d and 5.9 d ± 1.2 d, P = 0.005). The length of postoperative stay was significantly increased in patients with BⅡ reconstruction compared with patients with RY reconstruction with/without NG decompression (15.4 d ± 4.3 d in BⅡgroup vs 12.6 d ± 3.1 d in decompressed RY and 11.4 d ± 3.4 d in the tubeless RY group, P = 0.035). The postoperative pneumonia rate was lowest in the tubeless group and highest in the BⅡ group (1.4% vs 4.6%, P = 0.01). Severe sore throat was noted in 59 (20.7%) members of the BⅡ group, 18 (17.4%) members of the decompressed RY group and 6 (4.2%) members of the tubeless RY group. Fewer patients in the tubeless group complained of severe sore throat (P = 0.001).CONCLUSION: This study provides support for abandoning routine NG decompression in patients undergoing subtotal gastrectomy with Roux-en-Y gastrojejunostomy.

  15. Effect comparison of remifentanil combined with sevoflurane or with isoflurane in elderly patients undergoing radical gastrectomy for cancer%瑞芬太尼复合七氟烷或异氟烷麻醉在老年胃癌根治术中的效果比较

    Institute of Scientific and Technical Information of China (English)

    丁娟; 谭志明

    2012-01-01

    目的 探讨七氟烷或异氟烷复合瑞芬太尼吸入全身麻醉用于老年胃癌根治术患者的麻醉效果和恢复情况.方法 选择择期行胃癌根治术的老年患者62例,美国麻醉医师学会分级Ⅱ、Ⅲ级,按随机数字表法随机分为两组:七氟烷复合瑞芬太尼组(SR组)31例,异氟烷复合瑞芬太尼组(IR组)31例.两组的麻醉诱导用药及方法相同,均于插管后即刻用微量泵连续恒速泵入瑞芬太尼,瑞芬太尼血浆靶浓度为6μg/L,其中SR组气管插管后持续吸入1.5% ~2.0%七氟烷,IR组气管插管后持续吸入异氟烷,吸入浓度为1%~2%.术毕前5 min停止吸入七氟烷或异氟烷;缝皮时停止输注瑞芬太尼,术毕前20 min静脉注射芬太尼0.1 mg.分别于麻醉诱导前(T0)、麻醉诱导后(T1)、气管插管即刻(T2)以及手术开始后5 min(T3)、30 min(T4)和术毕时(T5)记录收缩压、舒张压、心率等值;记录苏醒时间及拔管时间,并进行拔管后苏醒质量评分(OAAS).结果 两组术中各时点收缩压、舒张压及心率比较差异均无统计学意义(P均>0.05),SR组苏醒时间、拔管时间显著短于IR组[(10.4±3.9)、(16.3±5.8)min,t=6.25,P=0.02;(5.9±3.1)、(9.7±2.5) min,t=4.19,P=0.01].SR组OAAS显著高于IR组[(4.1±1.2)、(2.9±1.0)分,t=3.27,P=0.03].结论 异氟烷或七氟烷复合瑞芬太尼麻醉均可应用于老年胃癌根治术患者.与异氟烷复合瑞芬太尼麻醉比较,七氟烷复合瑞芬太尼麻醉后患者恢复较快,更适合老年患者.%Objective To compare the clinical effects of remifentanil combined with sevoflurane or with isoflurane in elderly patients undergoing radical gastrectomy for cancer and their recovery.Methods Sixty-two patients,who scheduled for radical gastrectomy for cancer was randomly divided into remifentanil combined with sevoflurane group ( SR group,n =31 ) and remifentanil combined with isoflurane group ( IR group,n =31 ).They were classified into

  16. Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

    Directory of Open Access Journals (Sweden)

    Chen Qi-Yue

    2012-11-01

    Full Text Available Abstract Background The application of laparoscopic surgery for advanced gastric cancer (AGC remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG for advanced gastric cancer without serosal invasion. Methods From January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results. Results There are not significant differences in clinicopathological characteristics between the two groups (P > 0.05. The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859. The mean number of resected lymph nodes (LNS between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786. Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05. No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05 and the survival curve after surgery between the LAG group and OG group. Conclusion Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with

  17. Effect on changes of blood coagulation function, cytokines and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jia-Qi Liu; Shao-Jun Yang; Jie-Qing Chen; Ru-Kui Su; Zhong Huang; Yin-Zhuo Qi

    2017-01-01

    Objective:To explore the changes of coagulation function, cytokines and T lymphocyte in patients undergoing laparoscopic radical gastrectomy for gastric cancer and its clinical significance.Methods: 40 cases of laparoscopic radical gastrectomy for gastric cancer patients and 40 cases of open radical gastrectomy for gastric cancer patients in our hospital were selected to detect and investigate the perioperative coagulation function [APTT (activated partial thromboplastin time), FIB (fibrinogen), and PLT (platelet)], cytokines [CRP (C reactive protein), IL-6 (IL-6) and TNF-alpha (Tumor necrosis factor-alpha)] and T lymphocytes (CD4+, CD8+ and CD4+/CD8+) changes and clinical meaning of patients in the two groups.Results: The coagulation function related indicators, cytokines and T lymphocytes of the two groups before treatment did not change significantly (P>0.05). 1 d after operation, blood coagulation, TNF-alpha, CD4+ and CD4+/CD8+ levels were significantly lower than that before operation in two groups of patients (P<0.05), while IL-6, CRP and CD8+ were significantly higher than that before the operation (P<0.05), and the index change in open group was more obvious. 3 d after surgery, the APTT, IL-6, CRP, CD4+, CD8+ and PLT levels in two group patients were significantly lower than that 1 d after surgery, while FIB, TNF-alpha and CD4+/CD8+ were significantly higher than that 1 d after surgery; blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ were significantly lower in the laparotomy group patients than in laparoscopic group, while IL-6, CRP and CD8+ were significantly higher than the laparoscopic group (P<0.05). 5 d after operation, the APTT, TNF-alpha, FIB, CD4+, CD4+/CD8+ and PLT in two groups were significantly higher than that 3 d after surgery (P<0.05), while IL-6, CRP and CD8+ levels were significantly lower than that of 3 d after surgery (P<0.05); blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ in the laparotomy group patients were

  18. Segmental gastrectomy with radical lymph node dissection for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Takeru; Matsuda; Kunihiko; Kaneda; Manabu; Takamatsu; Keishi; Aishin; Masahide; Awazu; Akiko; Okamoto; Katsunori; Kawaguchi

    2010-01-01

    AIM: To describe a new surgical technique and evaluate the early results of segmental gastrectomy (SG) with modified D2 lymph node (LN) dissection for early gastric cancer (EGC). METHODS: Fourteen patients with EGC underwent SG with modified D2 dissection from 2006 to 2008. Their operative results and postoperative courses were compared with those of 17 patients who had distal gastrectomy (DG) for EGC during the same period. RESULTS: Operating time, blood loss, and hospital stay were similar between the 2 g...

  19. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer.

    Science.gov (United States)

    Huang, Dong-Dong; Zhou, Chong-Jun; Wang, Su-Lin; Mao, Shu-Ting; Zhou, Xuan-You; Lou, Neng; Zhang, Zhao; Yu, Zhen; Shen, Xian; Zhuang, Cheng-Le

    2017-03-01

    The association between sarcopenia and postoperative outcomes has been well reported. However, the impact of different sarcopenia stages on postoperative outcomes has never been investigated. We conducted a large, prospective study of patients who underwent radical gastrectomy for gastric cancer from August 2014 to December 2015. Sarcopenia was staged as "presarcopenia," "sarcopenia," and "severe sarcopenia" according to the definition of the European Working Group on Sarcopenia in Older People. Univariate and multivariate analyses evaluating the risk factors for total, surgical, and medical complications were performed. A total of 470 patients were included, in which 20.6%, 10%, and 6.8% of the patients were identified as having "presarcopenia," "sarcopenia," and "severe sarcopenia," respectively. Postoperative complications, duration of hospital stays, and costs increased with advancing sarcopenia stages. Severe sarcopenia, visceral fat area to total abdominal muscle area ratio, American Society of Anesthesiologists grade III, and tumor located at the cardia were independent risk factors for total complications. Visceral fat area to total abdominal muscle area ratio and tumor located at the cardia were independent risk factors for operative complications. Presarcopenia, sarcopenia, and severe sarcopenia were all identified as independent risk factors for medical complications, as well as age ≥75 years and Charlson Comorbidity Index. Patients had worse postoperative outcomes after gastric cancer operation with advancing sarcopenia stages. Severe sarcopenia, but not presarcopenia or sarcopenia, was an independent risk factor for total postoperative complications. The 3 sarcopenia stages independently influence medical but not surgical complications. Recognizing sarcopenia stages is important for preoperative risk stratification. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Liu G

    2016-06-01

    Full Text Available Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC patients.Methods: Eighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21, FTS + laparotomy group (Group B, n=21, conventional perioperative care (CC + laparoscopic group (Group C, n=21, and CC + laparotomy group (Group D, n=21. Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators.Results: Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05. There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05. Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest.Conclusion: FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more

  1. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. PMID:27043677

  2. Pancreatic fistula may be an important complication following spleen-preserving radical gastrectomy with dissection of No.10 and No.11 lymph nodes

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jun; ZHANG Zhong-tao; WANG Yu; WANG Kang-li

    2010-01-01

    @@ In recent years, spleen-preserving radical gastrectomy with dissection of No.10 and No.11 lymph nodes has been gradually accepted because of an improved understanding of immune function of the spleen in the perioperative period and for prognosis of gastric cancer.

  3. Comparison of peritoneal free gastric cancer cells' detecting rates between laparoscopically assisted and open radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods:Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy (n=34) and conventional surgery (n=31). Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide (CO2) was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results: The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45%. Conclusion: During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.

  4. Clinical efficacy of neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy for advanced gastric cancer%新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的疗效分析

    Institute of Scientific and Technical Information of China (English)

    帅晓明; 高金波; 刘兴华; 张鹏; 白洁; 蔡开琳; 王国斌; 陶凯雄

    2016-01-01

    Objective To explore the clinical efficacy of neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy for advanced gastric cancer.Methods The retrospective cohort study was adopted.The clinical data of 112 patients with advanced gastric cancer who were admitted to the Wuhan Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to June 2015 were collected.The neoadjuvant chemotherapy was selectively performed based on patients' decisions.Of 112 patients,42 receiving neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy (NCLAG) were allocated into the NCLAG group and 70 receiving laparoscopy-assisted radical gastrectomy (LAG) without neoadjuvant chemotherapy were allocated into the LAG group.Patients in the NCLAG group underwent LAG at 4 weeks after neoadjuvant chemotherapy of 2-4 cycles FOLFOX6 regimen.The efficacy of neoadjuvant chemotherapy was divided into the complete remission (CR),partial remission (PR),stable disease (SD) and progressive disease (PD) based on the Response Evaluation Criteria in Solid Tumors (RECIST).Clinical response rate =[(number of patients with CR + number of patients with PR)/number of measurable patients] × 100%,disease control rate =[(number of patients with CR + number of patients with PR + number of patients with SD)/number of measurable patients] × 100%.The adverse reactions were observed during neoadjuvant chemotherapy and were divided into the grade 0,Ⅰ,Ⅱ,Ⅲ,and Ⅳ based on the grading standards for common adverse drug reactions of anticancer drugs issued by World Health Organization (WHO).The distal or total gastrectomy was selected according to tumor location.Observation indicators included (1) efficacy of neoadjuvant chemotherapy and grading of adverse reaction,(2) surgical situations,(3) postoperative recovery,(4) prognosis.The follow-up of outpatient examination and telephone interview was performed

  5. Study on the change of metabolic indexes and digestive enzymes of patients with laparoscopic radical gastrectomy for gastric cancer during the perioperative period

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao He; Jun Huang; Na Hu

    2016-01-01

    Objective:To investigate the influence degree of laparoscopic radical gastrectomy for gastric cancer on the related body indexes during the perioperative period, including metabolic indexes and digestive enzymes.Methods:A total of 70 patients with gastric cancer who received treatment during the time of January 2014 to November 2015 in our hospital were divided into two groups by the method of random number table, 35 patients with gastric cancer in control group were treated with open radical gastrectomy, 35 patients with gastric cancer in observation group were treated with laparoscopic radical operation, then the proteometabolism and digestive enzymes indexes at different time before and after the operations of two groups were detected and compared.Results:The differences of detection results of two groups before the operation were not obvious, while the related indexes of proteometabolism of observation group at first, third, seventh and fourteenth day after the operation were all higher than those of control group, and the related indexes of digestive enzymes were all better than those of control group, which were all obviously different.Conclusion: The influence of laparoscopic radical gastrectomy on the fluctuation of the metabolic indexes and digestive enzymes of patients during the perioperative period are relatively smaller, and the postoperative recovery of patients are relatively better.

  6. Prognostic Significance of MiR-34a Expression in Patients with Gastric Cancer after Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao Hui; Xiao-Bin Ma; Ying Zan; Xi-Jing Wang; Lei Dong

    2015-01-01

    Background:MiR-34a dysregulation has been implicated in tumorigenesis and progression of gastric cancer,but its role in prognosis of patients with gastric cancer remains unknown.The aim of this study was to investigate the expression and prognostic significance of miR-34a in gastric cancer patients after radical gastrectomy.Methods:Quantitative real-time polymerase chain reaction was performed to detect the expression of miR-34a in human gastric cancer cell lines and tissues in 76 patients with gastric adenocarcinoma from China.Results are assessed for association with clinical features and overall survival (OS) using Kaplan-Meier analysis.Prognostic values of miR-34a expression and clinical outcomes were evaluated by Cox regression analysis.A molecular prognostic stratification scheme incorporating miR-34a expression was determined using receiver operating characteristic analysis.Results:The results show that the expression level of miR-34a was decreased in human gastric cancer cell lines and tissues,and down-regulated expression of miR-34a was associated with Lauren classification (P =0.034).Decreased miR-34a expression in gastric cancer tissues was positively correlated with poor OS of gastric cancer patients (P =0.013).Further multivariate Cox regression analysis suggested that miR-34a expression was an independent prognostic indicator for gastric cancer (P=0.027).Applying the prognostic value of miR-34a expression to tumor node metastasis (TNM) stage system showed a better prognostic value in patients with gastric cancer than miR-34a expression (P =0.0435) or TNM stage (P =0.0249) alone.Conclusion:The results reinforce the critical role for the down-regulated miR-34a expression in gastric cancer and suggest that miR-34a could be a prognostic indicator for this disease.

  7. Effect of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Zhen Wang; Xiao-Fan Li; Hui Wang; Zhi-Jun Mao; Tong Xue; Rui Yang

    2016-01-01

    Objective:To investigate the effects of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Methods:A total of 84 gastric cancer patients in our hospital were randomly divided into observation group (42 cases) and control group (42 cases). Patients in observation group were treated by deep anesthesia, while the control group was treated with shallow anesthesia. The blood gas was observed and compared before and after CO2 pneumoperitoneum, and the immune function was observed and compared before anesthesia, after operation and 72 h post-operation. Results:The PaCO2 and pH level of patients in the two groups had no significant difference before pneumoperitoneum;Compared with before pneumoperitoneum, no obvious blood gas change was observed in the observation group, the difference had no statistically significant;Blood gas level of control group was significantly higher than that of before pneumoperitoneum , the difference was statistically significant, pH (7.26±0.07) was statistically decreased;After pneumoperitoneum, the level of PaCO2 and pH was significantly different in both groups , the difference was statistically significant. Indexes of the patients in the observation and control group of CD3+, CD4+, CD4+/CD8+, NK level had no significant difference before anesthesia, the difference was not statistically significant;The immunology index of CD3+, CD4+, CD4+/CD8+and NK cell levels of the postoperative patients in both groups were significantly lower than before anesthesia, and the differences were statistically significant, but each index in the observation group decreased significantly less than that of the control group, the difference was statistically significant;The immunological indexes can be restored to before anesthesia postoperative 72 h with two groups, and had no significant difference. Conclusion:The blood gas analysis index was stable and the immune function was suppressed in

  8. THE CLINICAL STUDY ON LAPAROSCOPIC RADICAL GASTRECTOMY FOR GASTRIC CANCER%腹腔镜胃癌根治手术的临床研究

    Institute of Scientific and Technical Information of China (English)

    李俊; 谭忆广; 周志涛; 毛常青; 吕培标; 钟国英; 王存川

    2011-01-01

    [目的]探讨腹腔镜胃癌根治手术的安全性、可行性及肿瘤根治性.[方法]选择2005年12月~2010年12月普外科行腹腔镜胃癌D2根治术35例为腹腔镜组,并选择同期开腹胃癌根治术40例为对照组,比较两组手术相关指标、肿瘤根治性指标及术后随访患者的生存率.[结果]腹腔镜组手术时间较对照组长,术中出血量较对照组少,切口长度较对照组短.差异具有统计学意义(均P<0.05);腹腔镜组术后排气时间、首次进流质时间及术后住院时间明显较对照组缩短(P<0.05),两组总并发症发生率比较差异无统计学意义(P>0.05);腹腔镜组肿瘤根治性指标淋巴结清扫数目、近远端切缘距离及1、3、5年生存率均与对照组差异无统计学意义(P>0.05).[结论]腹腔镜胃癌D2根治术是安全、可行的,能达到与开腹根治性全胃切除术相同的肿瘤根治性,且比开腹手术更具微创优势.%[Objective] To study the safety, feasibility and curative result of laparoscopic radical gastrectomy for gastric cancer. [Methods] 35 cases of laparoscopic radical gastrectomy for gastric cancer and 40 cases of open D2 radical gastrectomy were operated in our department from December 2005 to December 2010. The operative index, curative result index and survival rate in two groups were compared. [ Results] The operation time was longer, volume of bleeding was less, and the length of incision was shorter in laparoscopic radical gastrectomy group (P < 0.05) ; postoperative time of farting, the time of eating fluid and hospital stay were shorter in laparoscopic group compared to those in control group (P < 0.05). There was no significant difference in the rates of postoperative complications. The clear number of lymph node dissection , the proximal and distal margin from tumor and the 1-, 3-and 5-Y survival rate between the two groups were not different (P > 0.05). [ Conclusion] The laparoscopic D2 radical

  9. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort.

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-03-01

    Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm²/m² for women and 40.8 cm²/m² for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I.

  10. Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias.

    Science.gov (United States)

    Rodriguez, John H; Kroh, Matthew; El-Hayek, Kevin; Timratana, Poochong; Chand, Bipan

    2012-12-01

    Obesity is a risk factor for gastroesophageal reflux disease and hiatal hernia. Studies have demonstrated poor symptom control in obese patients undergoing fundoplication. The ideal operation remains elusive. However, addressing both obesity and the anatomic abnormality should be the goal. This study retrospectively identified 19 obese (body mass index [BMI], >30 kg/m(2)) and morbidly obese (BMI, >40 kg/m(2)) patients who presented between December 2007 and November 2011 for management of large or recurrent paraesophageal hernia. All the patients underwent a combined primary paraesophageal hernia repair and longitudinal gastrectomy. Charts were retrospectively reviewed to collect preoperative, operative, and short-term postoperative results. Quantitative data were analyzed using Student's t test and qualitative data with χ(2) testing. Laparoscopy was successful for all 19 patients. The mean preoperative BMI was 37.8 ± 4.1 kg/m(2), and the mean operative time was 236 ± 80 min. Preoperative endoscopy showed that 5 patients who had undergone prior fundoplication experienced anatomic failures, whereas the remaining 14 patients had type 3 and one type 4 paraesophageal Hernia. Mesh was used to reinforce the hiatus in 15 of the 19 cases. The postoperative complications included pulmonary embolism (n = 1) and pulmonary decompensation (n = 2) due to underlying chronic obstructive pulmonary disease. The mean hospital stay was 5.3 ± 3 days. Upper gastrointestinal esophagography was performed for all the patients, with no short-term recurrence of paraesophageal hernia. Weight loss was seen for all the patients during the first month, with a mean BMI drop of 2.7 ± 1 kg/m(2). All the patients experienced near to total resolution of their preoperative symptoms within the first month. Combined laparoscopic paraesophageal hernia repair and longitudinal gastrectomy offer a safe and feasible approach for the management of large or recurrent paraesophageal

  11. 胃癌根治术后胰瘘5例临床分析%Pancreatic fistula after radical gastrectomy for gastric carcinoma: report of 5 cases

    Institute of Scientific and Technical Information of China (English)

    孙益红; 汪学非; 沈振斌; 王单松; 陈伟东; 王聪; 秦净; 秦新裕

    2008-01-01

    目的 探讨胃癌根治术后胰瘘的病因、临床表现、诊断及治疗方法.方法 对5例胃癌根治术后胰瘘患者的临床资料进行回顾性分析.结果 5例患者出现胰瘘可疑症状的时间分别为术后第2、3、4、6、8天.5例均出现心动过速(HR>120次/min)、持续发热(T>38.5 oC)和血白细胞升高(WBC计数>15×109/L).影像学检查胸片提示胸腔积液3例,3例CT检查提示腹腔积液,2例同时伴有胰腺肿胀.5例腹腔引流液淀粉酶均>10 000 U/L.5例患者中2例经保守治疗3周后治愈,另3例经再次手术引流后1~4个月治愈.结论 术中胰腺损伤是导致胃癌根治术后胰瘘的主要原因;早期诊断,充分的引流是保证术后胰瘘治愈的关键.%Objective To analyze clinical characteristics, etiology, diagnosis and treatment of pancreatic fistula following radical gastrectomy for gastric carcinoma. Methods Clinical data of 5 patients with pancreatic fistula undergoing radical gastrectomy were analyzed retrospectively. Results Suspected symptoms of pancreatic fistula occurred in the 2nd, 3rd, 4th, 6th and 8th days after the first operation respectively. All patients showed tachyarrhythmia, persistent hyperpyrexia and increased count of leukocyte, 2 had abdominal distention, 2 had abdominal pain, and 2 had adequate abdominal drainage with a turbid appearance as well as increased level of amylase. Imaging examination showed that pleural effusion appeared in 3 patients, seroperitoneum in 3, and pancreas swelling in 2. Three of 5 patients received re-operations and the other 2 were treated conservatively. All of these patients recovered after thorough drainage. Conclusion The onset of pancreatic fistula following radical gastrectomy is iniatiated by surgical trauma of the pancreas. Reasonable range of lymphadenectomy plays a key role to avoid postoperative pancreatic fistula. Sufficient drainage of the abdominal cavity ensures a full recovery from pancreatic complications.

  12. 超声刀结合单极电凝应用于腹腔镜胃癌根治术的评价%Ultrasonic Scalpel and Monopolar Electrocoagulation in Laparoscopic-assisted Radical Gastrectomy for Gastric Carcinoma

    Institute of Scientific and Technical Information of China (English)

    鱼国盛; 汤黎明; 钱峻; 朱杰

    2011-01-01

    Objective To evaluate the outcome of ultrasonic scalpel combined with monopolar electrocoagulation in laparoscopic-assisted radical gastrectomy for gastric carcinoma. Methods From January 2010 to March 2011, 75 patients with curable gastric carcinoma underwent laparoscopic-assisted radical gastrectomy, of which 39 patients were treated solely by ultrasonic scalpel, the other 36 patients underwent ultrasonic scalpel combined with monopolar electrocoagulation. The operation time, intraoperative blood loss, number of resected lymph nodes, and postoperative drainage volume and complications were analyzed retrospectively and compared between the two groups. Results The mean operation time and blood loss of ultrasonic scalpel group were significantly more than that in the study group [ (347 ±38) min vs. (310 ±23) min, t =5. 049, P = 0. 000, and (274 ± 122) ml vs. (186 ± 90) ml, t = 3. 530, P = 0. 000]. The number of harvested lymph nodes, postoperative drainage volume and the incidence rate of complications were comparable between the two groups ( P > 0.05). Conclusion By combining ultrasonic scalpel with monopolar electrocoagulation in laparoscopic-assisted radical gastrectomy for gastric carcinoma, the advantages of the both methods can be utilized so that to reduce operation time and blood loss,and make lymph nodes resection easier.%目的 评价腹腔镜胃癌根治术中联合应用超声刀及单极电凝的效果.方法 回顾分析2010年1月~2011年3月75例腹腔镜胃癌D2根治术的临床资料,前39例单纯使用超声刀(超声刀组),后36例联合应用超声刀与单极电凝(联合组).比较2组手术时间、术中出血量、平均清扫淋巴结个数、术后引流量及术后并发症方面的差异.结果 与超声刀组相比,联合组术中出血少[(274±122)ml vs.(186±90) ml,t=3.530,P=0.000],手术时间短[(347±38)min vs.(310±23) min,t=5.049,P=0.000],2组清扫淋巴结个数、术后引流量及并发症

  13. Clinical comparison of laparoscopy-assisted radical gastrectomy and open radical gastrectomy in gastric cancer after endoscopic submucosal dissection%内镜黏膜下剥离术后复发胃癌行腹腔镜与开腹根治术的临床对比

    Institute of Scientific and Technical Information of China (English)

    魏法星; 陈志红; 蒋鹏程

    2014-01-01

    目的:评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后复发胃癌行腹腔镜下胃癌根治术的安全性和优越性.方法:回顾性分析ESD术后复发胃癌行胃癌根治性切除术的61例患者的临床资料.其中,41例行腹腔镜辅助下胃癌根治术(腹腔镜组),20例行开腹胃癌根治术(开腹组).统计并对比分析两组患者的一般资料、手术相关指标以及术后恢复的相关资料.结果:两组患者的年龄、性别、肿瘤距切缘长度、清扫淋巴结数目、病理分期,术中损伤情况以及术后并发症等差异均无统计学意义(P均>0.05).与开腹组比较,腹腔镜组手术时间长,住院费用高(P均<0.01),但C-反应蛋白低、手术切口长度小、术中出血量少以及术后镇痛药物使用例数少、首次通气时间早、胃肠减压拔除时间早、首次进流质饮食时间早、腹腔引流管拔除时间早及住院天数短(P均<0.05).结论:腹腔镜胃癌根治术治疗ESD术后复发胃癌安全、有效,与开腹胃癌根治术比较,具有明显的创伤小,出血量少,恢复快等优势.%Objective:To evaluate the safety and superiority of laparoscopy-assisted radical gastrectomy (LARG) for gastric cancer after endoscopic submucosal dissection (ESD).Methods:A total of 61 patients who underwent laparoscopic-assisted radical gastrectomy (LARG group,n =41) or open radical gastrectomy (open group,n =20) for gastric cancer after ESD were retrospectively analyzed.The general data,indicators related to the operation and postoperative recovery of relevant information of two group patients were analyzed.Results:There were no differences in the age,gender,length of the tumor to the cut edge,number of cleaning lymph nodes,pathological staging,intraoperative injury,postoperative complications between LARG group and open group (both P > 0.05).Compared with the open group,LARG group had longer operative time and higher expenditure(both P <0

  14. Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study.

    Science.gov (United States)

    Hu, Dan; Zhang, Hejun; Lin, Xiandong; Chen, Gang; Li, Chao; Liang, Binying; Chen, Yan; Cui, Zhaolei; Peng, Feng; Zheng, Xiongwei; Niu, Wenquan

    2017-01-01

    Aims: This cohort study was conducted to evaluate the prognostic impact of blood-routine parameters before radical gastrectomy on gastric cancer mortality. Methods: Total 3012 patients with gastric cancer were consecutively enrolled from a mono-center between 2000 and 2010, and the latest follow-up was completed in 2015. Results: The median follow-up time was 44.05 months. Finally, 1331 out of 3012 gastric cancer patients died from gastric cancer. Per standard deviation increment in neutrophil (hazard ratio or HR=1.08, P2.61 with ≤2.61 and NLR>1.87 with ≤1.87 were respectively associated with a 5.21-fold (P=0.004) and 2.36-fold (P=0.001) increased risk of gastric cancer mortality. The effect-size magnitude of NLR was further potentiated in patients with invasion depth T1/T2 (HR=1.73, P=0.001), regional lymph node metastasis N0 (HR=1.60, P<0.001), TNM stage I/II (HR=1.36, P=0.009) and tumor size ≤ 4.5 cm (HR=1.17, P<0.001). Conclusions: Our findings consolidated the prognostic impact of preoperative NLR on gastric mortality, and demonstrated that elevated preoperative NLR was a robust indicator of poor survival in patients at early stage.

  15. Vertical sleeve gastrectomy

    Science.gov (United States)

    ... sleeve; Gastrectomy - greater curvature; Gastrectomy - parietal; Gastric reduction; Vertical gastroplasty ... together using surgical staples. This creates a long vertical tube or banana-shaped stomach. The surgery does ...

  16. Combined radical retropubic prostatectomy and rectal resection.

    Science.gov (United States)

    Klee, L W; Grmoljez, P

    1999-10-01

    To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

  17. Combination of haloperidol, dexamethasone, and ondansetron reduces nausea and pain intensity and morphine consumption after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Benevides, Márcio Luiz; Oliveira, Sérgio de Souza; Aguilar-Nascimento, José Eduardo

    2013-01-01

    Postoperative nausea and vomiting (PONV) occur frequently after laparoscopic bariatric surgery. The combination of haloperidol, dexamethasone, and ondansetron may reduce these undesirable events. The aim of this study was to evaluate the intensity of nausea and pain, the number of vomiting episodes, and morphine consumption in postoperative (PO) obese patients undergoing laparoscopic sleeve gastrectomy (LSG). A clinical, randomized, controlled, double-blind study conducted with 90 patients with body mass index ≥ 35 kg.cm-2. Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg (Group O); ondansetron 8 mg and dexamethasone 8 mg (Group OD); and ondansetron 8 mg, dexamethasone 8 mg, and haloperidol 2 mg (Group HDO). We evaluated the intensity of nausea and pain using the verbal numeric scale, cumulative number of vomiting episodes, and morphine consumption in the period of 0-2, 2-12, 12-24, and 24-36 hours postoperatively. Nausea intensity was lower in Group HDO compared to Group O (p = 0.001), pain intensity was lower in Group HDO compared to Group O (p = 0.046), and morphine consumption was lower in Group HDO compared to Group O (p = 0.037). There was no difference between groups regarding the number of vomiting episodes (p = 0.052). The combination of haloperidol, ondansetron, and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG.

  18. Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

    OpenAIRE

    2016-01-01

    Introduction: Obesity is a contributor to the global burden of chronic diseases, including non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). NASH cirrhosis is becoming a leading indication for liver transplant (LT). Obese transplanted patients have higher morbidity and mortality rates. One strategy, to improve the outcomes in these patients, includes bariatric surgery at the time of LT. Herein we report the first European combined LT and sleeve gastrectomy (SG). C...

  19. [Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000].

    Science.gov (United States)

    Torres Solis, José; Celis, J; Ruiz, E; Payet, E; Chavez, I; Berrospi, F; Young, F; Luque, C

    2011-01-01

    To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. A total de 148 patients were involved in this study. 29 of them (19.6%) develop gallbladder stones during the (x years of) follow up vs 119 (80.9%) . The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male.\\The mean time of develop gallbladder stones was 3.1 years.According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. The frecuency of gallbladder stones post gastrectomy in this study was 19.6%. The mean time of the develop and diagnosis of litiasis was 3.1 years.To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer.We need furthermore studies to have conclusions about the risk factors.

  20. Study on unplanned re-operation after radical gastrectomy for gastric cancer: Seven years' experience%胃癌根治术后非计划再手术35例

    Institute of Scientific and Technical Information of China (English)

    黄嫣妮; 钱雷敏; 黄建明; 戈军刚; 高林; 刘惠钧

    2013-01-01

    Objective To investigate the causes of unplanned re-operation following radical surgery for gastric cancer and to summarize clinical experience.Methods The clinical data of gastric cancer patients who underwent radical gastrectomy from Jan.2006 to Dec.2012 were retrospectively analyzed in the study,especially focusing on the preoperative,intraoperative and postoperative situations of unplanned re-operation cases at the same hospitalization.Results During seven years,radical gastrectomy for gastric cancer was implemented in 1707 cases,35 of which had unplanned re-operations.The rate of such re-operation was 2.05 %,following the mortality rate of 8.57%.Besides age,basic chronic illness and TNM stage,the primary operation way,which caused the higher incidence of unplanned re-operation,was radical total gastrectomy.Some complications after radical gastrectomy required unplanned re-operations,of which the most common was wound disruption and others,in turn,were pleural effusions/ascites,post-traumatic focal pancreatitis (PTFP),intestinal obstruction,intraperitoneal hemorrhage,while the most serious consequence was anastomotic leakage or stump fistula and partly led to death.Conclusion Unplanned re-operation after radical gastrectomy for gastric cancer can increase residential time,total treatment cost and the mortality rate.Comprehensive preoperative analysis,correct intraoperative and postoperative management,as well as timely treatment of complications are important measures to reduce the incidence of those unplanned re-operations.%目的 探讨胃癌根治术后非计划再手术的原因及总结临床治疗体会.方法 回顾性分析2006年1月—2012年12月间行胃癌根治术患者的临床资料,并重点分析同一住院期间非计划再手术病例的术前、手术及术后情况.结果 7年间共实施胃癌根治术1 707例,发生非计划再手术35例,再手术率2.05%,再手术死亡率8.57%.发生率较高者的初次手术方式为根治

  1. Intrathoracic Hernia after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Yoshihiko Tashiro

    2016-05-01

    Full Text Available Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

  2. 健康教育干预在胃癌根治术后患者的应用效果观察%Application of Health Education Intervention effect observation in patients with gastric cancer after radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    张志华

    2015-01-01

    Objective:To discuss the effect of health education intervention in patients after radical gastrectomy.Method:100 patients with gastric cancer were compared after radical gastrectomy in our hospital in groups,the effect of the mental state and physical state of them going through strong health education intervention in phychological and dietary aspects were observed and the following changes were recorded.Result:The patient’s mental state and physical condition in the experimental group were significantly better than those of the control group,differences between two groups were statistically significant(P<0.05).Conclusion:The application of psychological and dietary health education intervention to the patients after radical gastrectomy for gastric cancer results in a healthy and optimistic state of mind,improves the nutritional state after operation,thereby promoting the quality of life.%目的:探讨健康教育干预在胃癌根治术后患者的应用效果。方法:对笔者所在医院收治的100例胃癌根治术后患者进行分组比较,观察加强心理与饮食方面健康教育干预后胃癌根治术后患者心理状态与身体状态的变化效果。结果:观察组患者的心理状态、身体状态均显著优于对照组,两组比较差异均有统计学意义(P<0.05)。结论:加强心理与饮食方面的健康教育干预能使胃癌根治术后患者处于积极、健康、乐观的心理状态,改善术后身体营养状态,从而提高其生活质量。

  3. 手助腹腔镜胃癌 D2根治术的团队配合%Teamwork Cooperation in Hand-assisted Laparoscopic D2 Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    周均; 曹永宽; 宋亚宁; 王永华; 张国虎; 王培红; 李旭

    2014-01-01

    目的:探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月~2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定,只需术者及扶镜手两人相互配合,就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术,全胃切除术84例,远端胃切除术81例,近端胃切除术15例。手术切口长度(6.9±0.5)cm;术中出血量(226.1±127.0)ml;手术时间(172.2±34.1)min;病检获淋巴结数(17.3±5.0)枚;术后住院时间(9.3±2.0) d。围手术期死亡1例,手术残端癌残留2例。手术相关并发症率6%(11/180)。术后随访1~24个月,失访12例(失访率7%),同时性肝转移4例,异时性淋巴结转移2例,局部复发1例,未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件,对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。%Objective To discuss the importance of teamwork coorperation in hand-assisted laparoscopic D2 radical gastrectomy. Methods Clinical materials of 180 patients with gastric cancer undergoing hand-assisted laparoscopic D2 radical gastrectomy from December 2010 to June 2013 were summarized retrospectively.The lymph nodes dissection and radical tumor excision were performed by two persons of cooperation that the operator surgeon worked with camera assistant in a relatively fixed mode in the operation. Results The hand-assisted laparoscopic D2 radical gastrectomy was accomplished in all the patients.Among the 180 patients, gastrectomy was performed in 84 cases, distal gastrectomy in 81 cases, and proximal gastrectomy in 15 cases.The average length of incision was (6.9 ±0.5) cm, the blood loss was (226.1 ±127.0) ml, the operative time was (172.2 ±34.1) min, the number

  4. Clinical Effect of Keeping Vagus Nerve Radical Gastrectomy for Gastric Cancer Patients%保留迷走神经胃癌根治术治疗胃癌患者的临床疗效

    Institute of Scientific and Technical Information of China (English)

    谭贵永

    2013-01-01

    Objective:To analyze the clinical effect of keeping vagus nerve radical gastrectomy in treatent of gastric cancer patients.Method:114 cases of gastric cancer patients were randomly divided into research group(64 cases)and control group(50 cases). Patients in research group were treated with keeping vagus nerve radical gastrectomy and patients in control group were treated with traditional radical gastrectomy. The operative bleeding volume,operative time,postoperative anal exhaust and defecate time,intraoperative lymph node scanning ratio,occurrence rate of complication and 5 years survival rate were analyzed and compared. Result:There were no significant differences between two groups about operative bleeding volume and time(P>0.05). The postoperative anal exhaust and defecate time of research group was shorter than that in control group. The intraoperative lymph node scanning ratio was high,occurrence rate of complication was low and 5 years survival rate was high in research group. Eating situation total effect of research group was significantly better than that in control group(P<0.05). Conclusion:The clinical effect is better of keeping vagus nerve radical gastrectomy in treatment of gastric cancer patients and it is worthy of popularization and application.%  目的:分析保留迷走神经胃癌根治术治疗胃癌患者的临床疗效。方法:将114例胃癌患者分为观察组(64例)与对照组(50例),分别采用保留迷走神经胃癌根治术和传统胃癌根治术治疗,对手术出血量、手术时间、术后肛门排气和排便时间,以及术中淋巴结扫描比、手术并发症发生率和5年生存率分别统计比较。结果:在手术出血量和手术时间上,两组差异无统计学意义;术后排气和排便时间观察组相对更短;另外,观察组手术淋巴结扫描比更高,术后并发症发生率更低,5年生存率明显更高;术后12个月观察组患者进食情况明显更佳

  5. 保留迷走神经腹腔支胃癌根治术的临床研究%Clinical Study of Abdominal Nerve Branch of Vagus Nerve-Preserving Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    胡英斌; 江勃年; 唐自元; 付忠平; 谢江波

    2011-01-01

    目的 探讨保留迷走神经腹腔支胃癌根治术的临床应用价值.方法 128例胃癌病例随机分为两组,各64例,分别实行保留迷走神经腹腔支胃癌根治术(观察组)和传统胃癌根治术(对照组),并进行胃肠动力学和胃肠激素分泌水平的对比.结果 观察组在术后首次排气时间、首次排便时间优于对照组(P0.05).观察组血清胃泌素和基础胃酸分泌量明显低于对照组(P=0.001或P0.05).结论 保留迷走神经腹腔支的胃癌根治术能加快病人胃肠道功能的恢复和更好的营养吸收.%Objective To explore the clinical value of celiac branch of vagus nerve-preserving radical gastrectomy. Methods A total of 128 gastric cancer patients were randomly divided into observation group ( n =64) receiving celiac branch of vagus nerve-preserving radical gastrectomy and control group ( n =64) receiving traditional classic radical resection. The two groups were compared gastro-intestinal dynamics and hormone levels. Results The first exhaust time and the first bowel movement were better in the observation group than the control group (P <0.05), while the number of lymph node dissection had no significant difference (P >0. 05).The basis levels of observed serum gastrin and gastric acid secretion were significantly lower in the observation group than those in the control group ( P < 0. 05 ). There was no significant difference of the fasting serum insulin levels (P >0.05). The fasting plasma pancreatic polypeptide levels was significantly higher in the observation group than thecontrolgroup(P<0.05). Conclusion Abdominal vagus nerve branch retention of the radical surgery for gastric cancer patients can accelerate the recovery of gastrointestinal function and get better nutrient absorption.

  6. The robotic third arm as a competent analog of an assisting surgeon in radical gastrectomy: impact on short-term clinical outcomes.

    Science.gov (United States)

    Shim, Jung Ho; Kim, Jun Gi; Jeon, Hae Myung; Park, Cho Hyun; Song, Kyo Young

    2013-05-01

    Robotic surgery was invented to overcome difficulties associated with conventional laparoscopic surgery. However, ways in which to improve the efficacy of such surgery have not yet been discussed. This report focuses on the role of a robotic third arm in maximizing the efficacy of lymph node dissection in robot-assisted gastrectomy. Thirty-five robotic gastrectomies were performed between April 2009 and December 2010. We evaluated our surgical procedures by reviewing video recordings of robotic operations and analyzed the steps involved in lymph node dissections frame by frame. Then, we analyzed the short-term clinical outcomes to look at the impact of standardized use of the third arm on clinical outcomes. The initial 15 cases (Group A) were compared with 20 later cases (Group B) in terms of postoperative inflammation and pancreatitis. The clinicopathologic characteristics, including operation type, hospital stay, morbidity, and pathological features, were not different between the two groups. However, postoperative serum amylase levels as well as drain amylase levels were significantly lower in Group B than in Group A (Probotic third arm.

  7. Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy?

    Science.gov (United States)

    Park, Ji Yeon; Ryu, Keun Won; Reim, Daniel; Eom, Bang Wool; Yoon, Hong Man; Rho, Ji Yoon; Choi, Il Ju; Kim, Young-Woo

    2015-07-01

    The adoption of robotic systems for gastric cancer surgery has been proven feasible and safe; however, a benefit over the laparoscopic approach has not yet been well-documented. We aimed to investigate the surgical outcomes of robotic versus laparoscopic gastrectomy for gastric cancer, according to the extent of surgery and patients' obesity status. Between January 2009 and July 2011, 770 patients were enrolled in this retrospective analysis. All had stage IA/IB gastric cancer preoperatively and underwent either laparoscopic (n = 622) or robotic (n = 148) gastrectomy. Patients were classified into obese and non-obese groups on the basis of visceral fat area (VFA). The extent of surgery was defined by whether patients underwent distal or total gastrectomy. The surgical outcomes following distal gastrectomy were similar between the robotic and laparoscopic groups regardless of the obesity status. After total gastrectomy, the number of total and N2-area lymph nodes were significantly higher in the robotic group than in the laparoscopic group in non-obese patients with VFA obese population. Robotic group developed less severe complications after total gastrectomy compared to laparoscopic group in non-obese patients (p = 0.036). Robotic assistance did not improve surgical outcomes over the laparoscopic approach in obese patients undergoing distal gastrectomy. However, non-obese patients with low VFA may benefit from robotic assistance during total gastrectomy in terms of radical D2 lymphadenectomy with fewer serious complications.

  8. Prospective comparative study of laparoscopic-assisted and open radical gastrectomy for gastric cancer%胃癌腹腔镜与开腹手术的前瞻性对照临床研究

    Institute of Scientific and Technical Information of China (English)

    岑庆; 张军; 蔡军; 吴国聪; 金岚; 王康里; 张忠涛

    2013-01-01

    Objective Through the prospective comparative study of laparoscopic-assistcd and open radical gastrectomy for gastric cancer,to evaluate the safety,feasibility,radical and postoperative short-term efficacy of laparoscopic-assisted gastrectomy.Methods From May 2010 to December 2011,29 gastric cancer patients matching the inclusion criteria were chosen as the laparoscopic group.According to the same inclusion criteria,29 gastric cancer patients with the same or similar clinical T stage (AJCC 7th edition) were extracted as the open group.Then the two groups information was carried out a comparative study.Results The mean operation time of the laparoscopic group was longer[(210.34 ± 44.76) min vs (151.55 ± 42.28) min,P =0.000] and the mean hospitalization costs were higher[(61 251 ±17 226) yuan vs (52 016 ±27 767) yuan,P=0.000],while the mean incision length was shorter[(5.83 ± 1.10) cm vs (15.93 ± 1.39) cm,P =O.000] than the open group.There was no significant difference on blood loss,of dissected lymph nodes number,proximal and distal resection margins,the first flatus time,the first liquid diet time,postoperative hospital stay,postoperative complications and cumulative survival rates between the two groups.Conclusion The laparoscopic-assisted gastrectomy for gastric cancer is safe and feasible,can achieve equivalent radical and short-term efficacy with the open surgery.%目的 通过对胃癌腹腔镜与开腹手术的前瞻性对照临床研究,评估前者的安全可行性、根治性及术后近期疗效.方法 2010年8月-2011年12月,选择符合人选标准的胃癌患者29例列为腹腔镜组,同时按照同一入组标准选择相同或相似临床T分期(AJCC第7版)的胃癌患者29例作为开腹对照组,对以上两组进行对比研究.结果 腹腔镜组手术时间长于开腹组[(210.34 ±44.76) min vs (151.55±42.28) min,P=0.000],住院总费用高于开腹组[(61 251±17 226)元vs(52 016 ±27 767)元,P=0.000],切口长度小于开腹组[(5

  9. 抗焦虑对胃癌根治术患者七氟烷用量及术后恢复的影响%Effect of anti-anxiety treatment on sevoflurane requirement and postoperative recovery in patients undergoing radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    蔡静; 印春铭

    2012-01-01

    目的:研究劳拉西泮联合咪达唑仑对择期胃癌根治术患者抗焦虑作用的有效性,及该方法对术中七氟烷用量和术后疼痛的影响.方法:观察组手术前l d服劳拉西泮,术前40min静注咪达唑仑,术中BIS监测控制麻醉深度,观察两组患者术前Spielberge状态—特质焦虑问卷(STAI)评分,术中七氟烷用量,麻醉恢复时间及术后2、6、24 h疼痛VAS评分.结果:观察组状态-特质焦虑问卷评分低于对照组(S-A1:53.60±4.45 vs 62.70±3.98,P<0.05; T-AI:54.78±3.97 vs 65.65±4.21,P<0.05),七氟烷的使用量少于对照组(34.70±0.46 vs 36.20±0.44,P<0.05).两组术后苏醒及拔管时间无统计学差异.两组患者术后6、24 h VAS评分,观察组低于对照组(6 h VAS评分:3.45±1.60 vs 4.89±1.91,P<0.05; 24 hVAS评分:3.51±1.76 vs 5.17±1.71,P<0.05).结论:劳拉西泮联合咪达唑可以减轻术前患者的焦虑状态,减少术中七氟烷的使用,有利于减轻患者术后疼痛.%AIM: To investigate the effect of anti-anxiety treatment with lorazepam and midazolam on sevoflurane requirement and postoperative recovery in patients undergoing radical gastrectomy. METHODS: Sixty patients undergoing radical gastrectomy were divided into two groups: observation group and control group. The observation group was administered with lorazepam the night before surgery and midazolam 40 min before the induction of anesthesia, while the control group was not given such drugs. BIS monitoring was used to control the depth of anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) scores were obtained preop-eratively, while the requirement of sevoflurane during operation and the VAS scores 2 h, 6 h and 24 h postoperatively were also calculated.RESULTS: The observation group had lower STAI scores (S-AI: 53.6 ± 4.45 vs 62.70 ± 3.98, P 0.05).CONCLUSION: Combined use of lorazepam and midazolam can reduce preoperative anxiety, intraoperative sevoflurane requirement, and

  10. The effect of early enteral nutrition plus parenteral nutrition on short-term outcomes after radical gastrectomy%胃癌术后早期肠内营养联合肠外营养的近期效果

    Institute of Scientific and Technical Information of China (English)

    刘琳

    2015-01-01

    Objective: to compare the short-term effects of early enteral nutrition plus parenteral nutrition with those of early total parenteral nutrition on postoperative outcomes of gastric cancer and evaluate the effects on health economics. Method: 40 patients who underwent radical gastrectomy were randomly divided into two groups of early enteral nutrition plus parenteral nutrition and early total parenteral nutrition. the level of blood nutrition indicators was determined 7 days after surgery and anal exhaust time, complications, length of hospital stay and hospitalization cost were observed and analyzed between two groups. Results: the gradually early enteral nutrition plus parenteral nutrition which had a low intolerance rate shortened anal exhaust time, postoperative hospital stay and total hospitalization time, reduced the total hospitalization cost comparing with total parenteral nutrition. Conclusion: Gradually early enteral nutrition plus parenteral nutrition is well tolerated after 24 hours of radical gastrectomy and has better effect on health economics compared with early total parenteral nutrition.%目的:探讨早期肠内营养联合肠外营养以及早期完全肠外营养对胃癌术后患者近期临床结局的影响,并进行卫生经济学效果评价。方法选取胃癌根治术后患者40例,随机分为早期肠内营养联合肠外营养组和早期完全肠外营养组;记录并比较两组肛门排气/排便时间、术后7天营养指标、术后并发症发生率、术后住院时间、总住院时间、总住院费用。结果术后24小时渐进式肠内营养联合肠外营养不耐受率低;与早期完全肠外营养相比,明显缩短了肛门排气/排便时间,缩短了术后住院时间与总住院时间,减少了总住院费用。结论胃癌根治术后24小时实施渐进式早期肠内营养联合肠外营养耐受性好,与早期完全肠外营养相比具有更好的卫生经济效果。

  11. [Treatment outcomes of colon cancer surgery combined with radical lymphadenectomy].

    Science.gov (United States)

    Lipská, L; Visokai, V; Mrácek, M; Levý, M

    2008-05-01

    The authors analyzed a group of 1281 subjects with colorectal cancer operated and followed up in a single institution from I/1992 to VIII/2007. Colon carcinoma patients were assessed separately (C18). Patients with rectal and rectosigmoid tumors are not included in the presentation. A total of 846 patients were operated for colon carcinomas. In 546 subjects, radical R0 resections were achieved. In the R0 group, the male/female ratio is 315/231, age 29-94 years, the mean age of 69 years. The R0 group stratification by TNM classification was: I 17.8%, II 49.6%, III 24.0%, IV 8.1%, TNMx 0.5%. Irrespective of the TNM staging, three-year, five-year and ten-year survival rates were 80%, 71%, and 51%, resp. The median survival time was 9.85 years. Postoperative morality was 5.5%, morbidity 29.8%, anastomic leak occured in 5.7%. Systematic lymph node dissection up to the apical level, had been gradually introduced as an integral part of the R0 surgery. The aim of the study is to analyze outcomes of the colon carcinoma surgical management, combined with radical lymphadenectomy. Furthermore, effects of the extensive procedure on the postoperative morbidity and moratility rates are analyzed as well.

  12. Diagnosis and treatment of anastomotic stoma leakage after laproscopic radical gastrectomy%腹腔镜胃癌根治术后吻合口漏的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    刘金钢; 孙威

    2015-01-01

    Clinical data have confirmed the advantages of laproscopic radical gastrectomy ( LRG) such as mini-invasion and rapid recovery.Consequently, LRG has become more and more popular in treating gastric cancer with expanded indications in recent years.But the complications of LRG are marked, for example, anastomotic stoma leakage.This paper is to review the literature about diagnosis and treatment of anastomotic stoma leakage after LRG.%大量的临床观察结果表明,腹腔镜胃癌根治术具有手术创伤小、术后康复快速等优点。因此,腹腔镜胃癌根治术的手术例数逐年增加,治疗谱不断扩大,已被广泛的接受。随之,腹腔镜胃癌根治术的并发症问题便渐受关注。尤其是吻合口漏。本文便结合文献对腹腔镜胃手术吻合口漏的诊断及治疗做一阐述。

  13. 达芬奇机器人与腹腔镜行胃癌根治术的对照研究%Comparative study on da Vince robotic and laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    刘江; 阮虎; 赵坤; 王刚; 李民; 江志伟

    2014-01-01

    Objective To compare the short-term clinical outcomes of laparoscopic and da Vince robotic radical gastrectomy for gastric cancer and evaluate the safety and efficacy of robotic system. Methods Clinical data of 200 consecutive gastric cancer patients undergoing radical gastrectomy , including 100 cases of robotic (RRG group) and 100 cases of laparoscopic (LRG group), in our department from January 2012 to May 2013 were retrospectively analyzed. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in LRG group, and intracorporeal robot-sewn anastomosis in RRG group. Comparative analysis between the two groups for intraoperative factors (conversion, blood loss, operative time, incision length), oncologic outcomes (TMN stage, lymph node dissection, margin) and postoperative parameters (ventilation time, hospital stay, complications, mortality) was performed. Result There was only 1 conversion in LRG group. As compared to LRG group, RRG group was associated with less blood loss [(60±16) vs. (98±17) ml, P=0.005], longer operative time [(215±46) vs. (188±52) min, P=0.001], shorter incision length [(4.2± 1.7) vs. (8.9±2.6) cm, P=0.028], and shorter postoperative hospital stay [(4.5±2.6) vs. (5.7±3.1) d, P=0.018] in RRG group. While there were no significant differences in other aspects between the two groups, such as number of harvested lymph nodes, distance to upper or lower margin of tumor, postoperative bowel function recovery, and postoperative complication morbidity. Conclusion Robotic radical gastrectomy is feasible and safe for gastric cancer , and has better short-term and oncologic outcomes compared with laparoscopic radical gastrectomy.%目的:探讨全机器人系统进行胃癌根治术的安全性和有效性。方法回顾性分析2012年1月至2013年7月间在南京军区南京总医院行机器人胃癌根治术的100例胃癌患者(机器人组)的临床资料,并选取同期

  14. Combination of organotrifluoroborates with photoredox catalysis marking a new phase in organic radical chemistry.

    Science.gov (United States)

    Koike, Takashi; Akita, Munetaka

    2016-08-01

    Combination of organotrifluoroborates and visible-light-driven photoredox catalysis, both of which have attracted the attention of synthetic chemists, marks a new phase in the field of organic radical chemistry. We have developed photoredox-catalyzed radical reactions with organotrifluoroborates, which turn out to serve not only as a source of organic radicals but also as radical acceptors. The first part of this Perspective deals with the generation of organic radicals from organotrifluoroborates, and the latter part describes addition of the CF3 radical to alkenyltrifluoroborates. The good chemistry between organoborates and photoredox catalysis and its future will be discussed.

  15. Decreased radical gastrectomy in treating early-staging gastric cancer%缩小根治术治疗早期胃癌的临床效果评价

    Institute of Scientific and Technical Information of China (English)

    邵文生

    2016-01-01

    目的:考察缩小根治术与常规根治术治疗早期胃癌的临床效果。方法将90例接受手术治疗的早期胃癌患者随机分为两组,每组45例。常规全胃切除术组患者接受常规腹腔镜胃癌根治术,缩小根治术组患者接受腹腔镜缩小根治术。应用SPSS20.0软件包进行数据处理,手术时间、术中出血量肿瘤切缘、清扫淋巴结数量、术后进食时间、疼痛持续时间、肛门排气时间、住院时间等计量资料以(x珋±s)表示,采用t检验;并发症发生率等计数资料采用χ2检验。P<0.05为差异具有统计学意义。结果缩小根治术组近端切缘为(3.5±1.4) cm、远端切缘为(2.5±0.9) cm显著低于常规全胃切除术组的(4.3±1.6) cm和(3.3±1.1) cm( t=2.524、3.776, P<0.01);缩小根治术组淋巴结清扫数目(8.7±3.2)显著低于常规全胃切除术组的(14.5±4.6)(t=6.943, P<0.01)。缩小根治术组患者术后进半流食时间为(5.2±1.9) d、肛门排气时间为(2.1±1.2) d显著低于常规全胃切除术组(7.1±2.1) d和(4.3±1.4) d(t=4.501、8.004, P<0.01)以上差异均有统计学意义。两组患者手术时间、术中出血量、疼痛持续时间、住院时间、并发症发生率、随访期间患者复发率和病死率差异均无统计学意义(P>0.05)。结论缩小根治术治疗早期胃癌手术安全有效,在保证手术效果的同时降低了患者的术中损伤,具有临床应用价值。%Objective To investigate the clinical outcome of decreased radical gastrectomy in treating early-staging gastric cancer .Methods A total of 90 patients with early gastric cancer were randomly divided into decreased radical gastrectomy group (45 patients) and routine radical gastrectomy group (45). SPSS 20.0 software package was employed for data analysis .The measurement

  16. Investigation of the diet and nutritional status of gastric cancer patients after radical gastrectomy%胃癌根治术患者饮食及营养状况的调查

    Institute of Scientific and Technical Information of China (English)

    英圣艳; 路潜; 任晖; 庞冬; 杨萍; 金三丽

    2013-01-01

    目的 调查胃癌患者术后早期的饮食及营养状况,为临床营养护理提供参考.方法 对70例行胃癌根治术的患者在入院时、出院时及术后4~6周时进行调查,评估其饮食、营养状况,调查患者接受饮食指导及在饮食恢复过程中遇到的问题.结果 胃癌患者术后的饮食性质发生改变;入院时、出院时及术后4~6周时患者的每日进食量较未生病时减少.出院时患者的体质量、体质指数、上臂围、上臂肌围、白蛋白均低于入院时(P<0.05);术后4~6周时患者的体质量、体质指数、三头肌皮褶厚度、上臂围、白蛋白均低于出院时(P<0.05);术后4~6周时患者的体质量、体质指数、三头肌皮褶厚度、上臂围、上臂肌围均低于入院时(P<0.05).但发现患者得到的指导存在不足.结论 胃癌患者术后的进食量不足,营养状况持续恶化,建议完善饮食指导的内容与方法,必要时为患者提供院外的饮食指导.%Objective To investigate the diet and nutritional status of gastric cancer patients during the early postoperative period after radical gastrectomy,so as to provide references for clinical nutritional nursing.Methods Seventy gastric cancer patients undergoing radical gastrectomy were recruited and investigated about their diet and nutritional status at admission,discharge and 4 to 6 weeks after surgery.Dietary guidance received by patients at discharge and problems encountered in diet recovery process were also recorded.Results Obvious diet changes were observed among gastric cancer patients after surgery.Daily food intake decreased at admission,discharge and 4 to 6 weeks after surgery,more decreased after surgery.The patients'body weigh (BW),body mass index (BMI),arm circumference (AC),arm muscle circumference (AMC),albumin (ALB) were significantly lower than what were at admission (P < 0.05).The patients'BW,BMI,triceps skin fold thickness (TSF),AC and albumin 4 to 6

  17. Comparative study of laparoscope and laparotomy D2 radical gastrectomy in the treatment of distal gastric cancer%腹腔镜与开腹远端胃癌D2根治术的对比研究

    Institute of Scientific and Technical Information of China (English)

    何洪生; 曾文龙; 朱柏炼; 杜永御; 赖扬城

    2014-01-01

    目的:通过对比腹腔镜与开腹远端胃癌D2根治术的疗效及安全性,探讨腹腔镜辅助远端胃癌D2根治术的临床价值。方法221例行远端胃癌D2根治术患者,分为两组。其中腹腔镜组115例,开腹组106例,对两组手术时间、术中出血量、术后排气时间、首次进流质时间、淋巴结清扫数目、术后住院天数、并发症进行比较。结果腹腔镜组手术时间、淋巴结清扫数与开腹组差异无统计学意义(P>0.05),而腹腔镜组术中出血量少,术后肛门排气时间早,首次进流质时间早,术后住院时间短,并发症发生率低(P0.05). However, the laparoscope group had fewer intraoperative bleeding volumes, earlier postoperative anal exhaust time, earlier first time of liquid diet, shorter postoperative hospital stays and lower incidence of complications (P<0.05). Conclusion Laparoscope assisted D2 radical gastrectomy in the treatment of distal gastric cancer has small trauma, few bleeding, quick recovery and less complications. The recent curative effect is similar as that of laparotomy, and the treatment is safe and feasible, and worthy of clinical promotion.

  18. Application Experience Elderly Gastric Cancer after Total Gastrectomy the Early Enteral Combined Parenteral Nutrition Support%老年胃癌全胃切除术后早期肠内联合肠外营养支持的应用体会

    Institute of Scientific and Technical Information of China (English)

    李飞

    2013-01-01

    Objective:To investigate the elderly gastric cancer patients with total gastrectomy early postoperative enteral nutrition and parenteral nutrition combination clinical value.Method:From January 2008 to December 2012,52 elderly patients (>60 years) with gastric cancer treated with radical total gastrectomy(D2) were randomly divided into 2 groups:(1) parenteral nutrition group(TPN group,n=27);(2)enteral nutrition and parenteral nutrition combined group(CEP,n=25).To observe the incidence of complications,postoperative patients with gastrointestinal function recovery time,hospital stay, and postoperative hospitalization expenses of each index in the treatment process of the two groups,and to do comparative analysis.Result:CEP group anal exhaust time and hospitalization time compared to the TPN group was significantly shorter (P0.05).Conclusion:Elderly gastric cancer underwent total gastrectomy joint early postoperative enteral parenteral nutrition is safe and feasible,it shortens the duration of hospitalization,and reduce the cost of treatment, particularly for primary hospital.%目的:探讨老年胃癌患者行全胃切除术后早期肠内营养和肠外营养联合应用的临床价值。方法:回顾本院2008年1月-2012年12月收治的老年胃癌患者(大于60岁)行根治性全胃切除术(D2)52例,随机分为两组:(1)肠外营养组(TPN组,n=27);(2)肠内营养和肠外营养联合组(CEP, n=25)。观察治疗过程中两组患者并发症的发生率、术后胃肠功能恢复时间、术后住院时间、住院费用的各项指标,并进行对比分析。结果:CEP组术后肛门排气时间及住院时间较TPN组明显缩短(P0.05)。结论:老年胃癌患者行全胃切除术后早期肠内联合肠外营养是安全可行的,它缩短了住院时间,减少了治疗费用,特别适合基层医院开展。

  19. Application of the Radical Proximal Subtotal Gastrectomy or Total Gatrectomy and Splenectomy in Gastric Cancer with Portal Hypertension%根治性近端胃次全切或全胃切除加脾切除术在胃癌合并肝硬化门脉高压症中的应用

    Institute of Scientific and Technical Information of China (English)

    邓荣文; 李义廷; 李承良

    2011-01-01

    目的:探讨根治性近端胃次全切或全胃切+脾切除术在胃癌合并肝硬化门脉高压症患者(childA级)外科治疗中的作用.方法:回顾性分析我院10年间运用根治性近端胃次全切或全胃切+脾切除术治疗8例肝功能child A级胃癌合并肝硬化门脉高压症患者的临床资料.术前充分评估患者的肝功能、凝血机制、营养状态后积极改善,预测肿瘤切除的可能性,行根治性近端胃次全切除+脾切除3例,全胃切+脾切除术5例.结果:8例患者术后均出现不同程度的腹水,创面渗血2例,膈下感染1例.均经积极治疗后恢复,无围手术期间死亡.结论:根治性近端胃次全切或全胃切除+脾切除术应用于肝功能childA级胃癌合并肝硬化门脉高压症患者是合理的选择.%Objective: To evaluate the effect of the radical proximal subtotal gastrectomy or total gatrec-tomy +splenectomy in treating gastric cancer with portal hypertension. Method: Clinical datas of 8 patients (child A)of the radical proximal subtotal gastrectomy or total gatrectomy + splenectomy in treating gastric cancer with portal hypertension who were surgically treated in our hospital during the last 10 years were studied retrospectively. Preoperatively, a detailed examination, and improvement of their liver function, prothrom-bin time and nutritional status were aggressively made, and the possibility of tumor removal was estimated. Three patients underwent radical proximal subtotal gasterectomy and splenectomy, and five patients urderwent total gastrectomy and splenectomy. Result: All 8 patients had varying degrees of ascites. Wound oozing in 2 cases, subdiaphrogmatic abscess 1 case. All patients recovered after treatment. There were no perioperative deaths in this series. Conclusion: Radical proximal subtotal gastrectomy or total gatrectomy +splenectomy in treating gastric cancer with portal hypertension is a reasonable choice.

  20. 术前口服碳水化合物对胃癌术后胰岛素抵抗影响的机制研究%Effects of preoperative oral carbohydrate on postoperative insulin resistance in radical gastrectomy patients

    Institute of Scientific and Technical Information of China (English)

    于洋; 周岩冰; 刘汉成; 曹守根; 张坚; 王智浩

    2013-01-01

    .Resting energy expenditure (REE),fasting blood glucose,insulin and triglyceride level were detected in 4 hours preoperatively.The 500 ml carbohydrate or placebo were administrated orally 2-3 hours before anaesthesia.Two group patients underwent radical distal subtotal gastrectomy under epidural compounded intravenous anesthesia.After laparotomy and before the abdomen was closed,a piece of rectus abdominis was taken and fixed in 3% glutaraldehyde.REE,fasting blood glucose,insulin and triglyceride level were detected immediately after surgery.The changes of insulin resistance index,blood triglycerides level,REE and respiratory quotient were compared pre-and postoperatively.The changes of rectus abdominis mitochondrial ultrastructure were observed by transmission electron microscopy respectively.Results There were 48 patients (34 males and 14 females) completed the trial.The 24 and 24 patients in oral placebo and carbohydrate groups respectively.In oral placebo group,post-operative insulin resistance index,REE,respiratory quotient,serum triglyceride level and the rectus abdominis mitochondrial damage index were 12.68 ± 3.13,(1458 ± 169) kcal/d,0.73 ± 0.42,(0.53 ± 0.24) g/L and 1.14 ± 0.33,respectively.And the above items were 5.67 ± 1.40,(1341 ± 110) kcal/d,0.79 ± 0.22,(1.04 ± 0.97) g/L and 0.92 ± 0.19 in oral carbohydrate groups respectively.All difference was statistically significant (t = 6.646,2.851,6.546,2.542 and 2.730,all P < 0.05).Oral placebo group showed a markedly swollen mitochondria,steep membrane was not clear,mitochondria appeared vacuolated changes.Conclusions Preoperative oral carbohydrate could reduce the insulin resistance and REE,improve the material metabolism status in radical gastrectomy patients.The possible mechanisms should be related to promotion of insulin release and protection of mitochondrial function.

  1. Surgical Approach of Laparoscopic D2 Radical Gastrectomy for Distal Gastric Cancer%腹腔镜远端胃癌D2根治术手术路径的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    徐建; 王守光; 滕世岗; 季志刚; 刘忠诚

    2011-01-01

    目的 探讨腹腔镜远端胃癌D2根治术手术路径的临床效果. 方法 2007年10月~2010年5月,对56例远端胃癌实施腹腔镜远端胃癌D2根治手术.手术路径:大网膜切除和横结肠系膜前叶剥离;解剖腹腔动脉、肝总动脉、脾动脉及清扫相应淋巴结;处理胃右动脉和5组淋巴结;清扫12a组淋巴结等顺序进行,淋巴清扫以4d→4 sb→14v→6→7/9→11 p→8a→5→12a→1→3的路径进行. 结果 手术时间130 ~375 min,(203.4±48.4) min.清扫淋巴结13 ~21枚,(16.2±1.2)枚.术后胃肠功能恢复时间48 ~120 h,(80.6±17.7)h.标本远近切缘无癌残留.无围手术期死亡病例.术后72 h吻合口出血1例,96 h输出端梗阻1例.56例术后随访2~31个月,(14.1±6.9)月,死亡8例:肿瘤广泛转移6例,心脑血管疾病2例;带瘤生存5例,无瘤生存43例,无瘤生存时间最长已31个月. 结论 腹腔镜远端胃癌D2根治术按照合理的路径进行手术,能够保证手术在正确的间隙和解剖层面进行,有利于在遵循肿瘤根治的原则下完成手术.%Objective To investigate the clinical effects of the surgical pathway of laparoscopic D2 radical gastrectomy for distal gastric cancer. Methods Totally 56 patients underwent laparoscopic D2 radical resection for distal gastric cancer from October 2007 to May 2010. The operation included 5 main steps in a certain order; first, resecting the omentum and divesting anterior lobe of the transverse mesocolon; second, anatomizing the celiac, common hepatic, splenic arteries and dissecting corresponding lymph nodes; third, managing the right gastric artery and five lymph node groups; fourth, dissecting the lymph node of 12a group;finally, the lymph nodes were dissected following the order of 4d→4sb→14v→6→7/9→llp→8a→5→12a→1→3. Results The operation time was 130 - 375 minutes [ mean, (203. 4 ±48. 4) minutes], number of harvested lymph nodes was 13 - 21 ( mean,16. 2 ± 1. 2) , and the

  2. Effects of different anaesthesia methods on postoperative analgesia of radical gastrectomy%全身麻醉复合硬膜外麻醉对胃癌术后镇痛的影响

    Institute of Scientific and Technical Information of China (English)

    路喻清; 冯阳阳; 史军军; 张向东; 胡彬

    2011-01-01

    Objective: To observe the effects of different anaesthesia methods on postoperative analgesia of radical gastrectomy. Methods: Ninety patients ( ASA Ⅰ or Ⅱ ) with gastric carcinoma were randomly divided into two groups ( G + E, G ). All patients were given preemptive analgesia and PCIA. Visual analogue scale ( VAS ) was used to assess the pain intensity at 2, 4,8,24 and 48h after surgery. Results: VAS of G + E group at 2,4,8 hours after surgery were significantly less than G group ( P < 0.05 ) . The effective press frequency of G + E group in 24 hours after surgery was significantly less than G group ( P < 0.05 ) . Adverse reaction of G + E group was significantly less than G group ( P < 0.05 ). Conclusion: General anaesthesia plus epidural anesthesia used in gastric carcinoma can significantly enhance the effect of postoperative analgesia and decrease adverse reaction.%目的:观察全身麻醉复合硬膜外麻醉对胃癌手术病人术后镇痛的影响.方法:90例择期行胃癌根治术患者,ASA I-II 级,年龄33-60 岁,随机均分为2组:G+E(全麻+硬膜外)组和G(单纯全麻)组.均采用超前镇痛和PCIA.观察术后48h内(2,4,8,24,48h)的镇痛评分(VAS),PCA使用次数,不良反应.结果:术后2,4,8h G+E(全麻+硬膜外)组的VAS评分明显低于G(单纯全麻)组(P<0.05).术后24h内PCA按压次数G+E(全麻+硬膜外)组明显低于G(单纯全麻)组(P<0.05).G+E(全麻+硬膜外)组的不良反应发生率明显低于G(单纯全麻)组(P<0.05).结论:胃癌手术时应用全身麻醉复合硬膜外麻醉可以明显加强术后镇痛效果,降低不良反应.

  3. 胃癌根治术中切缘肿瘤残留危险因素的分析%Study of the risk factors of resection-margin involvement in radical gastrectomy of gastric cancer patients

    Institute of Scientific and Technical Information of China (English)

    李勃; 李妍; 蔡慧; 张杭; 马立业; 韩一芳

    2016-01-01

    Objective:To investigate the risk factors of resection-margin (RM)involvement (R1 )in radical gastrectomy of gastric cancer patients.Methods:The clinical data of 412 cases of radical gastrectomy performed from January 2008 to November 2009 in Changhai Hospital were analyzed retrospectively.The potential risk factors of proximal resection margins(PRM)/distal resection margins(DRM)R1 were analyzed by univariate and multivariate Logistic regression analysis. Assess the value of PRM/DRM distance in the anticipating of PRM/DRM R0 .Results:The univariate analysis showed that the risk factors of PRM R1 included tumor size,tumor location,Borrmann type,tumor marker in serum,operation method,PRM distance,T stage,N stage and TNM stage(all P<0.05),and the risk factors of DRM R1 included DRM distance,T stage and vascular invasion (all P<0.05).The multivariate Logistic regression analysis showed that the risk factors of PRM R1 included N3(RR= 2.677)and PRM distance (RR= 0.423),and the risk factors of DRM R1 was DRM distance (RR= 0.407).The best cutoff value point of PRM distance in the anticipating of PRM R0 was 2.05 cm (sensitivity 79.9%and specificity 75.0%),the best cutoff value point of DRM distance in the anticipating of DRM R0 was 1.65 cm (sensitivity 88.6% and specificity 6 6 .7%).Conclusions:N3 stage and PRM distance are independent risk factors of the incidence of PRM R1 and DRM distance is the only independent risk factors of the incidence of DRM R1 .The best cutoff value point of PRM/DRM distance can be used to help the surgeons obtain PRM R0 .%目的:明确胃癌根治术(D2)中切缘(resection margins,RM)肿瘤残留(R1)发生的独立危险因素。方法:回顾性分析2008年1月至2009年11月长海医院普通外科收治的412例行胃癌根治术患者资料。对影响上切缘(proximal resection margins,PRM)/下切缘(distal resection margins,DRM)R1发生的相关因素进行单因素分析及Logistic多因素回归分析。

  4. A TMS examination of semantic radical combinability effects in Chinese character recognition.

    Science.gov (United States)

    Hsiao, Janet Hui-Wen; Shillcock, Richard; Lavidor, Michal

    2006-03-17

    The proposal of human foveal splitting assumes a vertical meridian split in the foveal representation and the consequent contralateral projection of information in the two hemifields to the two hemispheres and has been shown to have important implications for visual word recognition. According to this assumption, in Chinese character recognition, the two halves of a centrally fixated character may be initially projected to and processed in different hemispheres. Here, we describe a repetitive transcranial magnetic stimulation (rTMS) investigation of hemispheric processing in Chinese character recognition, through examining semantic radical combinability effects in a character semantic judgment task. The materials used were a dominant type of Chinese character which consists of a semantic radical on the left and a phonetic radical on the right. Thus, according to the split fovea assumption, the semantic and phonetic radicals are initially projected to and processed in the right hemisphere and the left hemisphere, respectively. We show that rTMS over the left occipital cortex impaired the facilitation of semantic radicals with large combinability, whereas right occipital rTMS did not. This interaction between stimulation site and radical combinability reveals a flexible division of labor between the hemispheres in Chinese character recognition, with each hemisphere responding optimally to the information in the contralateral visual hemifield to which it has direct access. The results are also consistent with the split fovea claim, suggesting functional foveal splitting as a universal processing constraint in reading.

  5. An examination of semantic radical combinability effects with lateralized cues in Chinese character recognition.

    Science.gov (United States)

    Hsiao, Janet Hui-Wen; Shillcock, Richard; Lavidor, Michal

    2007-04-01

    Auclair and Siéroff examined lateralized cuing effects in the identification of centrally presented letter strings and reported no cuing effects for short word stimuli. They argued for a redistribution of attention over the entire word for short familiar words. We explored cuing effects with Chinese phonetic compounds, which can be considered extreme examples of short words, in a character-level semantic judgment task. When the semantic radical position was placed on the left of the characters, strong radical combinability and semantic transparency effects were observed. There was also a significant interaction between cue position (left vs. right) and radical combinability: A left cue facilitated semantic judgment of characters with small radical combinability more than did a right cue. This behavior reflects the information profile of Chinese phonetic compounds. Semantic radicals with small combinability are more informative than those with large combinability in determining the meaning of the whole character; they therefore benefit more from a left than a right cue. A mechanism redistributing attention over the whole of the character was not in evidence at the level of semantic processing.

  6. D2 dissection in laparoscopic and open gastrectomy for gastric cancer

    Science.gov (United States)

    Cui, Ming; Xing, Jia-Di; Yang, Wei; Ma, Yi-Yuan; Yao, Zhen-Dan; Zhang, Nan; Su, Xiang-Qian

    2012-01-01

    AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopy-assisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage. RESULTS: There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P > 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no significant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had significantly less blood loss, but a longer operation time (P dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG. PMID:22371644

  7. Functionalized graphene quantum dots loaded with free radicals combined with liquid chromatography and tandem mass spectrometry to screen radical scavenging natural antioxidants from Licorice and Scutellariae.

    Science.gov (United States)

    Wang, Guoying; Niu, XiuLi; Shi, Gaofeng; Chen, Xuefu; Yao, Ruixing; Chen, Fuwen

    2014-12-01

    A novel screening method was developed for the detection and identification of radical scavenging natural antioxidants based on a free radical reaction combined with liquid chromatography with tandem mass spectrometry. Functionalized graphene quantum dots were prepared for loading free radicals in the complex screening system. The detection was performed with and without a preliminary exposure of the samples to specific free radicals on the functionalized graphene quantum dots, which can facilitate charge transfer between free radicals and antioxidants. The difference in chromatographic peak areas was used to identify potential antioxidants. This is a novel approach to simultaneously evaluate the antioxidant power of a component versus a free radical, and to identify it in a vegetal matrix. The structures of the antioxidants in the samples were identified using tandem mass spectrometry and comparison with standards. Fourteen compounds were found to possess potential antioxidant activity, and their free radical scavenging capacities were investigated. The order of scavenging capacity of 14 compounds was compared according to their free radical scavenging rate. 4',5,6,7-Tetrahydroxyflavone (radical scavenging rate: 0.05253 mL mg(-1) s(-1) ) showed the strongest capability for scavenging free radicals.

  8. Radical curative efficacy of tafenoquine combination regimens in Plasmodium cynomolgi-infected Rhesus monkeys (Macaca mulatta

    Directory of Open Access Journals (Sweden)

    Kenworthy David

    2011-07-01

    Full Text Available Abstract Background Tafenoquine is an 8-aminoquinoline being developed for radical cure (blood and liver stage elimination of Plasmodium vivax. During monotherapy treatment, the compound exhibits slow parasite and fever clearance times, and toxicity in glucose-6-phosphate dehydrogenase (G6PD deficiency is a concern. Combination with other antimalarials may mitigate these concerns. Methods In 2005, the radical curative efficacy of tafenoquine combinations was investigated in Plasmodium cynomolgi-infected naïve Indian-origin Rhesus monkeys. In the first cohort, groups of two monkeys were treated with a three-day regimen of tafenoquine at different doses alone and in combination with a three-day chloroquine regimen to determine the minimum curative dose (MCD. In the second cohort, the radical curative efficacy of a single-day regimen of tafenoquine-mefloquine was compared to that of two three-day regimens comprising tafenoquine at its MCD with chloroquine or artemether-lumefantrine in groups of six monkeys. In a final cohort, the efficacy of the MCD of tafenoquine against hypnozoites alone and in combination with chloroquine was investigated in groups of six monkeys after quinine pre-treatment to eliminate asexual parasites. Plasma tafenoquine, chloroquine and desethylchloroquine concentrations were determined by LC-MS in order to compare doses of the drugs to those used clinically in humans. Results The total MCD of tafenoquine required in combination regimens for radical cure was ten-fold lower (1.8 mg/kg versus 18 mg/kg than for monotherapy. This regimen (1.8 mg/kg was equally efficacious as monotherapy or in combination with chloroquine after quinine pre-treatment to eliminate asexual stages. The same dose of (1.8 mg/kg was radically curative in combination with artemether-lumefantrine. Tafenoquine was also radically curative when combined with mefloquine. The MCD of tafenoquine monotherapy for radical cure (18 mg/kg appears to be biologically

  9. 多层螺旋CT血管造影在胃癌规范性根治术术前评估中的价值%Preoperative Evaluation Value of Multislice Spiral Computed Tomography Angiography for Normative Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    刘超; 黄源; 林进令

    2011-01-01

    Objective To explore the evaluation value of preoperative multislice spiral computed tomography angiography (MSCTA) for normative radical gastrectomy. Methods The anatomic distributions of celiac trunk and its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which compared with postoperative pathological results. Results The accuracy rate of preoperative MSCTA evaluating the distribution of celiac trunk and its three branches and their tributaries was 100%. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25.58%. Abnormal right hepatic arteries were found in 11 cases (12.79%), abnormal left hepatic arteries in 7 cases (8.14%), both abnormal right and left hepatic arteries in 1 case (1.16%), and abnormal common hepatic arteries in 3 cases (3.49%). Straight splenic arteries were found in 24 cases (27.91% ), slightly curved splenic arteries in 44 cases (51.16 % ), and significantly curved splenic arteries in 18 cases (20. 93 % ). Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58% (65/86), 74.42% (64/86), and 91.86% (79/86), respectively. Conclusions Preoperative MSCTA is an objective way to assess the distributions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.%目的 探讨多层螺旋CT血管造影(multislice spiral computed tomography angiography,MSCTA)在胃癌规范性根治术术前评估中的价值.方法

  10. Clinical observation on one period radical gastrectomy on treatment of 92 cases of perianal abscess%一期根治术治疗肛周脓肿92例临床观察

    Institute of Scientific and Technical Information of China (English)

    马进生

    2014-01-01

    为探讨一期根治术治疗肛周脓肿的临床疗效。回顾分析92例行一期根治术治疗肛周脓肿患者的治疗资料,结果显示92例患者中,90例一期愈合,2例形成肛瘘,经二次手术治愈。疗程23~37天,平均26.5天。92例患者有87例获访18个月,无复发,无肛门失禁、变形。一期根治术治疗肛周脓肿疗效满意,及经济负担,配合中药可减轻患者的痛苦,是一种理想的治疗方法。%To explore the clinical effect of one stage radical operation in the treatment of perianal abscess. Retrospective analysis of the treatment data of 92 routine surgery in treatment of the patients with perianal abscess, results showed that 92 patients, 90 cases were healed, 2 cases formed fistula, after two times of operation cure. Treatment 23-37 days, average 26.5 days. In 92 patients, 87 patients were followed up for 18 months, no recurrence, no anal incontinence, deformation. One stage radical operation in the treatment of perianal abscess curative effect is satisfactory, and the economic burden, combined with traditional Chinese medicine can relieve the pain of patients, and is an ideal treatment method.

  11. Loading of free radicals on the functional graphene combined with liquid chromatography-tandem mass spectrometry screening method for the detection of radical-scavenging natural antioxidants.

    Science.gov (United States)

    Wang, Guoying; Shi, Gaofeng; Chen, Xuefu; Chen, Fuwen; Yao, Ruixing; Wang, Zhenju

    2013-11-13

    A novel free radical reaction combined with liquid chromatography electrospray ionization tandem mass spectrometry (FRR-LC-PDA-ESI/APCI-MS/MS) screening method was developed for the detection and identification of radical-scavenging natural antioxidants. Functionalized graphene was prepared by chemical method for loading free radicals (superoxide radical, peroxyl radical and PAHs free radical). Separation was performed with and without a preliminary exposure of the sample to specific free radicals on the functionalized graphene, which can facilitate reaction kinetics (charge transfers) between free radicals and potential antioxidants. The difference in chromatographic peak areas is used to identify potential antioxidants. The structure of the antioxidants in one sample (Swertia chirayita) is identified using MS/MS and comparison with standards. Thirteen compounds were found to possess potential antioxidant activity, and their free radical-scavenging capacities were investigated. The thirteen compounds were identified as 1,3,5-trihydroxyxanthone-8-O-β-D-glucopyranoside (PD1), norswertianin (PD2), 1,3,5,8-tetrahydroxyxanthone (PD3), 3, 3', 4', 5, 8-penta hydroxyflavone-6-β-D-glucopyranosiduronic acid-6'-pentopyranose-7-O-glucopyranoside (PD4), 1,5,8-trihydroxy-3-methoxyxanthone (PD5), swertiamarin (PS1), 2-C-β-D-glucopyranosyl-1,3,7-trihydroxylxanthone (PS2), 1,3,7-trihydroxylxanthone-8-O-β-D-glucopyranoside (PL1), 1,3,8-trihydroxyl xanthone-5-O-β-D-glucopyranoside (PL2), 1,3,7-trihydroxy-8-methoxyxanthone (PL3), 1,2,3-trihydroxy-7,8-dimethoxyxanthone (PL4), 1,8-dihydroxy-2,6-dimethoxy xanthone (PL5) and 1,3,5,8-tetramethoxydecussatin (PL6). The reactivity and SC50 values of those compounds were investigated, respectively. PD4 showed the strongest capability for scavenging PAHs free radical; PL4 showed prominent scavenging capacities in the lipid peroxidation processes; it was found that all components in S. chirayita exhibited weak reactivity in the superoxide

  12. 二级前哨淋巴结示踪技术:进展期胃癌根治术中淋巴结示踪新方法%Secondary sentinel lymph node tracing technique:a new method for tracing lymph nodes in radical gastrectomy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Zong-lin LI; Huai-wu JIANG; Min SONG; Liang XU; Dong XIA; Qing LIU

    2015-01-01

    目的:探讨二级前哨淋巴结(SSLN)示踪技术在进展期胃癌(AGC)根治术中的可行性及临床价值。  创新点:提出 SSLN概念并以 SSLN理论为指导对 AGC实施个体化淋巴结清扫术。  方法:将2009年1月至2011年6月于我院手术治疗的进展期胃角部癌患者247例随机分为A、B两组:A组138例于术中肿瘤切除前向第3组淋巴结转移结节边缘注亚甲蓝示踪剂,寻找并切取 SSLN进行病理活检,并根据SSLN的活检结果进行个体化淋巴结清扫术;B组109例直接进行标准D2胃癌根治术。对A、B组患者进行术后随访和生存分析。  结论:SSLN 示踪技术应用于 AGC 手术是可行的。 SSLN示踪技术可以了解AGC淋巴结转移的终末状态,对指导 AGC 个体化淋巴结清扫及改善预后具有重要的临床价值。%Objective: To explore the feasibility and clinical value of secondary sentinel lymph node (SSLN) tracing technique in radical gastrectomy for advanced gastric cancer (AGC). Methods: From January 2009 to June 2011, 247 patients who suffered from gastric angle cancer with metastasis in No. 3 group lymph nodes were divided randomly into groups A and B. Methylthioninium chloride was injected into the peripheral tissue of the metastatic No. 3 group lymph nodes of 138 patients in group A before tumor resections. SSLNs were traced and individual lymphadenecto-mies were carried out based on the biopsy results of the SSLNs. Standard D2 radical gastrectomies were carried out directly on 109 patients in group B. Postoperative folow-up and survival analysis were carried out for patients in both groups. Results: SSLNs were found in 114 (82.6%) patients in group A. Ninety of those patients (78.9%) demonstrated existing metastasis in SSLNs. According to Kaplan-Meier’s method, the postoperative 3-year cumulative survival rates were 63.5% and 47.5%, and the median survival time were 40 and 36 months for the patients of

  13. A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis Treated with Preoperative FOLFOX Chemotherapy Followed by Radical Subtotal Gastrectomy and D2 Lymph Node Dissection

    Directory of Open Access Journals (Sweden)

    Byoung Jo Suh

    2017-02-01

    Full Text Available We report the case of a 73-year-old female who was diagnosed with advanced gastric cancer. Esophagogastroduodenoscopy was used to diagnose Borrmann type 3 advanced gastric cancer located at the gastric antrum. A biopsy revealed poorly differentiated adenocarcinoma. Abdominopelvic computed tomography (CT and 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT scans demonstrated multiple lymph node metastases, including the para-aortic lymph nodes. Systemic chemotherapy with 5-fluoruracil (5-FU, oxaliplatin, and leucovorin (FOLFOX was initiated. An abdominopelvic CT scan taken after 4 cycles of chemotherapy showed improvement in the ulceroinfiltrative gastric lesion and marked regression of several enlarged lymph nodes. Consequently, we performed a subtotal gastrectomy with D2 lymphadenectomy. The postoperative histopathological report was early gastric carcinoma with no lymph node metastasis in the 48 resected lymph nodes. Another 4 cycles of FOLFOX chemotherapy were performed after surgery. A FDG-PET-CT scan taken 12 months postoperatively showed no definite evidence of local recurrence or distant metastasis, and the previously noted retroperitoneal lymph nodes had disappeared. A FDG-PET-CT taken 16 months postoperatively showed multiple lymph node metastases, including the left supraclavicular lymph node. Despite 8 cycles of secondary chemotherapy with 5-FU, irinotecan, and leucovorin (FOLFIRI and radiotherapy, the patient died 38 months after the operation.

  14. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV

    Science.gov (United States)

    PINTO, José Máximo Costa; de LIMA, Marianna Gomes Cavalcanti Leite; de ALMEIDA, Ana Luiza Melo Cavalcanti; SOUSA, Marcelo Gonçalves

    2016-01-01

    ABSTRACT Introduction: It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. Objective: To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Methods: Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. Conclusion: It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. PMID:27683793

  15. Post-gastrectomy spleen enlargement and esophageal varices: Distal vs total gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Takatsugu; Oida; Kenji; Mimatsu; Hisao; Kano; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano

    2010-01-01

    AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-t...

  16. D2 dissection in laparoscopic and open gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ming Cui; Jia-Di Xing; Wei Yang; Yi-Yuan Ma; Zhen-Dan Yao; Nan Zhang; Xiang-Qian Su

    2012-01-01

    AIM:To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer.METHODS:Clinicopathological data from 209 patients with gastric cancer,who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011,were analyzed retrospectively.Among these patients,131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG).The parameters analyzed included operative time,blood loss,blood transfusion,morbidity,mortality,the number of harvested lymph nodes (HLNs),and pathological stage.RESULTS:There were no significant differences in sex,age,types of radical resection [radical proximal gastrectomy (PG + D2),radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)],and stages between the LAG and OG groups (P > 0.05).Among the two groups,127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs,respectively.The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P =0.233).In the same type of radical resection,there were no significant differences in the number of HLNs between the two groups (PG + D2:21.7 ± 7.5 vs 22.4 4-9.3;DG + D2:25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2:30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons).Tumor free margins were obtained in all cases.Compared with OG group,the LAG group had significantly less blood loss,but a longer operation time (P < 0.001).The morbidity of the LAG group was 9.9%,which was not significantly different from the OG group (7.7%) (P=0.587).The mortality was zero in both groups.CONCLUSION:Laparoscopic D2 dissection is equivalent to OG in the number of HLNs,regardless of tumor location.Thus,this procedure can achieve the same radicalness as OG.

  17. Mechanism of the OH radical scavenging activity of nordihydroguaiaretic acid: a combined theoretical and experimental study.

    Science.gov (United States)

    Galano, Annia; Macías-Ruvalcaba, Norma A; Medina Campos, Omar Noel; Pedraza-Chaverri, José

    2010-05-20

    The antioxidant nordihydroguaiaretic acid (NDGA) is a plant phenolic lignan originally isolated from the creosote bush (Larrea tridentata). It has been shown that NDGA scavenges efficiently hydroxyl radicals ((*)OH). In the present paper the mechanism by which NDGA scavenges (*)OH is addressed performing a combined experimental and theoretical investigation. We found that NDGA protects, in a concentration-dependent way, bovine serum albumin and DNA from the damage induced by (*)OH generated by the Fenton reaction. In addition, the NDGA + (*)OH reaction is predicted to be diffusion-controlled. The first step of this reaction is proposed to occur mainly by a sequential electron proton transfer from NDGA to (*)OH generating a neutral radical of NDGA, which after a second oxidation step gives a diradical that after a cascade sequential complex reaction produces a cyclic compound. This cyclic product is predicted to have a UV-vis spectrum very similar to that of NDGA, making its identification by this technique very difficult. The electrochemical studies performed in water support the formation of a cyclic compound (C2) as the main product of the reaction. It is concluded that NDGA can scavenge at least two (*)OH.

  18. Removal of Nox from flue gas with radical oxidation combined with chemical scrubber

    Institute of Scientific and Technical Information of China (English)

    LIN He; GAO Xiang; LUO Zhong-yang; GUAN Shi-pian; CEN Kefa; HUANG Zhen

    2004-01-01

    In this paper, removal of NOx(namely DeNOx) from flue gas by radical injection combined with NaOH solution(26% by weight of NaOH in water) scrubbing was investigated. The experimental results showed that the steady streamer corona occurs through adjusting the flow rate of the oxygen fed into the nozzles electrode. The vapor in the oxygen has influence on the V-I characteristics of corona discharge. Both HNO2 and HNO3 come into being in the plasma reactor and the DeNOx efficiency in the plasma reactor is more than 60%. The overall DeNOx efficiency of the whole system reaches 81.7% when the NaOH solution scrubbing is collaborated.

  19. The research of hemodynamic changes in portal hypertension combining with subtotal gastrectomy%猪远端胃大部分切除术后合并门静脉高压症模型中门脉血流系统的变化

    Institute of Scientific and Technical Information of China (English)

    张贺云; 李文滨; 褚忠华; 彭耀荣; 吴卓; 王捷

    2011-01-01

    Objective To build up a pig model of portal hypertension combined with subtotal gastrectomy,and study the hemodynamic changes of portal vein system.Methods 26 Susscrota domesticas are divided into three groups randomly.The experimental group ( EG,n =10) will receive the subtotal gastrectomy in the onestage operation,and will be subtotally coarctated the vena portae after one month.The portal hypertension group (PG,n =10) will receive the sham subtotal gastrectomy at first and followed by subtotally coarctated the vena portae.And the shamoperated group ( SG,n =6) will receive the sham subtotal gastrectomy at first and the sham subtotally coarctated the vena portae one month later.The portal pressure will be measured,and the hemodynamic changes in all groups will be detected by computer tomography and cast form.Results ( 1 ) The portal pressure in the EG and PG are statistically significance higher than the SG.And no difference was found between the EG and PG after the operation.(2) After subtotal gastrectomy,there are no new blood vessel appear in the gastric stump and the anastomosis between the stomach and the intestines.The blood supply of the gastric stump are mainly supported by the left gastric arteria and arteriae gastro-omentalis sinistra.The venous return of the gastric are mainly through the left gastric vein and left gastroepiploic vein.Conclusion ( 1 ) The method of subtotally coarctating the vena portae can build up a model of portal hypertension combined with subtotal gastrectomy.(2) The patients of portal hypertension who alreadly underwent subtotal gastrectomy is not suitable for the pericardial devascularization and the modified Sugiura procedure.%目的 建立猪远端胃大部分切除术后合并门静脉高压症模型,观察该模型门脉系统的血流动力学变化.方法 将26只家猪随机分为3组,实验组(EG,10只)一期行远端胃大部分切除、二期行门静脉部分缩窄术;门静脉高压组(PG,10只)一期行开关腹

  20. 免疫增强型肠内营养对胃癌根治患者术后免疫功能和炎症反应的影响%Effect of immune enhanced enteral nutrition on postoperative immune function and inflammatory responses in gastric cancer patients with radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    刘卓; 于杰

    2011-01-01

    为了观察术后免疫增强型肠内营养对胃癌根治患者术后免疫功能及炎症反应的影响,选择胃癌根治患者42例,采用简单随机分组法,即抽签法分为免疫增强型肠内营养组(研究组)和常规肠内营养组(对照组)各21例.两组患者均于术后d1~d8,研究组使用含谷氨酰胺、精氨酸、ω-3多不饱和脂肪酸的免疫增强型肠内营养制剂,对照组使用常规的制剂能全力.观察术前1 d、术后1 d和术后9 d两组患者的免疫指标和炎症反应指标:1)T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)、自然杀伤(NK)细胞、免疫球蛋白(IgG、lgM、IgA);2)肿瘤坏死因子(TNF-α)、血清中细胞因子白介素(IL-6).结果研究组术后第9天,CD3、CD4、CD8、CD4/CD8、NK和免疫球蛋白(IgG、IgM、IgA)明显高于时照组,P<0.05;炎症反应指标,研究组IL-6、TNF-α显著低于对照组,P<0.05.初步研究结果提示,免疫增强型肠内营养可减轻胃癌根治患者术后的机体炎症反应,改善免疫功能.%The objective of this study was evaluate the effect of immune-enhanced enteral nutrition on postoperative immune function and inflammatory responses in gastric cancer patients with radical gastrectomy. Totally 42 gastric cancer patients were randomized to study and control group, 21 patients in each group. Enteral nutrition were stated d1-d8 after surgery, containing glutamine, arginine, ω-3 polyunsaturated fatty acids. And Nutrison Fibre was given to control group. T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8), NK, immunoglobulin (IgG, IgM,IgA), tumor necrosis factor (TNF-α) and serum cytokines interleukin (IL-6) were investigated d1 preoperative, and d1 and d9 postoperative. In study Group CD3, CD4, CD8, CD4/CD8, NK level and immunoglobulin (IgG, IgM,lgA) were significantly higher(P<0. 05). Inflammatory response indicators, IL-6, TNF-α in study group were significantly lower than those in the control group(P<0.05). Immune-enhancd enteral

  1. 免疫增强型肠内营养对胃癌根治病人术后免疫功能和炎症反应的影响%The effect of postoperative immune enhanced enteral nutrition on host immune function and inflammatory responses in gastric cancer patients with radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    赵得新; 朱甲明; 陈云波

    2011-01-01

    Objective To evaluate the effect of postoperative immune-enhanced enteral nutrition on host immune function and inflammatory responses in gastric cancer patients with radical gastrectomy .Methods 42 gastric cancer patients were randomized to study and control group ,each group have 21 patients .Enteral nutrition were stated 1days after surgery and continued for 8 days .Using immune enhanced nutrition ,containing glutamine 、 arginine 、 ε-3 polyunsaturated fatty acids ,and Nutrison Fibre in the study and control group respectively .① T- lymphocyte subsets (CD4 ,CD8 ,CD4/CD8 ) ,immunoglobulin (IgG ,IgM ,IgA ) and ② tumor necrosis factor (TNF-α) ,serum cytokines interleukin (IL-6) were investigated in 1th day preoperative and 1th 、 9th day postoperative .Results Study Group IgA ,CD4 level and CD4/CD8 were significantly higher ( P<0.05 ) .Inflammatory response indicators ,the Study Group IL-6 ,TNF-α was significantly lower than the control group ( P<0.05 ).Conclusion immune-enhancd enteral nutrition can alleviate the postoperative inflammatory response and improve immune function in in gastric cancer patients with radical gastrectomy .%目的 观察术后免疫增强型肠内营养对胃癌根治病人术后免疫功能及炎症反应的影响.方法 胃癌根治病人42例,随机分为研究组、对照组,各21例.于术后1-8 d,研究组使用含谷氨酰胺、精氨酸、ω-3多不饱和脂肪酸的免疫增强型肠内营养制剂,对照组使用常规的制剂能全力.观察术前1 d、术后1 d和术后9 d;①T淋巴细胞亚群(CD4、CD8、CD4/CD8)、免疫球蛋白(IgG、IgM、IgA);②肿瘤坏死因子(TNF-α)、血清中细胞因子白介素(IL-6).结果 研究组IgA、CD4水平及CD4/CD8显著高于对照组(P<0.05).炎症反应指标,研究组IL-6、TNF-α显著低于对照组(P<0.05).结论 免疫增强型肠内营养可减轻胃癌根治病人术后的机体炎症反应,改善免疫功能.

  2. Effect of chemotherapy after radical surgery of colon cancer combined with cascade primed immune cell therapy on patients’ prognosis

    Institute of Scientific and Technical Information of China (English)

    Xin-Cheng Shu; Ping Gao; Xin-Jua Zuo

    2016-01-01

    Objective:To study the effect of chemotherapy after radical surgery of colon cancer combined with cascade primed immune cell therapy on patients' prognosis.Methods:A total of78 cases of patients with colon cancer who received radical surgery of colon cancer assisted by postoperative chemotherapy in our hospital from May 2012 to December 2014 were selected for treatment and randomly divided into two groups, combined treatment group received chemotherapy combined with cascade primed immune cell therapy, simple chemotherapy group received FOLFOX chemotherapy, and then serum tumor marker contents and angiogenesis molecule contents as well as red blood cell immune function indicators in peripheral blood were detected.Results:Serum tumor markers CCSA-2, CCSA-3, CCSA-4, PTN, NGAL and sMICA as well as angiogenesis molecules VEGF, FGF10, sICAM-1, sVCAM-1, Musashi1 and Dkk1 contents of combined treatment group were lower than those of conventional chemotherapy group; the proportion of CR1, CR3, CD58 and CD59 as well as the rosette formation rates of red blood cell C3b receptor and immune complex in peripheral blood of combined treatment group were significantly higher than those of conventional chemotherapy group.Conclusions:Chemotherapy after radical surgery of colon cancer combined with cascade primed immune cell therapy helps to kill tumor cells and inhibit angiogenesis while enhance red blood cell immune function, and it can improve the prognosis of radical surgery of colon cancer.

  3. Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report

    Directory of Open Access Journals (Sweden)

    Laura Tariciotti, PhD MD

    2016-01-01

    Conclusion: Despite the ideal approach to the management of the obese LT patients remains unknown, we strongly support the combined procedure during LT in selected patients, offering advantages in terms of allograft and patient survival, maintenance of weigh loss that will ultimately reduce obese related co-morbidities.

  4. Gallstone Ileus, Bouveret’s Syndrome and Choledocholithiasis in a Patient with Billroth II Gastrectomy – A Case Report of Combined Endoscopic and Surgical Therapy

    Directory of Open Access Journals (Sweden)

    R. Fejes

    2010-02-01

    Full Text Available Intestinal obstruction due to gallstone is a rare, but quite severe gastrointestinal disorder, which always requires a rapid and correct diagnosis to achieve optimal therapy. Digestive endoscopy is an important method to determine the level of the bowel obstruction and to plan an optimal therapeutic strategy. Our present case demonstrates that in a high-risk patient, a combined endoscopic and surgical therapy is the best choice to solve the obstruction of the colon, of the stomach and of the common bile duct caused by multiple gallstones.

  5. Clinical study on the effect of selective regional chemoinfusion on prognosis after radical gastrectomy for gastric cancer%选择性区域灌注化疗对胃癌根治术后患者预后的影响

    Institute of Scientific and Technical Information of China (English)

    吴有军; 何建苗; 杨波; 秦荣; 曹志宇; 董立国; 蒲永东

    2011-01-01

    目的 评价选择性区域灌注化疗对根治性胃癌切除术后患者预后的影响.方法 2003年1月—2005年l2月解放军309医院普外科收治的胃癌患者共127例,入院后完善辅助检查除外远处转移,随机分为术中置泵(置泵组)和术中不置泵(对照组)两组.置泵组共63例,其中男51例,女12例,年龄50.7±6.2岁;对照组共64例,其中男54例,女10例,年龄53.3±7,5岁.两组在性别、年龄、TNM分期、病变部位、病理类型等方面的构成无统计学差异(P>0.05).所有患者均行胃癌根治术,置泵组术中放置胃网膜右动、静脉和腹腔化疗泵,术后全身化疗联合区域灌注化疗,对照组术后仅行静脉化疗.比较两组并发症、局部复发率、肝脏转移率、腹腔转移率、1年生存率、3年生存率、5年生存率等指标.结果 所有患者均成功实施手术,手术并发症主要为胃瘫和切口感染,多数患者完成6周期术后化疗,主要不良反应为轻到中度的恶心呕吐和白细胞减少,无手术和化疗相关死亡.置泵组和对照组分别有6例和9例患者未能完成化疗,原因包括不能耐受及化疗泵堵塞等.置泵组随访11.7~60个月,失访2例,对照组随访10.5~60个月,失访4例.置泵组和对照组间比较,局部复发率(17.5%,32.8%),肝脏转移率(27.0%,43.8%),腹腔转移率(14.3%,29.7%),3年生存率(71.4%,53.1%)和5年生存率的差异均有统计学意义(46.0%,28.1%,P均<0.05),但1年生存率间差异无统计学意义(92.1%,87.5%,P>0.05).结论 胃癌根治术后的选择性区域灌注化疗是对现有治疗模式的一种有益补充,值得临床推广应用.%Objective To evaluate the effect of selective regional chemoinfusion on prognosis after radical gastrectomy for gastric cancer. Methods The present study selects 127 cases of gastric cancer treated by the General Surgery Department of 309 Hospital of PLA from January 2003 to December 2005. Patients

  6. 达芬奇机器人手术系统与腹腔镜胃癌根治术近期疗效的Meta分析%Short-term efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer: a Meta analysis

    Institute of Scientific and Technical Information of China (English)

    李政焰; 石彦; 余佩武

    2015-01-01

    目的 系统评价达芬奇机器人手术系统与腹腔镜胃癌根治术的近期疗效.方法 以gastric cancer、gastrectomy、da Vinci surgical system、laparoscopic、laparoscopy、胃癌、胃切除术、达芬奇机器人手术系统、腹腔镜为检索词,检索PubMed、EMBASE、Cochrane Library、Medline、中国期刊全文数据库、万方数据库、维普数据库及中国生物医学期刊文献数据库.检索时间为2002年5月至2014年3月.纳入研究达芬奇机器人手术系统与腹腔镜胃癌根治术的临床疗效的相关对照试验,由2名研究者独立筛选文献和提取数据,并进行文献质量评价.行达芬奇机器人手术系统胃癌根治术患者为机器人组,行腹腔镜胃癌根治术患者为腹腔镜组.应用RevMan 5.2统计软件进行Meta分析.计数资料采用相对危险度(RR)及95%可信区间(95% CI)表示,计量资料采用加权均数差(WMD)及95% CI表示.采用I2对异质性进行分析.结果 最终纳入符合标准的相关研究共11篇,累计样本量3 698例,其中机器人组953例,腹腔镜组2 745例.Meta分析结果显示:与腹腔镜组比较,机器人组胃癌患者手术时间显著延长,术中出血量显著减少,术后肛门排气时间、术后经口进食时间及术后住院时间显著缩短,差异有统计学意义(WMD=51.23,-36.96,-0.24,-0.26,-1.11,95%CI:28.01 ~ 74.46,-61.28~-12.65,-0.42 ~-0.06,-0.39~-0.14,-1.92~-0.29,P<0.05);淋巴结检出数目,远、近切缘距肿瘤距离及术后并发症发生率两组比较,差异无统计学意义(WMD=1.63,0.21,0.06,RR=1.11,95%CI:-0.49 ~ 3.76,-0.65~1.06,-0.13~0.25,0.90 ~1.37,P>0.05).结论 达芬奇机器人手术系统与腹腔镜胃癌根治术同样安全可行,且前者手术创伤更小,术后恢复更快,患者能在近期疗效上获益.%Objective To compare the short-term efficacy between da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.Methods Database including

  7. Calculational and Experimental Investigations of the Pressure Effects on Radical - Radical Cross Combinations Reactions: C2H5 + C2H3

    Science.gov (United States)

    Fahr, Askar; Halpern, Joshua B.; Tardy, Dwight C.

    2007-01-01

    Pressure-dependent product yields have been experimentally determined for the cross-radical reaction C2H5 + C2H3. These results have been extended by calculations. It is shown that the chemically activated combination adduct, 1-C4H8*, is either stabilized by bimolecular collisions or subject to a variety of unimolecular reactions including cyclizations and decompositions. Therefore the "apparent" combination/disproportionation ratio exhibits a complex pressure dependence. The experimental studies were performed at 298 K and at selected pressures between about 4 Torr (0.5 kPa) and 760 Torr (101 kPa). Ethyl and vinyl radicals were simultaneously produced by 193 nm excimer laser photolysis of C2H5COC2H3 or photolysis of C2H3Br and C2H5COC2H5. Gas chromatograph/mass spectrometry/flame ionization detection (GC/MS/FID) were used to identify and quantify the final reaction products. The major combination reactions at pressures between 500 (66.5 kPa) and 760 Torr are (1c) C2H5 + C2H3 yields 1-butene, (2c) C2H5 + C2H5 yields n-butane, and (3c) C2H3 + C2H3 yields 1,3-butadiene. The major products of the disproportionation reactions are ethane, ethylene, and acetylene. At moderate and lower pressures, secondary products, including propene, propane, isobutene, 2-butene (cis and trans), 1-pentene, 1,4-pentadiene, and 1,5-hexadiene are also observed. Two isomers of C4H6, cyclobutene and/or 1,2-butadiene, were also among the likely products. The pressure-dependent yield of the cross-combination product, 1-butene, was compared to the yield of n-butane, the combination product of reaction (2c), which was found to be independent of pressure over the range of this study. The [ 1-C4H8]/[C4H10] ratio was reduced from approx.1.2 at 760 Torr (101 kPa) to approx.0.5 at 100 Torr (13.3 kPa) and approx.0.1 at pressures lower than about 5 Torr (approx.0.7 kPa). Electronic structure and RRKM calculations were used to simulate both unimolecular and bimolecular processes. The relative importance

  8. Radical resection for low rectal carcinoma combined with infusion pump chemotherapy via internal iliac artery

    Directory of Open Access Journals (Sweden)

    Bo YANG

    2011-10-01

    Full Text Available Objective To evaluate the effects and practicability of radical resection for low rectal carcinoma with infusion pump chemotherapy via internal iliac artery,and explore the correlation factors influencing the therapeutic effects.Methods Data of 316 patients with low rectal carcinoma,admitted from Oct.1997 to Mar.2008,were retrospectively analyzed and assigned into 2 groups according to the treatment: Patients received infusion pump chemotherapy via internal iliac artery to target area combined with intravenous systemic chemotherapy were assigned into group A(n=249,and those receiving systemic chemotherapy alone following radical resection were assigned to group B(n=67.The timing of pump chemotherapy to target area in group A was set at day 12 after recovery of digestive function,with regimen of 5-FU at 0.5g per dose plus hydroxycamptothecin at 10-15mg per dose,twice a week,four times as a treatment course for a total of 6 courses,and it was followed by intravenously systemic chemotherapy with a regimen of FOLFIRI or FOLFOX.In group B,at day 12 right after recovery of digestive function,the intravenous sytemic chemotherapy was started with the same regimen as in group A.The local recurrence rate,metastasis rate and survival rate after 1,3 and 5 years in the two groups were respectively observed and compared,and the correlation between the clinicopathological features and the 5 year local recurrence rates and survival rates was analyzed in patients of group A.Results In group A,the local recurrence rate at year 1,3 and 5 was 0,1.68%(4/238 and 3.79%(8/211,respectively,the metastasis rate was 0.80%(2/249,4.62%(11/238 and 10.90%(23/211,respectively,and the survival rate was 100%,77.73%(185/238 and 72.04%(152/211,respectively.In group B,the local recurrence rate at year 1,3 and 5 was 0,9.52%(6/63 and 16.36%(9/55,respectively,the metastasis rate was 1.49%(1/67,15.87%(10/63 and 27.27%(15/55,respectively,and the survival rate was 100

  9. Anterograde jejunojejunal intussusception resulted in acute efferent loop syndrome after subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Jung; Myun; Kwak; Jin; Kim; Sung; Ock; Suh

    2010-01-01

    Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intussusception,and jejunojejunal intussusception has been rarely reported.We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth Ⅱ anastomosis in a 38-year-old Korean woman with early gastric cancer,and include a review of the literature on thi...

  10. Laparoscopic Plicated Sleeve Gastrectomy: a Technical Report.

    Science.gov (United States)

    Ji, Yun; Ye, Huan; Wang, Yuedong; Zhan, Xiaoli; Zhu, Jinhui

    2016-01-01

    The standard approach to laparoscopic sleeve gastrectomy (LSG) involves sleeve-forming through a vertical gastrectomy, producing a narrow, tubular stomach. Considerable laparoscopic skills are required to find a suitable size at which the pressure of the sleeve is not excessive and the restriction is sufficient for obtaining good weight-loss effect without increasing the risk of complications. There is no doubt that considerable technical details are required to create a “perfect sleeve.” We report our sleeve-forming technique for LSG involving both vertical gastrectomy and plication, which we have termed “laparoscopic plicated sleeve gastrectomy.” This technique was shown to be safe and efficacious for the treatment of severe obesity and can reduce technical difficulties in the creation of a “perfect sleeve.”

  11. 肠外营养起始时间对胃癌根治术患者术后恢复的影响%Effect of Different Parenteral Nutrition Starting Time on Postoperative Recovery of Gastric Cancer Patients Treated with Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    明军

    2014-01-01

    Objective To explore and analyze the different parenteral nutrition starting time on postoperative recovery of gastric cancer patients treated with radical gastrectomy .Methods 60 cases of gastric cancer patients treated with radical gastrec-tomy were randomly divided into the observation group and the control group ,30 cases in each group .The observation group was given parenteral nutrition within 48 h after surgery ,the control group were treated with parenteral nutrition 3 d after surgery .Re-covery was observed and postoperative immune function and nutritional status of the 2 groups were evaluated .Results Postopera-tive bowel function recovery time , exhaust time , length of hospital stay in the observation group were significantly shorter than those of the control group;CD3,CD4,CD8,CD4/CD8 the 2 groups increased significantly after surgery ,and CD3,CD4,CD8, CD4/CD8 parameters(67.03 ±6.81)%,(49.66 ±0.28)%,(19.63 ±2.88)%, (2.51 ±0.33)% in the observation group were significantly higher than those of the control group after surgery;PAB、ALB and TF in the observation group were higher than those of the control group after surgery ,P<0.05,there had statistical difference .Conclusion Early parenteral nutrition therapy for gastric cancer patients after radical surgery has good clinical outcome ,it is advisable to implement within 48 h after surgery .It can improve the postoperative immune function and nutritional status ,and it is worthy of clinical application .%目的:探究不同肠外营养起始时间对胃癌根治术患者术后恢复的影响。方法选取2009年10月-2012年10月经胃癌根治术治疗的胃癌患者60例作为临床研究对象,并随机分为观察组和对照组,每组各30例。观察组患者于术后48 h内给予肠外营养,对照组患者于术后72 h给予肠外营养。观察并比较2组患者术后的恢复情况,并将2组患者术后免疫功能及营养状况进行评价。结果观察组患者术后肠功

  12. A combined high-temperature experimental and theoretical kinetic study of the reaction of dimethyl carbonate with OH radicals.

    Science.gov (United States)

    Khaled, Fethi; Giri, Binod Raj; Szőri, Milán; Mai, Tam V-T; Huynh, Lam K; Farooq, Aamir

    2017-03-08

    The reaction kinetics of dimethyl carbonate (DMC) and OH radicals were investigated behind reflected shock waves over the temperature range of 872-1295 K and at pressures near 1.5 atm. Reaction progress was monitored by detecting OH radicals at 306.69 nm using a UV laser absorption technique. The rate coefficients for the reaction of DMC with OH radicals were extracted using a detailed kinetic model developed by Glaude et al. (Proc. Combust. Inst. 2005, 30(1), 1111-1118). The experimental rate coefficients can be expressed in Arrhenius form as: kexpt'l = 5.15 × 10(13) exp(-2710.2/T) cm(3) mol(-1) s(-1). To explore the detailed chemistry of the DMC + OH reaction system, theoretical kinetic analyses were performed using high-level ab initio and master equation/Rice-Ramsperger-Kassel-Marcus (ME/RRKM) calculations. Geometry optimization and frequency calculations were carried out at the second-order Møller-Plesset (MP2) perturbation level of theory using Dunning's augmented correlation consistent-polarized valence double-ζ basis set (aug-cc-pVDZ). The energy was extrapolated to the complete basis set using single point calculations performed at the CCSD(T)/cc-pVXZ (where X = D, T) level of theory. For comparison purposes, additional ab initio calculations were also carried out using composite methods such as CBS-QB3, CBS-APNO, G3 and G4. Our calculations revealed that the H-abstraction reaction of DMC by OH radicals proceeds via an addition elimination mechanism in an overall exothermic process, eventually forming dimethyl carbonate radicals and H2O. Theoretical rate coefficients were found to be in excellent agreement with those determined experimentally. Rate coefficients for the DMC + OH reaction were combined with literature rate coefficients of four straight chain methyl ester + OH reactions to extract site-specific rates of H-abstraction from methyl esters by OH radicals.

  13. 保留脾脏的第10组与11组淋巴结整体清扫在胃癌D2根治术中的应用价值%Application value of spleen-preserving No.10 and 11 lymph nodes dissection in the D2 radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    何磊; 文刚; 涂从银; 陶应田; 丁丁

    2016-01-01

    Objective To investigate the feasibility and safety of spleen-preserving No.10 and 11 lymph nodes dissection in the D2 radical gastrectomy for gastric cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 32 patients with advanced proximal gastric carcinoma who were admitted to the Third Affiliated Hospital of Anhui Medical University from January 2013 to May 2016 were collected.All the patients underwent open D2 radical total gastrectomy and spleen-preserving No.10 and 11 lymph nodes dissection by the same operation team.Observation indicators included operation time,volume of intraoperative blood loss,time of No.10 and 11 lymph nodes dissection,number of lymph nodes dissection,number of positive lymph nodes,positive rate of lymph nodes,lymph node metastasis rate,histological classification,pTNM staging,duration of postoperative hospital stay,postoperative complications (splenic translocation,splenic torsion,splenic infarction,anastomotic leakage,pancreatic leakage and lymphorrhagia) and follow-up.The follow-up using outpatient examination and telephone interview was performed to detect the oncologic prognosis up to September 2016.Measurement data with normal distribution were represented as (x) ± s.Count data were represented as a ratio.Results Among the 32 patients,gastric body cancer and cardiac cancer were respectively detected in 12 and 20 patients,they received open radical total gastrectomy and spleen-preserving No.10 and 11 lymph nodes dissection.The operation time and volume of intraoperative blood loss were (242 ± 34) minutes and (98 ± 67) mL.Time of lymph nodes dissection,number of lymph nodes dissection,number of positive lymph nodes,positive rate of lymph nodes and lymph node metastasis rate were (30 ± 12)minutes,141 (3.8 ±2.4),22,15.60% (22/141),18.75% (6/32) in No.10 lymph nodes and (8 ±3)minutes,168 (4.0-± 3.6),36,21.43% (36/168),25.00% (8/32) in No.11 lymph nodes

  14. Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer

    Directory of Open Access Journals (Sweden)

    Daniel Fernández-Martínez

    2014-01-01

    CONCLUSION: En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration.

  15. Surface modification of carbon nanotubes via combination of mussel inspired chemistry and chain transfer free radical polymerization

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Qing; Tian, Jianwen; Liu, Meiying; Zeng, Guangjian; Huang, Qiang [Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang, 330031 (China); Wang, Ke; Zhang, Qingsong [Department of Chemistry and the Tsinghua Center for Frontier Polymer Research, Tsinghua University, Beijing, 100084 (China); Deng, Fengjie, E-mail: fengjiedeng@aliyun.com [Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang, 330031 (China); Zhang, Xiaoyong, E-mail: xiaoyongzhang1980@gmail.com [Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang, 330031 (China); Wei, Yen, E-mail: weiyen@tsinghua.edu.cn [Department of Chemistry and the Tsinghua Center for Frontier Polymer Research, Tsinghua University, Beijing, 100084 (China)

    2015-08-15

    Graphical abstract: A novel strategy combination of mussel inspired chemistry and chain transfer free radical polymerization has been developed for surface modification of carbon nanotubes with polymers for the first time. - Highlights: • Surface modification of CNTs via mussel inspired chemistry. • Preparation of aminated polymers through free radical polymerization. • Functionalized CNTs with aminated polymers via Michael addition reaction. • Highly dispersed CNTs in organic and aqueous solution. - Abstract: In this work, a novel strategy for surface modification of carbon nanotubes (CNTs) was developed via combination of mussel inspired chemistry and chain transfer free radical polymerization. First, pristine CNTs were functionalized with polydopamine (PDA), which is formed via self-polymerization of dopamine in alkaline conditions. These PDA functionalized CNTs can be further reacted with amino-terminated polymers (named as PDMC), which was synthesized through chain transfer free radical polymerization using cysteamine hydrochloride as chain transfer agent and methacryloxyethyltrimethyl ammonium chloride as the monomer. PDMC perfectly conjugated with CNT-PDA was ascertained by a series of characterization techniques including transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR), thermal gravimetric analysis (TGA) and X-ray photoelectron spectroscopy (XPS). The dispersibility of obtained CNT nanocomposites (named as CNT-PDA-PDMC) was further examined. Results showed that the dispersibility of CNT-PDA-PDMC in aqueous and organic solutions was obviously enhanced. Apart from PDMC, many other amino-terminated polymers can also be used to functionalization of CNTs via similar strategy. Therefore, the method described in this work should be a general strategy for fabrication various polymer nanocomposites.

  16. Radical cations from dipyridinium derivatives: a combined EPR and DFT study.

    Science.gov (United States)

    Stipa, Pierluigi

    2006-06-01

    The monoelectronic reduction of 1,1'-dimethyl-2,2'-dicyano-4,4'-bipyridinium (DCMV++) bis-methylsulphate, conducted directly in the cavity of the electron paramagnetic resonance (EPR) spectrometer at room temperature and in DMSO solution, gave the signal of the corresponding radical cation (DCMV.+) whose interpretation has been carried out with the aid of density functional theory (DFT) calculations run at different levels. The model chemistries considered yielded in general hyperfine coupling constants (hfcc) in good agreement with the experimental ones, except for the methyl protons directly bonded to the pyridinium nitrogens. The use of various computational methods accounting for solvent-solute interactions did not give significant improvements with respect to the gas phase results, while the geometry optimizations performed showed that the two pyridinium rings are coplanar in the radical cation but staggered in the parent dication, although the corresponding energy barrier involved is very low.

  17. Effect of radicals combination on acetylene yield in process of coal pyrolysis by hydrogen plasma

    Energy Technology Data Exchange (ETDEWEB)

    Dai, B.; Fan, Y.; Yang, J.; Xiao, J. [Tsinghua University, Beijing (China). Dept. of Engineering Mechanics

    1999-07-01

    A new process for production of acetylene by pyrolysis of coal in hydrogen plasma overcomes the disadvantage of discontinuity and pollution in the conventional carbide method. Complex homogeneous reactions take place after pulverized coal is injected into a high-temperature plasma reactor. In order to preserve C{sub 2}H{sub 2} in low-temperature gas, quenching is needed to avoid the dissociation of acetylene. The objective of this paper is to indicate that radicals recombination is also important in acetylene production. Therefore the quenching process should be optimized to obtain high yield of acetylene. In this work, C-H equilibrium system in high-temperature range of 2000-5000 K is obtained using the free energy minimization method. At lower temperature, the decomposition of acetylene can be avoided while the recombination reaction of radicals C{sub 2}H and H will not be interrupted. As a result, the acetylene concentration in quenched gas will increase. The theoretical acetylene content in quenched gas is computed using the radical recombination mechanism based on the composition of thermal equilibrium, and the optimized C/H ratio is determined simultaneously. The maximum acetylene content is 59.9% in volume. 4 refs., 3 figs., 1 tab.

  18. Total gastrectomy for non-neoplastic diseases

    DEFF Research Database (Denmark)

    Bjorn, Niels; Ainsworth, Alan Patrick; Mortensen, Michael Bau

    2017-01-01

    Background: The aim of this study was to describe patients who had total gastrectomy for non-neoplastic diseases within a well-defined geographical area. Material and Methods: Retrospective study of patients who had gastrectomy for a non-neoplastic disease at the Department of Surgery, Odense...... University Hospital from 1 January 2005 to 31 December 2014. Results: A total of 268 gastrectomies were performed with the 10-year period. Of these, ten (4%) were done for non-neoplastic diseases. Two were men and eight women with a median age of 51 years (range 31 to 96 years). Six had emergency surgery...... and four were planned procedures. Four patients had no complications following surgery, whereas severe complications where seen in 6 patients, where anastomotic leakage occurred in 3 patients. Median length of postoperative stay was 21 days (range 6 to 98 days), and the 30-days and 90-days mortality was 1...

  19. Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery.

    Science.gov (United States)

    Guerra, Francesco; Giuliani, Giuseppe; Iacobone, Martina; Bianchi, Paolo Pietro; Coratti, Andrea

    2017-04-04

    Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery. PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3. A total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13). Although minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.

  20. A combined high-temperature experimental and theoretical kinetic study of the reaction of dimethyl carbonate with OH radicals

    KAUST Repository

    Khaled, Fathi

    2017-02-08

    The reaction kinetics of dimethyl carbonate (DMC) and OH radicals were investigated behind reflected shock waves over the temperature range of 872-1295 K and at pressures near 1.5 atm. Reaction progress was monitored by detecting OH radicals at 306.69 nm using a UV laser absorption technique. The rate coefficients for the reaction of DMC with OH radicals were extracted using a detailed kinetic model developed by Glaude et al. (Proc. Combust. Inst. 2005, 30(1), 1111-1118). The experimental rate coefficients can be expressed in Arrhenius form as: kexpt\\'l = 5.15 × 10(13) exp(-2710.2/T) cm(3) mol(-1) s(-1). To explore the detailed chemistry of the DMC + OH reaction system, theoretical kinetic analyses were performed using high-level ab initio and master equation/Rice-Ramsperger-Kassel-Marcus (ME/RRKM) calculations. Geometry optimization and frequency calculations were carried out at the second-order Møller-Plesset (MP2) perturbation level of theory using Dunning\\'s augmented correlation consistent-polarized valence double-ζ basis set (aug-cc-pVDZ). The energy was extrapolated to the complete basis set using single point calculations performed at the CCSD(T)/cc-pVXZ (where X = D, T) level of theory. For comparison purposes, additional ab initio calculations were also carried out using composite methods such as CBS-QB3, CBS-APNO, G3 and G4. Our calculations revealed that the H-abstraction reaction of DMC by OH radicals proceeds via an addition elimination mechanism in an overall exothermic process, eventually forming dimethyl carbonate radicals and H2O. Theoretical rate coefficients were found to be in excellent agreement with those determined experimentally. Rate coefficients for the DMC + OH reaction were combined with literature rate coefficients of four straight chain methyl ester + OH reactions to extract site-specific rates of H-abstraction from methyl esters by OH radicals.

  1. Radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph,and soft-tissue dissection in pancreatic head cancer

    Institute of Scientific and Technical Information of China (English)

    SHAO Qin-shu; YE Zai-yuan; LI Shu-guang; CHEN Kan

    2008-01-01

    Background Recent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior,which is characterized by neural infiltration.This study aimed to investigate the clinical significance of radical pancreatOduodenectomy combined with retroperitoneal nerve,lymph,and soft-tissue dissection for carcinoma of the pancreatic head.Methods Forty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005.The patients were divided into two groups:radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph and soft-tissue dissection (group A,n=25) and routine Whipple's operation (group B,n=21).There were no significant differences between the two groups in relation to age,gender and preoperative risk factors,and perioperative conditions,pathological data and survival rates were studied.Results There were no significant differences in tumor size,surgical procedure time,postoperative complications,and time of hospitalization.However,the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B (P<0.05).The 1-and 3-year survival rate in group A were 80% and 53%,respectively,which was higher than those in group B (P<0.05).There were significant differences in the survival rates between patients with and without nerve infiltration in group A (P<0.05).Conclusions Radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph and soft-tissue dissection,can effectiveoly remove the lymph and nerve tissues that were infiltrated by tumor.Meanwhile,this method can reduce the local recurrence rate so as to improve the long-term survival of patients.

  2. One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach☆

    Science.gov (United States)

    de Gordejuela, Amador G. Ruiz; Gebelli, Jordi Pujol; García, Núria Vilarrasa; Medayo, Lluis Secanella; Marín, Araceli Estepa; Badía, Anna Casajoana

    2013-01-01

    INTRODUCTION The advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome. PRESENTATION OF CASE A 52 year-old male patient with a BMI of 53 kg/m2 was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome. DISCUSSION Teams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy. CONCLUSION Both procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach. PMID:24394858

  3. Catenation through a Combination of Radical Templation and Ring-Closing Metathesis.

    Science.gov (United States)

    Gibbs-Hall, Ian C; Vermeulen, Nicolaas A; Dale, Edward J; Henkelis, James J; Blackburn, Anthea K; Barnes, Jonathan C; Stoddart, J Fraser

    2015-12-23

    Synthesis of an electrochemically addressable [2]catenane has been achieved following formation by templation of a [2]pseudorotaxane employing radically enhanced molecular recognition between the bisradical dication obtained on reduction of the tetracationic cyclophane, cyclobis(paraquat-p-phenylene), and the radical cation generated on reduction of a viologen disubstituted with p-xylylene units, both carrying tetraethylene glycol chains terminated by allyl groups. This inclusion complex was subjected to olefin ring-closing metathesis, which was observed to proceed under reduced conditions, to mechanically interlock the two components. Upon oxidation, Coulombic repulsion between the positively charged and mechanically interlocked components results in the adoption of a co-conformation where the newly formed alkene resides inside the cavity of the tetracationic cyclophane. (1)H NMR spectroscopic analysis of this hexacationic [2]catenane shows a dramatic upfield shift of the resonances associated with the olefinic and allylic protons as a result of them residing inside the tetracationic component. Further analysis shows high diastereoselectivity during catenation, as only a single (Z)-isomer is formed.

  4. Pancreas-centered Anatomy in D2 Radical Lymphadenectomy in Laparoscopic-assisted Distal Gastrectomy%“胰腺中心解剖法”在腹腔镜辅助远端胃癌D2根治术淋巴结清扫中的应用

    Institute of Scientific and Technical Information of China (English)

    肖俊峰; 暨玲; 阮小蛟; 郑晓风

    2013-01-01

    目的 探讨“胰腺中心解剖法”在腹腔镜辅助远端胃癌D2根治术淋巴结清扫中的价值.方法 回顾性分析2009年9月~ 2011年5月开展的20例以胰腺为解剖中心的腹腔镜辅助远端胃癌D2根治术病例资料(A组),并以2009年5月~8月同术者20例传统腹腔镜辅助远端胃癌D2根治术为对照(B组),比较2组一般资料、手术相关指数、切缘距肿瘤距离、术后恢复时间、术后生活质量评分、术后30天内并发症以及1、2年生存率.结果 与B组相比,A组手术时间短[(110.3-20.1)min vs.(160.0±30.4)min,t=-6.100,P=0.000],术中出血量少[(149.6±60.4)ml vs.(332.0±104.5)ml,t=-6.757,P=n.000].2组淋巴结清扫数目、切缘距肿瘤距离、肛门排气时间、进食时间、术后住院时间、生活质量评分以及术后30天内并发症发生率差异均无显著性(P>0.05),A组1、2年的生存率分别为54.30%、34.30%,B组为52.87%、34.30%,2组差异无显著性(x2=0.132,P=0.717).结论 “胰腺中心解剖法”可以缩短腹腔镜辅助远端胃癌D2根治术手术时间,减少出血.%Objective To evaluate pancreas-centered anatomy in D2 radical lymphadenectomy in laparoscopic-assisted distal gastrectomy ( LADG). Methods We reviewed the clinical data of 20 patients with distal gastric cancer, who underwent LADG with D2 lymphadenectomy by using pancreas centered anatomy in our hospital from September 2009 to May 2011 (group A). Another 20 patients with distal gastric cancer, who recieved LADG with D2 lymphadenectomy by using traditional methods from May 2009 to August 2009, were set as a control group (group B). The genera! information, operation related indexes,distance between tumor and incisional margin, and postoperative recovering time, quality of life, rate of complications within 30 days, and 1- and 2-year survival rate were compared between the two groups. Results Compared to group B, group A showed significantly shorter operation time and less

  5. Surface modification of carbon nanotubes via combination of mussel inspired chemistry and chain transfer free radical polymerization

    Science.gov (United States)

    Wan, Qing; Tian, Jianwen; Liu, Meiying; Zeng, Guangjian; Huang, Qiang; Wang, Ke; Zhang, Qingsong; Deng, Fengjie; Zhang, Xiaoyong; Wei, Yen

    2015-08-01

    In this work, a novel strategy for surface modification of carbon nanotubes (CNTs) was developed via combination of mussel inspired chemistry and chain transfer free radical polymerization. First, pristine CNTs were functionalized with polydopamine (PDA), which is formed via self-polymerization of dopamine in alkaline conditions. These PDA functionalized CNTs can be further reacted with amino-terminated polymers (named as PDMC), which was synthesized through chain transfer free radical polymerization using cysteamine hydrochloride as chain transfer agent and methacryloxyethyltrimethyl ammonium chloride as the monomer. PDMC perfectly conjugated with CNT-PDA was ascertained by a series of characterization techniques including transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR), thermal gravimetric analysis (TGA) and X-ray photoelectron spectroscopy (XPS). The dispersibility of obtained CNT nanocomposites (named as CNT-PDA-PDMC) was further examined. Results showed that the dispersibility of CNT-PDA-PDMC in aqueous and organic solutions was obviously enhanced. Apart from PDMC, many other amino-terminated polymers can also be used to functionalization of CNTs via similar strategy. Therefore, the method described in this work should be a general strategy for fabrication various polymer nanocomposites.

  6. Radical cure of experimental babesiosis in immunodeficient mice using a combination of an endochin-like quinolone and atovaquone.

    Science.gov (United States)

    Lawres, Lauren A; Garg, Aprajita; Kumar, Vidya; Bruzual, Igor; Forquer, Isaac P; Renard, Isaline; Virji, Azan Z; Boulard, Pierre; Rodriguez, Eduardo X; Allen, Alexander J; Pou, Sovitj; Wegmann, Keith W; Winter, Rolf W; Nilsen, Aaron; Mao, Jialing; Preston, Douglas A; Belperron, Alexia A; Bockenstedt, Linda K; Hinrichs, David J; Riscoe, Michael K; Doggett, J Stone; Ben Mamoun, Choukri

    2016-06-27

    Human babesiosis is a tick-borne multisystem disease caused by Babesia species of the apicomplexan phylum. Most clinical cases and fatalities of babesiosis are caused by Babesia microti Current treatment for human babesiosis consists of two drug combinations, atovaquone + azithromycin or quinine + clindamycin. These treatments are associated with adverse side effects and a significant rate of drug failure. Here, we provide evidence for radical cure of experimental babesiosis in immunodeficient mice using a combination of an endochin-like quinolone (ELQ) prodrug and atovaquone. In vivo efficacy studies in mice using ELQ-271, ELQ-316, and the ELQ-316 prodrug, ELQ-334, demonstrated excellent growth inhibitory activity against the parasite, with potency equal to that of orally administered atovaquone at 10 mg/kg. Analysis of recrudescent parasites after ELQ or atovaquone monotherapy identified genetic substitutions in the Qi or Qo sites, respectively, of the cytochrome bc1 complex. Impressively, a combination of ELQ-334 and atovaquone, at doses as low as 5.0 mg/kg each, resulted in complete clearance of the parasite with no recrudescence up to 122 d after discontinuation of therapy. These results will set the stage for future clinical evaluation of ELQ and atovaquone combination therapy for treatment of human babesiosis. © 2016 Lawres et al.

  7. Hiatal Hernia as a Total Gastrectomy Complication

    Directory of Open Access Journals (Sweden)

    Bruna do Nascimento Santos

    2016-02-01

    Full Text Available Introduction: According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report: A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion: Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

  8. Failure of nutritional recovery after total gastrectomy.

    Science.gov (United States)

    Curran, F T; Hill, G L

    1990-09-01

    Malnutrition is reported to be an inevitable consequence of total gastrectomy, although there are few data to support this contention. Six patients of median age 63 years underwent total gastrectomy for malignancy. At follow-up (median 45 months, range 25-60 months) each patient was clinically tumour-free and underwent dietary assessment, faecal fat and nitrogen measurement and routine haematological testing. Protein and fat stores, measured by neutron activation analysis and the tritiated water dilution technique, were compared with the same measurements made before operation and with predicted values. Mean (s.d.) dietary intake (2224(381) kcal day-1 and 81(15)g protein day-1) met the patients' estimated requirements. Mean(s.d.) serum albumin and faecal nitrogen values were normal but there was notable steatorrhoea (21(17) g day-1). Body composition measurements revealed profound deficiencies of body-weight (P less than 0.02), protein (P less than 0.01) and fat (P less than 0.02) before operation which were not corrected by an apparently curative total gastrectomy (P less than 0.05), although further deterioration was prevented.

  9. Combined molecular MRI and immuno-spin-trapping for in vivo detection of free radicals in orthotopic mouse GL261 gliomas.

    Science.gov (United States)

    Towner, Rheal A; Smith, Nataliya; Saunders, Debra; De Souza, Patricia Coutinho; Henry, Leah; Lupu, Florea; Silasi-Mansat, Robert; Ehrenshaft, Marilyn; Mason, Ronald P; Gomez-Mejiba, Sandra E; Ramirez, Dario C

    2013-12-01

    Free radicals play a major role in gliomas. By combining immuno-spin-trapping (IST) and molecular magnetic resonance imaging (mMRI), in vivo levels of free radicals were detected within mice bearing orthotopic GL261 gliomas. The nitrone spin trap DMPO (5,5-dimethyl pyrroline N-oxide) was administered prior to injection of an anti-DMPO probe (anti-DMPO antibody covalently bound to a bovine serum albumin (BSA)-Gd (gadolinium)-DTPA (diethylene triamine penta acetic acid)-biotin MRI contrast agent) to trap tumor-associated free radicals. mMRI detected the presence of anti-DMPO adducts by either a significant sustained increase (pfree radicals from a glioma model.

  10. Rational preparation of dibenzothiophene-imprinted polymers by surface imprinting technique combined with atom transfer radical polymerization

    Science.gov (United States)

    Yang, Wenming; Liu, Lukuan; Zhou, Zhiping; Liu, Hong; Xie, Binze; Xu, Wanzhen

    2013-10-01

    A computational simulation method is introduced to simulate the dibenzothiophene-monomer pre-assembly system of molecular imprinted polymers. The interaction type and intensity between dibenzothiophene and monomer are discussed from the binding energy and spatial position distribution. The simulation and analysis results indicate that the amount of the function monomer is not the more the better in preparing molecular imprinted polymers. Based on the above results, a novel dibenzothiophene-imprinted polymers with the favorable specific adsorption effect was prepared by surface imprinting technique combined with atom transfer radical polymerization. This combined technologies are used for preparing a desulfurization adsorbent for the first time. Various measures were selected to characterize the structure and morphology of the prepared adsorbent. The characterization results show that the adsorbent has suitable features for further adsorption process. A series of static adsorption experiments were conducted to analyze its adsorption performance. The adsorption process follows Elovich model by the kinetic analysis and Sips equation by the isothermal analysis. The approach we described will provide another opportunity in the deep desulfurization field.

  11. [Laparoscopic distal gastrectomy for gastric cancer: initial experience].

    Science.gov (United States)

    Berrospi, Francisco; Celis, Juan; Ruíz, Eloy; Payet, Eduardo; Chávez, Iván; Young, Frank

    2008-01-01

    To report the initial experience with the laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Between May 2006 and May 2007, 29 consecutive GC patients with gastric cancer underwent LADG with D2 lymphadenectomy. The operation consisted in a laparoscopic time to perform lymphadenectomy and mobilization of the distal stomach, followed by a minilaparotomy for exteriorization of the specimen and construction of a hand sewn anastomosis. Twenty-nine patients underwent LADG with D2 lymphadenectomy for gastric cancer. Mean age was 58.2 years. Mean operative time was 287.4 min. Mean number of lymph nodes resected was 42.6. Twelve patients were early gastric cancer, and seventeen were advanced gastric cancer. Mean proximal and distal resection margin were 5.8 cm and 3.5 cm, respectively. Resection margins were negative in all cases. Mean number of lymph nodes resected was 42.6. Thirty-day morbidity rate was 10.3 %. There were no postoperative deaths.CONCLUSION. The short-term results of our LADG with D2 lymphadenectomy for the treatment of gastric cancer shows that a radical surgery, in terms of resection margins and lymphadenectomy, can be done with low morbidity.

  12. Determining the site of spin trapping of the equine myoglobin radical by combined use of EPR, electrophoretic purification, and mass spectrometry.

    Science.gov (United States)

    Harris, Michael N; Burchiel, Scott W; Winyard, Paul G; Engen, John R; Mobarak, Charlotte D; Timmins, Graham S

    2002-12-01

    Although myoglobin protein radicals are thought important intermediates in peroxide-induced toxicity, the site of spin trapping of this radical in equine myoglobin using the trap 3,5-dibromo-4-nitrosobenzene sulfonate (DBNBS) is unclear. We have combined EPR, electrophoretic adduct purification, and mass spectrometry approaches to unambiguously determine the site of trapping to be Tyr-103 and suggest that reports of trapping at Trp-7 or Trp-14 may be due to nonradical addition to proteolytically derived Trp-containing peptides with DBNBS. The technique developed here of combining electrophoretic separation of DBNBS adducts with MS of resultant peptides will also allow proteomic-like approaches to determining identities and sites of radical formation and translocation on complex mixtures of proteins.

  13. [Incontinence after radical prostatectomy and cystectomy: are combined training with mechanical devices and whole body vibration effective?].

    Science.gov (United States)

    Zellner, M

    2011-04-01

    In spite of improvements in nerve-sparing operation techniques in radical prostatectomies, a disturbance of (early) continence is subjectively perceived by a number of patients as burdensome, which can last for several months. Skilled physiotherapy is appreciated as causal therapy in the hands of the qualified therapist. In an open randomised controlled trial the efficacy of a standardised rehabilitation therapy with pelvic floor re-education instructed by a physiotherapist (n=25) as the control group in comparison to a group with additional combined electrostimulation and biofeedback device (Myo 420™; n=25) or whole body vibration therapy (FitVibe medical™; n=25). Pre- and post-therapeutic evaluation of the International Prostate Symptom Score (IPSS), the enclosed question about quality of life (IPSS-QL), pad test, pelvic floor strength, maximum uroflow, micturition volume, serum testosterone and blood glucose was done. Within the treatment duration of 3-4 weeks in all treatment groups a statistically significant improvement of IPSS and IPSS-QL was seen. Due to whole body vibration the reduction of urine loss (pad test), increase of voided volume and maximum uroflow were statistically significant. Whereas for isolated physiotherapy during the short therapy duration merely a trend for the improvement of pelvic floor muscle strength was seen, the difference was significant in the Myo 420 and the whole body vibration groups, respectively. It was shown that a continuous improvement in continence depends on the consistent continuation of the training also under domestic conditions. The controlled trial conditions also confirm the efficacy, acceptance and tolerance of a standardised pelvic floor re-education under the conditions of urological inpatient rehabilitation treatment. By additional use of a combined electro- and multichannel biofeedback device or a whole body vibration device, the treatment results could be further improved. Due to the different causal

  14. Late onset of chylous ascites following distal gastrectomy with D1(+ dissection for gastric cancer: A case report

    Directory of Open Access Journals (Sweden)

    Hüseyin Çiyiltepe

    2015-12-01

    Full Text Available Chyloperitoneum is the accumulation of lymphatic fluid in the peritoneal cavity. Chylous ascites can occur if it is not recognized during surgery. The incidence of chylous ascites after oncological surgery was approximately 7.4% however, the incidence of lymphorrhea after radical gastrectomy for gastric cancer is so low. Extensive lymph node dissection leads to a higher incidence of lymphorrhea. There have been few cases associated with D1 dissection In most patients conservative treatment is recommended that includes paracentesis, total parenteral nutrition (TPN, a medium chain triglyceride (MCT based diet, and somatostatin. Surgery is the last choice only when conservative treatment fails. In this case we aimed to present a late onset of chylous ascites after subtotal gastrectomy and D1+ dissection that was treated with percutaneous drainage and conservative management.

  15. Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy.

    Science.gov (United States)

    Cesana, Giovanni; Uccelli, Matteo; Ciccarese, Francesca; Carrieri, Domenico; Castello, Giorgio; Olmi, Stefano

    2014-06-27

    To evaluate laparoscopic re-sleeve gastrectomy as a treatment of weight regain after Sleeve. Laparoscopic sleeve gastrectomy is a common bariatric procedure. Weight regain after long-term follow-up is reported. Patients were considered for laparoscopic re-sleeve gastrectomy when we observed progressive weight regain and persistence of comorbidities associated with evidence of dilated gastric fundus and/or antrum on upper gastro-intestinal series. Follow-up visits were scheduled at 1, 3, 6 and 12 mo after surgery and every 6 mo thereafter. Measures of change from baseline at different times were analyzed with the paired samples t test. We observed progressive weight regain after sleeve in 11 of the 201 patients (5.4%) who had a mean follow-up of 21.1 ± 9.7 mo (range 6-57 mo). Three patients started to regain weight after 6 mo following Sleeve, 5 patients after 12 mo, 3 patients after 18 m. Re-sleeve gastrectomy was always performed by laparoscopy. The mean time of intervention was 55.8 ± 29.1 min. In all cases, neither intra-operative nor post-operative complications occurred. After 1 year follow-up we observed a significant (P weight loss (%EWL) increase (+31.0% ± 15.8%). An important reduction of antihypertensive drugs and hypoglycemic agents was observed after re-sleeve in those patients affected by hypertension and diabetes. Joint problems and sleep apnea syndrome improved in all 11 patients. Laparoscopic re-sleeve gastrectomy is a feasible and effective intervention to correct weight regain after sleeve.

  16. Enhanced hydroxyl radical generation in the combined ozonation and electrolysis process using carbon nanotubes containing gas diffusion cathode.

    Science.gov (United States)

    Wu, Donghai; Lu, Guanghua; Zhang, Ran; Lin, Qiuhong; Yan, Zhenhua; Liu, Jianchao; Li, Yi

    2015-10-01

    Combination of ozone together with electrolysis (ozone-electrolysis) is a promising wastewater treatment technology. This work investigated the potential use of carbon nanotube (CNT)-based gas diffusion cathode (GDC) for ozone-electrolysis process employing hydroxyl radicals (·OH) production as an indicator. Compared with conventional active carbon (AC)-polytetrafluoroethylene (PTFE) and carbon black (CB)-PTFE cathodes, the production of ·OH in the coupled process was improved using CNTs-PTFE GDC. Appropriate addition of acetylene black (AB) and pore-forming agent Na2SO4 could enhance the efficiency of CNTs-PTFE GDC. The optimum GDC composition was obtained by response surface methodology (RSM) analysis and was determined as CNTs 31.2 wt%, PTFE 60.6 wt%, AB 3.5 wt%, and Na2SO4 4.7 wt%. Moreover, the optimized CNT-based GDC exhibited much more effective than traditional Ti and graphite cathodes in Acid Orange 7 (AO7) mineralization and possessed the desirable stability without performance decay after ten times reaction. The comparison tests revealed that peroxone reaction was the main pathway of ·OH production in the present system, and cathodic reduction of ozone could significantly promote ·OH generation. These results suggested that application of CNT-based GDC offers considerable advantages in ozone-electrolysis of organic wastewater.

  17. Food intake and nutritional status after gastrectomy

    DEFF Research Database (Denmark)

    Bisballe, S; Buus, S; Lund, B

    1986-01-01

    .01). The serum concentration of alkaline phosphatase was raised and the concentration of calcium, phosphorus and 25-hydroxycholecalciferol reduced in the gastrectomized group. None of these results could be explained from the nutritional study as both the intake of energy and protein and the intake of calcium......Food intake and nutritional status was studied in 67 patients, who had had a gastrectomy 2-30 years earlier, and in a randomly selected, matched group of healthy persons. The gastrectomized patients weighed less than the control persons (women 56.4 +/- 9.5 vs 61.4 +/- 6.9 kg; P less than 0.05; men...

  18. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV.

    Science.gov (United States)

    Pinto, José Máximo Costa; Lima, Marianna Gomes Cavalcanti Leite de; Almeida, Ana Luiza Melo Cavalcanti de; Sousa, Marcelo Gonçalves

    It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. Estima-se que haja quase 40 milhões de pessoas com o vírus da imunodeficiência adquirida (HIV) no mundo. Com o advento dos antirretrovirais, observou-se aumento da obesidade e de taxas metabólicas nos pacientes em tratamento. Assim, inúmeras terapias cirúrgicas para a perda de peso estão sendo estudadas para a melhoria contínua da saúde dos pacientes com HIV, sendo a gastrectomia vertical uma opção de trânsito íntegro. Avaliar a aplicabilidade da gastrectomia vertical em pacientes com obesidade mórbida e HIV. Foi realizada revisão sistemática de literatura, de artigos publicados nas bases eletrônicas de dados Scopus, Pubmed, Cinahl

  19. Effect of radical surgery combined with splenectomy in treatment of gastric cancer:a Meta-analysis%胃癌根治术联合脾脏切除治疗胃癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    刘启领

    2016-01-01

    Objective To evaluate the effect of radical gastrectomy (RG) combined with splenectomy (SE) on long-term outcomes of patients with gastric cancer by a Meta-analysis.Methods A search of databases to identify randomized controlled trials ( RCTs) in PubMed, Cochrane, Web of knowledge, Ovid, SpringerLink, CNKI, WanFang data were per-formed.Outcome measures were survival rate, operation-related events, postoperative mortality (30 days).The Meta-a-nalysis was performed by RevMan 5.3.Results Five RCT studies met the inclusion criteria, including 588 patients in SE group and 756 patients in splean-preserving group.There was no significant difference in the 5-year overall survival rate between SE group and spleen-preserving group (OR=0.80, 95%CI:0.60~1.06, P>0.05).Sensitivity analysis indi-cated the 5-year overall survival rate in SE group was lower than that in spleen-preserving group ( OR=0.72, 95%CI:0.53~0.97, P0.05).Conclusion SE did not show a beneficial effect on survival rate compared with splenic preservation.Routinely performing SE should not be recommended.%目的:评估胃癌根治术( radical gastrectomy, RG)联合脾脏切除术( splenectomy, SE)治疗进展期胃癌的长期效果。方法以PubMed、Cochrane、Web of knowledge、Ovid SpringerLink、中国知网、万方、维普为数据源,检索相关文献,采用RevMan对切脾与保脾的RG随机对照试验( RCT)进行Meta分析,结局变量为患者5年生存率、手术操作相关并发症、术后30 d死亡率。结果符合纳入标准的RCT研究共5篇,包括1344例病例,切脾组588例,保脾组756例,切脾组与保脾组5年生存率比较,差异无统计学意义(OR=0.80,95%CI:0.60~1.06,P>0.05),灵敏性分析切脾组患者5年生存率低于保脾组(OR=0.72,95%CI:0.53~0.97,P<0.05);切脾组操作相关并发症发生率明显高于保脾组(OR=2.51,95%CI:1.90~3.33,P<0.05

  20. [Survival after gastrectomy for cancer. 209 cases].

    Science.gov (United States)

    Le Treut, Y P; Capobianco, C; Botti, G; Christophe, M; Lebreuil, G; Bricot, R

    1992-09-26

    The long-term results of 209 gastrectomies performed for adenocarcinoma, including 117 which were prospectively collected, are presented. Resection was curative in 154 cases (73.6 percent). The TNM distribution of the tumours was: stage I (TxNOMO) 75 cases, stage II (TxN1MO) 46 cases, stage III (TxN2MO) 33 cases and stage IV (TxNxM1) 55 cases. Lymph node involvement was more frequent in the prospective than in the retrospective study. With a more than 5 years' follow-up of 80 percent of the patients operated upon, the actuarial survival rate at 5 years (operative mortality included) was 38 percent for all lesions, 52 percent for curative resection and 2 percent for palliative resection. Following curative resection, the survival rates for tumours of the upper, middle and lower thirds of the stomach were 40, 60 and 55 percent respectively. These rates were 60 percent for stage I tumours, 54 percent for stage II tumours and 25 percent for stage III tumours. The results obtained in this series, where most of the curative gastrectomies included excision of N1 and N2 lymph nodes, show that lymph node involvement has no significant importance for the prognosis when it is proximal (N1) and is not incompatible with prolonged survival when it is pedicular (N2).

  1. Function-preserving gastrectomy for gastric cancer in Japan

    Science.gov (United States)

    Nomura, Eiji; Okajima, Kunio

    2016-01-01

    Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy

  2. Simultaneous gastric band removal and sleeve gastrectomy: a comparison with front-line sleeve gastrectomy.

    Science.gov (United States)

    Rebibo, Lionel; Mensah, Emile; Verhaeghe, Pierre; Dhahri, Abdennaceur; Cosse, Cyril; Diouf, Momar; Regimbeau, Jean-Marc

    2012-09-01

    The placement of a gastric band (GB) prior to a sleeve gastrectomy (LSG) would increase postoperative complications, whether it is withdrawn or not at the time of the LSG. The purpose of this retrospective study was to evaluate and compare postoperative morbidity and outcome weight for simultaneous GB removal (RGB) and LSG (the RGB + LSG group) and front-line LSG only (the LSG group) after unsuccessful GB. From May 2005 to May 2009, 305 patients underwent first- or second-line LSG at Amiens University Hospital. The primary endpoint was the postoperative complication rate (according to the Clavien classification) in the RGB + LSG and LSG groups. The secondary endpoints were intra-operative data, postoperative data, and weight loss over a period of 2 years (body mass index, percentage of excess weight loss, and percentage of excess body mass index (BMI) loss). Univariate and multivariate propensity score analyses were used to search for independent risk factors for postoperative complications. The RGB + LSG group (n = 46) had a mean age of 42 and a mean BMI of 44 kg/m(2). The indication for surgery was renewed weight gain or insufficient weight loss in 68 % of these cases. The LSG group (n = 259) had a mean age of 41 and a mean BMI of 49.2 kg/m(2). All procedures were performed laparoscopically. The complication rate was 8.6 % in the RGB + LSG group and 8 % in the SG group (p = 0.42). The fistula rates in the two groups were 4.3 and 3.4 %, respectively (p = 0.56), and the mean BMI at 2 years was 33.4 kg/m(2) (RGB + LSG group) and 34.4 kg/m(2), respectively (p = 0.83). The operating time for LSG (after subtracting the time associated with RGB for a combined procedure) averaged 107 min, whereas the operating time for front-line LSG was 89 min (p = 0.011). The propensity score analysis failed to find independent risk factors for postoperative complications. The performance of RGB + LSG is feasible and does not increase the postoperative

  3. The Relation Between Laparoscopic Sleeve Gastrectomy and Ghrelin

    Directory of Open Access Journals (Sweden)

    Sema Çalapkorur

    2017-07-01

    Full Text Available Recently, obesity has become an important worldwide health problem. One of the obesity treatment alternatives is bariatric surgery methods and their efficiency is increasing from day to day. In laparoscopic Sleeve gastrectomy being a bariatric surgery method, as a result of stomach fundus excretion, levels of some hormones change. Therefore, weight losses seen after the treatment are related to these changes. Basically, it is claimed that, after laparoscopic Sleeve gastrectomy, levels of ghrelin hormones secreted by stomach fundus, being effective for appetite and getting foods change. Although there are many studies examining varieties of ghrelin levels after laparoscopic sleeve gastrectomy, there is no final judgment concerning the subject yet. In this review, in the light of literature knowledge, giving information regarding effects of laparoscopic sleeve gastrectomy on ghrelin levels is aimed.

  4. Prognostic factors for gastrectomy in elderly patients with gastric cancer.

    Science.gov (United States)

    Ueno, Daisuke; Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Akiyama, Takashi; Shiotani, Akiko; Hirai, Toshihiro

    2017-03-11

    The aim of the present study was to investigate the age-specific prognostic factors in patients who underwent gastrectomy for gastric cancer. The medical records of 366 patients with gastric cancer who underwent surgical resection at our hospital between January 2007 and December 2014 were retrospectively reviewed. Of the 366 patients, 117 were aged 75 years or older and 249 were aged 74 years or younger. All factors that were identified as significant using univariate analysis were included in the multivariate analysis. The median follow-up duration was 52.9 months (range, 1.0-117.5 months). We found that in patients aged 75 years or older, postoperative complications and the extent of cancer were independent prognostic factors of overall survival and disease-free survival. In contrast, in patients aged 74 years or younger, only the lymph node status and postoperative chemotherapy were independent prognostic factors for overall survival and disease-free survival, respectively. Pathological outcomes and postoperative complications are important prognostic factors for survival in patients aged 75 years or older with gastric cancer, whereas pathological outcomes and postoperative chemotherapy are important prognostic factors for survival in patients aged 74 years or younger. Because the prevention of postoperative complications may contribute to improvements in the prognosis of elderly patients with gastric cancer, we suggest that it is necessary to consider limited surgery instead of radical surgery, depending on the patient's general condition and co-morbidities.

  5. Laparoscopic sleeve gastrectomy for morbid obesity

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The incidence of obesity is steadily rising,and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues.In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity.Bariatric surgery proved effective in providing weight loss of large magnitude,correction of comorbidities and excellent short-term and long-term outcomes,decreasing overall mortality and providing a marked survival advantage.The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very "trendy" among laparoscopic surgeons involved in bariatric surgery.As LSG proved to be effective in achieving considerable weight loss in the shortterm,it has been proposed by some as a sole bariatric procedure.This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity.

  6. Robot-assisted laparoscopic gastrectomy for gastric cancer

    Science.gov (United States)

    Caruso, Stefano; Franceschini, Franco; Patriti, Alberto; Roviello, Franco; Annecchiarico, Mario; Ceccarelli, Graziano; Coratti, Andrea

    2017-01-01

    Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer. PMID:28101302

  7. Effect of new adjuvant chemotherapy combined with reserving nipple and areola breast modified radical mastectomy on breast retention beauty effect and immune function

    Institute of Scientific and Technical Information of China (English)

    Yan-Lin Xiao

    2015-01-01

    Objective:To study the effects of new adjuvant chemotherapy combined with reserving nipple and areola breast modified radical mastectomy on breast retention beauty effect and immune function.Methods:110 cases patients with breast cancer were enrolled and randomly divided into observation group and control group. Observation group received reserving nipple and areola breast modified radical mastectomy, control group received conventional modified radical mastectomy. Then cosmetic effect, quality of life and negative emotion and immune function were compared.Results:(1) Cosmetic effects: Cosmetic effect of the observation group was significantly better than that of the control group (92.73%vs. 58.18%). (2) Negative emotions: AMA, HAMD, SAS, SDS scores of the observation group were significantly lower than that of the control group; (3) Immune function: CD3+ T cells, CD4+ T cells of the observation group were significantly higher than those of control group; CD8+ T cells were significantly lower than those of control group. (4) Life quality and negative emotions: life quality score and HAMA score, HAMD score, SAS score, SDS score of the observation group were lower than those of control group.Conclusion: Reserving nipple and areola breast modified radical mastectomy helps to improve cosmetic effect, alleviate negative mood, enhance immune function, and improve patients’ life quality.

  8. 近端胃切除术后肠内外营养联合应用对血清营养及免疫学指标的影响%Effect of combined enteral and parenteral nutrition on nutritional and immune status of patients after proximal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    张洁; 吴俊本; 王树静; 张同军; 巩本刚

    2011-01-01

    对40例经腹行近端胃切除术治疗的胃上部癌患者术后均给予肠外营养,待肠功能恢复后逐步过渡为全量肠内营养,观察术前及术后第1、8天血白蛋白、前白蛋白、转铁蛋白等营养学指标及IgA、IgG、IgM、C3、G4等免疫学指标.平均住院时间14 d,肛门排气时间平均(58±6)h.术前、术后血生化及肝肾功能指标无显著改变(P>0.05);术后第1天营养指标及免疫指标与术前比较差异有统计学意义(P<0.05),除IgM术前与术后第1天、IgG术前与术后第8天比较差异无统计学意义外,其他差异均有统计学意义(P<0.05).3例(8%)并发症中:膈下感染1例,吻合口瘘2例,经保守治疗后痊愈出院.提示,近端胃切除术后肠内外联合营养支持可改善患者的营养及免疫状态.%Parenteral nutrition (PN) was given to 40 patients with upper gastric carcinoma after proximal gastrectomies; and full enteral nutrition (EN) was subsequently given when bowels function recovered.The nutritional indicators including serum albumin ( Alb),prealbumin .(PA) and transferring,and immunological indicators including IgA,IgG,IgM,C3,C4 were measured before and 1st,8th day after operation.The data were processed by software SPSS 13.0.The average length of hospital stay was 14 d and the aerofluxus time was (58 ±6)hours.There were no changes in blood biochemistry,hepatic function and renal function pre- and post-operation( P >0.05 ).The nutritional and immune indicators except the IgM in 1 st day after operation were decreased significantly ( P < 0.05 ).The immune indicators except the IgG in 8th day after operation were significantly improved in comparison of those before and 1st day after operation ( P < 0.05 ).Post-operative complications occurred in 3 patients including 1 case of subphrenic infection and 2 cases of anastomotic leakage.After proper treatment,all patients recovered well.Combined application of EN and PN may improve nutrition and

  9. Is the combination of epidural clonidine–levobupivacaine has same analgesic efficacy and safety as the combination fentanyl–levobupivacaine after radical cystectomy?

    Directory of Open Access Journals (Sweden)

    Essam A. Mahran

    2014-04-01

    Conclusion: We concluded that both clonidine and fentanyl can be used as effective additive to epidural levobubivacaine for postoperative analgesia after radical cystectomy with no significant difference between them in vital signs, analgesic, sedative effects and safety profile on adding each of them in doses not exceeding 20 μg/h to epidural continuous levobupivacaine infusion.

  10. Clinical effect of laparoscopic-assisted radical gastrectomy in treatment of advanced gastric cancer and its effects on serum tumor markers and high sensitive C reactive protein in elderly patients%腹腔镜辅助胃癌根治术治疗老年进展期胃癌的临床效果及对血清肿瘤标志物和高敏C反应蛋白的影响

    Institute of Scientific and Technical Information of China (English)

    赵昕波; 游红勇; 李兵; 陈智敏; 刘东涛

    2015-01-01

    Objective To investigate the long-term clinical efficiency of laparoscopic-assisted radical gastrectomy in the treatment of advanced gastric cancer and the effects on the serum tumor markers and high sensitive C reactive protein (hs-CRP) in elderly patients.Methods Totally 86 elderly patients of advanced gastric cancer from August 2008 to June 2012 were enrolled and divided into laparoscopic group (43 cases) and laparotomy group (43 cases).The long-term therapeutic efficiency was evaluated.The levels of serum tumor markers including carcino embryonic antigen (CEA),neuron-specific enolase (NSE),cytokeratin fragment antigen 21-1 (CYFRA21-1) carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9(CA19-9),hs-CRP,blood coagulation index before and after operation were measured and compared between two groups.Results The operation time and the number of dissected lymph node showed no significant difference between two groups (P > 0.05);bleeding,using times of analgesic,gastrointestinal recovery time,hospitalization time and incidence of adverse reactions in laparoscopic group were significantly lower than those in traditional laparotomy group [(89 ±19) mlvs (122±25) ml,(0.68 ±0.28) timesvs (2.19 ±0.53) times,(2.6 ±0.4) d vs (3.9 ±0.5) d,(9.1 ±1.8) d vs (12.6 ±2.4) d,14.0% (6/43) vs 39.5% (17/43),P<0.05];overall survival of laparoscopic group and laparotomy group had no significant difference [10.2 months (95% CI:8.211-13.089) and 9.7 months (95% CI:5.804-10.596) (x2 =3.481,P =0.062).The serum tumor markers,coagulation indices and hs-CRP showed no significant differences between two groups before operation (P > 0.05);they were all improved after operation.The levels of CEA,NSE,CA125,CA19-9 and hs-CRP in laparoscopic group were all significantly lower compared with those in laparotomy group after operation [(10.1 ± 2.6) μg/L vs (18.8 ±5.2) μ.g/L,(14±3) μg/L vs (22±7) μg/L,(31 ±7) kU/L vs (45 ±7) kU/L,(28 ±7) kU/L vs (47±17) kU/L,(2

  11. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly.

    Science.gov (United States)

    Qiu, Jiang-Feng; Yang, Bing; Fang, Lei; Li, Yi-Ping; Shi, Yi-Jiu; Yu, Xiu-Chong; Zhang, Mou-Cheng

    2014-01-01

    To evaluate safety and efficacy of laparoscopy-assisted radical gastrectomy (LARG) for advanced gastric cancer patients aged 70 years or older. Clinical data were retrospectively collected from patients with IIA-IIIC gastric cancer who underwent LARG (n = 30) and open radical gastrectomy (ORG, n = 34) in Department of Gastrointestinal Surgery in the Ningbo First Hospital from January 2012 to December 2013. The mean operative time was longer in the LARG group than in the ORG group but there was no statistical difference between the two groups. The intraoperative blood loss (120 ± 52.7 ml vs 227.3 ± 146.9 ml), incidence of postoperative complication (23.0% vs 47%) were lower in the LARG group than those in the ORG group. In addition, the time to first flatus (2.9 ± 0.8 d vs 4.6 ± 1.2 d), time to first ambulation (1.2 ± 0.4 vs 4.1 ± 1.0 d), time of nasogastric intubation (2.5 ± 1.0 d vs 3.5 ± 1.4 d), and postoperative hospital stay (13.0 ± 4.2 d vs 16.9 ± 4.1 d) were significantly shorter in the LARG group than in the ORG group, respectively. No statistical difference in the number of harvested lymph nodes was noted between the two groups (30.2 ± 12.0 vs 28.1 ± 11.8, P > 0.05). LARG is safer, more effective and less invasive for the elderly patients with advanced gastric cancer.

  12. Multivariate analysis of the prognostic factors of squamous cell cervical cancer treated by radical hysterectomy or combined radiation therapy; Carcinoma espinocelular do colo uterino submetido a cirurgia radical isolada ou em combinacao com radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Coelho, Francisco Ricardo Gualda; Kowalski, Luiz Paulo; Abrao, Fauzer Simao [Fundacao Antonio Prudente, Sao Paulo, SP (Brazil). Hospital A.C. Camargo; Franco, Eduardo Luiz [McGill Univ., Montreal, PQ (Canada). Dept. of Oncology; Zeferino, Luiz Carlos [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Medicina; Brentani, Maria Mitzi [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina

    1996-04-01

    Six hundred and nine cases of invasive squamous cell carcinoma of the cervix uteri in a retrospective analysis (1953-1982) at the A.C. Camargo Hospital, Antonio Prudente Foundation, Sao Paulo, Brazil. The patients were submitted to radical surgery and radiation therapy, individually or in combination. A multivariate analysis of the different variables were performed according to the Cox`s regression method. The variables of prognosis value, in decreasing order of importance, were: the decade of patient`s admission, the modality of therapy employed, the presence of residual tumor in the surgical specimens and the clinical stage of the disease. Other variables like ethnic group, age of first menstrual flux, menopause, number of pregnancy, kind of delivery, number and kind of abortion, were found to be of no prognostic importance. The decade of admission was of independent prognostic significance. The presence of residual tumor in the surgical specimens was more important than lymph nodes spreading, but the overall survival was affected by the increase in the number of positive lymph nodes. Patient`s age was a weak prognostic factor accounting for a reduction in the survival time among cases with age upper to 45 years old. Radiation therapy sterilizes a considerable number of lymph nodes but not all of them in every patient. There are a specific group of patients where the radical surgery is necessary in order to carry a complete debulking of the disease. (author) 82 refs., 10 figs.

  13. Incidence and clinical features of endoscopic ulcers developing after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Woo Chul Chung; Eun Jung Jeon; Kang-Moon Lee; Chang Nyol Paik; Sung Hoon Jung; Jung Hwan Oh; Ji Hyun Kim

    2012-01-01

    AIM:To determine the precise incidence and clinical features of endoscopic ulcers following gastrectomy.METHODS:A consecutive series of patients who underwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed.A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled.We analyzed differences in patient age,sex,size of the lesions,method of operation,indications for gastric resection,and infection rates of Helicobacter pylori (H.pylori)between the nonulcer and ulcer groups.RESULTS:The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%.Ulcers were more common in patients with Billroth Ⅱ anastomosis and pre-existing conditions for peptic ulcer disease (PUD).Infection rates of H.pyloridid not differ significantly between the two groups.The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission.CONCLUSION:H.pylori was not an important factor in ulcerogenesis following gastrectomy.For patients who underwent surgery for PUD,clinical course of marginal ulcers was more severe.

  14. Weight Loss after Sleeve Gastrectomy in Super Superobesity

    Directory of Open Access Journals (Sweden)

    J.-M. Catheline

    2012-01-01

    Full Text Available Objective. This prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss (%EWL in super superobese patients (BMI >60 Kg/m2. Results. Thirty patients (33 women and 7 men were included, with mean age of 35 years (range 18 to 59. Mean preoperative BMI was 66 Kg/m2 (range 60 to 85. The study included one patient with complete situs inversus and 4 (14% with previous restrictive gastric banding. The mean operative time was 120 minutes (range 80 to 220 min and the mean hospital stay was 7.5 days (4 to 28 days. There was no postoperative mortality or need for a laparotomy conversion. Two subphrenic hematomas, one gastric fistula, and one pulmonary embolism, were the major complications. After 18 months 17 (77% had sufficient weight loss and six had insufficient results, leading to either re-sleeve gastrectomy (3, or gastric bypass (2. Three years after the initial laparoscopic sleeve gastrectomy, the mean EWL was 51% (range 21 to 82. Conclusion. The laparoscopic sleeve gastrectomy is a safe and efficient operating procedure for treating super superobesity. In the case of insufficient weight loss, a second-stage operation like resleeve gastrectomy or gastric bypass can be proposed.

  15. Free radical scavenging capacity, anticandicidal effect of bioactive compounds from Sida cordifolia L., in combination with nystatin and clotrimazole and their effect on specific immune response in rats.

    Science.gov (United States)

    Ouédraogo, Maurice; Konaté, Kiessoun; Lepengué, Alexis Nicaise; Souza, Alain; M'Batchi, Bertrand; Sawadogo, Laya L

    2012-12-26

    Infectious diseases caused by fungi are still a major threat to public health, despite numerous efforts by researchers. Use of ethnopharmacological knowledge is one attractive way to reduce empiricism and enhance the probability of success in new drug-finding efforts. In this work, the total alkaloid compounds (AC) from Sida cordifolia L. (Malvaceae) have been investigated for their free radical scavenging capacity, antifungal and immunostimulatory properties. The antifungal activity was investigated against five candida strains using the microplate dilution method and the Fractional Inhibitory Concentration Index (FICI) of compounds was evaluated. The antioxidant activity of the samples was evaluate using three separate methods, at last, the immunostimulatory effect on immunosuppressed wistar rats was performed. As for the antifungal activity, result varied according to microorganism. The results obtained in this antifungal activity were interesting and indicated a synergistic effect between alkaloid compounds and the antifungal references such as Nystatin and Clotrimazole. Antioxidant capacity noticed that the reduction capacity of DPPH radicals obtained the best result comparatively to the others methods of free radical scavenging. Our results showed a low immunostimulatory effect and this result could be explained by the lack of biologically active antioxidants such as polyphenol compounds lowly contained in the alkaloid compounds. The results of this study showed that alkaloid compounds in combination with antifungal references (Nystatin and Clotrimazole) exhibited antimicrobial effects against candida strains tested. The results supported the utilization of these plants in infectious diseases particularly in treatment of candida infections.

  16. Free radical scavenging capacity, anticandicidal effect of bioactive compounds from Sida Cordifolia L., in combination with nystatin and clotrimazole and their effect on specific immune response in rats

    Directory of Open Access Journals (Sweden)

    Ouédraogo Maurice

    2012-12-01

    Full Text Available Abstract Background Infectious diseases caused by fungi are still a major threat to public health, despite numerous efforts by researchers. Use of ethnopharmacological knowledge is one attractive way to reduce empiricism and enhance the probability of success in new drug-finding efforts. In this work, the total alkaloid compounds (AC from Sida cordifolia L. (Malvaceae have been investigated for their free radical scavenging capacity, antifungal and immunostimulatory properties. Method The antifungal activity was investigated against five candida strains using the microplate dilution method and the Fractional Inhibitory Concentration Index (FICI of compounds was evaluated. The antioxidant activity of the samples was evaluate using three separate methods, at last, the immunostimulatory effect on immunosuppressed wistar rats was performed. Results As for the antifungal activity, result varied according to microorganism. The results obtained in this antifungal activity were interesting and indicated a synergistic effect between alkaloid compounds and the antifungal references such as Nystatin and Clotrimazole. Antioxidant capacity noticed that the reduction capacity of DPPH radicals obtained the best result comparatively to the others methods of free radical scavenging. Our results showed a low immunostimulatory effect and this result could be explained by the lack of biologically active antioxidants such as polyphenol compounds lowly contained in the alkaloid compounds. Conclusion The results of this study showed that alkaloid compounds in combination with antifungal references (Nystatin and Clotrimazole exhibited antimicrobial effects against candida strains tested. The results supported the utilization of these plants in infectious diseases particularly in treatment of candida infections.

  17. Complicated course after sleeve gastrectomy for obesity.

    Science.gov (United States)

    Zonca, P; Cambal, M; Jacobi, C A

    2010-01-01

    The authors present a case of a 52-year old female patient with sleeve gastrectomy for obesity. Two major complications occured after the surgery. The first one was a leakage on the third day after the surgery. The routine swallow examination on the first day after the surgery was normal. The pathological secretion from the drainage occurred on the third day after the surgery with a simultaneous increase in inflammatory markers. There were no clinical signs of sepsis. An indication for laparoscopic revision was done and a small defect in the staple line was identified. The oversewing of the small defect on the stomach was performed. Immediately after the second surgery the patient was clinicaly without any problems. The inflammatory markers decreased promptly after the surgery. The second complication was presented with decompensated psychosis, which developed on the 4th day after the second surgery. The patient complained of problems with swallowing despite the fact that the swallow contrast examination was normal. The patient received her psychiatric medication intravenously. The problem with swallowing was not based on any organic reason, and lasted for 4 weeks. During this period the patient was fed only parenterally. Almost 6 weeks after the surgery the patient became compensated and was dismissed. We would like to point out to the problems potentially occuring in patients with a psychiatric disease. Good compensation and stabilization of psychiatric disease is a condition that has to be met before a surgery (Tab. 1, Fig. 1, Ref. 21).

  18. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Amir Abu Zikry

    2011-01-01

    Full Text Available Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO 2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO 2 and SaO 2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.

  19. [Perioperative managment of laparoscopic sleeve gastrectomy].

    Science.gov (United States)

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  20. Facile Preparation of Crosslinked Polymeric Nanocapsules via Combination of Surface-Initiated Atom Transfer Radical Polymerization and Ultraviolet Irradiated Crosslinking Techniques

    Directory of Open Access Journals (Sweden)

    Mu Bin

    2009-01-01

    Full Text Available Abstract A facile approach for the preparation of crosslinked polymeric nanocapsules was developed by the combination of the surface-initiated atom transfer radical polymerization and ultraviolet irradiation crosslinking techniques. The well-defined polystyrene grafted silica nanoparticles were prepared via the SI-ATRP of styrene from functionalized silica nanoparticles. Then the grafted polystyrene chains were crosslinked with ultraviolet irradiation. The cross-linked polystyrene nanocapsules with diameter of 20–50 nm were achieved after the etching of the silica nanoparticle templates with hydrofluoric acid. The strategy developed was confirmed with Fourier transform infrared, thermogravimetric analysis, and transmission electron microscopy.

  1. Morbid obesity and sleeve gastrectomy: how does it work?

    Science.gov (United States)

    Papailiou, Joanna; Albanopoulos, Konstantinos; Toutouzas, Konstantinos G; Tsigris, Christos; Nikiteas, Nikolaos; Zografos, George

    2010-10-01

    Laparoscopic sleeve gastrectomy is known to be a safe and effective procedure for treating morbid obesity and is performed with increasing frequency both in Europe and the USA. Despite its broad use, many questions about the remaining gastric tube diameter, its long-term efficacy, its effects on gastric emptying, and the hormones involved still remain to be answered. In order to use such a relatively new surgical procedure wisely, it is essential for every surgeon and physician to understand how sleeve gastrectomy acts in obesity and what its potential benefits on the patients' metabolism are. This review focuses on the most important pathophysiologic questions referred to sleeve gastrectomy on the literature so far, in an attempt to evaluate the different issues still pending on the subject.

  2. Application and Nursing of Nasogastric Tube Enteral Nutrition in Patients With Radical Gastrectomy for Gastric Cancer%鼻饲肠内营养管在胃癌根治术患者治疗中的应用及护理

    Institute of Scientific and Technical Information of China (English)

    高巍

    2015-01-01

    Objective To investigate the clinical effect of nasogastric enteral nutrition and nursing methods of patients treated with radical surgery in the stomach. Methods 320 patients with gastric cancer radical surgery using nasogastric enteral nutrition tube for treatment with clinical data were retrospectively analyzed. Results 320 patients with gastric cancer radical surgery through nasogastric enteral nutrition tube to complete a supplemental nutrition therapy. Through the system of professional care,nasogastric enteral nutrition tube using effect is good,no serious complications occurred. Conclusion The gastric cancer radical surgery patients with nasogastric enteral nutrition tube,can effectively supplement nutrition in patients after operation,reduce the amount of intravenous fluid and promote the recovery of gastrointestinal function in patients,shorten the hospitalization time,reduce the hospitalization costs. The nursing of nasogastric enteral nutrition tube for professional system can ensure the effective use.%目的:探讨鼻饲肠内营养管在胃癌根治术患者治疗中应用的临床效果及护理方法。方法对320例行胃癌根治术应用鼻饲肠内营养管进行治疗患者的临床资料进行回顾性分析。结果320例行胃癌根治术患者都通过鼻饲肠内营养管完成补充营养治疗,通过专业系统的护理,鼻饲肠内营养管使用效果良好,无严重并发症发生。结论胃癌根治术患者应用鼻饲肠内营养管,可以有效地补充患者术后营养,减少静脉补液量,促进患者胃肠道功能恢复,缩短住院时间,降低患者的住院费用。对鼻饲肠内营养管进行专业系统的护理,可以保障其有效使用。

  3. Efficacy evaluation of subtotal and total gastrectomies in robotic surgery for gastric cancer compared with that in open and laparoscopic resections: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Liang Zong

    Full Text Available Robotic gastrectomy (RG, as an innovation of minimally invasive surgical method, is developing rapidly for gastric cancer. But there is still no consensus on its comparative merit in either subtotal or total gastrectomy compared with laparoscopic and open resections.Literature searches of PubMed, Embase and Cochrane Library were performed. We combined the data of four studies for RG versus open gastrectomy (OG, and 11 studies for robotic RG versus laparoscopic gastrectomy (LG. Moreover, subgroup analyses of subtotal and total gastrectomies were performed in both RG vs. OG and RG vs. LG.Totally 12 studies involving 8493 patients met the criteria. RG, similar with LG, significantly reduced the intraoperative blood loss than OG. But the duration of surgery is longer in RG than in both OG and LG. The number of lymph nodes retrieved in RG was close to that in OG and LG (WMD = -0.78 and 95% CI, -2.15-0.59; WMD = 0.63 and 95% CI, -2.24-3.51. And RG did not increase morbidity and mortality in comparison with OG and LG (OR = 0.92 and 95% CI, 0.69-1.23; OR = 0.72 and 95% CI, 0.25-2.06 and (OR = 1.06 and 95% CI, 0.84-1.34; OR = 1.55 and 95% CI, 0.49-4.94. Moreover, subgroup analysis of subtotal and total gastrectomies in both RG vs. OG and RG vs. LG revealed that the scope of surgical dissection was not a positive factor to influence the comparative results of RG vs. OG or LG in surgery time, blood loss, hospital stay, lymph node harvest, morbidity, and mortality.This meta-analysis highlights that robotic gastrectomy may be a technically feasible alternative for gastric cancer because of its affirmative role in both subtotal and total gastrectomies compared with laparoscopic and open resections.

  4. Complications and nutrient deficiencies two years after sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Pech Nicole

    2012-07-01

    Full Text Available Abstract Background The aim of this systematic study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a median follow-up of two years. Methods Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results From September 26, 2005 to May 28, 2009, 100 patients (female: male = 59:41 with a mean age of 43.6 years (range: 22–64 and a preoperative BMI of 52.3 kg/² (range: 36–77 underwent SG. The mean operative time was 86.4 min (range: 35–275. Major complications were observed in 8.0 % of the patients. During the follow-up period, 25 patients (25.0 % underwent a second bariatric intervention (22 DS and 3 RYGBP. Out of the total 100 patients, 48 % were supplemented with iron, 33 % with zinc, 34 % with a combination of calcium carbonate and cholecalciferol, 24 % with vitamin D, 42 % with vitamin B12 and 40 % with folic acid. The patients who received only a SG (n = 75 had %EWL of 53.6, 65.8 and 62.6 % after 6, 12 and 24 months, respectively. Conclusions SG is a highly effective bariatric intervention for morbidly obese patients. Nutritional deficiencies resulting from the procedure can be detected by routine nutritional screening. Results of the study show that Vitamin B12 supplementation should suggested routinely.

  5. Early outcome after emergency gastrectomy for complicated peptic ulcer disease.

    Science.gov (United States)

    Cheng, Mina; Li, W H; Cheung, M T

    2012-08-01

    OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease. DESIGN. Prognostic study on a historical cohort. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital. MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities. RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors. CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication.

  6. Modification of early postoperative X-ray research after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Sapounov, S.

    1982-10-01

    A modification of the early postoperative X-ray research after gastrectomy is described. The application of gastrografin happens through a nasogastric tube. By changing the position of its tip during the screening control, and excellent and precise represention of the anastomotic region will be achieved. We present a research of 35 patients.

  7. Well-defined polyethylene-based graft terpolymers by combining nitroxide-mediated radical polymerization, polyhomologation and azide/alkyne “click” chemistry†

    KAUST Repository

    Alkayal, Nazeeha

    2016-03-30

    Novel well–defined polyethylene–based graft terpolymers were synthesized via the “grafting onto” strategy by combining nitroxide-mediated radical polymerization (NMP), polyhomologation and copper (I)-catalyzed azide-alkyne cycloaddition (CuAAC) “click” chemistry. Three steps were involved in this approach: (i) synthesis of alkyne-terminated polyethylene-b-poly(ε-caprolactone) (PE-b-PCL-alkyne) block copolymers (branches) by esterification of PE-b-PCL-OH with 4-pentynoic acid; the PE-b-PCL-OH was obtained by polyhomologation of dimethylsulfoxonium methylide to afford PE-OH, followed by ring opening polymerization of ε-caprolactone using the PE-OH as macroinitiator, (ii) synthesis of random copolymers of styrene (St) and 4-chloromethylstyrene (4-CMS) with various CMS contents, by nitroxide-mediated radical copolymerization (NMP), and conversion of chloride to azide groups by reaction with sodium azide (NaN3) (backbone) and (iii) “click” linking reaction to afford the PE-based graft terpolymers. All intermediates and final products were characterized by high-temperature size exclusion chromatography (HT-SEC), Fourier transform infrared spectroscopy (FTIR), proton nuclear magnetic resonance spectroscopy (1H NMR) and differential scanning calorimetry (DSC).

  8. Clinical Significance of Biliary Dilatation and Cholelithiasis after Subtotal Gastrectomy.

    Science.gov (United States)

    Yoon, Harry; Kwon, Chang Il; Jeong, Seok; Lee, Tae Hoon; Han, Joung Ho; Song, Tae Jun; Hwang, Jae Chul; Kim, Dae Jung

    2015-07-01

    The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer. Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer. A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (pœ0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase. The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.

  9. Combination of electrografting and atom-transfer radical polymerization for making the stainless steel surface antibacterial and protein antiadhesive.

    Science.gov (United States)

    Ignatova, Milena; Voccia, Samuel; Gilbert, Bernard; Markova, Nadya; Cossement, Damien; Gouttebaron, Rachel; Jérôme, Robert; Jérôme, Christine

    2006-01-03

    A two-step "grafting from" method has been successfully carried out, which is based on the electrografting of polyacrylate chains containing an initiator for the atom transfer radical polymerization (ATRP) of 2-(tert-butylamino)ethyl methacrylate (TBAEMA) or copolymerization of TBAEMA with either monomethyl ether of poly(ethylene oxide) methacrylate (PEOMA) or acrylic acid (AA) or styrene. The chemisorption of this type of polymer brushes onto stainless steel surfaces has potential in orthopaedic surgery. These films have been characterized by ATR-FTIR, Raman spectroscopy, atomic force microscopy (AFM), and measurement of contact angles of water. The polymer formed in solution by ATRP and that one detached on purpose from the surface have been analyzed by size exclusion chromathography (SEC) and (1)H NMR spectroscopy. The strong adherence of the films onto stainless steel has been assessed by peeling tests. AFM analysis has shown that addition of hydrophilic comonomers to the grafted chains decreases the surface roughness. According to dynamic quartz crystal microbalance experiments, proteins (e.g., fibrinogen) are more effectively repelled whenever copolymer brushes contain neutral hydrophilic (PEOMA) co-units rather than negatively charged groups (PAA salt). Moreover, a 2- to 3-fold decrease in the fibrinogen adsorption is observed when TBAEMA is copolymerized with either PEOMA or AA rather than homopolymerized or copolymerized with styrene. Compared to the bare stainless steel surface, brushes of polyTBAEMA, poly(TBAEMA-co-PEOMA) and poly(TBAEMA-co-AA) decrease the bacteria adhesion by 3 to 4 orders of magnitude as revealed by Gram-positive bacteria S. aureus adhesion tests.

  10. Highly efficient aerobic oxidation of alcohols by using less-hindered nitroxyl-radical/copper catalysis: optimum catalyst combinations and their substrate scope.

    Science.gov (United States)

    Sasano, Yusuke; Kogure, Naoki; Nishiyama, Tomohiro; Nagasawa, Shota; Iwabuchi, Yoshiharu

    2015-04-01

    The oxidation of alcohols into their corresponding carbonyl compounds is one of the most fundamental transformations in organic chemistry. In our recent report, 2-azaadamantane N-oxyl (AZADO)/copper catalysis promoted the highly chemoselective aerobic oxidation of unprotected amino alcohols into amino carbonyl compounds. Herein, we investigated the extension of the promising AZADO/copper-catalyzed aerobic oxidation of alcohols to other types of alcohol. During close optimization of the reaction conditions by using various alcohols, we found that the optimum combination of nitroxyl radical, copper salt, and solution concentration was dependent on the type of substrate. Various alcohols, including highly hindered and heteroatom-rich ones, were efficiently oxidized into their corresponding carbonyl compounds under mild conditions with lower amounts of the catalysts.

  11. Cyclic Multiblock Copolymers via Combination of Iterative Cu(0)-Mediated Radical Polymerization and Cu(I)-Catalyzed Azide-Alkyne Cycloaddition Reaction.

    Science.gov (United States)

    Xiao, Lifen; Zhu, Wen; Chen, Jiqiang; Zhang, Ke

    2017-02-01

    Cyclic multiblock polymers with high-order blocks are synthesized via the combination of single-electron transfer living radical polymerization (SET-LRP) and copper-catalyzed azide-alkyne cycloaddition (CuAAC). The linear α,ω-telechelic multiblock copolymer is prepared via SET-LRP by sequential addition of different monomers. The SET-LRP approach allows well control of the block length and sequence as A-B-C-D-E, etc. The CuAAC is then performed to intramolecularly couple the azide and alkyne end groups of the linear copolymer and produce the corresponding cyclic copolymer. The block sequence and the cyclic topology of the resultant cyclic copolymer are confirmed by the characterization of (1) H nuclear magnetic resonance spectroscopy, gel permeation chromatography, Fourier transform infrared spectroscopy, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  12. A combined experimental and theoretical study of reactions between the hydroxyl radical and oxygenated hydrocarbons relevant to astrochemical environments.

    Science.gov (United States)

    Shannon, R J; Caravan, R L; Blitz, M A; Heard, D E

    2014-02-28

    The kinetics of the reactions of the hydroxyl radical (OH) with acetone and dimethyl ether (DME) have been studied between 63-148 K and at a range of pressures using laser-flash photolysis coupled with laser induced fluorescence detection of OH in a pulsed Laval nozzle apparatus. For acetone, a large negative temperature dependence was observed, with the rate coefficient increasing from k1 = (1.6 ± 0.8) × 10(-12) cm(3) molecule(-1) s(-1) at 148 K to (1.0 ± 0.1) × 10(-10) cm(3) molecule(-1) s(-1) at 79 K, and also increasing with pressure. For DME, a similar behaviour was found, with the rate coefficient increasing from k2 = (3.1 ± 0.5) × 10(-12) cm(3) molecule(-1) s(-1) at 138 K to (1.7 ± 0.1) × 10(-11) cm(3) molecule(-1) s(-1) at 63 K, and also increasing with pressure. The temperature and pressure dependence of the experimental rate coefficients are rationalised for both reactions by the formation and subsequent stabilisation of a hydrogen bonded complex, with a non-zero rate coefficient extrapolated to zero pressure supportive of quantum mechanical tunnelling on the timescale of the experiments leading to products. In the case of DME, experiments performed in the presence of O2 provide additional evidence that the yield of the CH3OCH2 abstraction product, which can recycle OH in the presence of O2, is ≥50%. The experimental data are modelled using the MESMER (Master Equation Solver for Multi Energy Well Reactions) code which includes a treatment of quantum mechanical tunnelling, and uses energies and structures of transition states and complexes calculated by ab initio methods. Good agreement is seen between experiment and theory, with MESMER being able to reproduce for both reactions the temperature behaviour between ~70-800 K and the pressure dependence observed at ~80 K. At the limit of zero pressure, the model predicts a rate coefficient of ~10(-11) cm(3) molecule(-1) s(-1) for the reaction of OH with acetone at 20 K, providing evidence that the

  13. [Comparison of body weight loss in gastrectomy patients who underwent only surgery and those who underwent surgery followed up with S-1 adjuvant chemotherapy].

    Science.gov (United States)

    Aoyama, Toru; Yoshikawa, Takaki; Shirai, Junya; Hayashi, Tsutomu; Ogata, Takashi; Cho, Haruhiko; Yukawa, Norio; Oshima, Takashi; Rino, Yasushi; Ozawa, Yukihiro; Kitani, Yuichi; Wada, Hiroo; Masuda, Munetaka; Tsuburaya, Akira

    2012-11-01

    Body weight loss is a common outcome in patients with gastric cancer who have undergone gastrectomy. However, the rate of body weight loss after surgery is unknown. In this retrospective study, we selected patients who underwent radical gastrectomy for gastric cancer and were diagnosed with Stage II or III disease. Further, we compared the body weight loss after surgery between patients in the surgery alone group and the S-1 adjuvant chemotherapy group. We evaluated 163 patients, of which 81 underwent only surgery, and 82 underwent surgery followed up with S-1 adjuvant chemotherapy. The body weight loss rate at 1, 3, and 6 months in the surgery alone group were 93.1%, 92.9%, and 94.9%, while those in the S-1 adjuvant group were 92.9%, 90.4%,and 91.9%, which was a significant difference. Body weight loss after gastrectomy was higher in the S-1 adjuvant group than in the surgery alone group. Further, nutritional support is required for these patients to maintain body weight after surgery.

  14. 进展期胃癌腹腔镜辅助与开放 D2根治术围手术期临床效果比较%Comparison of the perioperative clinical results of laparoscopy -assisted and open radi-cal D2 gastrectomy in advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    王进; 郭绍春; 樊林; 王海江; 周力波; 贾宗良; 车向明

    2016-01-01

    目的:比较腹腔镜辅助与开放 D2胃癌根治术手术、病理与术后恢复情况。方法:回顾性分析我科收治的202例胃癌患者。查阅电子病历系统,收集腹腔镜与开放胃癌根治术患者的病历资料,比较腹腔镜组和开放组手术时间、术中出血量、淋巴结清扫数目、术后并发症与术后恢复等相关指标。结果:与开放组相比,腹腔镜组术中出血量少[(90.63±78.66)vs (154.15±151.65)ml,P <0.001],淋巴结清扫数目相当[(21.4±10.5)vs (21.7±11.4)个,P =0.810],术后伤口脂肪液化发生少,术后通气时间早[(3.0±0.8)vs (3.5±1.0)天,P <0.001],术后进半流食时间早[(6.2±1.5)vs (6.8±2.3)天,P =0.028],术后住院时间短[(9.4±2.3)vs (11.3±3.0)天,P =0.022],仅手术时间稍长[(222±36)vs(205±62)min,P =0.021]。结论:在进展期胃癌 D2根治术中,虽然腹腔镜手术时间略长于开放组,总体而言,腹腔镜组能达到与开放手术相同的淋巴结清扫数目,且具有术中出血量少,术后恢复快的优势。%Objective:To compare the character of pathology,and postoperative between laparoscopic assisted D2 gastric cancer radical surgery and open D2 gastric cancer radical surgery for advanced gastric cancer.Methods:To choose 202 patients in our department from April 2014 to April 2015.Clinical dara of all 202 patients were studied retrospectively.The operation time,intraoperative blood loss,number of retrieved lymph node,time to first flatus,time to liquid diet,postoperative hospital stay,postoperative complications were compared between the two groups.Results:As compared with the open group,the bleeding amount of LAG group was significantly less[(90.63 ±78.66)vs (154.15 ±151.65)ml,P <0.001 ],no significantly diffrence was found in the number of rerieved lymph node [(21.4 ±10.5)vs (21

  15. Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer

    OpenAIRE

    SUMER, Fatih; Kayaalp, Cuneyt; Karagul, Servet

    2016-01-01

    Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Addit...

  16. Systematic review of feasibility and safety of laparoscopic gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jiwen Jiang

    2012-01-01

    Objective: The purpose of the present study was to retrospectively and systematically evaluate the feasibility and safety of laparoscopic gastrectomy for gastric cancer.Methods: Research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy was screened through computer-based online system.Meta-analysis of acquired data was performed.The inverse variance method was used to test the significance of continuous data, while the Mantel-Haenszel method was used for dichotomous data.The chi-square test was used for evaluation of data heterogeneity.Homogenous data were calculated using the fixed effect model, and heterogeneous data were calculated using freedom model.Statistical data were expressed as 95% confidence interval (95% CI).Funnel plot was used for sensitivity analysis to show potential publication bias.Results: Five papers met the inclusion criteria, 164 cases underwent laparoscopic gastrectomy and 162 cases received open gastrectomy.Meta-analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy (both P < 0.01), but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay (P < 0.01).But there were no significant differences in terms of time to resumption of oral intake, postoperative complications, postoperative morbidity rate, and tumor recurrence.Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node.Subgroup analysis showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy.Conclusion: All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.

  17. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

    OpenAIRE

    2015-01-01

    Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal ...

  18. Surgical effects of obesity on laparoscopy-assisted distal gastrectomy.

    Science.gov (United States)

    Kawamura, Hideki; Tanioka, Toshiro; Funakoshi, Tohru; Takahashi, Masahiro

    2011-06-01

    To compare the effects of obesity on laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG). A retrospective study was conducted on 249 patients, who underwent LADG and 224 patients who underwent ODG. The regression coefficient of the primary regression equation between operative time and body mass index (BMI) for LADG was greater than ODG; and between blood loss and BMI for LADG was almost the same as ODG. In overweight patients (BMI ≥25), no significant difference was seen between LADG and ODG regarding postoperative complications, and the benefits of the less-invasive nature of LADG were also seen in some parameters. Obesity-associated difficulties are more while performing LADG than during ODG; however, the influence of obesity on LADG decreases with surgical experience. Moreover, even in overweight patients, the benefits of the less-invasive nature of LADG still remain, but the degree of the benefits is smaller than that in nonobese patients.

  19. Totally Laparoscopic Gastrectomy for Gastric Cancer Associated with Recklinghausen's Disease

    Directory of Open Access Journals (Sweden)

    Yoshihisa Sakaguchi

    2010-01-01

    Full Text Available This paper documents the first case of gastric cancer associated with Recklinghausen's disease, which was successfully treated by a totally laparoscopic operation. A 67-year-old woman with Recklinghausen's disease was referred to this department to undergo surgical treatment for early gastric cancer. The physical examination showed multiple cutaneous neurofibromas throughout the body surface, which made an upper abdominal incision impossible. Laparoscopic surgery requiring only small incisions was well indicated, and a totally laparoscopic distal gastrectomy with lymph node dissection was performed. Billroth I reconstruction was done intra-abdominally using a delta-shaped anastomosis. The patient followed a satisfactory postoperative course with no complications. Since the totally laparoscopic gastrectomy has many advantages over open surgery, it should therefore be preferentially used as a less invasive treatment in the field of gastric cancer.

  20. 胃底贲门癌根治术后不同消化道重建方式的效果比较%Comparative analysis of different kinds of digestive tract reconstruction after radical gastrectomy in the treatment of gastric cardia carcinoma

    Institute of Scientific and Technical Information of China (English)

    贾晓斌; 吉锋英; 毕红革

    2015-01-01

    目的:探讨胃底贲门癌根治术后三种不同消化道重建方式效果。方法:收集胃底贲门癌患者32例,随机分为间置空肠吻合术组、空肠食管Roux‐en‐Y吻合术组、食管残胃后壁吻合术组3组,比较3组患者的治疗效果。结果:食管残胃后壁吻合术组返流性食管炎发生率高于间置空肠吻合术组(P<0.05);手术后,间置空肠吻合术组患者在整体健康状况、便秘、恶心呕吐上评分均低于空肠食管Roux‐en‐Y吻合术组和食管残胃后壁吻合术组(P<0.05);间置空肠吻合术组患者的腹泻评分高于空肠食管Roux‐en‐Y吻合术组和食管残胃后壁吻合术组(P<0.05)。结论:间置空肠吻合术重建消化道具有较低的返流性食管炎发生率和较好的预后。%Objective:To compare the different kinds of digestive tract reconstruction after radical gas‐trectomy in the treatment of gastric cardia carcinoma .Methods :32 patients randomly divided into interstitial anasto‐mosis group ,jejunal Roux‐en‐Y anastomosis group ,the posterior wall of esophagus gastric remnant anastomosis group ,Compare the treatment effect between the three groups .Result :The posterior wall of esophagus gastric remnant anastomosis group was higher than the stromal anastomosis group in the incidence rate of reflux esophagitis (P<0 .05);after the operation ,interstitial anastomosis group was lower than jejunal Roux‐en‐Y anastomosis group and the posterior wall of esophagus gastric remnant anastomosis group in overall health ,constipation ,nausea and vomiting ,diarrhea (P<0 .05);interstitial anastomosis group was higher than jejunal Roux‐en‐Y anastomosis group and the posterior wall of esophagus gastric remnant anastomosis group(P<0 .05) ,were more than those of jejunal Roux‐en‐Y anastomosis group and the posterior wall of esophagus gastric remnant anastomosis group (P<0 .05) . Conclusion :Interstitial

  1. Direction-Dependent Effects of Combined Static and ELF Magnetic Fields on Cell Proliferation and Superoxide Radical Production.

    Science.gov (United States)

    Naarala, Jonne; Kesari, Kavindra Kumar; McClure, Ian; Chavarriaga, Cristina; Juutilainen, Jukka; Martino, Carlos F

    2017-01-01

    Proliferation of human umbilical vein endothelial cells was stimulated by a nearly vertical 60 or 120 μT static magnetic field (MF) in comparison to cells that were shielded against MFs. When the static field was combined with an extremely low frequency (ELF) MF (18 Hz, 30 μT), proliferation was suppressed by a horizontal but not by a vertical ELF field. As these results suggested that the effects of an ELF MF depend on its direction in relation to the static MF, independent experiments were carried out to confirm such dependence using 50 Hz MFs and a different experimental model. Cytosolic superoxide level in rat glioma C6 cells exposed in the presence of a nearly vertical 33 μT static MF was increased by a horizontal 50 Hz, 30 μT MF, but not affected by a vertical 50 Hz MF. The results suggest that a weak ELF MF may interact with the static geomagnetic field in producing biological effects, but the effect depends on the relative directions of the static and ELF MFs.

  2. A Multifactorial Analysis of Reconstruction Methods Applied After Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Oktay Büyükaşık

    2010-12-01

    Full Text Available Aim: The aim of this study was to evaluate the reconstruction methods applied after total gastrectomy in terms of postoperative symptomology and nutrition. Methods: This retrospective study was conducted on 31 patients who underwent total gastrectomy due to gastric cancer in 2. Clinic of General Surgery, SSK Ankara Training Hospital. 6 different reconstruction methods were used and analyzed in terms of age, sex and postoperative complications. One from esophagus and two biopsy specimens from jejunum were taken through upper gastrointestinal endoscopy from all cases, and late period morphological and microbiological changes were examined. Postoperative weight change, dumping symptoms, reflux esophagitis, solid/liquid dysphagia, early satiety, postprandial pain, diarrhea and anorexia were assessed. Results: Of 31 patients,18 were males and 13 females; the youngest one was 33 years old, while the oldest- 69 years old. It was found that reconstruction without pouch was performed in 22 cases and with pouch in 9 cases. Early satiety, postprandial pain, dumping symptoms, diarrhea and anemia were found most commonly in cases with reconstruction without pouch. The rate of bacterial colonization of the jejunal mucosa was identical in both groups. Reflux esophagitis was most commonly seen in omega esophagojejunostomy (EJ, while the least-in Roux-en-Y, Tooley and Tanner 19 EJ. Conclusion: Reconstruction with pouch performed after total gastrectomy is still a preferable method. (The Medical Bulletin of Haseki 2010; 48:126-31

  3. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity

    Institute of Scientific and Technical Information of China (English)

    Asim Shabbir; Dallan Dargan

    2015-01-01

    The rapid reversal of diabetes,hypertension,hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome.Sleeve gastrectomy,which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch,has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure.Superior excess weight loss,a low complication rate,and excellent food tolerance,combined with a short hospital stay,have made this the procedure of choice for patients and surgeons across the globe.High volume centres nurture the ongoing development of experienced and specialized teams,pathways and regimens.Optimum surgical outcomes allow minimization of metabolic syndrome,reducing cardiovascular and cerebrovascular risk.

  4. [A case of S-1/CDDP chemotherapy for inoperable advanced gastric cancer which led to gastrectomy with histological complete response].

    Science.gov (United States)

    Kobayashi, Kenji; Tanizaki, Keiko; Aoki, Taro; Takachi, Kou; Nishioka, Kiyonori; Matsumoto, Takashi; Komori, Takamichi; Chono, Teruhiro; Kato, Aya; Hyuga, Satoshi; Watanabe, Risa; Uemura, Yoshio

    2011-11-01

    As the treatment for inoperable advanced gastric cancer, S-1/CDDP combination therapy (SP chemotherapy) has become a standard treatment. In our hospital, a second course of chemotherapy was performed on an outpatient basis in order to improve a traditional QOL. In this case, it showed remarkable effects in 15 months after starting chemotherapy. Then gastrectomy was performed. Histological findings of the resected specimens confirmed pCR in all tumors. We report on progress of this case and explain about the ingenuity of SP chemotherapy.

  5. Repeat sleeve gastrectomy compared with primary sleeve gastrectomy: a single-center, matched case study.

    Science.gov (United States)

    Rebibo, Lionel; Fuks, David; Verhaeghe, Pierre; Deguines, Jean-Baptiste; Dhahri, Abdennaceur; Regimbeau, Jean-Marc

    2012-12-01

    Longitudinal sleeve gastrectomy (LSG) has been validated for the treatment of morbid obesity. However, treatment failures can appear several months after SG. Additional malabsorptive surgery is generally recommended in such cases. The objective of the present study was to evaluate the outcomes of repeat SG (re-SG) relative to first-line SG. This was a retrospective study included 15 patients underwent re-SG after failure of first-line SG (i.e. University Hospital, France; Public Practice). These patients were matched (for age, gender, body mass index and comorbidities) 1:2 with 30 patients having undergone first-line SG. The efficacy criteria comprised intra-operative data and postoperative data. The overall study population comprised 45 patients. The re-SG and first-line SG groups did not differ significantly in terms of median age (p = NS). The median BMI was similar in the two groups (43 kg/m(2) vs. 42.3 kg/m(2), p = NS). The two groups were similar in terms of the prevalence of comorbidities. The mean operating time was longer in the re-SG group (116 vs. 86 min; p ≤ 0.01). The postoperative complication rate was twice as high in the re-SG group (p = 0.31). Two patients in the re-SG group developed a gastric fistula (p = 0.25) and one of the latter died. At 12 months, the Excess Weight Loss was 66% (re-SG group) and 77% (first-line SG group) (p = 0.05). Re-SG is feasible but appears to be associated with a greater risk of complications. Nevertheless, re-SG can produce results (in terms of weight loss), equivalent to those obtained after first-line SG.

  6. Prophylactic Laparoscopic Total Gastrectomy with Jejunal Pouch Reconstruction in Patients Carrying a CDH1 Germline Mutation

    NARCIS (Netherlands)

    Haverkamp, L.; Sluis, P.C. van der; Ausems, M.G.; Horst, S. van der; Siersema, P.D.; Ruurda, J.P.; Offerhaus, G.J.; Hillegersberg, R. van

    2015-01-01

    BACKGROUND: For patients with an identified germline E-cadherin-1 (CDH1) mutation, prophylactic gastrectomy is the treatment of choice to eliminate the high risk of developing diffuse gastric cancer. Laparoscopic total gastrectomy with jejunal pouch reconstruction is a novel approach that may be esp

  7. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

    Directory of Open Access Journals (Sweden)

    Fernando Gabriel Wright

    2017-01-01

    Conclusion: We present a case of an esophageal adenocarcinoma five years after a laparoscopic sleeve gastrectomy for morbid obesity. There is need to better determine the relationship between sleeve gastrectomy and gastroesophageal reflux disease in order to prevent its related complications, such as esophageal adenocarcinoma.

  8. Facile synthesis of dendrimer-like star-branched poly(isopropylacrylamide) via combination of click chemistry and atom transfer radical polymerization

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    We report a facile synthesis method of dendrimer-like star-branched poly(N-isopropylacrylamide) (PNIPAM) via the combination of click chemistry and atom transfer radical polymerization (ATRP) by employing the arm-first approach.First,the α-azido-ω-chloro-heterodifunctionalized building block,N3-PNIPAM-Cl (G0-Cl),was synthesized via ATRP by 3-azidopropyl 2-chloropropionate as the initiator.Taking advantage of click chemistry,the first generation (G1) of dendrimer-like star-branched PNIPAM,G1-(Cl)3,was facilely prepared via the click coupling reaction between G0-Cl and tripropargylamine.For the construction of second generation (G2) dendrimer-like star-branched PNIPAM,G2-(Cl)6,terminal chloride moieties of G1-(Cl)3 were first converted to azide,and then reacted with excess tripropargylamine to give G1-(alkynyl)6 ;G2-(Cl)6 was subsequently prepared via click reaction between G1-(alkynyl) 6 and G0-Cl.Gel permeation chromatography (GPC) and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry were employed to confirm the successful construction of dendrimer-like star-branched polymers.The unique thermal phase transition behavior of this dendrimer-like star-branched polymer in aqueous solutions was further investigated by turbidimetry and micro-differential scanning calorimetry (Micro-DSC).

  9. Surface polyPEGylation of Eu3+ doped luminescent hydroxyapatite nanorods through the combination of ligand exchange and metal free surface initiated atom transfer radical polymerization

    Science.gov (United States)

    Zeng, Guangjian; Liu, Meiying; Heng, Chunning; Huang, Qiang; Mao, Liucheng; Huang, Hongye; Hui, Junfeng; Deng, Fengjie; Zhang, Xiaoyong; Wei, Yen

    2017-03-01

    The Eu3+ doped luminescent hydroxyapatite (HAp) nanorods with uniform size and morphology can be synthesized by hydrothermal route. However, these HAp nanorods are coated by hydrophobic oleylamine, which makes them difficult to be dispersed in aqueous solution and impede their biomedical applications. In this work, Eu3+ doped luminescent polymers functionalized HAp nanorods were prepared through the combination of ligand exchange reaction and metal free surface initiated atom transfer radical polymerization (ATRP) method. In this procedure, the amino group functionalized HAp nanorods were first prepared by ligand exchange reaction using adenosine monophosphate (AMP) as ligand. Then the Br-containing initiators (HAp-Br) were introduced onto the surface of HAp-AMP nanorods through the amidation reaction. Finally, polymers functionalized HAp nanorods were prepared by metal free ATRP method using poly(ethylene glycol) methacrylate (PEGMA) as monomer and 10-phenylphenothiazine (PTH) as organic photocatalyst. The properties of these obtained HAp nanocomposites (HAP-polyPEGMA nanorods) were characterized by means of transmission electron microscopy, Fourier transformed infrared spectroscopy, X-ray photoelectron spectroscopy and thermogravimetric analysis in detail. The cell imaging of these HAP-polyPEGMA nanorods was examined using laser scanning confocal microscope to evaluate their biomedical applications. We demonstrated for the first time that hydrophobic luminescent HAp nanorods can be functionalized with polyPEGMA through the combination of ligand exchange reaction and metal free surface initiated ATRP. As compared with the traditional ATRP, the metal free ATRP can overcome the toxic and fluorescence quenching effects of metal catalysts such as copper ions. More importantly, the strategy described in this work should also be utilized for fabrications of many other luminescent polymer nanocomposites due to its good monomer adoptability.

  10. Robotic versus open gastrectomy for gastric cancer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Guixiang Liao

    Full Text Available AIM: To evaluate the safety and efficacy of robotic gastrectomy versus open gastrectomy for gastric cancer. METHODS: A comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Knowledge was performed. Systematic review was carried out to identify studies comparing robotic gastrectomy and open gastrectomy in gastric cancer. Intraoperative and postoperative outcomes were also analyzed to evaluate the safety and efficacy of the surgery. A fixed effects model or a random effects model was utilized according to the heterogeneity. RESULTS: Four studies involving 5780 patients with 520 (9.00% cases of robotic gastrectomy and 5260 (91.00% cases of open gastrectomy were included in this meta-analysis. Compared to open gastrectomy, robotic gastrectomy has a significantly longer operation time (weighted mean differences (WMD =92.37, 95% confidence interval (CI: 55.63 to 129.12, P<0.00001, lower blood loss (WMD: -126.08, 95% CI: -189.02 to -63.13, P<0.0001, and shorter hospital stay (WMD = -2.87; 95% CI: -4.17 to -1.56; P<0.0001. No statistical difference was noted based on the rate of overall postoperative complication, wound infection, bleeding, number of harvested lymph nodes, anastomotic leakage and postoperative mortality rate. CONCLUSIONS: The results of this meta-analysis suggest that robotic gastrectomy is a better alternative technique to open gastrectomy for gastric cancer. However, more prospective, well-designed, multicenter, randomized controlled trials are necessary to further evaluate the safety and efficacy as well as the long-term outcome.

  11. Development and validation of a simple high performance thin layer chromatography method combined with direct 1,1-diphenyl-2-picrylhydrazyl assay to quantify free radical scavenging activity in wine.

    Science.gov (United States)

    Agatonovic-Kustrin, Snezana; Morton, David W; Yusof, Ahmad P

    2016-04-15

    The aim of this study was to: (a) develop a simple, high performance thin layer chromatographic (HPTLC) method combined with direct 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay to rapidly assess and compare free radical scavenging activity or anti-oxidant activity for major classes of polyphenolics present in wines; and (b) to investigate relationship between free radical scavenging activity to the total polyphenolic content (TPC) and total antioxidant capacity (TAC) in the wine samples. The most potent free radical scavengers that we tested for in the wine samples were found to be resveratrol (polyphenolic non-flavonoid) and rutin (flavonoid), while polyphenolic acids (caffeic acid and gallic acid) although present in all wine samples were found to be less potent free radical scavengers. Therefore, the total antioxidant capacity was mostly affected by the presence of resveratrol and rutin, while total polyphenolic content was mostly influenced by the presence of the less potent free radical scavengers gallic and caffeic acids. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Clinicopathological characteristics and prognosis of early gastric cancer after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    WANG Yong-xiang; SHAO Qin-shu; YANG Qiong; WANG Yuan-yu; YANG Jin; ZHAO Zhong-kuo; XU Ji; YE Zai-yuan

    2012-01-01

    Background Assessment of lymph node metastasis (LNM) is important in early gastric cancer (EGC) and affects treatment decisions.However,the relationship between clinicopathological characteristics and LNM in EGC remains unclear.This study therefore explored favorable predictors of LNM in EGC.Methods A total of 716 specimens from gastric cancer patients who underwent curative gastrectomy between 1996 and 2003 at Zhejiang Provincial People's Hospital were reviewed.Forty-five cases were EGC,and clinicopathological characteristics such as gender,age,tumor size,location,gross type,differentiation,invasion depth,and vessel involvement were assessed to identify predictive factors for LNM and survival time.Results The overall cumulative 5-year survival rate of EGC patients was 88.92%.Among these,22.4% developed LNM,which was associated with a poor 5-year survival rate of only 72.7%.Patients with tumors larger than 2 cm in diameters,with depth of tumor invasion to the submucosa,and with positive lymphatic or nerve involvement were also inclined to have poorer survival performances.EGC limited to the mucosa but poorly differentiated also had a high risk for LNM.Multivariate analysis identified lymphatic invasion and tumor size as independent prognosis factors related to survival in EGC patients.Conclusions Careful planning is required in EGC patients at high risk of lymph node metastases.Endoscopic mucosal resection or endoscopic submucosal dissection and laparoscopic partial gastrectomy should be cautiously used in EGC,and curative gastrectomy including lymphatic dissection and postoperative adjuvant therapy might be considered to improve the prognosis.

  13. [Have Case Loads of Radical Surgery for Prostate Cancer Been Concentrated in Hospitals with Robotic Equipment ?--Analyses with Questionnaire Survey and Diagnostic Procedure Combination (DPC) Data].

    Science.gov (United States)

    Tsukamoto, Taiji; Tanaka, Shigeru

    2016-04-01

    We investigated whether installation of robot-assisted surgical equipment in hospitals resulted in concentration of the case loads of radical prostatectomy. We selected 11 areas with populations of around 1 million or more where there were one or more hospitals with robotic equipment and 4 or more without it. In addition, annual changes of case loads for prostatectomy over 4 years from 2010 to 2013 were clearly determined in these areas. The case loads were determined based on the results of a questionnaire survey for the hospitals with robots and on the Diagnostic Procedures Combination data provided by the Ministry of Health, Labor and Wealth for those without such equipment. The concentration of the case loads was principally defined as when hospitals with robots had more predominant proportion of cases than those without them in the comparison between case loads prior to instillation of robots (or in the initial year of the study) and those in the final years. The 11 selected areas included 44 hospitals with robots and 156 without them. Concentration of case loads was found in 5 areas. In 4 areas, installation of robots did not have a specific relation to the distribution pattern s of case loads in hospitals with or without the equipment. The remaining 2 areas tended to have a weak but not definite concentration of case loads. In the areas in which installation did not influence case loads the further analysis revealed that their case loads had already been concentrated in the initial year (2010) of the study. Although the current results were found in a single department of the hospital, robotic installation may result in concentration of prostatectomy case loads for such hospitals in some areas. The current results are intriguing when we consider the future roles of acute care hospitals and beds in our country where the number of aged patients having chronic diseases will increase. In conclusion, installation of robotic equipment may result in concentration

  14. Muoniated acyl and thioacyl radicals

    Energy Technology Data Exchange (ETDEWEB)

    McKenzie, Iain [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada); Brodovitch, Jean-Claude [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada); Ghandi, Khashayar [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada); Percival, Paul W. [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada)]. E-mail: percival@sfu.ca

    2006-03-31

    The product of the reaction of muonium with tert-butylisocyanate was previously assigned as the muoniated tert-butylaminyl radical (I. McKenzie, J.-C. Brodovitch, K. Ghandi, S. Kecman, P. W. Percival, Physica B 326 (2003) 76). This assignment is incorrect since the muon and {sup 14}N hyperfine-coupling constants (hfcc) of this radical would have the opposite sign, which is in conflict with the experimental results. The radical is now reassigned as the muoniated N-tert-butylcarbamoyl radical, based on the similarities between the experimental muon and {sup 14}N hfcc and hfcc calculated at the UB3LYP/6-311G(d,p)//UB3LYP/EPR-III level. The large zero-point energy in the N-Mu bond results in the dissociation barrier of the muoniated N-tert-butylcarbamoyl radical being above the combined energy of the reactants, in contrast to the N-tert-butylcarbamoyl radical where the dissociation barrier lies below the combined energy of the reactants. The reaction of muonium with tert-butylisothiocyanate produced both conformers of the muoniated N-tert-butylthiocarbamoyl radical and their assignment was based on the similarities between the experimental and calculated muon hfcc. These are the first acyl and thioacyl radicals to be directly detected by muon spin spectroscopy.

  15. EFFECTS OF ENTERAL AND PARENTERAL NUTRITION ON GASTROENTERIC HORMONES AND GASTRIC MOTILITY AFTER SUBTOTAL GASTRECTOMY

    Institute of Scientific and Technical Information of China (English)

    Wei-ming Kang; Jian-chun Yu; Qun Zhang; Mei-yun Ke; Jia-ming Qian

    2008-01-01

    Objective To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motilityand gastroenteric hormones after subtotal gastrectomy.Methods Forty-one patients underwent gastrectomy were randomly divided into EN group ( n = 20) and PN group (n =21 ). From the fast postoperative day to the seventh day, patients received either EN (EN group) or PN (Pnplasma motilin (MTL), and plasma cholecystokinin (CCK) were measured on preoperative day, the fast and seventh postoperative day. Electrogastrography (EGG) was measured on preoperative day and the seventh postoperative day.Results Compared with preoperation, blood GAS, MTL, and CCK levels of 41 patients decreased significantlyon the first day after subtotal gastrectomy (P<0. 001), but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained ( P <0. 001 ). On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group ( P < 0.05 ).There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper-atively.Conclusions The levels of gastroenteritic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.

  16. Radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens; Jakobsen, Henrik

    2014-01-01

    OBJECTIVE: The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. MATERIAL AND METHODS: Patient and tumour...... surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood...... loss and functional outcomes were compared between groups. RESULTS: Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone...

  17. Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy

    Institute of Scientific and Technical Information of China (English)

    De-Chuan Chan; Kuo-Liang Shen; Yao-Chi Liu; Cheng-Jueng Chen; Jyh-Cherng Yu; Heng-Cheng Chu; Fa-Chang Chen; Teng-Wei Chen; Huan-Fa Hsieh; Tzu-Ming Chang

    2005-01-01

    AIM: To assess the efficacy of metoclopramide (Met) for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy (IPC).METHODS: Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allocated to two groups. Sixteen patients received Met immediately after operation (group A), and 16 did not (group B). Another 16 patients who underwent D2 gastrectomy without IPC were enrolled as the control group (group C). All patients had received epidural pain control. The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort. Secondary endpoints were early complications during hospitalization.RESULTS: Gender, the type of resection, operating time,blood loss, tumor status and amount of narcotics were connparable in the three groups. However, the group C patients were older than those in groups A and B (67.5±17.7 vs 56.8±13.2, 57.5±11.7 years, P= 0.048). First bowel flatus occurred after 4.35±0.93 d in group A, 4.94±1.37 d in group B, and 4.71±1.22 d in group C (P>0.05). Oral feeding of a soft diet was tolerated 7.21±1.92 d after operation in group A, 10.15±2.17 d in group B, and 7.53±1.35 d in group C(groups A and C vsgroup B, P<0.05). There was no significant difference in respect to the first flatus among the three groups. However, the time of tolerating oral intake with soft food in groups A and C patients was significantly shorter than that in group B patients. Levels of C-reactive protein (CRP) were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC. The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus. There was no increased risk of anastomotic leakage in patients receiving Met.CONCLUSION: The results suggest that a combination of intravenous

  18. Concurrent laparoscopic morgagni hernia repair and sleeve gastrectomy.

    Science.gov (United States)

    Chiou, Grace; Tedesco, Maureen; Eisenberg, Dan

    2012-12-01

    The Morgagni-type anterior diaphragmatic hernia is a congenital defect that is a very uncommon hernia presenting in an adult. Surgical repair is usually recommended upon diagnosis and often requires synthetic mesh for a durable, tension-free repair. The use of synthetic mesh concurrently with several of bariatric operations is controversial owing to the potential for mesh infection. In this report we describe a laparoscopic repair of a symptomatic Morgagni hernia with synthetic mesh, concurrently with sleeve gastrectomy, in a morbidly obese man. The patient was a 58-year-old man with a body mass index of 48 kg/m(2) and associated co-morbid conditions that included obstructive sleep apnea, hypertension, hyperlipidemia, impaired fasting glucose, and osteoarthritis. He was diagnosed with Morgagni hernia with exertional dyspnia. He underwent concurrent laparoscopic Morgagni hernia repair with mesh and sleeve gastrectomy. At 2 months after surgery the patient was doing well and tolerating solid foods, and his percentage excess weight loss was 35%. He was exercising regularly and had no exertional dyspnea. Laparoscopy is an attractive approach to performing multiple intra-abdominal procedures concurrently. The Morgagni hernia repair with mesh can be performed safely and effectively using a laparoscopic approach. This can be performed concurrently with bariatric surgery in the morbidly obese.

  19. Is prophylactic placement of drains necessary after subtotal gastrectomy?

    Institute of Scientific and Technical Information of China (English)

    Manoj Kumar; Seung Bong Yang; Vijay Kumar Jaiswal; Jay N Shah; Manish Shreshtha; Rajesh Gongal

    2007-01-01

    AIM: To determine the evidence-based values of prophylactic drainage in gastric cancer surgery.METHODS: One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups.RESULTS: No significant differences were observed between the drain group and no-drain group in terms of operating time (171±42 min vs 156±39 min), number of post-operative days until passage of flatus (3.7±0.5d vs 3.5±1.0 d), number of post-operative days until initiation of soft diet (4.9±0.7 d vs 4.8±0.8 d), length of post-operative hospital stay (9.3±2.2 d vs 8.4±2.4 d), mortality rate (5.4% vs 3.8%), and overall postoperative complication rate (21.4% vs19.2%).CONCLUSION: Prophylactic drainage placement is not necessary after subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.

  20. Wernicke’s encephalopathy after sleeve gastrectomy: Literature review

    Science.gov (United States)

    Pardo-Aranda, Fernando; Perez-Romero, Noelia; Osorio, Javier; Rodriguez-Santiago, Joaquín; Muñoz, Emilio; Puértolas, Noelia; Veloso, Enrique

    2016-01-01

    Objective To describe a case of Wernicke’s encephalopathy after laparoscopic sleeve gastrectomy. Setting Emergency Department and gastrointestinal surgery department. Case report A 20-year-old man class III obesity (BMI 50.17 kg/m2) underwent laparoscopic sleeve gastrectomy with uneventful recovery. Five weeks after surgery he was admitted in the Emergency Department because of persistent vomiting and dysphagia to solids. Esophagogastroduodenal transit and upper gastrointestinal endoscopy were requested but no relevant findings were shown. Laboratory analyses showed vitamin B1 12.2 ng/mL and 48 h following admission the patient experienced generalized weakness, sialorrhea and restrictions of actions such as reading a book. Neurological evaluation found confusion, motor ataxia, diplopy and nystagmus. A brain magnetic resonance was normal. According to low level of vitamin B1 and symptoms found in the patient a presumed diagnosis of Wernicke encephalopathy was made and parenteral thiamine 100 mg/day was started. The patient was discharged asymptomatic with oral intake of vitamin B1 600 mg per day. Conclusion Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors. PMID:26826934

  1. Dual High-Resolution α-Glucosidase and Radical Scavenging Profiling Combined with HPLC-HRMS-SPE-NMR for Identification of Minor and Major Constituents Directly from the Crude Extract of Pueraria lobata

    DEFF Research Database (Denmark)

    Liu, Bingrui; Kongstad, Kenneth Thermann; Qinglei, Sun

    2015-01-01

    The crude methanol extract of Pueraria lobata was investigated by dual high-resolution α-glucosidase inhibition and radical scavenging profiling combined with hyphenated HPLC-HRMS-SPE-NMR. Direct analysis of the crude extract without preceding purification was facilitated by combining chromatograms...... from two analytical-scale HPLC separations of 120 and 600 μg on-column, respectively. High-resolution α-glucosidase and radical scavenging profiles were obtained after microfractionation of the eluate in 96-well microplates. This allowed full bioactivity profiling of individual peaks in the HPLC...... chromatogram of the crude methanol extract. Subsequent HPLC-HRMS-SPE-NMR analysis allowed identification of 21 known compounds in addition to two new compounds, i.e., 3′-methoxydaidzein 8-C-[α-d-apiofuranosyl-(1→6)]-β-d-glucopyranoside and 6″-O-malonyl-3′-methoxydaidzin, as well as an unstable compound...

  2. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Aleksandr Kalabin

    2017-01-01

    Full Text Available Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threatening postoperative complication following laparoscopic sleeve gastrectomy. From our extensive review of literature, there is no existing report of acute pancreatitis with splenic infarction postsleeve gastrectomy to this date.

  3. Effect of obesity on laparoscopy-assisted distal gastrectomy compared with open distal gastrectomy for gastric cancer.

    Science.gov (United States)

    Makino, Hirochika; Kunisaki, Chikara; Izumisawa, Yusuke; Tokuhisa, Motohiko; Oshima, Takashi; Nagano, Yasuhiko; Fujii, Shoichi; Kimura, Jun; Takagawa, Ryo; Kosaka, Takashi; Ono, Hidetaka A; Akiyama, Hirotoshi; Endo, Itaru

    2010-08-01

    This study compared surgical outcomes between patients undergoing laparoscopy-assisted distal gastrectomy (LADG) and those undergoing open distal gastrectomy (ODG) from the viewpoint of obesity. Between June 2002 and May 2008, 146 patients with preoperatively diagnosed early gastric cancer who underwent LADG (n = 90) or ODG (n = 56) were enrolled in this study and compared in terms of clinicopathological findings and operative outcome. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed as identifiers of obesity using FatScan software. The relationship between obesity and operative outcomes after LADG and ODG was evaluated. There were no significant correlations between intraoperative blood loss (IBL) and any obesity-related factors, or between operation time (OT) and any obesity-related factors in the LADG group. There was a significant correlation between IBL and BMI (r = 0.486, P = 0.0001), IBL and VFA (r = 0.456, P = 0.0003), IBL and SFA (r = 0.311, P = 0.0193), OT and BMI (r = 0.406, P = 0.0017), OT and VFA (r = 0.314, P = 0.0178), and between OT and SFA (r = 0.382, P = 0.0034) in the ODG group. LADG may be a useful operative manipulation that is not influenced by obesity, whereas ODG may be influenced by obesity even after reaching the surgical plateau. (c) 2010 Wiley-Liss, Inc.

  4. Gastric Cancer Surgery – A Balance of Risk and Radicality

    Science.gov (United States)

    Lamb, Peter; Sivashanmugam, T; White, Martin; Irving, Mark; Wayman, John; Raimes, Simon

    2008-01-01

    INTRODUCTION The aim of this study was to determine whether tailoring the extent of resection would allow radical gastric cancer surgery to be performed safely in a UK population. PATIENTS AND METHODS A total of 180 consecutive patients (median age 70 years; male:female ratio 2:1) undergoing resection for gastric adenocarcinoma with curative intent were studied. Extent of lymphadenectomy was based upon pre-operative and intra-operative staging, and balanced against the patient's age and fitness. RESULTS In the study group, 83 patients underwent subtotal or distal partial gastrectomy and 97 patients underwent total or proximal partial gastrectomy. Operative procedures were: D1 lymphadenectomy (n = 62); modified (spleen and pancreas preserving) D2 lymphadenectomy (n = 73); D2 lymphadenectomy (n = 42); and extended resection (n = 3). TNM classification was: stage 1 (n = 45); stage 2 (n = 37); stage 3 (n = 61); and stage 4 (n = 37). Of the patients, 48 developed postoperative complications including 17 patients with a major surgical complication. The in-hospital mortality was 1.7% (3 of 180). Predicted mortality according to POSSUM and P-POSSUM was 21.4% and 7.8%, respectively. Disease-specific 5-year survival according to stage was 85.4%, 64.2%, 33.3%, and 6.9%. CONCLUSIONS By tailoring the extent of resection and balancing risk and radicality, gastric cancer surgery can be performed with low mortality in Western patients. PMID:18430340

  5. De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

    Directory of Open Access Journals (Sweden)

    M. Masrur

    2016-01-01

    Conclusions: No direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery.

  6. Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum

    Institute of Scientific and Technical Information of China (English)

    I-Ming Kuo; Frank Wang; Keng-Hao Liu; Yi-Yin Jan

    2009-01-01

    Gastrectomy is commonly performed for both benign and malignant lesions. Although the incidence of post-gastrectomy acute pancreatitis (PGAP) is low compared to other well-recognized post-operative complications, it has been reported to be associated with a high mortality rate. In this article, we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis. His postoperative course was complicated by acute pancreatitis and intra-abdominal sepsis. The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage, together with aggressive antibiotic therapy and nutritional support. For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy, clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.

  7. Effect of neoadjuvant chemotherapy on sevoflurane MAC-BAR value of patients undergoing radical stomach carcinoma surgery

    OpenAIRE

    Du, Wei; Li, Chao; Wang, Hemei; Zhao, Aihua; Shen, Junmei; Yong, Fangfang; Jia, Huiqun

    2015-01-01

    Objective: To determine the minimum alveolar concentration (MAC) of sevoflurane required for 50% blockade of the adrenergic response (BAR) to surgical incision in patients treated with neoadjuvant chemotherapy prior to radical gastrectomy. Patients and design: Forty-four patients were selected for this study. Patients with preoperative neoadjuvant chemotherapy comprised the NC group (n = 22) and patients without preoperative neoadjuvant chemotherapy were included as the C group (n = 22). Pati...

  8. Laparoscopic versus open gastrectomy for gastric cancer, a multicenter prospectively randomized controlled trial (LOGICA-trial).

    Science.gov (United States)

    Haverkamp, Leonie; Brenkman, Hylke J F; Seesing, Maarten F J; Gisbertz, Suzanne S; van Berge Henegouwen, Mark I; Luyer, Misha D P; Nieuwenhuijzen, Grard A P; Wijnhoven, Bas P L; van Lanschot, Jan J B; de Steur, Wobbe O; Hartgrink, Henk H; Stoot, Jan H M B; Hulsewé, Karel W E; Spillenaar Bilgen, Ernst J; Rütter, Jeroen E; Kouwenhoven, Ewout A; van Det, Marc J; van der Peet, Donald L; Daams, Freek; Draaisma, Werner A; Broeders, Ivo A M J; van Stel, Henk F; Lacle, Miangela M; Ruurda, Jelle P; van Hillegersberg, Richard

    2015-07-29

    For gastric cancer patients, surgical resection with en-bloc lymphadenectomy is the cornerstone of curative treatment. Open gastrectomy has long been the preferred surgical approach worldwide. However, this procedure is associated with considerable morbidity. Several meta-analyses have shown an advantage in short-term outcomes of laparoscopic gastrectomy compared to open procedures, with similar oncologic outcomes. However, it remains unclear whether the results of these Asian studies can be extrapolated to the Western population. In this trial from the Netherlands, patients with resectable gastric cancer will be randomized to laparoscopic or open gastrectomy. The study is a non-blinded, multicenter, prospectively randomized controlled superiority trial. Patients (≥18 years) with histologically proven, surgically resectable (cT1-4a, N0-3b, M0) gastric adenocarcinoma and European Clinical Oncology Group performance status 0, 1 or 2 are eligible to participate in the study after obtaining informed consent. Patients (n = 210) will be included in one of the ten participating Dutch centers and are randomized to either laparoscopic or open gastrectomy. The primary outcome is postoperative hospital stay (days). Secondary outcome parameters include postoperative morbidity and mortality, oncologic outcomes, readmissions, quality of life and cost-effectiveness. In this randomized controlled trial laparoscopic and open gastrectomy are compared in patients with resectable gastric cancer. It is expected that laparoscopic gastrectomy will result in a faster recovery of the patient and a shorter hospital stay. Secondly, it is expected that laparoscopic gastrectomy will be associated with a lower postoperative morbidity, less readmissions, higher cost-effectiveness, better postoperative quality of life, but with similar mortality and oncologic outcomes, compared to open gastrectomy. The study started on 1 December 2014. Inclusion and follow-up will take 3 and 5

  9. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

    OpenAIRE

    Portanova Michel

    2010-01-01

    Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent to...

  10. Ataxic gait following total gastrectomy for gastric cancer

    Science.gov (United States)

    Hwang, Chang Ho; Park, Dong Jin; Kim, Gyu Yeol

    2016-01-01

    A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal. This was followed by weekly intramuscular injections of vitamin B12 for another 2 wk and oral administration of vitamin B12 three times per day. After comprehensive rehabilitation for 4 wk, she showed sufficient improvements in strength and ataxic gait, enabling her to return to her normal daily activities. PMID:27729749

  11. [Wernicke encephalopathy after subtotal gastrectomy for morbid obesity].

    Science.gov (United States)

    Gabaudan, C; La-Folie, T; Sagui, E; Soulier, B; Dion, A-M; Richez, P; Brosset, C

    2008-05-01

    Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

  12. Retrospective Analysis on the Gallstone Disease after Gastrectomy for Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Kyong-Hwa Jun

    2015-01-01

    Full Text Available Background. The aim of this study is to evaluate the incidence of gallstone after gastrectomy, risk factors for gallstone formation, and the surgical outcome of cholecystectomy after gastrectomy. Methods. A total of 2480 gastric cancer patients who underwent curative resection at two institutions between January 1997 and December 2012 were retrospectively reviewed. The patients’ age, gender, diabetes mellitus, type of gastrectomy, extent of node dissection, and type of reconstruction were evaluated. Results. Gallstone formation occurred in 128 of 2480 (5.2% patients who had undergone gastrectomy for gastric cancer. The incidence of gallstones was significantly higher after total compared with subtotal gastrectomy. Roux-en-Y reconstruction and lymph node dissection in the hepatoduodenal ligament were associated with a significantly higher incidence. In multivariate analysis, diabetes mellitus and reconstruction method were identified as significant risk factors for gallstone development. The proportion of silent stone was higher in the laparoscopic cholecystectomy (LC group than in the open cholecystectomy (OC group. Operation time and hospital stay were shorter in the LC group than in the OC group. Conclusions. Diabetes mellitus and Roux-en-Y reconstruction are risk factors for gallstones after gastrectomy. Only a few postoperative complications after subsequent cholecystectomy occurred, even when using a laparoscopic approach.

  13. Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

    Directory of Open Access Journals (Sweden)

    Yano Seiji

    2011-05-01

    Full Text Available Abstract Here we report the method of anastomosis based on double stapling technique (hereinafter, DST using a trans-oral anvil delivery system (EEATM OrVilTM for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. We used EEATM OrVilTM as a device that permitted mechanical purse-string suture similarly to conventional EEA, and endo-Surgitie. After the gastric lymph node dissection, the esophagus was cut off using an automated stapler. EEATM OrVilTM was orally and slowly inserted from the valve tip, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. Yarn was cut to disconnect the anvil from a tube and the anvil head was retained in the esophagus. The end-Surgitie was inserted at the right subcostal margin, and after the looped-shaped thread was wrapped around the esophageal stump opening, assisting Maryland forceps inserted at the left subcostal and left abdomen were used to grasp the left and right esophageal stump. The surgeon inserted anvil grasping forceps into the right abdomen, and after grasping the esophagus with the forceps, tightened the end Surgitie, thereby completing the purse-string suture on the esophageal stump. The main unit of the automated stapler was inserted from the cut-off stump of the lifted jejunum, and a trocar was made to pass through. To prevent dropout of the small intestines from the automated stapler, the automated stapler and the lifted jejunum were fastened with silk thread, the abdomen was again inflated, and the lifted jejunum was led into the abdominal cavity. When it was confirmed that the automated stapler and center rod

  14. Preoperative Metabolic Syndrome Is Predictive of Significant Gastric Cancer Mortality after Gastrectomy: The Fujian Prospective Investigation of Cancer (FIESTA) Study.

    Science.gov (United States)

    Hu, Dan; Peng, Feng; Lin, Xiandong; Chen, Gang; Zhang, Hejun; Liang, Binying; Ji, Kaida; Lin, Jinxiu; Chen, Lin-Feng; Zheng, Xiongwei; Niu, Wenquan

    2017-02-01

    Metabolic syndrome (MetS) has been shown to be associated with an increased risk of gastric cancer. However, the impact of MetS on gastric cancer mortality remains largely unknown. Here, we prospectively examined the prediction of preoperative MetS for gastric cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. This study was conducted among 3012 patients with gastric cancer who received radical gastrectomy between 2000 and 2010. The latest follow-up was completed in 2015. Blood/tissue specimens, demographic and clinicopathologic characteristics were collected at baseline. During 15-year follow-up, 1331 of 3012 patients died of gastric cancer. The median survival time (MST) of patients with MetS was 31.3months, which was significantly shorter than that of MetS-free patients (157.1months). The coexistence of MetS before surgery was associated with a 2.3-fold increased risk for gastric cancer mortality (P<0.001). The multivariate-adjusted hazard ratios (HRs) were increased with invasion depth T1/T2 (HR=2.78, P<0.001), regional lymph node metastasis N0 (HR=2.65, P<0.001), positive distant metastasis (HR=2.53, P<0.001), TNM stage I/II (HR=3.00, P<0.001), intestinal type (HR=2.96, P<0.001), negative tumor embolus (HR=2.34, P<0.001), and tumor size ≤4.5cm (HR=2.49, P<0.001). Further survival tree analysis confirmed the top splitting role of TNM stage, followed by MetS or hyperglycemia with remarkable discrimination ability. In this large cohort study, preoperative MetS, especially hyperglycemia, was predictive of significant gastric cancer mortality in patients with radical gastrectomy, especially for early stage of gastric cancer. Copyright © 2016. Published by Elsevier B.V.

  15. Ignorance Radicalized

    Directory of Open Access Journals (Sweden)

    Gergo Somodi

    2009-12-01

    Full Text Available The aim of this paper is twofold. I criticize Michael Devitt's linguistic---as opposed to Chomsky's psychological---conception of linguistics on the one hand, and I modify his related view on linguistic intuitions on the other. I argue that Devitt's argument for the linguistic conception is in conflict with one of the main theses of that very conception, according to which linguistics should be about physical sentence tokens of a given language rather than about the psychologically real competence of native speakers. The basis of this conflict is that Devitt's view on language, as I will show, inherits too much from the criticized Chomskian view. This is also the basis of Devitt's strange claim that it is the linguist, and not the ordinary speaker, whose linguistic intuition should have an evidential role in linguistics. I will argue for the opposite by sketching a view on language that is more appropriate to the linguistic conception. That is, in criticizing Devitt, I am not defending the Chomskian approach. My aim is to radicalize Devitt's claims.

  16. LETTING GO: DE-RADICALIZATION IN EGYPT

    Directory of Open Access Journals (Sweden)

    Zeynep Kaya

    2016-03-01

    Full Text Available The literature on the causes of how terrorist organizations are formed and how counter terrorism measures can be more effective is immense. What is novel in terrorism literature is de-radicalization in terrorist organizations. This paper hopes to shed light on the de-radicalization process in terrorist organizations based in Egypt. In order to achieve that goal, the first part of the paper will deal with the de-radicalization process. The second part will briefly describe the major radical terrorist organizations that are effective in Egypt. The last part will combine the two parts and bring in suggestions on the de-radicalization process itself. Terrorism and de-radicalization are complicated threats to nearly all societies. Therefore, it is important to go beyond security and intelligence approaches and take proactive measures. It is best to view what is de-radicalization and how it can be achieved.

  17. Terrorism, radicalization, and de-radicalization

    NARCIS (Netherlands)

    Doosje, B.; Moghaddam, F.M.; Kruglanski, A.W.; de Wolf, A.; Mann, L.; Feddes, A.R.

    2016-01-01

    In this article, we review the literature and present a model of radicalization and de-radicalization. In this model, we distinguish three phases in radicalization: (1) a sensitivity phase, (2) a group membership phase and (3) an action phase. We describe the micro-level, meso-level and macro-level

  18. [Predictive factors of esophagojejunal fistula after total gastrectomy in gastric cancer patients].

    Science.gov (United States)

    Ben Maamer, A; Zaafouri, H; Noomene, R; Haoues, N; Bouhafa, A; Oueslati, A; Cherif, A

    2013-04-01

    The main complication observed after total gastrectomy is the oesophagojejunal anastomosic fistla. Its incidence varies between 7.4% and 11.5%. The mortality after anastomic leafage is high at around 20%, representing 30% and 54% of global mortality after total gastrectomy. This study aimed to evaluate mortality and morbidity after total gastrectomy and to determine their predictive factor this is retrospective study about 80 cases of total gastrectomy for gastric cancer, collected in the departmentof General Surgery of the University Hospital Habib Thameur Tunis during the period 1 January 1995 to 31 December 2010. Reconstruction of the alimentary tract was achieved by Roux-en-Y-jejunal-loop. Esophagojejunal anastomotic leeakage developed in 14 patients (17%). In 8 patients treatment of anastomotic leakage consisted of re-operation with surgical drainage and confection of jejunostomy. in one patient treatment required resutre of the anastomosis and drainage of an abscess. In one patient treatment required resuture of the anastomosis and drainage of an abscess. in 5 of the 14 patients with a proven leak of oesophagojejunal anastomosis, conservative treatment with parental alimentation, placement of an irrigation-aspiration system and systemic antibiotics was performed. This treatment was successful in all cases. The presence of anastomic fistula extends the median lenght of post operative stay in the hospital of 20 days compared for the payents withiut fistula.Global mortalilty was 8/80 (10%). After esophagojejunal anastomotic leakage, the mortality was 3/8 (21%). Leakage of the oesophago-intestinal anastomosis may occur after total gastrectomy for gastric cancer. it's serious complication contributes to mortality after total gastrectomy. Knowledge of the predective factors of esophagojejunal fistula after total gastrectomy in gastric cancer can decrease its incidence .

  19. Fast Identification of Radical Scavengers from Securigera varia by Combining 13C-NMR-Based Dereplication to Bioactivity-Guided Fractionation.

    Science.gov (United States)

    Sientzoff, Pacôme; Hubert, Jane; Janin, Coralie; Voutquenne-Nazabadioko, Laurence; Renault, Jean-Hugues; Nuzillard, Jean-Marc; Harakat, Dominique; Magid, Abdulmagid Alabdul

    2015-08-14

    Securigera varia (Fabaceae) is a common herbaceous perennial plant widely growing in Europe and Asia and purposely established for erosion control, roadside planting, and soil rehabilitation. The aim of this study was to determine the radical scavenging activity of a crude methanol extract of S. varia aerial parts by using the free radical DPPH (1,1-diphenyl-2-picrylhydrazyl) and to rapidly identify the compounds involved in this activity. The crude extract was initially separated in five fractions on Diaion HP20 resin and the most active part was fractionated by Centrifugal Partition Extraction (CPE). Known compounds were directly identified by a (13)C-NMR-based dereplication method. Semi-preparative high performance liquid chromatography purification experiments were further performed to identify unknown or minor active compounds. As a result, one new (13) and twelve known flavonoid glycosides together with three nitropropanoylglucopyranoses were isolated, including astragalin (1), kaempferol-3-O-(6-O-acetyl)-β-D-glucopyranoside (2), kaempferol-3,4'-di-O-β-D-glucopyranoside (3), trifolin (4), isoquercitrin (5), hyperoside (6), isovitexin (7), isoorientin (8), isovitexin 4'-O-β-D-glucopyranoside (9), apigenin 7-O-β-D-glucuronopyranoside (10), luteolin 7-O-β-D-glucuronopyranoside (11), apigenin 7-O-α-L-rhamnopyranosyl-(1→2)-β-D-glucuronopyranoside (12), apigenin 7-O-β-D-glucopyranosyl-(1 → 2)-β-D-glucuronopyranoside (13), 6-O-(3-nitropropanoyl)-β-D-glucopyranoside (14), coronillin (16) and coronarian (15). 120 mg of the most active compound isoorientin against the free radical DPPH was recovered by CPE with an HPLC purity of 99%.

  20. Fast Identification of Radical Scavengers from Securigera varia by Combining 13C-NMR-Based Dereplication to Bioactivity-Guided Fractionation

    Directory of Open Access Journals (Sweden)

    Pacôme Sientzoff

    2015-08-01

    Full Text Available Securigera varia (Fabaceae is a common herbaceous perennial plant widely growing in Europe and Asia and purposely established for erosion control, roadside planting, and soil rehabilitation. The aim of this study was to determine the radical scavenging activity of a crude methanol extract of S. varia aerial parts by using the free radical DPPH (1,1-diphenyl-2-picrylhydrazyl and to rapidly identify the compounds involved in this activity. The crude extract was initially separated in five fractions on Diaion HP20 resin and the most active part was fractionated by Centrifugal Partition Extraction (CPE. Known compounds were directly identified by a 13C-NMR-based dereplication method. Semi-preparative high performance liquid chromatography purification experiments were further performed to identify unknown or minor active compounds. As a result, one new (13 and twelve known flavonoid glycosides together with three nitropropanoylglucopyranoses were isolated, including astragalin (1, kaempferol-3-O-(6-O-acetyl-β-D-glucopyranoside (2, kaempferol-3,4′-di-O-β-D-glucopyranoside (3, trifolin (4, isoquercitrin (5, hyperoside (6, isovitexin (7, isoorientin (8, isovitexin 4′-O-β-D-glucopyranoside (9, apigenin 7-O-β-D-glucuronopyranoside (10, luteolin 7-O-β-D-glucuronopyranoside (11, apigenin 7-O-α-L-rhamnopyranosyl-(1→2-β-D-glucuronopyranoside (12, apigenin 7-O-β-D-glucopyranosyl-(1→2-β-D-glucuronopyranoside (13, 6-O-(3-nitropropanoyl-β-D-glucopyranoside (14, coronillin (16 and coronarian (15. 120 mg of the most active compound isoorientin against the free radical DPPH was recovered by CPE with an HPLC purity of 99%.

  1. Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy.

    Science.gov (United States)

    Alvarez, Veronica; Carrasco, Fernando; Cuevas, Ada; Valenzuela, Barbara; Muñoz, Giselle; Ghiardo, Daniela; Burr, Maria; Lehmann, Yael; Leiva, Maria J; Berry, Marcos; Maluenda, Fernando

    2016-03-01

    Weight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which factors are related to weight regain in the long-term after sleeve gastrectomy (SG). A retrospective case-control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m(2)), was performed. Patients were grouped according percentile->50% (cases) or weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. RESULTS (MEDIAN [P25-P75]): The evaluation was conducted 38.5 mo (34-41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% [13-37.1]). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. When combined X-ray and polarized neutron diffraction data challenge high-level calculations: spin-resolved electron density of an organic radical.

    Science.gov (United States)

    Voufack, Ariste Bolivard; Claiser, Nicolas; Lecomte, Claude; Pillet, Sébastien; Pontillon, Yves; Gillon, Béatrice; Yan, Zeyin; Gillet, Jean Michel; Marazzi, Marco; Genoni, Alessandro; Souhassou, Mohamed

    2017-08-01

    Joint refinement of X-ray and polarized neutron diffraction data has been carried out in order to determine charge and spin density distributions simultaneously in the nitronyl nitroxide (NN) free radical Nit(SMe)Ph. For comparison purposes, density functional theory (DFT) and complete active-space self-consistent field (CASSCF) theoretical calculations were also performed. Experimentally derived charge and spin densities show significant differences between the two NO groups of the NN function that are not observed from DFT theoretical calculations. On the contrary, CASSCF calculations exhibit the same fine details as observed in spin-resolved joint refinement and a clear asymmetry between the two NO groups.

  3. THERMOCHEMISTRY OF HYDROCARBON RADICALS

    Energy Technology Data Exchange (ETDEWEB)

    Kent M. Ervin, Principal Investigator

    2004-08-17

    Gas phase negative ion chemistry methods are employed to determine enthalpies of formation of hydrocarbon radicals that are important in combustion processes and to investigate the dynamics of ion-molecule reactions. Using guided ion beam tandem mass spectrometry, we measure collisional threshold energies of endoergic proton transfer and hydrogen atom transfer reactions of hydrocarbon molecules with negative reagent ions. The measured reaction threshold energies for proton transfer yield the relative gas phase acidities. In an alternative methodology, competitive collision-induced dissociation of proton-bound ion-molecule complexes provides accurate gas phase acidities relative to a reference acid. Combined with the electron affinity of the R {center_dot} radical, the gas phase acidity yields the RH bond dissociation energy of the corresponding neutral molecule, or equivalently the enthalpy of formation of the R{center_dot} organic radical, using equation: D(R-H) = {Delta}{sub acid}H(RH) + EA(R) - IE(H). The threshold energy for hydrogen abstraction from a hydrocarbon molecule yields its hydrogen atom affinity relative to the reagent anion, providing the RH bond dissociation energy directly. Electronic structure calculations are used to evaluate the possibility of potential energy barriers or dynamical constrictions along the reaction path, and as input for RRKM and phase space theory calculations. In newer experiments, we have measured the product velocity distributions to obtain additional information on the energetics and dynamics of the reactions.

  4. Can Robotic Gastrectomy Surpass Laparoscopic Gastrectomy by Acquiring Long-Term Experience? A Propensity Score Analysis of a 7-Year Experience at a Single Institution

    Science.gov (United States)

    Hong, Sung-Soo; Shin, Ho-Jung; Cui, Long-Hai; Hur, Hoon; Han, Sang-Uk

    2016-01-01

    Purpose It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG). Materials and Methods From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups. Results The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793). Conclusions In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique. PMID:28053810

  5. Assessment of the quality of Internet information on sleeve gastrectomy.

    Science.gov (United States)

    Corcelles, Ricard; Daigle, Christopher R; Talamas, Hector Romero; Brethauer, Stacy A; Schauer, Philip R

    2015-01-01

    The Internet is an important source of information for morbidly obese patients who are potential candidates for bariatric procedures. Over the past few years, there is growing demand for sleeve gastrectomy because of perceived technical ease balanced with excellent outcomes. The aim of this study was to assess the quality and content of available internet information pertaining to sleeve gastrectomy. Our hypothesis is that this information is inconsistent and inaccurate. A total of 50 websites were analyzed in September 2013. We used the search term "sleeve gastrectomy" to identify sites on the most common internet search engines: Google, Yahoo, Bing, and Ask. Based on popularity of use, 20 websites were obtained through the Google engine and 10 sites by each of the others. Websites were classified as academic, physician, health professional, commercial, social media, and unspecified. Quality of information was evaluated using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Health on the Net code (HONcode) seal accreditation. The DISCERN score varies from 0-80 points and is based on 16 questions that evaluate publication quality and reliability. The JAMA benchmark criteria range from 0-4 points assessing website authorship, attribution, disclosure, and currency. HONcode certification was assessed as present or absent website accreditation. Duplicate and inaccessible websites were excluded from the analysis. We identified 43 websites from the United States, 6 from Mexico, and 1 from Australia. The average DISCERN and JAMA benchmark scores for all websites were 46.3±14.5 and 1.6±1.1, respectively, with a median DISCERN of 48.5 (range, 16-76) and JAMA score of 2.0 (range, 0-4). Website classification distribution was 21 physician, 11 academic, 7 commercial, 5 social media, 4 unspecified, and 2 health professional. The average DISCERN and JAMA benchmark scores were 55.4±13.4 and 2.4±1.0 in the academic group, 49

  6. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu

    2012-01-01

    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  7. A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index≥30).

    Science.gov (United States)

    Kim, Min Gyu; Kim, Kap Choong; Kim, Beom Su; Kim, Tae Hwan; Kim, Hee Sung; Yook, Jeong Hwan; Kim, Byung Sik

    2011-06-01

    In the surgical treatment of gastric cancer, obesity is known to be a predictive factor for poor early surgical outcomes. To evaluate the more effective modality of laparoscopic gastrectomy in obese patients, we compared the early surgical outcomes of laparoscopy-assisted and totally laparoscopic gastrectomy. We retrospectively analyzed early surgical outcomes in 1,480 consecutive patients who underwent distal gastrectomy for gastric cancer between April 2004 and July 2010. To compare surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) with those of totally laparoscopic distal gastrectomy (TLDG) in 76 obese patients (LADG, n = 39; TLDG, n=37), the patients were classified as either obese or nonobese. The obesity was defined using the WHO classification BMI cutoff of 30 kg/m2. In the analysis of surgical outcomes of the LADG group, there were significant differences between the obese and nonobese groups with respect to operative time (P=0.004, obese, 171.8 min; nonobese, 141.0 min), time to first flatus (P=0.027, obese, 3.3 days; nonobese, 3.1 days), commencement of soft diet (P=0.040, obese, 4.6 days; nonobese, 4.0 days), postoperative complication rate (P=0.045, obese, 15.4%; nonobese, 6.5%), and postoperative hospital stay (P=0.014, obese, 8.9 days; nonobese, 7.2 days). In TLDG group, on the other hand, there were no significant differences in surgical outcomes between the groups. Based on these findings, early surgical outcomes of LADG were strongly influenced by the obesity. TLDG without minilaparotomy, however, was unaffected by the obesity. These findings strongly suggest that TLDG could be a safe procedure to avoid the impact of obesity.

  8. Surgical treatment of non-early gastric remnant carcinoma developing after distal gastrectomy for gastric cancer.

    Science.gov (United States)

    Ohashi, Masaki; Morita, Shinji; Fukagawa, Takeo; Kushima, Ryoji; Katai, Hitoshi

    2015-02-01

    The optimal surgical procedure for gastric remnant carcinoma (GRC) remains debatable. The aim of this study was to retrospectively evaluate the surgical treatments for T2-4 GRC developing after distal gastrectomy for gastric cancer. Between 1970 and 2012, a total of 50 patients underwent R0 resection for T2-4 GRC. The clinicopathologic features, therapeutic methods, and follow-up data of these patients were reviewed. The tumor was located at a non-anastomotic site of the remnant stomach in 43 of the 50 patients. Total gastrectomy was performed in 48 patients and partial gastrectomy was in two patients. Lymph node metastasis was found in 19 patients. Major postoperative complications occurred in 16 patients. The overall 1-, 3-, and 5-year survival rates of the 50 patients were 90%, 66%, and 44%, respectively. Presence of small intestinal or esophageal infiltration and postoperative complications was independently associated with poorer survival. Dissection of the perigastric and splenic hilar/artery nodes was found to have potential therapeutic benefit. Surgical resection for T2-4 GRC developing after distal gastrectomy for gastric cancer can be invasive, but is feasible and effective. Total gastrectomy with splenectomy is one of the recommendable procedures for this disease. © 2014 Wiley Periodicals, Inc.

  9. Gastric wall thickening on spiral CT after subtotal gastrectomy for gastric cancer: comparision between recurrent caner and benign thickening

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang Sook; Choi, Jong Cheol; Yoon, Sung Kuk; Kim, Jae Ik; Oh, Jong Young; Kang, Myung Jin; Lee, Ki Nam; Nam, Kyuung Jin [Donga Univ. College of Medicine, Pusan (Korea, Republic of)

    2000-12-01

    To determine the features revealed by two-phase spiral CT scanning useful for differential diagnosis between recurrent cancer and benign wall thickening in patients who have undergone subtotal gastrectomy for stomach cancer. We retrospectively reviewed 25 cases in which wall thickening of more than 1cm in the remnant stomach after subtotal gastrectomy was revealed by two-phase spiral CT scanning. All cases were confirmed: 11 were recurrent cancer, and in 14, benign wall thickening was demonstrated. We analyzed the CT findings including maximal thickness of the gastric wall, patterns of wall thickening, degree of contrast enhancement seen during the arterial and portal phases, and the presence of perigastric strands. Maximal wall thickness was classified as either more or less than 15mm, and as either focal or diffuse. We also determined whether lymphadenopathy was present. Mean maximal gastric wall thickness was 18.4mm in the recurrent cancer group ({sup g}roup A{sup )} and 12.6mm in the benign group ({sup g}roup B{sup )}. The gastric wall was thicker than 15mm in 10 of 11 group A cases and in 3 of 14 in group B; wall thickening was focal (n=3) or diffuse (n=8) in group A, and focal (n=13) or diffuse (n=1) in group B, while the enhancement patterns seen during the arterial and portal phase, respectively, were high/high (n=8), low/high (n=1) and low/low (n=2) in group A, and low/low (n=7), low/high (n=4), high/low (n=1) and high/high (n=2) in group B. Perigastric strands were observed in nine cases in group A, but in none in group B, while lymphadenopathy was combined with wall thickening in seven group A cases but in none of those in group B. In patients who have undergone subtotal gastrectomy for gastric cancer, two-phase spiral CT findings including maximal thickness of the gastric wall, patterns of wall thickening, degree of contrast enhancement seen during the arterial and portal phase, the presence of perigastric strands, and lymphadenopathy are useful for

  10. Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sejin Lee

    2017-01-01

    Full Text Available Since the first report of robotic gastrectomy, experienced laparoscopic surgeons have used surgical robots to treat gastric cancer and resolve problems associated with laparoscopic gastrectomy. However, compared with laparoscopic gastrectomy, the superiority of robotic procedures has not been clearly proven. There are several advantages to using robotic surgery for gastric cancer, such as reduced estimated blood loss during the operation, a shorter learning curve, and a larger number of examined lymph nodes than conventional laparoscopic gastrectomy. The increased operation time observed with a robotic system is decreasing because surgeons have accumulated experience using this procedure. While there is limited evidence, long-term oncologic outcomes appear to be similar between robotic and laparoscopic gastrectomy. Robotic procedures have a significantly greater financial cost than laparoscopic gastrectomy, which is a major drawback. Recent clinical studies tried to demonstrate that the benefits of robotic surgery outweighed the cost, but the overall results were disappointing. Ongoing studies are investigating the benefits of robotic gastrectomy in more complicated and challenging cases. Well-designed randomized control trials with large sample sizes are needed to investigate the benefits of robotic gastrectomy compared with laparoscopic surgery.

  11. Kinetics of the addition reaction of methyl radicals with nitric oxide studied by pulse radiolysis combined with infrared diode laser spectroscopy

    DEFF Research Database (Denmark)

    Jodkowski, J.T.; Ratajczak, E.; Sillesen, A.

    1993-01-01

    The reaction CH3 + NO (+ M) --> CH3NO ( + M) was initiated by pulse radiolysis of acetone/nitric oxide mixtures and the kinetics of methyl radicals was studied by time-resolved infrared absorption spectroscopy. The rate constant was found to be strongly pressure dependent in the range of p (M) = 6.......5-150 mbar at 298 K with M = acetone as the third body. The experimental results are represented in terms of a fall-off curve centered at 37 mbar with limiting high- and low-pressure rate constants of k(rec,infinity) = (6.6 +/- 0.9) x 10(9) x (T/300)0.6 M-1 s-1 and k(rec,0)/[M] = (4.4 +/- 0.4) x 10(12) x (T...

  12. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Nicole Pech

    2012-01-01

    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  13. Psychological changes in morbidly obese patients after sleeve gastrectomy.

    Science.gov (United States)

    Melero, Yolanda; Ferrer, José Vicente; Sanahuja, Angel; Amador, Lydia; Hernando, Denise

    2014-01-01

    The aim of this study is to observe the psychological changes at one year postop in a group of patients undergoing laparoscopic vertical sleeve gastrectomy (GVL) and multidisciplinary follow- up. A total of 46 patients with a BMI-35 or higher, who were selected for GVL, completed psychological testing. After GVL surgery, patients received psychological, nutritional, and medical attention during 12 months, and they retook the same tests. Psychological tests showed an improvement on almost all scales tested, except perfectionism. The most significant change was in the benchmark for Eating Disorders with an improvement of 89% for bulimia (P<.01), and 55% for body dissatisfaction (P<.01) and ineffectiveness (P<.01). In quality of life there was an improvement of 57% in the change in health status (P<.01). During our study, a protocol involving GVL and multidisciplinary follow-ups seems proved to be an effective intervention for improving bulimic symptoms and quality of living. The results of these psychological changes are similar to Roux-en-Y Gastric bypass but different to vertical banded gastroplasty or adjustable gastric band, according to previous studies. However, long-term studies are necessary to confirm this trend. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  14. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  15. Catalytic Radical Domino Reactions in Organic Synthesis.

    Science.gov (United States)

    Sebren, Leanne J; Devery, James J; Stephenson, Corey R J

    2014-02-07

    Catalytic radical-based domino reactions represent important advances in synthetic organic chemistry. Their development benefits synthesis by providing atom- and step-economical methods to complex molecules. Intricate combinations of radical, cationic, anionic, oxidative/reductive, and transition metal mechanistic steps result in cyclizations, additions, fragmentations, ring-expansions, and rearrangements. This Perspective summarizes recent developments in the field of catalytic domino processes.

  16. Moment matrices, border bases and radical computation

    NARCIS (Netherlands)

    Mourrain, B.; Lasserre, J.B.; Laurent, M.; Rostalski, P.; Trebuchet, P.

    2011-01-01

    In this paper, we describe new methods to compute the radical (resp. real radical) of an ideal, assuming it complex (resp. real) variety is nte. The aim is to combine approaches for solving a system of polynomial equations with dual methods which involve moment matrices and semi-denite programming.

  17. Moment matrices, border bases and radical computation

    NARCIS (Netherlands)

    Mourrain, B.; Lasserre, J.B.; Laurent, M.; Rostalski, P.; Trebuchet, P.

    2013-01-01

    In this paper, we describe new methods to compute the radical (resp. real radical) of an ideal, assuming it complex (resp. real) variety is nte. The aim is to combine approaches for solving a system of polynomial equations with dual methods which involve moment matrices and semi-denite programming.

  18. Glycemic changes after gastrectomy in non-morbidly obese patients with gastric cancer and diabetes.

    Science.gov (United States)

    Shen, Zhiyong; Yu, Jiang; Lei, Shangtong; Mou, Tingyu; Hu, Yanfeng; Liu, Hao; Li, Guoxin

    2015-01-01

    To evaluate the glycemic changes after gastrectomy in non-morbidly obese patients with gastric cancer (GC) and type 2 diabetes mellitus (T2DM). Between December 2011 and June 2014, we included 46 patients with gastric cancer and T2DM of a body mass index (BMI) obese patients experienced an improvement of glycemic control. T2DM resolution happened 3 weeks after surgery. FPG decreased significantly after postoperative day 21 compared to preoperative FPG. 32 patients experienced DM improvement after postoperative day 21. The age and relatively lower preoperative TG patients, who underwent total gastrectomy (Pobese patients may also benefit from metabolic surgery for glycemic control, associated with age, extent of gastrectomy, reconstruction type, and preoperative triglyceride level.

  19. Post-gastrectomy patients need to be followed up for 20-30 years

    Institute of Scientific and Technical Information of China (English)

    Frank I. Tovey; Michael Hobsley

    2000-01-01

    AIM To investigate the incidence andmanagement of nutritional deficiencies followinga gastrectomy.METHODS A gastrectomy population of 227patients in London was followed up for 30 years after operation to detect and treat nutritional deficiencies.RESULTS By the end of the first decade iron deficiency was the commonest problem. Vitamin B12 deficiency became more important in the second decade. During the third decade both reached equal prevalence, being found in some 90% of the female and 70% of the male residual population. Vitamin D deficiency was a lesser problem, reaching its climax in the second decade. Overall, all women fared worse than men.CONCLUSION The importance of long-term follow-up of gastrectomy patients for iron,Vitamin B12 and Vitamin D deficiencies is emphasised.

  20. Three cases of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy for gastric cancer in remnant stomach.

    Science.gov (United States)

    Pan, Yu; Mou, Yi-Ping; Chen, Ke; Xu, Xiao-Wu; Cai, Jia-Qin; Wu, Di; Zhou, Yu-Cheng

    2014-11-13

    Gastric cancer in remnant stomach is a rare tumor but with poor prognosis. Compared with conventional open surgery, laparoscopic gastrectomy has potential benefits for these patients due to advantages resulting from its minimally invasive approach. Herein, we report on three patients with gastric cancer in remnant stomach who underwent laparoscopic total gastrectomy with intracorporeal esophagojejunostomy successfully. The operative time was 280, 250 and 225 minutes, the estimated blood loss was 100, 80 and 50 ml and the length of postoperative hospital stay was seven, eight and nine days respectively. Our experience has suggested that laparoscopic total gastrectomy with intracorporeal esophagojejunostomy can be a safe, feasible and promising option for patients with gastric cancer in remnant stomach.

  1. Secondary Omental Infarction Related to Open and Laparoscopic-Assisted Distal Gastrectomy: Report of Two Cases

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kyung Eun; Chung, Dong Jin; Kim, Wook; Hahn, Seong Tae; Lee, Jae Moon [St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2011-11-15

    Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

  2. Robotic versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Magouliotis, Dimitrios E; Tasiopoulou, Vasiliki S; Sioka, Eleni; Zacharoulis, Dimitrios

    2017-01-01

    We aim to review the available literature on obese patients treated with robotic or laparoscopic sleeve gastrectomy, in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library and EBSCOhost databases, in accordance with the PRISMA guidelines. Sixteen studies met the inclusion criteria incorporating 29,787 patients. Robotic sleeve gastrectomy (RSG) technique showed significantly higher mean operative time and increased length of hospital stay. Post-operative incidence of leakage, wound infection and bleeding, along with weight reduction, were comparable. The majority of the studies assessing charges found increased cost in RSG population. Well-designed, randomized controlled studies, comparing RSG to laparoscopic sleeve gastrectomy (LSG), are necessary to assess further their clinical outcomes and cost-effectiveness.

  3. Secondary omental infarction related to open and laparoscopic-assisted distal gastrectomy: report of two cases.

    Science.gov (United States)

    Park, Kyung Eun; Chung, Dong Jin; Kim, Wook; Hahn, Seong-Tae; Lee, Jae Moon

    2011-01-01

    Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

  4. Comparative Study on the Difference in Functional Outcomes at Discharge between Proximal and Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Kazuaki Kuwabara

    2012-06-01

    Full Text Available Several studies have regarded proximal gastrectomy (PG as optimal compared to total gastrectomy (TG for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG, we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.

  5. EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

    Directory of Open Access Journals (Sweden)

    Wilson Luiz da COSTA JUNIOR

    2013-12-01

    Full Text Available Context Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial. Objective To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. Methods A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. Results Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable presented “area under ROC curve” (AUC of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092. Conclusions This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%.

  6. Predictive factors for body weight loss and its impact on quality of life following gastrectomy.

    Science.gov (United States)

    Tanabe, Kazuaki; Takahashi, Masazumi; Urushihara, Takashi; Nakamura, Yoichi; Yamada, Makoto; Lee, Sang-Woong; Tanaka, Shinnosuke; Miki, Akira; Ikeda, Masami; Nakada, Koji

    2017-07-14

    To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL). We applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures. A total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss (P 25 kg/m(2)). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL (P weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.

  7. Short-term effects of supplementary feeding with enteral nutrition via jejunostomy catheter on post-gastrectomy gastric cancer patients

    Institute of Scientific and Technical Information of China (English)

    WU Quan; YU Jian-chun; KANG Wei-ming; MA Zhi-qiang

    2011-01-01

    Background Most gastric cancer patients who undergo gastrectomy develop malnutrition.It is,therefore,crucial to establish an effective means to provide nutrition for these patients.To perform home enteral nutrition (EN) to ensure adequate nutritional intake in gastric cancer patients,we placed a jejunostomy catheter during gastric surgery.Most patients showed improved nutritional status.Methods Twenty-nine inpatients at our hospital underwent radical gastrectomy and jejunostomy from December 2002 to December 2007 and were designated as the jejunostomy group,and 32 matched patients without a jejunostomy tube were designated as the tube-free group.The jejunostomy group was treated with EN from 72 hours to 3 months postoperatively.The tube-free group did not receive EN.Data including preoperative and postoperative body weight,body mass index (BMI),nutrition risk screening (NRS) score,Karnofsky performance score (KPS),and laboratory biochemical indicators were documented respectively and compared.Results Compared with preoperative week 1,both groups showed decreased body weight and BMI at 3 months postoperatively.The weight loss in the jejunostomy group ((7.1±3.3) kg) was significantly less than that in the tube-free group ((9.9±3.1) kg).Similarly,BMI decreased by (2.4+1.0) kg/m2 in the jejunostomy group,which was significantly less than in the tube-free group ((3.2±0.9) kg/m2).The number of patients with postoperative NRS ≥3 was decreased in the jejunostomy group,but was increased in the tube-free group,and this difference was significant.There were no significant differences between the two groups in total lymphocyte count,hemoglobin,albumin and prealbumin,and adverse drug effects.Conclusions Short-term (3 months) EN supplementation via jejunostomy tube can reduce the risk of malnutrition and weight loss,and improve tolerance of chemotherapy.Tube feeding is reliable for achieving these goals because it is not important whether or not the patients have appetites.

  8. Comprehensive analysis of commercial willow bark extracts by new technology platform: combined use of metabolomics, high-performance liquid chromatography-solid-phase extraction-nuclear magnetic resonance spectroscopy and high-resolution radical scavenging assay.

    Science.gov (United States)

    Agnolet, Sara; Wiese, Stefanie; Verpoorte, Robert; Staerk, Dan

    2012-11-02

    Here, proof-of-concept of a new analytical platform used for the comprehensive analysis of a small set of commercial willow bark products is presented, and compared with a traditional standardization solely based on analysis of salicin and salicin derivatives. The platform combines principal component analysis (PCA) of two chemical fingerprints, i.e., HPLC and (1)H NMR data, and a pharmacological fingerprint, i.e., high-resolution 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonate) radical cation (ABTS(+)) reduction profile, with targeted identification of constituents of interest by hyphenated HPLC-solid-phase extraction-tube transfer NMR, i.e., HPLC-SPE-ttNMR. Score plots from PCA of HPLC and (1)H NMR fingerprints showed the same distinct grouping of preparations formulated as capsules of Salix alba bark and separation of S. alba cortex. Loading plots revealed this to be due to high amount of salicin in capsules and ampelopsin, taxifolin, 7-O-methyltaxifolin-3'-O-glucoside, and 7-O-methyltaxifolin in S. alba cortex, respectively. PCA of high-resolution radical scavenging profiles revealed clear separation of preparations along principal component 1 due to the major radical scavengers (+)-catechin and ampelopsin. The new analytical platform allowed identification of 16 compounds in commercial willow bark extracts, and identification of ampelopsin, taxifolin, 7-O-methyltaxifolin-3'-O-glucoside, and 7-O-methyltaxifolin in S. alba bark extract is reported for the first time. The detection of the novel compound, ethyl 1-hydroxy-6-oxocyclohex-2-enecarboxylate, is also described.

  9. Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

    Directory of Open Access Journals (Sweden)

    Mani Habibi

    2016-07-01

    Full Text Available Gastric leakage postsurgery is the most feared complication of laparoscopic sleeve gastrectomy due to the difficulty of its management. While gastric leakagemanagement postsurgery is often performed using internal drainage catheters accompanied by self-expandable metal stents, endoscopic internal drainage by double pigtail catheter has recently become a recommended approach. Here we describe our treatment of a patient who experienced distal gastric leakage after undergoing laparoscopic sleeve gastrectomy using double pigtail catheter and our treatment recommendations based on the patient outcome.

  10. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To investigate the prognostic impact of metastatic lymph node ratio(rN) on gastric cancer after curative distal gastrectomy.METHODS:A total of 634 gastric cancer patients who underwent curative resection(R0) of lymph nodes at distal gastrectomy in 1995-2004.Correlations between positive nodes and retrieved nodes,between rN and retrieved nodes,and between rN and negative lymph node(LN) count were analyzed respectively.Prognostic factors were identif ied by univariate and multivariate analyses.Staging acc...

  11. Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report.

    Science.gov (United States)

    Hagiwara, Chie; Yajima, Kazuhito; Iwasaki, Yoshiaki; Oohinata, Ryouki; Yuu, Ken; Ishiyama, Satoshi; Amaki, Misato; Nakano, Daisuke; Yamaguchi, Tatsuro; Matsumoto, Hiroshi; Takahashi, Keiichi

    2016-02-01

    We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80-year-old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux-en-Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.

  12. Anemia after gastrectomy for early gastric cancer: Long-term follow-up observational study

    Science.gov (United States)

    Lim, Chul-Hyun; Kim, Sang Woo; Kim, Won Chul; Kim, Jin Soo; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Choi, Myung-Gyu; Song, Kyo-Young; Jeon, Hae Myung; Park, Cho-Hyun

    2012-01-01

    AIM: To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer. METHODS: The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed. Patients with anemia in the preoperative workup, cancer recurrence, undergoing systemic chemotherapy, with other medical conditions that can cause anemia, or treated during follow up with red cell transfusions or supplements for anemia were excluded. Anemia was defined by World Health Organization criteria (Hb anemia was defined as anemia with concomitant iron deficiency. Anemia from vitamin B12 deficiency was defined as megaloblastic anemia (mean cell volume > 100 fL) with vitamin B12 deficiency. The profile of anemia over 48 mo of follow-up was analyzed. RESULTS: One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed. The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery. The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery. Anemia of chronic disease and megaloblastic anemia were uncommon. The incidence of anemia in female patients was significantly higher than in male patients at 12 (40.0% vs 22.0%, P = 0.033), 24 (45.0% vs 25.0%, P = 0.023), 36 (55.0% vs 28.0%, P = 0.004), and 48 mo (52.0% vs 31.0%, P = 0.022) after surgery. Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery (60.7% vs 31.3%, P = 0.008). The incidence of iron deficiency was significantly higher in female patients than in male patients at 6 (35.4% vs 13.3%, P = 0.002), 12 (45.8% vs 16.8%, P Anemia was frequent after gastrectomy for early gastric cancer, with iron deficiency being the major cause. Evaluation for anemia including iron

  13. Synthesis of poly(poly(ethylene glycol) methacrylate)-polyisobutylene ABA block copolymers by the combination of quasiliving carbocationic and atom transfer radical polymerizations.

    Science.gov (United States)

    Szabó, Ákos; Szarka, Györgyi; Iván, Béla

    2015-01-01

    Systematic investigations are carried out on the synthesis of a series of new, unique ABA-type triblock copolymers consisting of the hydrophobic and chemically inert polyisobutylene (PIB) inner and the hydrophilic comb-shaped poly(poly(ethylene glycol) methacrylate) (PPEGMA) polymacromonomer as an outer block. Telechelic PIB macroinitiators with narrow molecular weight distributions (MWD) are synthesized by quasiliving carbocationic polymerization of isobutylene with a bifunctional initiator followed by quantitative chain end derivatizations. Atom transfer radical polymerization (ATRP) of PEGMAs with various molecular weights is investigated by using these macroinitiators. It is found that CuBr is an inefficient ATRP catalyst, while CuCl leads to high, nearly complete conversions of the PEGMA macromonomers. Gel permeation chromatography (GPC) analyses reveal slow initiation of PEGMA at relatively high PIB/PEGMA ratios or with PEGMAs of higher molecular weights due to steric hindrance between the macroinitiator and macromonomer. The occurrence of slow initiation, and not permanent termination, is proven by highly efficient ATRP of a low-molecular-weight monomer, methyl methacrylate, with the block copolymers as macroinitiators. Successful synthesis of PPEGMA-PIB-PPEGMA ABA block copolymers is obtained by using either low-molecular-weight PEGMA or relatively low macroinitiator/macromonomer ratios. Differential scanning calorimetry (DSC) indicates phase separation and significant suppression of the crystallinity of the pendant poly(ethylene glycol) (PEG) chains in these new block copolymers. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Gastropancreatic ligament: Description, incidence, and involvement during laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Rebibo, Lionel; Darmon, Ilan; Peltier, Johann; Dhahri, Abdennaceur; Regimbeau, Jean-Marc

    2017-04-01

    During laparoscopic sleeve gastrectomy (LSG), adhesions between the stomach and the pancreas are sometimes found, forming a "gastropancreatic ligament" (GPL). However, the GPL has only been described once in the literature, in 1985. The objective of this study was to determine the incidence of the GPL during LSG, describe this structure and assess its effect on the surgical technique. All patients undergoing primary LSG in our institution (n = 240) and patients referred for gastric fistula (GF) after primary LSG (n = 18) between January 2015 and December 2015 were included. The primary endpoint was the incidence of a GPL during primary LSG. The secondary endpoints were the postoperative complication rate, the postoperative GF rate, and the presence of this ligament during reoperation for GF. Among the 240 patients, a GPL was visible in 49 cases (20.4%) and was described as thin in 34 of these (69.4%). Twelve postoperative complications (5%) were observed, including seven major (2.9%). The GF rate was 2% (n = 5), not requiring reoperation. The gastric stenosis rate was 0.4% (n = 1). The GPL had been previously sectioned in one of the five patients (20%) with postoperative GF. During the study period, 18 patients were referred for GF and 14 were reoperated. A non-sectioned GPL, not described in the operating report, was observed in four patients (28.5%). A GPL was identified in 20.4% of cases. Identification of a GPL could be important in the context of LSG, as section of the ligament allows tension-free stapling to be performed and can therefore possibly reduce the risk of postoperative complications, particularly GF. Clin. Anat. 30:336-341, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. A radical approach to radical innovation

    NARCIS (Netherlands)

    D. Deichmann (Dirk); J.C.M. van den Ende (Jan)

    2014-01-01

    textabstractInnovation pays. Amazon, Apple, Facebook, Google – nearly every one of today’s most successful companies has a talent for developing radical new ideas. But how best to encourage radical initiative taking from employees, and does their previous success or failure at it play a role?

  16. A radical approach to radical innovation

    OpenAIRE

    Deichmann, Dirk; van der Ende, Jan

    2014-01-01

    textabstractInnovation pays. Amazon, Apple, Facebook, Google – nearly every one of today’s most successful companies has a talent for developing radical new ideas. But how best to encourage radical initiative taking from employees, and does their previous success or failure at it play a role?

  17. [Postoperative morbidity and in-hospital mortality of gastrectomy due to gastric adenocarcinoma: a report of 50 years].

    Science.gov (United States)

    Ruiz, Eloy; Payet, Carlos; Montalbetti, Juan Antonio; Celis, Juan; Payet, Eduardo; Berrospi, Francisco; Chavez, Ivan; Young, Frank

    2004-01-01

    Determine the postoperative morbidity and in-hospital mortality of gastrectomy due to gastric cancer. The study involved the review of the clinical records of all patients with histologically confirmed diagnostic of gastric adenocarcinoma, which underwent a gastrectomy at the Peruvian Institute of Neoplastic Diseases between January 1950 and December 1999. During that period, 2,033 gastrectomies were performed, 503 of which were total gastrectomies and 1,447 were distal subtotal gastrectomies. Postoperative morbidity of total and distal subtotal gastrectomy dropped from 23.7% and 14.3% during the 1950 decade, to 19.8% and 7.4% during the 1990 decade, respectively, while the in-hospital mortality of total and subtotal gastrectomy dropped from 28.9% and 19.4% during the 50s to 4.4% and 2.2% during the 90's. The most common complications were the esophagojejunal, gastrojejunal and duodenal fistulas, respiratory infections, intra-abdominal abscesses, pancreatic fistula, early intestinal obstruction, hemorrhage from the anastomosis site and surgical site infection. Multivariate logistics regression analysis showed that the risk factors for in-hospital mortality of total gastrectomy were hypoalbuminemia, intraoperative blood transfusion and re-resection (OR: 2.4, 5.9 and 1.7, respectively). For distal subtotal gastrectomy, the risk factors for in-hospital mortality were hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection (OR: 2.6, 2.46, 2.42 and 6.3, respectively). Based on our results, the in-hospital mortality risk depends on the postoperative variables (hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection) more than on the pre-operative variables, beyond the surgeon's control (age, sex, clinical stage, etc.).

  18. 高龄患者腹腔镜下胃癌及直肠癌联合根治术两例%Laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer in elderly patients: report of two cases

    Institute of Scientific and Technical Information of China (English)

    方佳峰; 卫洪波; 陈图锋; 黄勇; 魏波; 郑宗珩; 黄江龙; 徐皓中

    2012-01-01

    目的 探讨腹腔镜下高龄患者胃癌、直肠癌联合根治术的安全性和可行性.方法 回顾性分析接受腹腔镜胃癌、直肠癌同时根治性切除手术的2例高龄患者的临床资料.结果 2例患者年龄分别为78岁和75岁,术前均合并较多基础疾病,1例为Ⅱ期胃体癌和ⅠB期直肠癌,另1例为ⅢA期胃癌和ⅠB期直肠癌.予以腹腔镜下胃癌、直肠癌联合根治性切除术,手术切口长度为5cm,手术时间分别为260和255 min,术中出血量分别为60和80 ml,术程顺利,术中未出现任何并发症.术后恢复进食时间分别为4和5d,术后住院时间分别为13和14 d,术后亦未出现并发症.2例患者术后分别随访了13和12个月,均未发现肿瘤复发、转移.结论 由腹腔镜手术经验丰富的医师对高龄患者施行腹腔镜下胃癌、直肠癌联合根治术是安全、可行的,具有创伤小、恢复快的优点.%Objective To investigate the safety and feasibility of laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer in elderly patients.Methods Clinical data of two elderly patients undergoing laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer were analyzed retrospectively.Results The two cases were 78 and 75 years old respectively.Both were complicated with many medical conditions.One case suffered from stage Ⅱ cancer in the gastric body and stage Ⅰ B rectal cancer,and the other suffered from stage Ⅲ A gastric cancer and stage ⅠB rectal cancer.Both cases had received laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer,with 5 cm of incision.The operative time was 260 and 255 min and the intraoperative bleeding was 60 and 80 ml respectively.No complication occurred intraoperatively.Time to resume oral intake was 4 and 5 days and length of postoperative hospital stay was 13 and 14 days respectively.No postoperative complication occurred

  19. Effect of obesity on technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy--comparison with open distal gastrectomy.

    Science.gov (United States)

    Yamada, Hiroyuki; Kojima, Kazuyuki; Inokuchi, Mikito; Kawano, Tatsuyuki; Sugihara, Kenichi

    2008-06-01

    The aim of this study was to compare outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) in obese and non-obese patients. Subjects comprised 248 consecutive patients who underwent distal gastrectomy for gastric cancer between January 1999 and December 2005. Patients with body mass index (BMI) > or = 25 kg/m2 were defined as obese, and patients with BMI obese. Parameters analyzed included patients characteristics, tumor characteristics, operative details, postoperative outcomes, and prognosis. For LADG, 35 patients were considered obese, and 106 patients were non-obese. For ODG, 25 patients were considered obese, and 82 patients were non-obese. Mean operative times in each procedure were significantly longer for the obese group than for the non-obese group (ODG: 241.4 min vs. 199.5 min, p obese group than for the non-obese group in ODG (300 ml vs. 400 ml, p = 0.024), but no significant differences were observed between obese and non-obese groups for LADG. Incidence of major postoperative complications, number of retrieved lymph nodes, and disease-free survival rates were similar in obese and non-obese groups for each procedure. Our analysis revealed that LADG can be safely performed in obese patients, with complication rates and operation outcomes similar to those for non-obese patients.

  20. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer.

    Science.gov (United States)

    Kim, Min Gyu; Yook, Jeong Hwan; Kim, Kap Choong; Kim, Tae Hwan; Kim, Hee Sung; Kim, Beom Su; Kim, Byung Sik

    2011-06-01

    The aim of this study is to estimate the impact of obesity on surgical outcomes of laparoscopic-assisted gastrectomy for gastric cancer. Between January 2005 and January 2010, 1100 consecutive patients who underwent laparoscopic-assisted distal gastrectomy for gastric cancer were reviewed to evaluate the impact of obesity. The patients were classified into 3 groups according to the World Health Organization classification, as normal weight [body mass index (BMI) 18.5 to 24.9 kg/m], overweight (BMI 25 to 29.9 kg/m), and obese patients (BMI ≥30 kg/m). The postoperative complication rates for normal weight, overweight, and obese patients were 5.7%, 10.0%, 15.4%, respectively. Overweight and obese patients had a significantly prolonged operation time, increased intraoperative blood loss, prolonged first flatus, day of commencement of soft diet, increased number of administration of analgesics, and prolonged hospital stay. Overweight and obesity were associated with poor early surgical outcomes of laparoscopic-assisted gastrectomy. This study suggested that greater cautions and improved surgical techniques were required to improve early surgical outcomes of laparoscopic-assisted gastrectomy for overweight and obese patients.

  1. Application of colon interposition among the esophageal cancer patients with partial gastrectomy.

    Science.gov (United States)

    Chen, Qiuqiang; Mao, Weimin; Yu, Huanming; Liang, Yixian; Wang, Jiane; Chen, Guoping

    2016-12-01

    Esophageal reconstruction with colon interposition is an alternative solution for the esophageal cancer patients who have partial gastrectomy. The aim of this study was to investigate the therapeutic effects of colon interposition among the esophageal carcinoma patients with partial gastrectomy. Under institutional review board approval, 32 esophageal carcinoma patients with a history of partial gastrectomy were included in this study. All the patients had been diagnosed and confirmed squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma by histopathological examination. Surgical approaches, complications and therapeutic results were analyzed in the current study. Thirty-two esophageal carcinoma patients (29 men, 3 women, median age 63.2 years) were included in this study. Isoperistaltic colon interposition was carried out on 14 patients; their 1-year and 2-year survival rate was 92.9% and 78.6%, respectively. Antiperistaltic colon interposition was carried out on 18 patients; their 1-year and 2-year survival rate was 88.9% and 77.8%, respectively. In which, cervical anastomotic leakage was observed on six patients. Colon interposition is an ideal surgical approach for the esophageal carcinoma patients who had partial gastrectomy. Isoperistaltic colon interposition is preferred, but antiperistaltic colon interposition has the advantage that a longer colon can be used.

  2. Clinical–radiologic evaluation of the complications of laparoscopic sleeve gastrectomy: Value of multidetector CT

    Directory of Open Access Journals (Sweden)

    Tamir A. Hassan

    2015-12-01

    Conclusions: As LSG is performed increasingly and frequently, it is essential for radiologists to recognize the normal postoperative anatomy and identify the complications of this procedure. CT is an important imaging tool to diagnose suspected complications of laparoscopic sleeve gastrectomy procedure to ensure accurate diagnosis.

  3. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

    Science.gov (United States)

    Subhas, Gokulakkrishna; Gupta, Anupam; Sabir, Mubashir; Mittal, Vijay K

    2015-01-01

    Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on post-operative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement. PMID:26649158

  4. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men.

    Science.gov (United States)

    Tatara, Marcin R; Krupski, Witold; Szpetnar, Maria; Dąbrowski, Andrzej; Bury, Paweł; Szabelska, Anna; Charuta, Anna; Boguszewska-Czubara, Anna; Maciejewski, Ryszard; Wallner, Grzegorz

    2015-12-01

    The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid concentration in plasma obtained from overnight fasted patients.

  5. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Gokulakkrishna; Subhas; Anupam; Gupta; Mubashir; Sabir; Vijay; K; Mittal

    2015-01-01

    Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on postoperative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.

  6. Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy

    Directory of Open Access Journals (Sweden)

    Akira Umemura

    2015-04-01

    Full Text Available There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001 and stenosis (8.3% vs. 1.8%, p < 0.001 of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS.

  7. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer.

    Science.gov (United States)

    Kunisaki, Chikara; Makino, Hirochika; Yamaguchi, Naotaka; Izumisawa, Yusuke; Miyamato, Hiroshi; Sato, Kei; Hayashi, Tsutomu; Sugano, Nobuhiro; Suzuki, Yoshihiro; Ota, Mitsuyoshi; Tsuburaya, Akira; Kimura, Jun; Takagawa, Ryo; Kosaka, Takashi; Ono, Hidetaka Andrew; Akiyama, Hirotoshi; Endo, Itaru

    2016-12-01

    Although a few studies have reported the use of reduced-port laparoscopic gastrectomy (RPG) in gastric cancer patients, the feasibility of routinely using this technique remains unclear. It is therefore important to evaluate the surgical advantages of this technique in this patient group. Between August 2010 and July 2015, 165 patients underwent RPGs at our hospital, performed by a single surgeon. Of these patients, 88 underwent reduced-port laparoscopic distal gastrectomy (RPLDG) and 77 underwent reduced-port laparoscopic total gastrectomy (RPLTG). In addition to short-term surgical outcomes after RPG, survival times and the surgical learning curve were also evaluated. Blood losses during lymph node dissection in the RPLDG and RPLTG groups were not significantly different (p = 0.160). Conversion to open surgery was necessary in only two patients. Postoperative morbidities were observed in 14.8 % of the RPLDG group and 14.3 % of the RPLTG group, but there were no deaths. Most patients expressed high cosmetic satisfaction in both groups. In the RPLDG group, operation time during reconstruction decreased over the first 50 cases and then plateaued, as the surgeon's experience of the technique increased. In contrast, in the RPLTG group, operation times dropped with surgical experience for both lymph node dissection, plateauing after 40 cases, and for reconstruction, plateauing after 30 cases. Only three patients died of gastric cancer in the follow-up period and three patients died of other diseases. Five-year overall survival and 5-year disease-specific survival were 95.6 and 98.0 %, respectively. We have shown that reduced-port gastrectomy (RPG) could be an acceptable and satisfactory procedure for treating gastric cancer for an experienced laparoscopic gastric surgeon who has sufficient previous experience of conventional laparoscopic gastrectomies.

  8. Impact of Neoadjuvant Chemotherapy Among Patients with Pancreatic Fistula After Gastrectomy for Advanced Gastric Cancer.

    Science.gov (United States)

    Kosaka, Takashi; Akiyama, Hirotoshi; Makino, Hirochika; Kimura, Jun; Takagawa, Ryo; Ono, Hidetaka A; Kunisaki, Chikara; Endo, Itaru

    2016-04-01

    Neoadjuvant chemotherapy (NAC) has been widely adopted for patients with advanced gastric cancer; however, the safety of gastrectomy with D2 lymphadenectomy followed by NAC has not yet been evaluated. We retrospectively analyzed the influence of NAC on morbidity and mortality after gastrectomy in patients with advanced gastric cancer. A series of 364 patients with advanced gastric cancer who underwent gastrectomy without pancreatectomy between January 2008 and December 2010 at eight hospitals registered to the Yokohama Clinical Oncology Group were studied retrospectively. There were 330 patients who underwent surgical treatment immediately after diagnosis (surgery alone group) and 34 patients (NAC group) who first received NAC and then underwent surgical resection. Although there were no significant differences in the morbidity rate between the two groups, postoperative pancreatic fistula was more often observed in NAC patients than in patients of the group treated with surgery alone [5 cases (14.7%) vs. 11 cases (3.3%); p=0.011]. In the univariate analysis, NAC (p=0.029), bursectomy (pfistula, and NAC [odds ratio (OR)=4.901, 95% confidence interval (CI)=1.455-16.67; p=0.010] and bursectomy (OR=11.2, 95% CI=3.460-37.04; pfistula by multivariate analysis. The incidence of postoperative pancreatic fistula was 40.0% among patients who underwent gastrectomy with bursectomy followed by NAC. The incidence of pancreatic fistula in patients treated with NAC and bursectomy was significantly higher than that in other patients. Bursectomy may be discouraged for the prevention of pancreatic fistula from gastrectomy following NAC. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  9. Radical theory of rings

    CERN Document Server

    Gardner, JW

    2003-01-01

    Radical Theory of Rings distills the most noteworthy present-day theoretical topics, gives a unified account of the classical structure theorems for rings, and deepens understanding of key aspects of ring theory via ring and radical constructions. Assimilating radical theory's evolution in the decades since the last major work on rings and radicals was published, the authors deal with some distinctive features of the radical theory of nonassociative rings, associative rings with involution, and near-rings. Written in clear algebraic terms by globally acknowledged authorities, the presentation

  10. [Lavoisier and radicals].

    Science.gov (United States)

    Lafont, Olivier

    2007-01-01

    Lavoisier and his co-workers (Guyton de Morveau, Bertholet, Fourcroy) considered that acids were constituted of oxygen and of something else that they called radicals. These radicals were known in some cases, i.e. nitrogen for nitrous acid, carbon for carbonic acid, phosphorus for phosphoric acid. In the case of sulfur, the sulfuric radical could be associated with different quantities of oxigen leading to sulfuric or sulfurous acids. In other cases radicals remained unknown at the time i.e. muriatic radical for muriatic acid, or benzoyl radical for benzoic acid. It is interesting to notice that Lavoisier evoked the case of compound radicals constituted of different substances such as carbon and hydrogen.

  11. Quantitative measurement of hydroxyl radical (OH) concentration in premixed flat flame by combining laser-induced fluorescence and direct absorption spectroscopy

    Science.gov (United States)

    Chen, Shuang; Su, Tie; Li, Zhong-Shan; Bai, Han-Chen; Yan, Bo; Yang, Fu-Rong

    2016-10-01

    An accurate and reasonable technique combining direct absorption spectroscopy and laser-induced fluorescence (LIF) methods is developed to quantitatively measure the concentrations of hydroxyl in CH4/air flat laminar flame. In our approach, particular attention is paid to the linear laser-induced fluorescence and absorption processes, and experimental details as well. Through measuring the temperature, LIF signal distribution and integrated absorption, spatially absolute OH concentrations profiles are successfully resolved. These experimental results are then compared with the numerical simulation. It is proved that the good quality of the results implies that this method is suitable for calibrating the OH-PLIF measurement in a practical combustor. Project supported by the National Natural Science Foundation of China (Grant No. 11272338), the Science and Technology on Scramjet Key Laboratory Funding, China (Grant No. STSKFKT 2013004), and the China Scholarship Council.

  12. Evaluation of analgesic effect of two different doses of fentanyl in combination with bupivacaine for surgical site infiltration in cases of modified radical mastoidectomy: A double blind randomized study

    Science.gov (United States)

    Bhandari, Geeta; Shahi, Kedar Singh; Parmar, Nitish Kumar; Asad, Mohammad; Joshi, Hemchandra Kumar; Bhakuni, Rajni

    2013-01-01

    Background: Limited evidence supports the efficacy of peripheral route fentanyl and local anesthetic combination for postoperative analgesia. Our study was therefore designed to demonstrate the analgesic efficacy of two different doses of fentanyl in combination with bupivacaine for surgical site infiltration in patients undergoing modified radical mastoidectomy (MRM). Materials and Methods: 60 patients undergoing MRM under general anesthesia were randomly allocated into two groups, first group receiving 0.5% bupivacaine at a dose of 2 mg/kg body weight with 50 μg fentanyl and second group receiving bupivacaine 0.5% at a dose of 2 mg/kg body weight with 100 μg fentanyl as infiltration of operative field in and around the incision site, after the incision and just before completion of surgery. In postoperative period pain, nausea-vomiting and sedation was recorded at 0 hr, 2, 4, 6, 12 and 24 hrs. Results: Both the combinations of bupivacaine and fentanyl (Group I and Group II) were effective for postoperative analgesia. In both the groups the Visual Analogue Scale (VAS) score was less than 3 at each time interval. None of the patients required rescue analgesia. The comparison of VAS scores at different intervals showed that group II had lower VAS scores at all time points. Conclusions: Fentanyl and bupivacaine combinations in doses of 50 and 100 μg along with 0.5% bupivacaine at a fixed dose of 2 mg/kg body weight are effective in the management of postoperative pain. Patients who received 100 μg fentanyl (Group II) had lower VAS scores as compared to the patients who received 50 μg fentanyl (Group I) with similar side effects. PMID:25885841

  13. 胃癌切除术后胃肠道瘘的治疗%Gastrointestinal leakage after gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    唐云; 李荣; 陈凛; 卫勃; 武现生

    2010-01-01

    Objective To summarize the treatment experiences in gastrointestinal leaJcage atter gastrectomy for gastric cancer. Mehods From January 1997 to December 2006 the clinical data of 37 cases of gastrointestinal leakage including anastomotic leakage in 19 cases and duodenal stump leakage in 18 after gastrectomy for gastric cancer in People's Liberation Army General Hospital were analyzed retrospectively. Results All of the Cases were treated with abdominal drainage,continuous gastrointinal decomnression and parenteral nutrition combined with enteral nutrition.There were 32 cases receiving glutamine enrichment nutrition support,31 ases used somatostatin,13 cases received supplemented recombinarlt human growth hormone.Fistula healed in 21~30 d in 9 cases after gastrectomy,in the other 24 cases fistula healed in 30-60 d,while it healed in 60~81 d in the remaining 2 cases.Two died of leakage associated complications after gastrectomy for gastric cancer including anastomotlc leakage follwing esophagojejunostomy complicated by severe thoracic and lung infection in one and duodenal stump leakage complicated by severe abdominal cavity sepsis and hemorrhage in the other. Conclusion Patent and effective abdominal cavity drainage,continuous gastrointestinal decompression,parenteral nutrition combined with enteral nutrition,glutarnine,somatostafin and recombinant human growth hormone are the'mportant factors for the healing of gastrointestinal leakage after gastrectomy tor gastric cancer.%目的 总结胃癌切除术后胃肠道瘘的治疗经验,以提高对胃癌切除术后胃肠道瘘的治疗水平.方法 对1997年1月至2006年12月在北京解放军总医院治疗的胃癌切除术后19例吻合El瘘和18例十二指肠残端瘘共37例胃肠道瘘患者进行回顾性分析.结果 本组37例均加强了瘘口附近的腹腔引流,采用了持续胃肠减压,先给予肠外营养支持、然后从肠外营养支持逐步过渡到肠内营养支持的治疗手段.32

  14. Contemporary Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Qiang Fu

    2011-01-01

    Full Text Available Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

  15. Engineering a horseradish peroxidase C stable to radical attacks by mutating multiple radical coupling sites.

    Science.gov (United States)

    Kim, Su Jin; Joo, Jeong Chan; Song, Bong Keun; Yoo, Young Je; Kim, Yong Hwan

    2015-04-01

    Peroxidases have great potential as industrial biocatalysts. In particular, the oxidative polymerization of phenolic compounds catalyzed by peroxidases has been extensively examined because of the advantage of this method over other conventional chemical methods. However, the industrial application of peroxidases is often limited because of their rapid inactivation by phenoxyl radicals during oxidative polymerization. In this work, we report a novel protein engineering approach to improve the radical stability of horseradish peroxidase isozyme C (HRPC). Phenylalanine residues that are vulnerable to modification by the phenoxyl radicals were identified using mass spectrometry analysis. UV-Vis and CD spectra showed that radical coupling did not change the secondary structure or the active site of HRPC. Four phenylalanine (Phe) residues (F68, F142, F143, and F179) were each mutated to alanine residues to generate single mutants to examine the role of these sites in radical coupling. Despite marginal improvement of radical stability, each single mutant still exhibited rapid radical inactivation. To further reduce inactivation by radical coupling, the four substitution mutations were combined in F68A/F142A/F143A/F179A. This mutant demonstrated dramatic enhancement of radical stability by retaining 41% of its initial activity compared to the wild-type, which was completely inactivated. Structure and sequence alignment revealed that radical-vulnerable Phe residues of HPRC are conserved in homologous peroxidases, which showed the same rapid inactivation tendency as HRPC. Based on our site-directed mutagenesis and biochemical characterization, we have shown that engineering radical-vulnerable residues to eliminate multiple radical coupling can be a good strategy to improve the stability of peroxidases against radical attack.

  16. Pathways of arachidonic acid peroxyl radical reactions and product formation with guanine radicals.

    Science.gov (United States)

    Crean, Conor; Geacintov, Nicholas E; Shafirovich, Vladimir

    2008-02-01

    Peroxyl radicals were derived from the one-electron oxidation of polyunsaturated fatty acids by sulfate radicals that were generated by the photodissociation of peroxodisulfate anions in air-equilibrated aqueous solutions. Reactions of these peroxyl and neutral guanine radicals, also generated by oxidation with sulfate radicals, were investigated by laser kinetic spectroscopy, and the guanine oxidation products were identified by HPLC and mass spectrometry methods. Sulfate radicals rapidly oxidize arachidonic (ArAc), linoleic (LnAc), and palmitoleic (PmAc) acids with similar rate constants, (2-4) x 10 (9) M (-1) s (-1). The C-centered radicals derived from the oxidation of ArAc and LnAc include nonconjugated Rn(.) ( approximately 80%) and conjugated bis-allylic Rba(.) ( approximately 20%) radicals. The latter were detectable in the absence of oxygen by their prominent, narrow absorption band at 280 nm. The Rn(.) radicals of ArAc (containing three bis-allylic sites) transform to the Rba(.) radicals via an intramolecular H-atom abstraction [rate constant (7.5 +/- 0.7) x 10 (4) s (-1)]. In contrast, the Rn(.) radicals of LnAc that contain only one bis-allylic site do not transform intramolecularly to the Rba(.) radicals. In the case of PmAc, which contains only one double bond, the Rba(.) radicals are not observed. The Rn(.) radicals of PmAc rapidly combine with oxygen with a rate constant of (3.8 +/- 0.4) x 10(9) M(-1) s(-1). The Rba(.) radicals of ArAc are less reactive and react with oxygen with a rate constant of (2.2 +/- 0.2) x 10 (8) M (-1) s (-1). The ArAc peroxyl radicals formed spontaneously eliminate superoxide radical anions [rate constant = (3.4 +/- 0.3) x 10 (4) M (-1) s (-1)]. The stable oxidative lesions derived from the 2',3',5'-tri- O-acetylguanosine or 2',3',5'-tri- O-acetyl-8-oxo-7,8-dihydroguanosine radicals and their subsequent reactions with ArAc peroxyl radicals were also investigated. The major products found were the 2,5-diamino-4 H

  17. Thoracoscopy combined with laparoscopy in treatment of esophageal cancer radical operation (40 cases)%胸腹腔镜联合食管癌根治术40例临床总结

    Institute of Scientific and Technical Information of China (English)

    杨立民; 张震; 凌锋; 赵杰

    2016-01-01

    Objective To explore and analyze the application and problems of esophageal cancer radical opera-tion by thoracoscopy combined with laparoscopy. Methods From July, 2011 to December, 2014, clinical data of 40 patients undergoing esophageal cancer radical operation by thoracoscopy combined with laparoscopy were analyzed retrospectively. Results Except 2 cases being relayed to assisted small thoracic incision because of 1 case with clear tumor invading to trachea and 1 case with obvious tumor invasion to thoracic aortic artery, the remaining 38 cases were successfully completed operation. There were 2 cases with postoperative anastomotic fistula in the neck, 2 cases of anastomotic stenosis and 1 case of hoarseness, there was no perioperative death. Follow-up was within 36 months, 2 patients died 10 months and 24 months after surgery respectively, due to tumor local recurrence. 1 patient with supraclavicular lymph node metastasis underwent local radiation therapy. The remaining was all survival with re-lapse-free. Conclusions Esophageal cancer radical operation by thoracoscopy combined with laparoscopy is a good method with safety and reliability, minimal invasion, fast recovering, and satisfied recent curative effect. It is worthy of applying clinically.%目的:探讨胸腹腔镜联合在食管癌根治性切除术中的应用和应注意的问题。方法回顾性分析2011年7月-2014年12月40例胸腹腔镜联合食管癌根治术的临床资料。结果除1例因肿瘤明显外侵气管,1例因肿瘤明显外侵胸主动脉而中转小切口开胸完成手术外,其余38例顺利完成手术。术后颈部吻合口瘘2例,吻合口狭窄2例,声音嘶哑1例,无围手术期死亡。通过通讯和复诊随访6~36个月,2例患者术后10和24个月因局部复发死亡,1例出现锁骨上淋巴结转移行局部放射治疗后缓解。失访2例。结论胸腹腔镜联合行食管癌根治术安全可靠、微创、恢复快,且近期疗效

  18. Forgotten Radicals in Biology

    OpenAIRE

    2008-01-01

    Redox reactions play key roles in intra- and inter-cellular signaling, and in adaptative processes of tissues towards stress. Among the major free radicals with essential functions in cells are reactive oxygen species (ROS) including superoxide anion (O2 •-), hydroxyl radical (•OH) and reactive nitrogen species (RNS) such as nitric oxide (•NO). In this article, we review the forgotten and new radicals with potential relevance to cardiovascular pathophysiology. Approximately 0.3% of O2 •- pres...

  19. Catalytic Radical Domino Reactions in Organic Synthesis

    Science.gov (United States)

    Sebren, Leanne J.; Devery, James J.; Stephenson, Corey R.J.

    2014-01-01

    Catalytic radical-based domino reactions represent important advances in synthetic organic chemistry. Their development benefits synthesis by providing atom- and step-economical methods to complex molecules. Intricate combinations of radical, cationic, anionic, oxidative/reductive, and transition metal mechanistic steps result in cyclizations, additions, fragmentations, ring-expansions, and rearrangements. This Perspective summarizes recent developments in the field of catalytic domino processes. PMID:24587964

  20. Moment matrices, border bases and radical computation

    OpenAIRE

    Mourrain, B.; J. B. Lasserre; Laurent, Monique; Rostalski, P.; Trebuchet, Philippe

    2013-01-01

    In this paper, we describe new methods to compute the radical (resp. real radical) of an ideal, assuming it complex (resp. real) variety is nte. The aim is to combine approaches for solving a system of polynomial equations with dual methods which involve moment matrices and semi-denite programming. While the border basis algorithms of [17] are ecient and numerically stable for computing complex roots, algorithms based on moment matrices [12] allow the incorporation of additional polynomials, ...

  1. Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Murad Baba

    2015-01-01

    Full Text Available Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG. It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

  2. Modified esophagogastrostomy in laparoscopy-assisted proximal gastrectomy: A reverse-Tornado anastomosis.

    Science.gov (United States)

    Kubota, Keisuke; Suzuki, Akihiro; Fujikawa, Aoi; Watanabe, Takayuki; Sekido, Yuki; Shiozaki, Hironori; Taketa, Takashi; Shimada, Gen; Ohigashi, Seiji; Sakurai, Shintaro; Kishida, Akihiro

    2017-02-01

    The aim of this study was to introduce and examine a modified mechanical end-to-side esophagogastrostomy method ("reverse-Tornado" anastomosis) in laparoscopy-assisted proximal gastrectomy. Five patients with gastric cancer who underwent laparoscopy-assisted proximal gastrectomy were analyzed retrospectively. Esophagogastrostomy in the anterior wall was performed in three patients, and esophagogastrostomy in the posterior wall was performed in two patients. Clinicopathological features, operative outcomes (operative time, operative blood loss), and postoperative outcomes (complications, postoperative hospital stay, reflux esophagitis) were evaluated. Operative time was normal (278 min). There was no marked operative blood loss, postoperative complications, prolonged hospital stay, or reflux esophagitis. Esophagogastrostomy was completed in a normal time with reverse-Tornado anastomosis. This method can be safe and can enable good postoperative quality of life. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  3. [A case of pancreatic and duodenal fistula after total gastrectomy successfully treated with coagulation factor XIII].

    Science.gov (United States)

    Nishino, Hitoe; Kojima, Kazuhiro; Oshima, Hirokazu; Nakagawa, Koji; Fumura, Masao; Kikuchi, Norio

    2013-11-01

    Pancreatic fistula( PF) is a challenging postoperative complication. We report a case of PF following gastrectomy successfully treated using intravenous coagulation factor XIII( FXIII).A 78-year-old man with early gastric cancer underwent total gastrectomy with Roux-en-Y reconstruction. PF developed postoperatively, following which, leakage from the duodenal stump was observed. Percutaneous drainage and re-operative surgery were performed. A somatostatin analogue, antibiotic drugs, and gabexate mesilate were administrated along with nutritional support. The pancreatic and duodenal fistula had been producing duodenal juice for over 30 days since the re-operative surgery. As suspected, reduced FXIII activity was confirmed in the patient. After administering FXIII for 5 days, the amount of duodenal juice from the fistula markedly reduced, and the fistula closed immediately afterwards. The results of our study suggest that administration of FXIII could be a reasonable and effective treatment for patients with pancreatic or/and enterocutaneous fistula who are resistant to standard treatments.

  4. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Serhan Derici

    2016-01-01

    Full Text Available Background. Laparoscopic sleeve gastrectomy (LSG has become a popular operation during the recent years. This procedure requires resection of 80–90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

  5. Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Luís Gustavo Santos Périssé

    2015-06-01

    Full Text Available OBJECTIVE: to evaluate the use of endoscopic self-expandable metallic prostheses in the treatment of fistulas from sleeve gastrectomy and Roux en y gastric bypass.METHODS: all patients were treated with fully coated auto-expandable metallic prostheses and were submitted to laparoscopic or CT-guided drainage, except for those with intracavitary drains. After 6-8 weeks the prosthesis was removed and if the fistula was still open a new prostheses were positioned and kept for the same period.RESULTS: the endoscopic treatment was successful in 25 (86.21% patients. The main complication was the migration of the prosthesis in seven patients. Other complications included prosthesis intolerance, gastrointestinal bleeding and adhesions. The treatment failed in four patients (13.7% one of which died (3.4%.CONCLUSION: endoscopic treatment with fully coated self-expandable prosthesis was effective in treating most patients with fistula after sleeve gastrectomy and roux en y gastric bypass.

  6. Factors influencing lymph node recovery from the operative specimen after gastrectomy for gastric adenocarcinoma.

    Science.gov (United States)

    Schoenleber, Scott J; Schnelldorfer, Thomas; Wood, Christina M; Qin, Rui; Sarr, Michael G; Donohue, John H

    2009-07-01

    Regional lymph node metastases are an important predictor of survival for patients with resectable adenocarcinoma of the stomach. Currently, the number of lymph nodes examined is frequently less than requirements for accurate staging. Clinical factors associated with lymph node recovery are understood poorly. We performed a retrospective chart review of 99 consecutive patients who underwent gastrectomy for gastric adenocarcinoma distal to the gastroesophageal junction to determine clinical variables associated lymph node recovery. Ninety-nine patients underwent gastrectomy for gastric adenocarcinoma at our two hospitals. More than 15 lymph nodes were examined in 64% of specimens. Univariate analysis showed an association between the number of lymph nodes recovered and the number of positive nodes, lymphadenectomy extent, hospital, surgeon, and pathology technician (p analysis identified the pathology technician as the most important healthcare-related variable contributing to the variation of lymph node recovery, using fixed- (p technical aspects of specimen processing may be of benefit in maximizing the number of lymph nodes recovered.

  7. Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction.

    Science.gov (United States)

    Murata, S; Yamazaki, M; Kosugi, C; Hirano, A; Yoshimura, Y; Shiragami, R; Suzuki, M; Shuto, K; Koda, K

    2014-01-01

    Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.

  8. Anemia after gastrectomy for early gastric cancer:Long-term follow-up observational study

    Institute of Scientific and Technical Information of China (English)

    Chul-Hyun Lim; Sang Woo Kim; Won Chul Kim; Jin Soo Kim; Yu Kyung Cho; Jae Myung Park; In Seok Lee

    2012-01-01

    AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria (Hb < 12 g/dL in women and <13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 μg/dL.Vitamin B12 deficiency was defined as serum vitamin B12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B12 deficiency was defined as megaloblastic anemia (mean cell volume >100 fL) with vitamin B12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12 (40.0% vs 22.0%,P =0.033),24 (45.0% vs 25.0%,P =0.023),36 (55.0%vs 28.0%,P =0.004),and 48 mo (52.0% vs 31.0%,P =0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery (60.7% vs 31.3%,P =0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6 (35.4% vs

  9. Transient appearance of postoperative EDTA-dependent pseudothrombocytopenia in a patient after gastrectomy.

    Science.gov (United States)

    Wenzel, Folker; Lasshofer, Roland; Rox, Jutta; Fischer, Johannes; Giers, Günther

    2011-01-01

    Ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia (EDTA-PTCP) is a well known phenomenon. Antiplatelet antibodies cause platelet clumping in EDTA anticoagulated blood samples, and blood count analysers calculate a spurious low platelet count. We describe a case of a transient appearance of EDTA-PTCP in a patient after gastrectomy. A 58-year-old man underwent partial gastrectomy in for gastric cancer. Preoperatively, his platelet count was in a normal range, and the surgical procedure was performed without bleeding complications. At day 10 after surgery the patient showed a low platelet count, which could be identified as EDTA-PTCP. The phenomenon disappeared in a following postoperative time interval of 2 months. In cases of recently occurring thrombocytopenias EDTA-PTCP should always be considered as a possible cause of low platelet count, in particular in cases of inconspicuous clinical findings. Appropriate laboratory analysis should be applied.

  10. Radicalization and Radical Catalysis of Biomass Sugars: Insights from First-principles Studies

    Science.gov (United States)

    Yang, Gang; Zhu, Chang; Zou, Xianli; Zhou, Lijun

    2016-07-01

    Ab initio and density functional calculations are conducted to investigate the radicalization processes and radical catalysis of biomass sugars. Structural alterations due to radicalization generally focus on the radicalized sites, and radicalization affects H-bonds in D-fructofuranose more than in D-glucopyranose, potentially with outcome of new H-bonds. Performances of different functionals and basis sets are evaluated for all radicalization processes, and enthalpy changes and Gibbs free energies for these processes are presented with high accuracy, which can be referenced for subsequent experimental and theoretical studies. It shows that radicalization can be utilized for direct transformation of biomass sugars, and for each sugar, C rather than O sites are always preferred for radicalization, thus suggesting the possibility to activate C-H bonds of biomass sugars. Radical catalysis is further combined with Brønsted acids, and it clearly states that functionalization fundamentally regulates the catalytic effects of biomass sugars. In presence of explicit water molecules, functionalization significantly affects the activation barriers and reaction energies of protonation rather than dehydration steps. Tertiary butyl and phenyl groups with large steric hindrances or hydroxyl and amino groups resulting in high stabilities for protonation products drive the protonation steps to occur facilely at ambient conditions.

  11. Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Seki, Yosuke; Kasama, Kazunori; Haruta, Hidenori; Watanabe, Atsushi; Yokoyama, Renzo; Porciuncula, Jose Paolo Cabreira; Umezawa, Akiko; Kurokawa, Yoshimochi

    2017-03-01

    Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown. The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM. In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m(2), respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery. The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period. Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.

  12. Clinical feature and treatment of bleeding from remnant stomach after subtotal gastrectomy

    Directory of Open Access Journals (Sweden)

    Wei XIE

    2016-03-01

    Full Text Available Objective  To explore the clinical feature and effective method of treatment for upper gastrointestinal bleeding from remnant stomach. Methods  Seventy-one patients with remnant stomach suffering from upper gastrointestinal bleeding as confirmed by gastroscopy were admitted to Qingdao Municipal Hospital from January 2005 to January 2015. Kruskal Wallis test was used to compare the separate multiple sets of ordered categorical data. Results  Remnant stomach complicated by upper gastrointestinal bleeding was more common in males than females (83.01% vs 16.9%, and in elder patients (53/71, 74.6%, accompanied by tarry stool (47/71, 66.4%, undergoing subtotal gastrectomy over 5 years (63.4%, 45/71, and the procedure was Billroth Ⅱ subtotal gastrectomy (71.8%, 51/71. The differences in cause of bleeding were statistically different among younger, middle-aged and older groups (H=24.354, P<0.001, and the most common cause of bleeding was marginal ulcer. There were statistical differences in degree of bleeding, Forrest classification, and treatment methods (H=16.319, P=0.005; H=18.681, P=0.003; H=14.226, P=0.009 between patients with mild, moderate and severe condition. The efficacy rate for conservative medical treatment was 93.0% (66/71. The success rate of endoscopic hemostasis was 83.3% (15/18. Conclusions  Male, old age, longer than 5 years postoperation, and Billroth Ⅱ gastrectomy are high-risk factors for bleeding in the patients undergone subtotal gastrectomy. The comprehensive treatment with drugs, endoscopic hemostasis and surgical treatment are essential in rescuing critical patients. DOI: 10.11855/j.issn.0577-7402.2016.01.08

  13. MEDIUM-TERM FOLLOW-UP RESULTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY

    Science.gov (United States)

    RAMOS, Almino Cardoso; BASTOS, Eduardo Lemos de Souza; RAMOS, Manoela Galvão; BERTIN, Nestor Tadashi Suguitani; GALVÃO, Thales Delmondes; de LUCENA, Raphael Torres Figueiredo; CAMPOS, Josemberg Marins

    2015-01-01

    Background : The indications for sleeve gastrectomy in the surgical treatment of morbid obesity have increased worldwide. Despite this, several aspects related to results at medium and long term remain in constant research. Aim : To present the experience of sleeve gastrectomy in a center of excellence in bariatric surgery by analyzing clinical outcomes, complications and follow-up in the medium term. Methods : The study included 120 morbidly obese patients who underwent sleeve gastrectomy and who were followed for at least 24 months. Aspects related to surgical technique, surgical complications and clinical outcome were analyzed. Results : Seventy-five patients were women (62.5%) and the average age was 36 years. The body mass index preoperatively ranged from 35.5 to 58 kg/m2(average of 40.2 kg/m2). The length of stay ranged from 1 to 4 days (mean 2.1 days). Comorbidities observed were hypertension (19%), type 2 diabetes mellitus (6.6%), dyslipidemia (7.5%), sleep apnea (16.6%), reflux esophagitis (10%) and orthopedic diseases (7.5%). The mean body mass index and total weight loss percentage with 3, 12, 18 and 24 months were 32.2 kg/m2-19,9%; 29.5 kg/m2-26,5%; 28.2 kg/m2-30,3% and 26.9 kg/m2-32,7%, respectively. Remission of diabetes and dyslipidemia occurred in all patients. In relation to hypertension, there was improvement or remission in 86%. There were only two complications (bronchial pneumonia and dehydration), with good response to clinical treatment. There was no evidence digestive fistula and mortality was zero. Eleven patients (9.1%) had regained weighing more than 5 kg. Conclusion : The sleeve gastrectomy is surgical technique that has proven safe and effective in the surgical treatment of obesity and control of their comorbidities in postoperative follow-up for two years. PMID:26537277

  14. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

    OpenAIRE

    Aleksandr Kalabin; Mani, Vishnu R.; Ankita Mishra; Hector Depaz; Leaque Ahmed

    2017-01-01

    Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threat...

  15. The Effectiveness of Motivational Interviewing on Adherence to Treatment in Obese Patients Undergoing Sleeve Gastrectomy Surgery

    Directory of Open Access Journals (Sweden)

    2017-03-01

    Full Text Available Abstract Background & aim: Adherence is the degree of patient's success to do the health experts recommendations. The aim of present research was study the effects of motivational interviewing on adherence to in obese patients undergoing sleeve gastrectomy surgery. Methods: The design of present semi- experimental study was pre-test, post-test with control group. The statistical population included all obese patients (BMI≥35 that undergone laparoscopic sleeve gastrectomy surgery in Shiraz Ghadir Mother & Child Subspecialty Hospital, during the winter of 1394 and the spring of 1395. 30 of them were selected by using available sampling method and they randomly were asssigned to experimental (n=15 and control groups (n=15. The post bariatic surgery self-management behaviors questionnaire was used to collect data in two steps (pre-test and post-test. Motivational interviewing was implemented for the experimental group in four weeks (each week a 1/5 hour session. Data were analysed by using multivariate covariance analysis (MANCOVA. Results: MANCOVA results show that motivational interviewing led to a statistically significant difference between pre-test and post-test BSSQ total scores (P0/07. Conclusion: According to this study results, implementation of motivational interviewing is effective and appropriate in order to enhance adherence and self-management behaviors, achieve favorable weight loss & reduce postoperative complications, in obese patients undergoing sleeve gastrectomy surgery, but it appears that longer interventions are necessary to increase the rate of physical activity. Keywords: Motivational Interviewing, Adherence, Obese Patients, Sleeve Gastrectomy Surgery

  16. Evaluation of the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Chamanzari Hamid

    2016-08-01

    Full Text Available Background and Objective: The optimal treatment strategy for patients with gastric cancer is gastrectomy. Typically, nasogastric intubation is used after this type of surgery to feed patients; however, there seems to be no unanimity of opinion on this topic. Therefore, this study aimed to evaluate the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients. Materials and Method: This clinical trial was conducted on gastric cancer patients, admitted to the general ward of Imam Reza Hospital in Mashhad, Iran in 2015. In total, 68 patients were selected through randomized convenience sampling and divided into two intervention and control groups of 34 individuals. Nasogastric tube insertion was applied for the intervention group after the surgery. Patients of the study groups were fasted for three days after the surgery, which was followed by the removal of nasogastric tubes and initiation of oral feeding. Gastrointestinal function of all the participants was evaluated six hours after transferring to the ward up to seven days after the surgery on a daily basis using nausea and vomiting assessment tools and researcher-made questionnaire of gastrointestinal function. Data analysis was performed in SPSS version 16 using Fisher’s exact test, Chi-square, Mann-Whitney U, repeated measures ANOVA and paired t-test. Results: In this study, the severity of nausea and vomiting, the first time of passing gas and severity of flatulence Intensity were less observed in the control group, compared to the intervention group. Moreover, postoperative food tolerance was higher in the patients of the control group, compared to the other study group (P<0.05. Conclusion: According to the results of this study, nasogastric intubation can delay normal gastrointestinal function after gastrectomy. Therefore, it is not recommended to use this method after gastrectomy.

  17. Laparoscopic sleeve gastrectomy for a two-and half year old morbidly obese child ☆

    OpenAIRE

    Mohaidly, Mohammed Al; Suliman, Ahmed; Malawi, Horia

    2013-01-01

    INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is an accepted technique in bariatric surgery for reducing obesity. Recent reports indicate it to be effective even in children but it has not been tried in very young children. PRESENTATION OF CASE We report here a case of a 2 and half years old child subjected to LSG for his morbid obesity and associated obstructive sleep apnea and bowing of legs. LSG was performed after investigations ruled out hereditary or genetic causes of obesity. The ...

  18. The Radicalization Puzzle [video

    OpenAIRE

    Mohammed Hafez; Center for Homeland Defense and Security Naval Postgraduate School

    2015-01-01

    This 20 minute lecture, by Dr. Mohammad Hafez of the Naval Postgraduate School examines the driving factors behind the process of radicalization, turning seemingly ordinary men and women into potential terrorists. The lecture is based on the article "The Radicalization Puzzle: A Theoretical Synthesis of Empirical Approaches to Homegrown Extremism" in Studies in Conflict and Terrorism, by Mohammad Hafez and Creighton Mullins.

  19. Orgasm after radical prostatectomy

    NARCIS (Netherlands)

    Koeman, M; VanDriel, MF; Schultz, WCMW; Mensink, HJA

    1996-01-01

    Objective To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy, Patients and methods The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56-76) using a semi-structured interview and a self-administered

  20. Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

    Science.gov (United States)

    Almadi, Majid A; Bamihriz, Fahad; Aljebreen, Abdulrahman M

    2013-01-01

    Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents (SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwent a computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy. PMID:24392186

  1. Gastroduodenal ulcer treated by pylorus and pyloric vagus-preser-ving gastrectomy

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    AIM To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated with Billroth Ⅰ (BⅠ) and 20 cases with Billroth Ⅱ (BⅡ); advantages and shortcomings evaluated.RESULTS Not a single death after PPVPG. No recurrence of the disorder in the subsequent follow-up for an average of 6.5 years. Curative effect (visik Ⅰ & Ⅱ) 97.7%. Acidity reduction similar to that found in BⅠ and BⅡ, but 97.7% of the BⅠ and all BⅡ cases having more than second degree intestinal fluid reflux, in contrast to 7.1% in PPVPG cases. Dumping syndrome occurred in the BⅠ and BⅡ cases, none in PPVPG cases. With regard to gastric emptying, food digestion, absorption, body weight and life quality, PPVPG proved to be superior to Billroth procedure.CONCLUSION PPVPG has the advantages of conventional Billroth gastrectomy in reducing acid, removing ulcer focus, and at the same time preserves the pylorus and pyloric vagus for maintaining the normal gastric physiological function. Dumping syndrome, intestinal fluid reflux and other complications of conventional gastrectomy may be avoided.

  2. Long-term effect on carcinoma of esophagus of distal subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Yu-Ping Chen; Jie-Sheng Yang; Di-Tian Liu; Yu-Quan Chen; Wei-Ping Yang

    2004-01-01

    AIM: To investigate the surgical treatment and long-term survival for patients with carcinoma of esophagus after distal subtotal gastrectomy.METHODS: Resections of the tumor through left thoracotomy were performed in 85 patients with esophageal carcinoma following distal subtotal gastrectomy. The procedure involved preserving the left short gastric artery and transporting the residual stomach, the spleen and tail of the pancreas into the left thoracic cavity, and using the residual stomach to reconstruct the alimentary tract.RESULTS: The resectable rate was 91.8%, complication rate 10.3%, and no death occurred in the postoperative period. The 1-, 3-, 5-, and 10-year survival rates were 85.7%, 50.7%, 30.6% and 18.8%, respectively.CONCLUSION: Surgical resection is the optimal management method for the patients with esophageal carcinoma after distaJ subtotal gastrectomy. The reconstruction of digestive tract using anastomosis of the esophagus and the residual stomach is not only simple but also can achieve a better curative effect, promoting the digestive function and improving the quality of life.

  3. The Application of FJI and Its Comparison with Different Alimentary Reconstructions after Total Gastrectomy for Cances

    Institute of Scientific and Technical Information of China (English)

    HAOXishan; LIQiang; 等

    2002-01-01

    Objective To investigate the optimum reconstruction after total gastrectomy for malignant disease,especially the necessity of gastric substitute and duodenal passage.Methods Among the 459 total gastrectomy cases,6 kinds of reconstructions had been used,including Braun,modified Braun I(mBraun I),modified Braun Ⅱ(mBraun Ⅱ),Roux-en-Y,“P jejunal interposition(PJI)and functional jejunal interposition(FJI).Postoperative complains,body weight,food intake,serum nutritional paraments,complete blood cout,half-emptying time of the gastric substitute,PNI,Visick index were evaluated one year after r surgery.Results As compared with Braun group,the mBraun I,Ⅱ and Roux-en-Y groups which had some kinds of gastric substitute showed less reflux esophagitis and higher serum total protein(P<0.01).As compared with mBraun I,Ⅱ,Roux-en-Y,PJI and FJI groups which had duodenal passage showed better body weight,higher nutritional paraments and PNI(P<0.05).Conclusion It is essential to construct a gastric substitute and maintain the food chyme flowing through the duodenum after total gastrectomy,and the FJI is a better choice in this study.

  4. Endoscopic Retrograde Cholangiopancreatography Using a Dual-Lumen Endogastroscope for Patients with Billroth II Gastrectomy

    Directory of Open Access Journals (Sweden)

    Wei Yao

    2013-01-01

    Full Text Available Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy. Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed. Results. The success rate of selective cannulation was 82.6% (38/46. Of the 38 cases with successful selective cannulation, endoscopic sphincterotomy was achieved in 23 cases by placing the needle knife through the 2nd lumen, while endoscopic papillary balloon dilatation was conducted in the other 15 cases. Of the 8 failed cases of selective cannulation, 6 had failed afferent loop intubation, and 3 of these 6 patients had Braun’s anastomosis. The safety and efficacy of catheter-assisted endoscopic sphincterotomy were increased by placing the needle knife through the 2nd lumen without altering the conventional endoscopic sphincterotomy procedure. Conclusions. A dual-lumen forward-viewing endoscope can be safely and effectively used to perform ERCP in patients with a Billroth II gastrectomy, except for patients with additional Braun’s anastomosis.

  5. Effects of vagus nerve preservation and vagotomy on peptide YY and body weight after subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Hyung Hun Kim; Moo In Park; Sang Ho Lee; Hyun Yong Hwang; Sung Eun Kim; Seun Ja Park; Won Moon

    2012-01-01

    AIM:To investigate the relationship between the function of vagus nerve and peptide YY3-36 and ghrelin levels after subtotal gastrectomy,METHODS:We enrolled a total of 16 patients who underwent subtotal gastrectomy due to gastric cancer.All surgeries were performed by a single skilled surgeon.We measured peptide YY3-36,ghrelin,leptin,insulin,growth hormone levels,and body weight immediately before and one month after surgery.RESULTS:Vagus nerve preservation group showed less body weight loss and less increase of peptide YY3-36 compared with vagotomy group (-5.56 ± 2.24 kg vs -7.85 ± 1.57 kg,P =0.037 and 0.06 ± 0.08 ng/mL vs 0.19±0.12 ng/mL,P =0.021,respectively).Moreover,patients with body weight loss of less than 10% exhibited reduced elevation of peptide YY3-36 level,typically less than 20% [6 (66.7%) vs 0 (0.0%),P =0.011,odd ratio =3.333,95% confidence interval (1.293,8.591)].CONCLUSION:Vagus nerve preservation contributes to the maintenance of body weight after gastrectomy,and this phenomenon may be related to the suppressed activity of peptide YY3-36.

  6. Technique of totally robotic delta-shaped anastomosis in distal gastrectomy

    Directory of Open Access Journals (Sweden)

    Hidehiko Kitagami

    2017-01-01

    Full Text Available Background: We aimed to clarify the utility of delta-shaped anastomosis (Delta, an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG, in robot-assisted distal gastrectomy (RADG. Methods: RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler. Results: The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission. Conclusions: Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.

  7. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Portanova Michel

    2010-08-01

    Full Text Available Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent total gastrectomy, 9 of them had esophagojejunal fistula (5.2%. In three selected patients a trans-anastomotic naso-enteral feeding tube was placed under fluoroscopic vision when the fistula was clinically detected and a complete polymeric enteral formula was used. Results The complete closing of the esophagojejunal fistula was obtained in day 8, 14 and 25 respectively. Conclusion In some selected cases it is possible to make a successful enteral nutrition using a feeding tube distal to the leak area inserted with the help of fluoroscopic vision. The specialized management of a gastric surgery unit and nutritional therapy unit are highlighted.

  8. Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study.

    Directory of Open Access Journals (Sweden)

    Jian-Xian Lin

    Full Text Available BACKGROUND: Laparoscopic gastrectomy (LG for gastric cancer has increased in popularity due to advances in surgical techniques. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer compared with open gastrectomy (OG. METHODS: The study comprised 3,580 patients who were treated with curative intent either by laparoscopic gastrectomy (2,041 patients or open gastrectomy (1,539 patents between January 2005 and October 2013. The surgical outcomes were compared between the two groups. RESULTS: Laparoscopic gastrectomy was associated with significantly less blood loss, transfused patient number, time to ground activities, and post-operative hospital stay, but with similar operation time, time to first flatus, and time to resumption of diet, compared with the open gastrectomy. No significant difference in the number of lymph nodes dissected was observed between these two groups. The morbidity and mortality rates of the LG group were comparable to those of the OG group (13.6% vs. 14.4%, P = 0.526, and 0.3% vs. 0.2%, P = 0.740. The 3-year disease-free and overall survival rates between the two groups were statistically significant (P<0.05. According to the UICC TNM classification of gastric cancer, the 3-year disease-free and overall survival rates were not statistically different at each stage. CONCLUSIONS: Our single-center study of a large patient series revealed that LG for gastric cancer yields comparable surgical outcomes. This result was also true of local advanced gastric cancer (AGC. A well-designed randomized controlled trial comparing surgical outcomes between LG and OG in a larger number of patients for AGC can be carried out.

  9. Laparoscopic-assisted gastrectomy versus open gastrectomy for T4a gastric cancer in short-term and long-term outcomes.

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:To study thesafety of oncologic short-term and long-term outcomes of laparoscopic-assisted gastrectomy (LAG) performed for T4a stage gastric cancer. Methods: Between January 2009 and December 2014, 86 patients with American Joint Committee on Cancer (AJCC) stage T4a gastric cancer underwent LAG or conventional open gastrectomy (OG). Of these patients, 43 patients underwent LAG and they were compared with patients who underwent OG regarding short-term and long-term outcome. Results:The N stage (P=0.685) did not differ between the LAG and OG groups. Postoperative morbidity occurred in 6 (14.0%) OG and 8 (9.3%) LAG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OG and LAG, respectively. Recurrence occurred in 6 (14.0%) cases and 4 (9.3%) case in the OG and LAG group, respectively (P=0.077). hTe mean survival time in the OG group was 53.86 m)and in the LAG was 53.97 m with no signiifcant difference (P=0.295).Conclusion:The LAG is a feasible and safe procedure, and has several advantages over conventional OG.

  10. Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    Jong Won Kim; Jae-Ho Cheong; Woo Jin Hyung; Seung-Ho Choi; Sung Hoon Noh

    2012-01-01

    AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medical records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse. RESULTS: The mean follow-up duration was 33.7 mo (± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was significantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and significantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were significantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was significantly correlated to T2DM status (P = 0

  11. 地佐辛复合舒芬太尼在乳腺癌根治术术后镇痛中的应用%Application of dezocine combined with sufentanil for analgesia after breast cancer radical mastectomy

    Institute of Scientific and Technical Information of China (English)

    张钰; 齐敦益; 刘功俭; 卞新荣

    2014-01-01

    目的:评价地佐辛复合舒芬太尼用于乳腺癌术后患者自控静脉镇痛( PCIA)的可行性。方法 ASAⅠ-Ⅱ级乳腺癌根治术患者40例,随机分为2组:Ⅰ组为生理盐水组,手术结束前30 min注射生理盐水5 ml,术后PCIA使用舒芬太尼2μg/kg、托烷司琼4 mg;Ⅱ组为地佐辛组,手术结束前30 min注射地佐辛5 mg,术后PCIA使用舒芬太尼1μg/kg、地佐辛0.3 mg/kg、托烷司琼4 mg,均用生理盐水稀释为100 ml。记录术后1、4、8、244、8 h的视觉模拟镇痛评分( VAS)、Ramsay镇静评分及嗜睡、恶心、呕吐等不良反应发生情况。结果术后各时间点的VAS评分2组间差异无统计学意义(P>0.05),但Ⅱ组患者Ramsay镇静评分及患者术后的总体满意度显著优于Ⅰ组(P<0.05),且不良反应少。结论地佐辛复合舒芬太尼用于乳腺癌根治术术后PCIA的效果良好,且能明显减少舒芬太尼的用量,同时降低不良反应的发生。%Objective To evaluate the feasibility of a combination of dezocine and sufentanil for patient controlled intravenous analgesia (PCIA) after breast cancer radical mastectomy.Methods 40 ASA Ⅰ-Ⅱ patients undergoing breast cancer masterctomy were randomly divided into two groups .GroupⅠreceived 5 ml of normal saline 30 min prior to surgery, and then 2μg/kg sufentanil and 4 mg tropisetron for post-operative PCIA.GroupⅡwas injected with 5 mg of dezocine 30 min prior to surgery, and then 1μg/kg sufentanil, 0.3 mg/kg dezocine and 4 mg tropisetron (each dilu-ted with saline to 100 ml) for post-operative PCIA.Next, the visual analogue scale ( VAS) and the Ramsay sedation scale were scored 1, 4, 8, 24, and 48 hours after surgery.Meanwhile, drowsiness, nausea, vomiting and other adverse reactions were recorded .Results No statistical differences were found in the VAS scores of both groups at each time point (P>0.05).However, Group II reported remarkably superior

  12. Salvage robotic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Samuel D Kaffenberger

    2014-01-01

    Full Text Available Failure of non-surgical primary treatment for localized prostate cancer is a common occurrence, with rates of disease recurrence ranging from 20% to 60%. In a large proportion of patients, disease recurrence is clinically localized and therefore potentially curable. Unfortunately, due to the complex and potentially morbid nature of salvage treatment, radical salvage surgery is uncommonly performed. In an attempt to decrease the morbidity of salvage therapy without sacrificing oncologic efficacy, a number of experienced centers have utilized robotic assistance to perform minimally invasive salvage radical prostatectomy. Herein, we critically evaluate the existing literature on salvage robotic radical prostatectomy with a focus on patient selection, perioperative complications and functional and early oncologic outcomes. These results are compared with contemporary and historical open salvage radical prostatectomy series and supplemented with insights we have gained from our experience with salvage robotic radical prostatectomy. The body of evidence by which conclusions regarding the efficacy and safety of robotic salvage radical prostatectomy can be drawn comprises fewer than 200 patients with limited follow-up. Preliminary results are promising and some outcomes have been favorable when compared with contemporary open salvage prostatectomy series. Advantages of the robotic platform in the performance of salvage radical prostatectomy include decreased blood loss, short length of stay and improved visualization. Greater experience is required to confirm the long-term oncologic efficacy and functional outcomes as well as the generalizability of results achieved at experienced centers.

  13. Gnosticism and Radical Feminism

    DEFF Research Database (Denmark)

    Cahana, Jonathan

    2016-01-01

    and radical feminism would easily fall under this definition. There is, however, one major difference: since radical feminism is a relatively recent phenomenon which also benefited from modern modes of text production and preservation, almost all of the sources are still with us. This, in turn, may allow us...... to use radical feminism to make certain aspects of ancient Gnosticism re-emerge from their long submersion, provided that enough similarities can be independently drawn between the two phenomena to merit such a comparison. This paper therefore presents a comparison between concepts and positions...

  14. Radical aminomethylation of imines.

    Science.gov (United States)

    Fujii, Shintaro; Konishi, Takehito; Matsumoto, Yusuke; Yamaoka, Yousuke; Takasu, Kiyosei; Yamada, Ken-Ichi

    2014-09-05

    Taking advantage of the high level of performance of N-alkoxycarbonyl-imines, we achieved the first example of addition of the aminomethyl radical to imine. The reaction efficiency depended on the structure of the radical precursor, whether it is an iodide or a xanthate, and an electron-withdrawing group on the nitrogen atom of the radical. This reaction allows direct introduction of an N-substituted aminomethyl group onto imine to provide 1,2-diamine as well as the short-step synthesis of ICI-199,441.

  15. Radical chemistry of artemisinin

    Energy Technology Data Exchange (ETDEWEB)

    Denisov, Evgenii T; Solodova, S L; Denisova, Taisa G [Institute of Problems of Chemical Physics, Russian Academy of Sciences, Chernogolovka, Moscow Region (Russian Federation)

    2010-12-29

    The review summarizes physicochemical characteristics of the natural sesquiterpene peroxide artemisinin. The kinetic schemes of transformations of artemisinin radicals under anaerobic conditions are presented and analyzed. The sequence of radical reactions of artemisinin in the presence of oxygen is considered in detail. Special emphasis is given to the intramolecular chain oxidation resulting in the transformation of artemisinin into polyatomic hydroperoxide. The kinetic characteristics of elementary reaction steps involving alkyl, alkoxyl, and peroxyl radicals generated from artemisinin are discussed. The results of testing of artemisinin and its derivatives for the antimalarial activity and the scheme of the biochemical synthesis of artemisinin in nature are considered.

  16. Radical chemistry of artemisinin

    Science.gov (United States)

    Denisov, Evgenii T.; Solodova, S. L.; Denisova, Taisa G.

    2010-12-01

    The review summarizes physicochemical characteristics of the natural sesquiterpene peroxide artemisinin. The kinetic schemes of transformations of artemisinin radicals under anaerobic conditions are presented and analyzed. The sequence of radical reactions of artemisinin in the presence of oxygen is considered in detail. Special emphasis is given to the intramolecular chain oxidation resulting in the transformation of artemisinin into polyatomic hydroperoxide. The kinetic characteristics of elementary reaction steps involving alkyl, alkoxyl, and peroxyl radicals generated from artemisinin are discussed. The results of testing of artemisinin and its derivatives for the antimalarial activity and the scheme of the biochemical synthesis of artemisinin in nature are considered.

  17. A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition

    Directory of Open Access Journals (Sweden)

    Kazuhito Yajima

    2016-01-01

    Full Text Available A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SMN0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer’s early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach.

  18. A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition

    Science.gov (United States)

    Iwasaki, Yoshiaki; Yuu, Ken; Oohinata, Ryouki; Amaki, Misato; Kohira, Yoshinori; Natsume, Souichiro; Ishiyama, Satoshi; Takahashi, Keiichi

    2016-01-01

    A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SM)N0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer's early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach. PMID:27034881

  19. Enhanced binding capacity of boronate affinity adsorbent via surface modification of silica by combination of atom transfer radical polymerization and chain-end functionalization for high-efficiency enrichment of cis-diol molecules.

    Science.gov (United States)

    Wang, Wei; He, Maofang; Wang, Chaozhan; Wei, Yinmao

    2015-07-30

    Boronate affinity materials have been widely used for specific separation and preconcentration of cis-diol molecules, but most do not have sufficient capacity due to limited binding sites on the material surface. In this work, we prepared a phenylboronic acid-functionalized adsorbent with a high binding capacity via the combination of surface-initiated atom transfer radical polymerization (SI-ATRP) and chain-end functionalization. With this method, the terminal chlorides of the polymer chains were used fully, and the proposed adsorbent contains dense boronic acid polymers chain with boronic acid on the chain end. Consequently, the proposed adsorbent possesses excellent selectivity and a high binding capacity of 513.6 μmol g(-1) for catechol and 736.8 μmol g(-1) for fructose, which are much higher than those of other reported adsorbents. The dispersed solid-phase extraction (dSPE) based on the prepared adsorbent was used for extraction of three cis-diol drugs (i.e., epinephrine, isoprenaline and caffeic acid isopropyl ester) from plasma; the eluates were analyzed by HPLC-UV. The reduced amount of adsorbent (i.e., 2.0 mg) could still eliminate interferences efficiently and yielded a recovery range of 85.6-101.1% with relative standard deviations ranging from 2.5 to 9.7% (n = 5). The results indicated that the proposed strategy could serve as a promising alternative to increase the density of surface functional groups on the adsorbent; thus, the prepared adsorbent has the potential to effectively enrich cis-diol substances in real samples.

  20. Comparison of the short-term efficacies of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy in the treatment of obesity combined with type 2 diabetes mellitus%腹腔镜可调节胃束带术与胃袖状切除术治疗肥胖症合并2型糖尿病的近期疗效比较

    Institute of Scientific and Technical Information of China (English)

    王鑫; 常绪生; 印慨; 卓光鑽; 郑成竹

    2014-01-01

    Objective To compare the short-term efficacies of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity and type 2 diabetes mellitus,and to investigate the relationship between the body weight loss and the decrease of glucose of the 2 treatment methods.Methods The clinical data of 40 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Changhai Hospital of the Second Military Medical University from January 2010 to December 2011 were retrospectively analyzed.There were 14 patients treated by LAGB (LAGB group) and 26 by LSG (LSG group).The body weight loss and the decrease of glucose at postoperative year 1 of the 2 groups were compared.The differences in the body weight and glucose before and after operation within groups were compared using the paired t test,and the differences in the body weight and glucose between the 2 groups were compared using the multiple analysis of variance.The correlation between the body weight loss and the decrease of glucose was analyzed using the linear regression analysis.Results Laparoscopic surgery was successfully done without conversion to open surgery or intraoperative complications.The operation time and volume of blood loss were (69 ± 16)minutes and (31 ± 14)mL in the LAGB group,(120 ± 15) minutes and (148 ± 48) mL in the LSG group.Complications including postoperative malnutrition,electrolyte disturbance,delayed gastric emptying,bleeding,anastomotic leakage did not occurr in the 2 groups.Two patients were complicated with abdominal incision fat liquefaction,and were cured by symptomatic treatment.(1) The body weight,body mass index (BMI) and waistline had a decrease trend.The body weight,BMI and waistline in the LAGB group were decreased from (117 ± 28)kg,(40 ± 8)kg/m2 and (118 ± 15) cm before operation to (94 ± 28) kg,(33 ± 8) kg/m2 and (92 ± 15) cm at postoperative week 48.The body weight,BMI and waistline in the LSG

  1. Radical prostatectomy - discharge

    Science.gov (United States)

    ... to 6 months. You will learn exercises (called Kegel exercises) that strengthen the muscles in your pelvis. ... Radical prostatectomy Retrograde ejaculation Urinary incontinence Patient Instructions Kegel exercises - self-care Suprapubic catheter care Urinary catheters - ...

  2. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

    Directory of Open Access Journals (Sweden)

    Lin Jian-Xian

    2013-01-01

    Full Text Available Abstract Background Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion. Methods A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period. Results There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P Conclusion Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary.

  3. The impact of obesity on the use of a totally laparoscopic distal gastrectomy in patients with gastric cancer.

    Science.gov (United States)

    Oki, Eiji; Sakaguchi, Yoshihisa; Ohgaki, Kippei; Saeki, Hiroshi; Chinen, Yoshiki; Minami, Kazuhito; Sakamoto, Yasuo; Toh, Yasushi; Kusumoto, Testuya; Okamura, Takeshi; Maehara, Yoshihiko

    2012-06-01

    Since a patient's obesity can affect the mortality and morbidity of the surgery, less drastic surgeries may have a major benefit for obese individuals. This study evaluated the feasibility of performing a totally laparoscopic distal gastrectomy, with intracorporeal anastomosis, in obese patients suffering from gastric cancer. This was a retrospective analysis of the 138 patients, who underwent a totally laparoscopic distal gastrectomy from April 2005 to March 2009, at the National Kyushu Cancer Center. The body mass index of 20 patients was ≥25, and in 118 patients, it was obese patients than in the non-obese patients. The intraoperative blood loss, duration of surgery, post-operative complication rate, post-operative hospital stay, and a number of retrieved lymph nodes were not significantly different between the two groups. Intracorporeal anastomosis seemed to have a benefit for obese individuals. Totally laparoscopic gastrectomy is, therefore, considered to be a safe and an effective modality for obese patients.

  4. Staple-line leak after sleve gastrectomy in obese patients:A hot topic in bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Laparoscopic sleeve gastrectomy is a surgical procedurethat is being increasingly performed on obese patients.Among its complications, leaks are the most seriousand life threatening. The placement of esophageal,covered, self-expandable metal stents in these caseshas been performed by many authors but reports on theoutcome of this procedure are limited and the technicalaspects are not well defined. Stent migration is the maincomplication of the procedure and poses a challenge tothe surgeon, with a limited number of options. Here weevaluate the technical and clinical outcome of a new,dedicated, self-expanding metal stent, comparing theadvantages of this stent to those traditionally used totreat staple-line leak after sleeve gastrectomy. Whilepublished data are limited, they seem support the use ofthis kind of new stent as the best option for the stentingtreatment of a staple-line leak after sleeve gastrectomy,over other kinds of stents. Further studies based onlarger series are needed to better evaluate patientoutcome.

  5. [Laparoscopic Gastrostomy for a Patient with Wernicke's Encephalopathy after Gastrectomy--A Case Report with a Literature Review].

    Science.gov (United States)

    Arita, Tomohiro; Komatsu, Shuhei; Kosuga, Toshiyuki; Konishi, Hirotaka; Morimura, Ryo; Murayama, Yasutoshi; Kuriu, Yoshiaki; Shiozaki, Atsushi; Ikoma, Hisashi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Okamoto, Kazuma; Otsuji, Eigo

    2015-11-01

    Wernicke's encephalopathy is usually related to alcoholism, malnutrition, or hyperemesis gravidarum. We report a case of Wernicke's encephalopathy after distal gastrectomy for gastric cancer. A 58-year-old man underwent distal gastrectomy with Billroth Ⅰreconstruction for early gastric cancer. Nine months later, he developed anorexia and vomiting for a few days. Brain MRI showed no significant findings, and he resumed ingestion 5 days after admission. On the 8th day of hospitalization, dysphagia suddenly developed and brain MRI indicated Wernicke's encephalopathy. Vitamin B1 was immediately injected, and neurological symptoms gradually improved. However, dysphagia did not adequately improve, leading to severe aspiration pneumonitis. Laparoscopic gastrostomy was performed for aspiration of the stomach contents and initiation of enteral nutrition. After gastrostomy, the patient made good progress and was transferred to a rehabilitation hospital. We should recognize that gastrectomy can cause Wernicke's encephalopathy.

  6. [Simultaneous totally laparoscopic total gastrectomy and low anterior resection for synchronous gastric and rectal cancer; a case report].

    Science.gov (United States)

    Hidaka, Gen; Saeki, Hiroshi; Oki, Eiji; Morita, Masaru; Ikeda, Tetsuo; Maehara, Yoshihiko

    2013-08-01

    Simultaneous operations for synchronous cancers are thought to increase in the near future due to recent advancement of laparoscopic surgery. A 75-year-old male patient was admitted to our hospital and diagnosed as synchronous gastric and rectal cancer (gastric cancer: cT2N0M0 StageIB, rectal cancer: cSEN0M0 StagII). The simultaneous totally laparoscopic total gastrectomy and low anterior resection was scheduled. The low anterior resection was first performed with five ports on the lower abdomen, and followed by the total gastrectomy with addition of 3 ports on the upper abdomen. The postoperative course was uneventful. This case suggest that the simultaneous totally laparoscopic total gastrectomy and low anterior resection was useful operation for patients with synchronous gastric and rectal cancers. We herein report the case and discuss based on some literatures.

  7. Mobile protons versus mobile radicals: gas-phase unimolecular chemistry of radical cations of cysteine-containing peptides.

    Science.gov (United States)

    Lam, Adrian K Y; Ryzhov, Victor; O'Hair, Richard A J

    2010-08-01

    A combination of electrospray ionization (ESI), multistage, and high-resolution mass spectrometry experiments are used to examine the gas-phase fragmentation reactions of radical cations of cysteine containing di- and tripeptides. Two different chemical methods were used to form initial populations of radical cations in which the radical sites were located at different positions: (1) sulfur-centered cysteinyl radicals via bond homolysis of protonated S-nitrosocysteine containing peptides; and (2) alpha-carbon backbone-centered radicals via Siu's sequence of reactions (J. Am. Chem. Soc.2008, 130, 7862). Comparison of the fragmentation reactions of these regiospecifically generated radicals suggests that hydrogen atom transfer (HAT) between the alpha C-H of adjacent residues and the cysteinyl radical can occur. In addition, using accurate mass measurements, deuterium labeling, and comparison with an authentic sample, a novel loss of part of the N-terminal cysteine residue was shown to give rise to the protonated, truncated N-formyl peptide (an even-electron x(n) ion). DFT calculations were performed on the radical cation [GCG]*(+) to examine: the relative stabilities of isomers with different radical and protonation sites; the barriers associated with radical migration between four possible radical sites, [G*CG](+), [GC*G](+), [GCG*](+), and [GC(S*)G](+); and for dissociation from these sites to yield b(2)-type ions. Copyright 2010 American Society for Mass Spectrometry. Published by Elsevier Inc. All rights reserved.

  8. Effect of obesity on intraoperative bleeding volume in open gastrectomy with D2 lymph-node dissection for gastric cancer

    Directory of Open Access Journals (Sweden)

    Nagano Yasuhiko

    2008-04-01

    Full Text Available Abstract Background To investigate the effect of obesity on open gastrectomy with D2 lymph-node dissection. Methods Between January 2005 and March 2007, 100 patients with preoperatively diagnosed gastric cancer who underwent open gastrectomy with D2 lymph-node dissection were enrolled in this study. Of these, 61 patients underwent open distal gastrectomy (ODG and 39 patients underwent open total gastrectomy (OTG. Patients were classified as having a high body-mass index (BMI; ≥ 25.0 kg/m2; n = 21 or a normal BMI (2; n = 79. The visceral fat area (VFA and subcutaneous fat area (SFA were assessed as identifiers of obesity using FatScan software. Patients were classified as having a high VFA (≥ 100 cm2; n = 34 or a normal VFA (2; n = 66. The relationship between obesity and short-term patient outcomes after open gastrectomy was evaluated. Patients were classified as having high intraoperative blood loss (IBL; ≥ 300 ml; n = 42 or low IBL (n = 58. Univariate and multivariate analyses were used to identify predictive factors for high IBL. Results Significantly increased IBL was seen in the following: patients with high BMI versus normal BMI; patients with gastric cancer in the upper third of the stomach versus gastric cancer in the middle or lower third of the stomach; patients who underwent OTG versus ODG; patients who underwent splenectomy versus no splenectomy; and patients with high VFA versus low VFA. BMI and VFA were significantly greater in the high IBL group than in the low IBL group. There was no significant difference in morbidity between the high IBL group and the low IBL group. Multivariate analysis revealed that patient age, OTG and high BMI or high VFA independently predicted high IBL. Conclusion It is necessary to perform operative manipulations with particular care in patients with high BMI or high VFA in order to reduce the IBL during D2 gastrectomy.

  9. Converting a Sleeve Gastrectomy to a Gastric Bypass for Weight Loss Failure-Is It Worth It?

    Science.gov (United States)

    Nevo, Nadav; Abu-Abeid, Subhi; Lahat, Guy; Klausner, Joseph; Eldar, Shai M

    2017-09-10

    Sleeve gastrectomy (SG) is gaining popularity and has become the procedure of choice for many bariatric surgeons. Long-term weight loss failure is not uncommon. The preferred revisional procedure for these patients is still under debate. The objective of this study was to assess the safety and efficacy of laparoscopic gastric bypass as a revisional surgery for sleeve gastrectomy patients with weight loss failure. The study was done at a bariatric surgery center in a university hospital. We reviewed our prospectively collected database and identified all patients who underwent conversion of a sleeve gastrectomy to a gastric bypass for weight loss failure. Data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved. Twenty-three patients with a mean body mass index (BMI) of 41.6 kg/m2 (range 34.1-50.1 kg/m2) underwent conversion to a gastric bypass. Four patients underwent a gastric band prior to the sleeve gastrectomy, and two patients underwent a re-sleeve gastrectomy prior to conversion to a gastric bypass. At a mean follow-up of 24 months (range 9-46 months), the average body mass index (BMI) decreased to 33.8 kg/m2 and the excess body mass index loss (EBMIL) was 42.6%. Diabetes, hypertension, dyslipidemia, and obstructive sleep apnea resolved or improved in 44.4, 45.5, 50, and 50% of the patients, respectively. Three patients developed early postop complications (13%), while late complications occurred in four patients (17%). Converting a sleeve gastrectomy to a gastric bypass for weight loss failure is safe, yet weight loss benefit is limited.

  10. Free Radical Reactions in Food.

    Science.gov (United States)

    Taub, Irwin A.

    1984-01-01

    Discusses reactions of free radicals that determine the chemistry of many fresh, processed, and stored foods. Focuses on reactions involving ascorbic acid, myoglobin, and palmitate radicals as representative radicals derived from a vitamin, metallo-protein, and saturated lipid. Basic concepts related to free radical structure, formation, and…

  11. Efficacy of biofeedback combined with electrical stimulation therapy for retention after radical hysterectomy%生物反馈联合电刺激治疗宫颈癌根治术后尿潴留的疗效分析

    Institute of Scientific and Technical Information of China (English)

    傅琦博; 吕坚伟; 蒋晨; 吕婷婷; 李震东; 邱丰; 黄翼然

    2015-01-01

    ABSTRACT:Objective To investigate the efficacy of biofeedback combined with electrical stimulation therapy for reten‐tion after radical hysterectomy .Methods A total of 38 cases with retention after radical hysterectomy treated during June 2012 to May 2014 were randomly divided into two groups .The trial group was treated with pelvic floor biofeedback with elec‐trical stimulation AM800B for 20 to 30 minutes once daily for a week ,while the control group was treated with traditional blad‐der training .Results After one week of trement ,the effective rate for the trial group was 89 .47% (17/19) ,which was higher than 52 .63% (10/19) ,the rate for the control group (P0 .05 ) .Conclusions Pelvic floor biofeedback with electrical stimulation therapy can improve the urinary function effectively within a short period of time .It is worth clinical application .%目的:评估生物反馈联合电刺激治疗宫颈癌根治术后尿潴留的疗效。方法2012年6月至2014年5月共收治38例宫颈癌根治术后尿潴留患者,随机分成2组,治疗组采用生物反馈治疗仪进行生物反馈联合电刺激治疗,治疗时间约为20~30 min ,1次/d ,疗程1周;对照组采用传统膀胱功能训练进行治疗,对比两组间的疗效。结果1周后疗效比较,治疗组有效率89.47%(17/19),对照组52.63%(10/19),治疗组疗效明显优于对照组( P<0.05);2周后疗效比较,治疗组有效率达到94.74%(18/19),对照组89.47%(17/19),两组间统计学无明显差异( P>0.05)。结论采用生物反馈联合电刺激治疗宫颈癌根治术后尿潴留能明显缩短恢复患者排尿功能的时间,且创伤小,无明显不良反应,容易被患者接受,值得临床推广。

  12. Laparoscopic gastrectomy versus open gastrectomy for gastric cancer in patients with body mass index of 30 kg/m2 or more.

    Science.gov (United States)

    Son, Sang-Yong; Jung, Do-Hyun; Lee, Chang Min; Ahn, Sang-Hoon; Ahn, Hye Seong; Park, Do Joong; Kim, Hyung-Ho

    2015-08-01

    High body mass index (BMI) and high visceral fat area (VFA) are known to be a preoperative risk factor for laparoscopic gastrectomy (LG) for gastric cancer. However, the impact of obesity on LG still remains controversial. In the present study, we compared the operative outcomes of LG with those of OG in patients with BMI of 30 kg/m(2) or more. Seventy-seven patients who underwent distal or total gastrectomy for gastric cancer were enrolled. The patients were divided into two groups by approach method; an OG group (n = 19) and a LG group (n = 62). Aquarius iNtuition(®) program was used to measure VFA. The operation time, estimated blood loss, complication rate, the number of retrieved lymph nodes, and patient survival were compared between two groups. The mean BMI and VFA were 31.6 kg/m(2) and 195.3 cm(2). The complication rate was 42.1 % in OG group and 14.5 % in LG group, respectively (P = 0.010). LG group showed less estimated blood loss (P = 0.030) and fast recovery of bowel movement (P < 0.001). However, there were no significant differences in operation time, the number of retrieved lymph nodes, and the length of hospital stay between two groups. In subgroup analysis, there was significant correlation between estimated blood loss and VFA (R (2) = 0.113, P = 0.014), but there was no correlation between operation time and VFA (R(2) = 0.002, P = 0.734). In stage I, the 5-year survival was not different between two groups (P = 0.220). LG showed better operative outcomes compared with OG, in terms of less estimated blood loss, fast recovery of bowel movement, and low complication rate, in patients with BMI of ≥ 30 kg/m(2) or more.

  13. Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

    Directory of Open Access Journals (Sweden)

    Mikito Inokuchi

    2016-01-01

    Full Text Available Background. Some meta-analyses of case-controlled studies (CCSs have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG had some short-term advantages over open total gastrectomy (OTG. However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients’ status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29–0.85, P=0.01, I2 = 0%, and OR 0.46, 95% CI 0.17–0.52, P<0.0001, I2 = 0%. However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96–2.16, P=0.08, I2 = 0%. Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.

  14. Hydroxyl radical generation by red tide algae.

    Science.gov (United States)

    Oda, T; Akaike, T; Sato, K; Ishimatsu, A; Takeshita, S; Muramatsu, T; Maeda, H

    1992-04-01

    The unicellular marine phytoplankton Chattonella marina is known to have toxic effects against various living marine organisms, especially fishes. However, details of the mechanism of the toxicity of this plankton remain obscure. Here we demonstrate the generation of superoxide and hydroxyl radicals from a red tide unicellular organism, C. marina, by using ESR spectroscopy with the spin traps 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) and N-t-butyl-alpha-phenylnitrone (PBN), and by using the luminol-enhanced chemiluminescence response. The spin-trapping assay revealed productions of spin adduct of superoxide anion (O2-) (DMPO-OOH) and that of hydroxyl radical (.OH) (DMPO-OH) in the algal suspension, which was not observed in the ultrasonic-ruptured suspension. The addition of superoxide dismutase (500 U/ml) almost completely inhibited the formation of both DMPO-OOH and DMPO-OH, and carbon-centered radicals were generated with the disappearance of DMPO-OH after addition of 5% dimethyl sulfoxide (Me2SO) and 5% ethanol. Furthermore, the generation of methyl and methoxyl radicals, which are thought to be produced by the reaction of hydroxyl radical and Me2SO under aerobic condition, was identified using spin trapping with a combination of PBN and Me2SO. Luminol-enhanced chemiluminescence assay also supported the above observations. These results clearly indicate that C. marina generates and releases the superoxide radical followed by the production of hydroxyl radical to the surrounding environment. The velocity of superoxide generation by C. marina was about 100 times faster than that by mammalian phagocytes per cell basis. The generation of oxygen radical is suggested to be a pathogenic principle in the toxication of red tide to susceptible aquaculture fishes and may be directly correlated with the coastal pollution by red tide.

  15. [Total gastrectomy for gastric cancer in patients over 70 years old].

    Science.gov (United States)

    Ruiz, E; Quispe, D; Celis, J; Berrospi, F; Payet, E

    2001-01-01

    To determine if the morbidity and postoperative mortality after a full gastrectomy for gastric cancer performed on patients of more than 70 years of age were different from those of younger patients. Between 1980 and 1999, a total of 411 gastrectomies for gastric adenocarcinoma were performed at the Institute of Cancer Diseases (INEN). Of these, 87 were inpatients older than 70 years of age (elderly group) and 92 were inpatients between 50 and 59 years of age (young group). The clinical record of both groups were studied and the clinical-pathological features, morbidity and postoperative mortality, staying time in hospital and survival rate were compared. There was no significant difference between the two groups regarding clinical-pathological features except in the TNM stage. In the elderly group 23.0% had stage IV and 43.5% in the young group (p=0.007). The average operating time in the elderly group was shorter than in the young group (5.5 hours versus 6.0 hours, p=0.015). The morbidity for the elderly group was 29.9% and that of the young group was 34.8%, whereas the postoperative mortality for the elderly and young groups was 4.6% and 2.2%, respectively. Pneumonia was the most frequent postoperative complication (14.8%) and the primary cause of postoperative death in the elderly group. Time in hospital and survival were similar between both groups. The morbidity and postoperative mortality after a full gastrectomy for cancer of the stomach in the elderly is no different from those found in younger patients.

  16. Gastritis in patients undergoing sleeve gastrectomy: Prevalence, ethnic distribution, and impact on glycemic.

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables.One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications.Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP.There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results.

  17. Evaluation of electrical activity after vagus nerve-preserving distal gastrectomy using multichannel electrogastrography

    Science.gov (United States)

    Murakami, Haruaki; Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Nakamura, Masafumi; Hirai, Toshihiro

    2013-01-01

    Background Multichannel electrogastrography (M-EGG) can be used to evaluate gastrointestinal motility. The myoelectric activity of the remnant stomach after surgery has not been measured by M-EGG. This study examined whether myoelectric activity varied with surgical technique and compared vagus nerve-preserving distal gastrectomy (VP-DG) with standard distal gastrectomy without vagus nerve preservation (DG). Furthermore, we examined the relationship between the M-EGG findings and patients' postoperative symptoms. Methods Twenty-six patients who underwent VP-DG, 20 who underwent DG, and 12 healthy volunteers as controls were examined with M-EGG. The Gastrointestinal Symptom Rating Scale (GSRS) was used to assess postoperative symptoms. Results Longer periods of normal gastric function (normogastria, 2.0–4.0 cycle min–1) were detected in channel 1 in the VP-DG group than in the DG group in either the fasted or fed state (P<0.05). The percentage of slow wave coupling (%SWC) in the fed state correlated negatively with GSRS scores (reflux, r=–0.59, P=0.02; abdominal pain, r=–0.51, P=0.04, indigestion, r=–0.59, P=0.02 and total score, r=–0.75, P=0.02). Conclusions Slow waves can be recorded non-invasively using M-EGG in the remnant stomach following gastrectomy. The VP-DG group showed better preserved gastric myoelectric activity than the DG group, and the %SWC showed a significant negative correlation with scores of GSRS (reflux, abdominal pain, indigestion and total score) in the VP-DG group. PMID:23832614

  18. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

    Science.gov (United States)

    Fukuda, Yasunari; Yamamoto, Kazuyoshi; Hirao, Motohiro; Nishikawa, Kazuhiro; Nagatsuma, Yukiko; Nakayama, Tamaki; Tanikawa, Sugano; Maeda, Sakae; Uemura, Mamoru; Miyake, Masakazu; Hama, Naoki; Miyamoto, Atsushi; Ikeda, Masataka; Nakamori, Shoji; Sekimoto, Mitsugu; Fujitani, Kazumasa; Tsujinaka, Toshimasa

    2016-07-01

    Malignancy is a secondary cause of sarcopenia, which is associated with impaired cancer treatment outcomes. The aim of this study was to investigate the prevalence of preoperative sarcopenia among elderly gastric cancer patients undergoing gastrectomy and the differences in preoperative dietary intake and postoperative complications between sarcopenic and non-sarcopenic patients. Ninety-nine patients over 65 years of age who underwent gastrectomy for gastric cancer were analyzed. All patients underwent gait and handgrip strength testing, and whole-body skeletal muscle mass was measured using a bioimpedance analysis technique based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm for the evaluation of sarcopenia before surgery. Preoperative dietary intake was assessed using a food frequency questionnaire. Of these patients, 21 (21.2 %) were diagnosed with sarcopenia. Sarcopenic patients consumed fewer calories and less protein preoperatively (23.9 vs. 27.8 kcal/kg ideal weight/day and 0.86 vs. 1.04 g/kg ideal weight/day; P = 0.001 and 0.0005, respectively). Although the overall incidence of postoperative complications was similar in the two groups (57.1 % vs. 35.9 %; P = 0.08), the incidence of severe (Clavien-Dindo grade ≥ IIIa) complications was significantly higher in the sarcopenic group than in the non-sarcopenic group (28.6 % vs. 9.0 %; P = 0.029). In the multivariate analysis, sarcopenia alone was identified as a risk factor for severe postoperative complications (odds ratio, 4.76; 95 % confidence interval, 1.03-24.30; P = 0.046). Preoperative sarcopenia as defined by the EWGSOP algorithm is a risk factor for severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

  19. Gastrectomy for gastric carcinoma with situs inversus totalis: case report and literature review

    Science.gov (United States)

    Zhu, H; Yang, K; Hu, JK

    2015-01-01

    Background: Situs inversus totalis (SIT), a rare congenital anomaly, is characterized by a complete mirror image transposition of the thoracic and abdominal viscera. We report the case of a 66-year-old woman with SIT who was diagnosed with gastric antral carcinoma. Curative distal gastrectomy with Billroth-I anastomosis was performed. Description of the case: A 66-year-old woman visited our outpatient department complaining of abdominal pain in the left upper quadrant for about one year. Physical examination revealed that the apex beat was in the right fifth intercostal space, just at the midclavicular line while a soft systolic murmur was audible at the upper right sternal border. The abdominal examination was unremarkable. The preoperative diagnosis was confirmed by gastroscopy and biopsy. Preoperative echocardiogram revealed the presence of dextrocardia and atrial septal defect. Preoperative contrasted computed tomography showed a complete right-left reversal of the thoracic and abdominal organs and thickened wall of gastric antrum without distant metastasis. Laparotomy through a midline incision confirmed the complete mirror-image transposition of the abdominal visceral organs and a 4-cm tumor with serosal involvement at the gastric antrum. Curative distal gastrectomy with D2 lymphadenectomy and Billroth-I anastomosis was performed. The patient had a rapid recovery and was discharged without any complications. The final staging of this case was pT4aN1M0, stage IIIa and she received chemotherapy with the SOX regimen for three cycles. Fifteen months after the operation, the patient is alive without any signs of recurrence. Conclusions: The incidence of gastric cancer with SIT is very rare. Appropriate diagnostic modalities are very helpful for the diagnosis and preoperative planning. Gastrectomy with D2 lymphadenectomy in patients with SIT can be performed successfully with sufficient preoperative evaluation, comprehensive knowledge of anatomy, and meticulous

  20. Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Nobuaki Fujikuni; Kazuaki Tanabe; Noriaki Tokumoto; Takahisa Suzuki; Minoru Hattori; Toshihiro Misumi; Hideki Ohdan

    2016-01-01

    AIM: To assess the safety of enhanced recovery after surgery(ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance. METHODS: Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group(CG) or ERAS group(EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d. Secondary endpoints were the incidence of aspiration at anesthesia induction, incidence of postoperative complications, health related quality of life(HRQOL) using the SF8 Health Survey questionnaire, nutrition state [e.g., albumin, transthyretin(TTR), retinal-binding protein(RBP), and transferrin(Tf)], the homeostasis model assessment-insulin resistance(HOMA-R) index, postoperative urine volume,postoperative weight change, and postoperative oral intake.RESULTS: The ERAS program was noninferior to the conventional program in achieving discharge from the hospital within 12 d(95.0% vs 92.5% respectively; 95%CI:-10.0%-16.0%). There was no significant difference in postoperative morbidity between the two groups. Adverse events such as vomiting and aspiration associated with the induction of general anesthesia were not observed. There were no significant differences with respect to postoperative urine volume, weight change, and oral intake between the two groups. EG patients with preoperative HOMA-R scores above 2.5 experienced significant attenuation of their HOMA-R scores on postoperative day 1 compared to CG patients(P = 0.014). There were no significant differences with respect to rapid turnover proteins(TTR, RBP and Tf) or HRQOL scores using the SF8 method.CONCLUSION: Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.

  1. Sleeve gastrectomy prevents lipoprotein receptor-1 expression in aortas of obese rats

    Institute of Scientific and Technical Information of China (English)

    Jie Bai; Yong Wang; Yuan Liu; Dong-Hua Geng; Jin-Gang Liu

    2011-01-01

    AIM: To investigate the effects of sleeve gastrectomy on adipose tissue infiltration and lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) expression in rat aortas.METHODS: Twenty-four rats were randomized into three groups: normal chow (control), high fat diet (HD) and high fat diet with sleeve gastrectomy (SG). After surgery, the HD and SG groups were fed a high fat diet. Animals were sacrificed and plasma high density lipoprotein (HDL) and low density lipoprotein (LDL) lev-els were determined. LOX-1 protein and LOX-1 mRNA expression was also measured. Aortas were stained with Nile red to visualize adipose tissue.RESULT: Body weights were higher in the HD group compared to the other groups. HDL levels in control, HD, and SG groups were 32.9 ± 6.2 mg/dL, 43.4 ± 4.0 mg/dL and 37.5 ± 4.3 mg/dL, respectively. LDL levels in control, HD, and SG groups were 31.8 ± 4.5 mg/dL, 53.3 ± 5.1 mg/dL and 40.5 ± 3.7 mg/dL, respectively. LOX-1 protein and LOX-1 mRNA expression was greater in the HD group versus the other groups. Staining for adipose tissue in aortas was greater in the HD group in comparison to the other groups. Thus, a high fat diet elevates LOX-1 protein and mRNA expression in aorta. CONCLUSION: Sleeve gastrectomy decreases plasma LDL levels, and downregulates LOX-1 protein and mRNA expression.

  2. Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

    Institute of Scientific and Technical Information of China (English)

    Naoki; Hashimoto

    2015-01-01

    AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

  3. Leaks in fixed-ring banded sleeve gastrectomies: a management approach.

    Science.gov (United States)

    Foo, Jonathan W; Balshaw, James; Tan, Michael H L; Tan, Jeremy T H

    2017-08-01

    The use of a Fobi ring to prevent pouch dilation is sometimes used in Roux-en-Y gastric bypass (RYGB). Recently, it has been extrapolated to laparoscopic sleeve gastrectomy (LSG) procedures by placing a fixed-ring band a few centimeters below the gastroesophageal junction (GEJ). What is the consequence if a patient develops a leak? Tertiary metropolitan referral center, Australia. Over 18 months, all patients with either a conventional LSG or a fixed-ring banded sleeve gastrectomy (BLSG) who presented with a proven leak complication were included. The management approaches along with the surgical, endoscopic, and percutaneous procedures used were examined. Six patients had a BLSG leak and 6 had a LSG leak. All patients had leak resolution. There was no significant difference in body mass index (BMI), time to leak, initial white cell count (WCC), and C-reactive protein (CRP) levels between the 2 groups. LSG patients required a median of 2 endoscopic procedures (range: 1-3). Stents were deployed in 3 patients. All BLSG patients required a single surgical intervention with laparoscopic washout, drainage, removal of band±feeding jejunostomy. One stent was deployed in 1 BLSG patient. BLSG leak resolution was found at 34±12 days versus 85±12 days in the LSG group (P< .05). The BLSG is a new modification of the sleeve gastrectomy procedure. This study presents a management strategy for leak resolution employed in BLSG patients. The presence of a foreign body as a persistent nidus of infection mandates band removal. Copyright © 2017 American Society for Bariatric Surgery. All rights reserved.

  4. FXR is a molecular target for the effects of vertical sleeve gastrectomy

    DEFF Research Database (Denmark)

    Ryan, Karen K; Tremaroli, Valentina; Clemmensen, Christoffer

    2014-01-01

    Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are at present the most effective therapy for the treatment of obesity, and are associated with considerable improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms contributing......-X receptor, also known as NR1H4). We therefore examined the results of VSG surgery applied to mice with diet-induced obesity and targeted genetic disruption of FXR. Here we demonstrate that the therapeutic value of VSG does not result from mechanical restriction imposed by a smaller stomach. Rather, VSG...... molecular underpinning for the beneficial effects of this weight-loss surgery....

  5. The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer.

    Science.gov (United States)

    Lee, Hyuk-Joon; Kim, Hyung-Ho; Kim, Min-Chan; Ryu, Seong-Yeob; Kim, Wook; Song, Kyo-Young; Cho, Gyu-Seok; Han, Sang-Uk; Hyung, Woo Jin; Ryu, Seung-Wan

    2009-11-01

    Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI > or = 25 kg/m(2); n = 432) and low BMI (BMI gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

  6. Does Roux-en-Y gastrectomy for gastric cancer influence glucose homeostasis in lean patients?

    Science.gov (United States)

    Hayashi, Silvia Y; Faintuch, Joel; Yagi, Osmar K; Yamaguchi, Camila M; Faintuch, Jacob J; Cecconello, Ivan

    2013-08-01

    Cancer gastrectomy seems to benefit type 2 diabetes; however, results are conflicting. In a prospective protocol, including retrospective information, the aim was assessment of changes in glucose profile in patients with both normal and deranged preoperative glucose homeostasis. Patients (N = 164) with curative subtotal or total Roux-en-Y gastrectomy for gastric cancer (n = 92), or Roux-en-Y gastric bypass for morbid obesity (RYGB, n = 72) were preoperatively classified into diabetes (including prediabetes) and control group. Postoperative diabetes outcome was stratified as responsive or refractory, and results in controls were correspondingly defined as stable or new-onset diabetes (NOD), according to fasting blood glucose and HbA1c. Dietary intake and biochemical profile was documented. Statistical methods included analysis of variance, multivariate logistic regression, and propensity score matching according to postoperative weight loss. Age of cancer cases was 67.9 ± 11.5 years, 56.5 % males, initial body mass index (BMI) 24.7 ± 3.7, current BMI 22.6 ± 3.8 kg/m(2), and follow-up 102.1 ± 51.0 months, whereas in bariatric individuals age was 51.4 ± 10.1 years, 15.3 % males, initial BMI 56.7 ± 12.2, current BMI 34.8 ± 8.1 kg/m(2), and follow-up 104.1 ± 29.7 months. Refractory disease corresponded to 62.5 % (cancer) versus 23.5 % (bariatric) (P = 0.019), whereas NOD represented 69.2 versus 23.8 % respectively (P = 0.016). Weight loss (ΔBMI) was associated with diabetes response in cancer patients but not with NOD. No difference between subtotal and total gastrectomy was detected. Divergent outcomes (refractory vs. responsive) were confirmed in BMI-similar, propensity-matched cancer gastrectomy patients with preoperative diabetes, consistent with weight-dependent and -independent benefits. Diabetes response was confirmed, however with more refractory cases than in bariatric controls, whereas high proportions of NOD occurred. Such dichotomous pattern seems

  7. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report.

    Science.gov (United States)

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-03-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition.

  8. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report

    Science.gov (United States)

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-01-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition. PMID:25785319

  9. Hereditary diffuse gastric cancer: genetics, prophylactic total gastrectomy, and follow up

    Directory of Open Access Journals (Sweden)

    Shenoy S

    2011-04-01

    Full Text Available Santosh Shenoy1, Carl Palmer2, Teresa Dunsworth3, Stephen McNatt41Department of Surgery, Louis A Johnson VA Medical Center, Clarksburg, WV, USA; 2Department of Medicine, West Virginia University, General Internal Medicine and Geriatrics, Morgantown, WV, USA; 3General Internal Medicine and Geriatrics, West Virginia University, Morgantown, WV, USA; 4Department of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USABackground: Germline truncating mutations in the E-cadherin (CDH1 gene have been identified in families with hereditary diffuse gastric cancer (HDGC and lobular breast cancers. This disease entity has an autosomal dominant pattern of inheritance with approximately 70% to 80% penetrance. Currently there is no definitive diagnostic modality for surveillance to detect this form of gastric cancer (GC which carries a poor prognosis and high mortality. Prophylactic total gastrectomy is an option in the affected carriers and may offer improved long term survival for HDGC.Methods: Two siblings from a single family with multi generation history of GC were identified as carriers of the mutation. After genetic counseling, they underwent laparoscopic prophylactic total gastrectomy with Roux-en-y esophagojejunostomy reconstruction. We describe the demographics and pedigree analysis, and postoperative and 5-year outcomes, and review the literature.Results: Pathologic examination of the stomach revealed no foci of cancer in Patient 1; evidence of foci of gastric cancer was noted in Patient 2. Patient 2 subsequently developed lobular carcinoma of breast and underwent prophylactic bilateral mastectomy. No metastatic disease has been noted at 5-year follow up. She also had a successful pregnancy and birth of a healthy baby 3 years post gastrectomy. Both patients had a 30 to 40 lbs (13.5 to 18 kg permanent weight loss. Both patients have maintained their preoperative activities and occupations.Conclusion: HDGC is an uncommon

  10. Potential Mechanisms Mediating Sustained Weight Loss Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Makaronidis, Janine M; Batterham, Rachel L

    2016-09-01

    Bariatric surgery is the only effective treatment for severe obesity. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most commonly performed procedures, lead to sustained weight loss, improvements in obesity-related comorbidities and reduced mortality. In humans, the main driver for weight loss following RYGB and SG is reduced energy intake. Reduced appetite, changes in subjective taste and food preference, and altered neural response to food cues are thought to drive altered eating behavior. The biological mediators underlying these changes remain incompletely understood but changes in gut-derived signals, as a consequence of altered nutrient and/or biliary flow, are key candidates.

  11. Laparoscopic radical trachelectomy.

    Science.gov (United States)

    Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  12. Radical pancreatic resection combined with vascular resection and reconstruction:a report of12 cases%联合血管切除重建的胰腺癌根治术:附12例报告

    Institute of Scientific and Technical Information of China (English)

    匡天佐; 袁荣发; 胡昌昌; 张福杨; 朱鸿超; 黄明文

    2016-01-01

    Objective: To investigate the feasibility, indications and intraoperative precautions of radical surgery with vascular resection and reconstruction for pancreatic cancer with vascular invasion. Methods: The clinical data of 12 patients with pancreatic cancer invading the portal vein (PV)/superior mesenteric vein (SMV) undergoing radical surgery from March 2014 to December 2015 were retrospectively analyzed. Ten patients underwent pancreaticoduodenectomy, and of them synchronously, 3 cases had PV resection, one case had SMV resection, and 6 cases had PV plus SMV resection with splenic vein ligation without reconstruction, of whom, 5 cases had spleen preservation and one case had splenectomy due to severe splenic congestion; two patients underwent resection of the body and tail of the pancreas, and both cases had synchronous PV plus SMV resection and splenectomy. Portal vein occlusion time ranged from 16 to 30 min; end to end vascular anastomosis was performed in 10 cases and vascular prosthesis was used in 2 cases. Results: All 12 patients recovered uneventfully, and no perioperative death or complications such as biliary ifstula, pancreatic ifstula, bleeding, thrombosis, prosthetic gratf infection and liver function failure occurred, and no manifestations of regional portal hypertension were found in the short-term atfer operation. Conclusion: Pancreaticoduodenectomy or resection of the body and tail of the pancreas in combination with vascular resection is feasible for selected cases in qualiifed hospital, and can increase the resectability rate, improve patients’ quality of life, with no increase in operative mortality and incidence of complications. However, it requires careful intraoperative anatomic dissection and meticulous operation as well as achievement of radical resection visible to the naked eye, for improving the safety of the operation and long-term survival rates.%目的:探讨侵犯血管的胰腺癌根治手术中联合血管切除重建的可

  13. Sexuality Following Radical Prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Serefoglu, Ege C; Albersen, Maarten;

    2017-01-01

    INTRODUCTION: Radical prostatectomies can result in urinary incontinence and sexual dysfunction. Traditionally, these issues have been studied separately, and the sexual problem that has received the most focus has been erectile dysfunction. AIM: To summarize the literature on sexually related side...... effects and their consequences after radical prostatectomy and focus on the occurrence and management of problems beyond erectile dysfunction. METHODS: The literature on sexuality after radical prostatectomy was reviewed through a Medline search. Original research using quantitative and qualitative...... methodologies was considered. Priority was given to studies exploring aspects of sexuality other than erectile function. MAIN OUTCOME MEASURES: The prevalence, predictive factors, and management of post-prostatectomy sexual problems beyond erectile dysfunction. RESULTS: Most patients will develop urinary...

  14. Laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Lipke Michael

    2005-01-01

    Full Text Available Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1-6.9% for pT2a, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%.

  15. Gangs, Terrorism, and Radicalization

    Directory of Open Access Journals (Sweden)

    Scott Decker

    2011-01-01

    Full Text Available What can street gangs tell us about radicalization and extremist groups? At first glance, these two groups seem to push the boundaries of comparison. In this article, we examine the important similarities and differences across criminal, deviant, and extremist groups. Drawing from research on street gangs, this article explores issues such as levels of explanation,organizational structure, group process, and the increasingly important role of technology and the Internet in the context of radicalization. There are points of convergence across these groups, but it is important to understand the differences between these groups. This review finds little evidence to support the contention that American street gangs are becoming increasingly radicalized. This conclusion is based largely on organizational differences between gangs and terror groups.

  16. Enhanced binding capacity of boronate affinity adsorbent via surface modification of silica by combination of atom transfer radical polymerization and chain-end functionalization for high-efficiency enrichment of cis-diol molecules

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Wei; He, Maofang; Wang, Chaozhan; Wei, Yinmao, E-mail: ymwei@nwu.edu.cn

    2015-07-30

    Boronate affinity materials have been widely used for specific separation and preconcentration of cis-diol molecules, but most do not have sufficient capacity due to limited binding sites on the material surface. In this work, we prepared a phenylboronic acid-functionalized adsorbent with a high binding capacity via the combination of surface-initiated atom transfer radical polymerization (SI-ATRP) and chain-end functionalization. With this method, the terminal chlorides of the polymer chains were used fully, and the proposed adsorbent contains dense boronic acid polymers chain with boronic acid on the chain end. Consequently, the proposed adsorbent possesses excellent selectivity and a high binding capacity of 513.6 μmol g{sup −1} for catechol and 736.8 μmol g{sup −1} for fructose, which are much higher than those of other reported adsorbents. The dispersed solid-phase extraction (dSPE) based on the prepared adsorbent was used for extraction of three cis-diol drugs (i.e., epinephrine, isoprenaline and caffeic acid isopropyl ester) from plasma; the eluates were analyzed by HPLC-UV. The reduced amount of adsorbent (i.e., 2.0 mg) could still eliminate interferences efficiently and yielded a recovery range of 85.6–101.1% with relative standard deviations ranging from 2.5 to 9.7% (n = 5). The results indicated that the proposed strategy could serve as a promising alternative to increase the density of surface functional groups on the adsorbent; thus, the prepared adsorbent has the potential to effectively enrich cis-diol substances in real samples. - Highlights: • Boronate adsorbent is prepared via ATRP and chain-end functionalization. • The adsorbent has quite high binding capacity for cis-diols. • Binding capacity is easily manipulated by ATRP condition. • Chain-end functionalization can improve binding capacity significantly. • Reduced adsorbent is consumed in dispersed solid-phase extraction of cis-diols.

  17. Radical dematerialization and degrowth

    Science.gov (United States)

    Kallis, Giorgos

    2017-05-01

    The emission targets agreed in Paris require a radical reduction of material extraction, use and disposal. The core claim of this article is that a radical dematerialization can only be part and parcel of degrowth. Given that capitalist economies are designed to grow, this raises the question of whether, and under what circumstances, the inevitable `degrowth' can become socially sustainable. Three economic policies are discussed in this direction: work-sharing, green taxes and public money. This article is part of the themed issue 'Material demand reduction'.

  18. Detection of salicylate and its hydroxylated adducts 2,3- and 2,5-dihydroxybenzoic acids as possible indices for in vivo hydroxyl radical formation in combination with catechol- and indoleamines and their metabolites in cerebrospinal fluid and brain tissue

    NARCIS (Netherlands)

    Sloot, W.N.; Gramsbergen, J.B.P.

    1995-01-01

    It has been suggested that salicylate (SA) hydroxylation can be used to detect hydroxyl radical formation in vivo. Here we describe a rapid and sensitive HPLC method using ultraviolet absorbance (UV) and electrochemical detection (EC) to detect SA (UV), its hydroxylated adducts 2,3- and 2,5- dihydro

  19. A modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique.

    Directory of Open Access Journals (Sweden)

    Changming Huang

    Full Text Available The present study introduced a modified delta-shaped gastroduodenostomy (DSG technique and assessed the safety, feasibility and clinical results of this procedure in patients undergoing totally laparoscopic distal gastrectomy (TLDG for gastric cancer (GC.A total of 102 patients with distal GC undergoing TLDG with modified DSG between January 2013 and December 2013 were enrolled. A retrospective study was performed using a prospectively maintained comprehensive database to evaluate the results of the procedure. Univariate and multivariate analyses were performed to estimate the predictive factors for postoperative morbidity.The mean operation time was 150.6±30.2 min, the mean anastomosis time was 12.2±4.2 min, the mean blood loss was 48.2±33.2 ml, and the mean times to first flatus, fluid diet, soft diet and postoperative hospital stay were 3.8±1.3 days, 5.0±1.0 days, 7.4±2.1 days and 12.0±6.5 days, respectively. Two patients with minor anastomotic leakage after surgery were managed conservatively; no patient experienced any complications around the anastomosis, such as anastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that age, gastric cancer with hemorrhage and cardiovascular disease combined were significant factors that affected postoperative morbidity (P<0.05. Multivariate analysis found that gastric cancer with hemorrhage was the independent risk factor for the postoperative morbidity (P = 0.042. At a median follow-up of 7 months, no patients had died or experienced recurrent or metastatic disease.The modified DSG was technically safe and feasible, with acceptable surgical outcomes, in patients undergoing TLDG for GC, and this procedure may be promising in these patients.

  20. High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the prevalence and predictive factors of osteoporosis in patients with gastric adenocarcinoma after gastrectomy.METHODS: The study included 133 patients diagnosed with gastric adenocarcinoma but who did not undergo prior diagnostic work-up for osteoporosis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and vertebral deformity was assessed by plain X-rays. We evaluated the effects of age, sex, body mass index (BMI), anemia, back pain,vertebral deformity, tumor staging, reconstruction type,and past medical history to determine predictive factors of osteoporosis in these patients.RESULTS: The prevalence of osteoporosis in the lumbar spine was 38.3% (male, 28.9%; female, 54.0%), and 15.0% in the femoral neck (male, 10.8%; female,22.0%). The vertebral deformity rate was 46.6% (male,43.4%; female, 52.0%). Age, BMI and hemoglobin correlated with BMD (P < 0.01). In males, anemia and age > 64 years were independent predictive factors of osteoporosis in multivariate analysis. In females, back pain was an independent factor for osteoporosis.CONCLUSION: The results of this study revealed that prevalence of osteoporosis and vertebral bone deformity rate were high in gastric cancer patients, regardless of post-gastrectomy duration and operation type. Early diagnosis and a proper management plan must be established in these patients.

  1. A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

    Directory of Open Access Journals (Sweden)

    Erika Leung

    2015-09-01

    Full Text Available Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern. Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection. Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thromboses are normally treated with unfractionated or low-molecular-weight heparin.

  2. Feasibility and Nutritional Benefits of Laparoscopic Proximal Gastrectomy for Early Gastric Cancer in the Upper Stomach.

    Science.gov (United States)

    Kosuga, Toshiyuki; Ichikawa, Daisuke; Komatsu, Shuhei; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo

    2015-12-01

    Laparoscopic proximal gastrectomy (LPG) has recently been applied for early gastric cancer (EGC) in the upper stomach as a minimally invasive and function-preserving surgery. This study aimed to clarify the feasibility and nutritional benefits of LPG over laparoscopic total gastrectomy (LTG). This was a retrospective study of 77 patients with clinical stage I gastric cancer in the upper stomach. Of these patients, 25 underwent LPG, while 52 underwent LTG. Surgical outcomes and postoperative nutritional status such as changes in body weight and blood chemistries were compared between LPG and LTG. Intraoperative blood loss and C-reactive protein levels at 3 and 7 days after surgery were significantly lower in LPG than in LTG (p = 0.018, 0.036, and 0.042, respectively). No significant differences were observed in postoperative early or late complication rates between LPG and LTG. The incidence of Los Angeles Grade B or more severe reflux esophagitis after LPG was 9.1 %, which was similar to that after LTG (9.3 %). Postoperative changes in body weight at 6 months and 1 and 2 years after surgery were consistently less in LPG than in LTG (p = 0.001, 0.022, and 0.001, respectively). Moreover, postoperative levels of hemoglobin and serum albumin and total lymphocyte count were also higher in LPG than in LTG. LPG may be a better choice for EGC in the upper stomach than LTG because it has distinct advantages in terms of surgical invasiveness and postoperative nutritional status.

  3. Safe major abdominal operations:Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients

    Institute of Scientific and Technical Information of China (English)

    Yu-Lian Wu; Jun-Xiu Yu; Bin Xu

    2004-01-01

    AIM: To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy.METHODS: Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years.RESULTS: The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2%vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172).CONCLUSION: It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.

  4. Effect of Acupuncture on Postoperative Ileus after Distal Gastrectomy for Gastric Cancer

    Science.gov (United States)

    Jung, Se Yun; Chae, Hyun Dong; Kang, Ung Rae; Kwak, Min Ah

    2017-01-01

    Purpose Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. Materials and Methods Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. Results The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (Pacupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. Conclusions In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy. PMID:28337359

  5. Gastric microbiota and predicted gene functions are altered after subtotal gastrectomy in patients with gastric cancer.

    Science.gov (United States)

    Tseng, Ching-Hung; Lin, Jaw-Town; Ho, Hsiu J; Lai, Zi-Lun; Wang, Chang-Bi; Tang, Sen-Lin; Wu, Chun-Ying

    2016-02-10

    Subtotal gastrectomy (i.e., partial removal of the stomach), a surgical treatment for early-stage distal gastric cancer, is usually accompanied by highly selective vagotomy and Billroth II reconstruction, leading to dramatic changes in the gastric environment. Based on accumulating evidence of a strong link between human gut microbiota and host health, a 2-year follow-up study was conducted to characterize the effects of subtotal gastrectomy. Gastric microbiota and predicted gene functions inferred from 16S rRNA gene sequencing were analyzed before and after surgery. The results demonstrated that gastric microbiota is significantly more diverse after surgery. Ralstonia and Helicobacter were the top two genera of discriminant abundance in the cancerous stomach before surgery, while Streptococcus and Prevotella were the two most abundant genera after tumor excision. Furthermore, N-nitrosation genes were prevalent before surgery, whereas bile salt hydrolase, NO and N2O reductase were prevalent afterward. To our knowledge, this is the first report to document changes in gastric microbiota before and after surgical treatment of stomach cancer.

  6. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

    NARCIS (Netherlands)

    Homan, J.; Betzel, B; Aarts, E.O.; Laarhoven, K.J. van; Janssen, I.M.C.; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons. OBJECTIVES

  7. Concurrent Mesh Repair of a Morgagni and Umbilical Hernia during a Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Individual

    Directory of Open Access Journals (Sweden)

    N.R Kosai

    2016-10-01

    Full Text Available Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

  8. Influence of obesity on short- and long-term outcomes after laparoscopic distal gastrectomy for gastric cancer.

    Science.gov (United States)

    Chen, Hongbing; Sui, Wu

    2017-01-01

    Despite the increasing prevalence of obesity and gastric diseases, the impact of obesity on short- and long-term outcomes of laparoscopic distal gastrectomy for gastric cancer still remains unclear. Sixty-one consecutive obese patients with body mass index (BMI)≥30 kg/m(2), who underwent laparoscopic distal gastrectomy, were compared with 76 non-obese patients with BMIObesity was associated with a longer operative time and a greater estimated blood loss. The rate of conversion to open distal gastrectomy was similar between the two groups. There were no 30-day postoperative deaths in either group. There was no significant difference in the overall number or severity of 30-day postoperative complications between the two groups. Regarding long-term survival outcomes, there was no statistical difference in overall (OS) or disease-free survival (DFS) between the two groups. Multivariate analysis showed that BMI did not influence prognosis. Laparoscopic distal gastrectomy appears to be a safe and reasonable option for selected obese patients with gastric cancer and results in short- and long-term outcomes similar to those in non-obese patients.

  9. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

    NARCIS (Netherlands)

    Homan, J.; Betzel, B; Aarts, E.O.; Laarhoven, K.J. van; Janssen, I.M.C.; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons.

  10. Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

    Directory of Open Access Journals (Sweden)

    Ezri Tiberiu

    2015-04-01

    Full Text Available Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy.

  11. Gasless laparoscopy-assisted distal gastrectomy is feasible and useful for non-obese patients with early gastric cancer.

    Science.gov (United States)

    Hyodo, Masanobu; Hosoya, Yoshinori; Kurashina, Kentarou; Saitoh, Shin; Hirashima, Yuuki; Yokoyama, Taku; Arai, Wataru; Yasuda, Yoshikazu; Nagai, Hideo; Sekiguchi, Chuuji

    2007-09-01

    To evaluate the feasibility and usefulness of gasless laparoscopy-assisted distal gastrectomy except when treating obese patients compared with open distal gastrectomy for early cancer. We treated 92 patients with distal gastrectomy for early gastric cancer consecutively. Patients with massive submucosal invasion and/or LN swelling were allocated for the open method, and patients with slightly invasive submucosal cancer were allocated for gasless laparoscopy-assisted surgery. As exceptions we employed open surgery for overweight patients and gasless laparoscopy for elderly and/or feeble patients. We attempted to perform open and laparoscopy-assisted surgery on 52 and 40 patients, respectively. Three cases in the laparoscopy-assisted group were converted to open surgery because of obesity. The age was older and BMI was lower in the laparoscopy-assisted group. In terms of operative time and blood loss as well as postoperative recovery, the results for the laparoscopy-assisted group were superior to those of the open surgery group. There were no cases of cardiopulmonary complications for the laparoscopy-assisted group. Gasless laparoscopy-assisted distal gastrectomy is feasible and useful for early gastric cancer except when treating obese patients.

  12. Evaluation of gastrectomy in patients with delayed gastric emptying after antireflux surgery or large hiatal hernia repair

    NARCIS (Netherlands)

    Gerritsen, A.; Furnee, E.J.B.; Gooszen, H.G.; Wondergem, M.; Hazebroek, E.J.

    2013-01-01

    BACKGROUND: Revision antireflux surgery and large hiatal hernia repair require extensive dissection at the gastroesophageal junction. This may lead to troublesome symptoms due to delayed gastric emptying, eventually requiring gastrectomy. The aim of this study was to evaluate the outcome of gastrect

  13. Radical School Reform.

    Science.gov (United States)

    Gross, Beatrice, Ed.; Gross, Ronald, Ed.

    This book provides a comprehensive examination of the nature of the school crisis and the ways in which radical thinkers and educators are dealing with it. Excerpts from the writings of Jonathan Kozol, John Holt, Kenneth Clark, and others are concerned with the realities of education in ghettos and suburbs. Paul Goodman, Marshall McLuhan, Sylvia…

  14. Homegrown religious radicalization

    DEFF Research Database (Denmark)

    Khawaja, Iram

    It has been reported that a growing number of youngsters from Western Europe are engaging in conflicts motivated by religious and political conflicts in the Middle East. This paper explores the reasons behind this seemingly religious radicalization from the point of view of the youngsters and the...

  15. Radically enhanced molecular recognition

    KAUST Repository

    Trabolsi, Ali

    2009-12-17

    The tendency for viologen radical cations to dimerize has been harnessed to establish a recognition motif based on their ability to form extremely strong inclusion complexes with cyclobis(paraquat-p-phenylene) in its diradical dicationic redox state. This previously unreported complex involving three bipyridinium cation radicals increases the versatility of host-guest chemistry, extending its practice beyond the traditional reliance on neutral and charged guests and hosts. In particular, transporting the concept of radical dimerization into the field of mechanically interlocked molecules introduces a higher level of control within molecular switches and machines. Herein, we report that bistable and tristable [2]rotaxanes can be switched by altering electrochemical potentials. In a tristable [2]rotaxane composed of a cyclobis(paraquat-p-phenylene) ring and a dumbbell with tetrathiafulvalene, dioxynaphthalene and bipyridinium recognition sites, the position of the ring can be switched. On oxidation, it moves from the tetrathiafulvalene to the dioxynaphthalene, and on reduction, to the bipyridinium radical cation, provided the ring is also reduced simultaneously to the diradical dication. © 2010 Macmillan Publishers Limited. All rights reserved.

  16. Violent Radicalization in Europe

    DEFF Research Database (Denmark)

    Dalgaard-Nielsen, Anja

    2010-01-01

    When, why, and how do people living in a democracy become radicalized to the point of being willing to use or directly support the use of terrorist violence against fellow citizens? This question has been at the center of academic and public debate over the past years as terrorist attacks...

  17. Beyond Radical Educational Cynicism.

    Science.gov (United States)

    Wood, George H.

    1982-01-01

    An alternative is presented to counter current radical arguments that the schools cannot bring about social change because they are instruments of capitalism. The works of Samuel Bowles, Herbert Gintis, and Louis Althusser are discussed. Henry Giroux's "Ideology, Culture and the Process of Schooling" provides an alternative to cynicism.…

  18. Electromeric rhodium radical complexes

    NARCIS (Netherlands)

    Puschmann, F.F.; Harmer, J.; Stein, D.; Rüegger, H.; de Bruin, B.; Grützmacher, H.

    2010-01-01

    Radical changes: One single P-Rh-P angle determines whether the odd electron in the paramagnetic complex [Rh(trop2PPh)(PPh3)] is delocalized over the whole molecule (see picture, blue) or is localized on the P—Rh unit (red). The two energetically almost degenerate electromers exist in a fast equilib

  19. Homegrown religious radicalization

    DEFF Research Database (Denmark)

    Khawaja, Iram

    and their families. Existing literature and ways of thinking about the social psychological process of radicalization will be reviewed, such as social identity theory and transformative learning theory, and a theoretical framework based on a focus on belonging, recognition and the sense of community will be proposed...

  20. On Radical Feminism

    Institute of Scientific and Technical Information of China (English)

    翟良锴

    2015-01-01

    <正>All men are created equal.For centuries,human have been struggling for their rights.Women,as a special social force,are fighting vigorously for their equal rights with men.According to an introduction to feminism,there are three main types of feminism:socialist,reformist and radical(Feminism 101).In order

  1. The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass

    Science.gov (United States)

    Arndtz, Katherine; Steed, Helen; Hodson, James; Manjunath, Srikantaiah

    2016-01-01

    Background This study aimed to assess the endoscopic burden of bariatric surgical procedures at our trust. This is an enhanced parallel study to “The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass” published in Frontline Gastroenterology in 2013 incorporating the data for sleeve gastrectomy and comparison with Roux-en-Y gastric bypass (RYGB). Methods This is a retrospective study that included 211 patients undergoing sleeve gastrectomy over a 34-month period. We utilized previously collected data for the RYGB patient cohort which included 553 patients over a 29-month period. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications related to their surgery. Results 16.6% of the sleeve gastrectomy patients required post-operative endoscopy, of whom 11.4% underwent therapeutic procedures. This compares to 20.4% of the RYGB cohort of whom 50.4% needed therapeutic procedures (Psleeve gastrectomy patients encountered a post-operative staple line leak and collectively required 29 endoscopic procedures. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated an equivalent cost of €159,898 in endoscopy tariffs, or €177 per RYGB and €373 per sleeve gastrectomy performed. Conclusions Bariatric surgery can have significant implications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account. PMID:26752949

  2. Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Qi, Jin; Zhang, Peng; Wang, Yanan; Chen, Hao; Li, Yumin

    2016-01-01

    Background/Aims Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer. Methodology A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis. Results Ten retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006). Conclusion Based on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still

  3. Photoionisation of the tropyl radical

    Directory of Open Access Journals (Sweden)

    Kathrin H. Fischer

    2013-04-01

    Full Text Available We present a study on the photoionisation of the cycloheptatrienyl (tropyl radical, C7H7, using tunable vacuum ultraviolet synchrotron radiation. Tropyl is generated by flash pyrolysis from bitropyl. Ions and electrons are detected in coincidence, permitting us to record mass-selected photoelectron spectra. The threshold photoelectron spectrum of tropyl, corresponding to the X+ 1A1’ ← X 2E2” transition, reveals an ionisation energy of 6.23 ± 0.02 eV, in good agreement with Rydberg extrapolations, but slightly lower than the value derived from earlier photoelectron spectra. Several vibrations can be resolved and are reassigned to the C–C stretch mode ν16+ and to a combination of ν16+ with the ring breathing mode ν2+. Above 10.55 eV dissociative photoionisation of tropyl is observed, leading to the formation of C5H5+ and C2H2.

  4. Laparoscopic sleeve gastrectomy prevents the deterioration of renal function in morbidly obese patients over 40 years.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Giner, Lorena; Sarro-Sobrin, Felipe; Alsina, Maria Engracia; Marco, María Paz; Craver, Lourdes

    2015-05-01

    Chronic kidney disease (CKD) risk has been associated with elevated body mass index (BMI), especially in morbidly obese subjects. Aging and obesity can play a synergic effect on accelerating the renal function deterioration. Bariatric surgery (mainly gastric bypass or biliopancreatic diversion) has demonstrated an improvement on renal function, but little is known about the potential effect of sleeve gastrectomy on renal function. A prospective observational study was performed. Between 2009 and 2013, 50 morbidly obese patients over 40 years underwent a laparoscopic sleeve gastrectomy (LSG) at our institution. Renal function was evaluated by serum creatinine, urea, and estimated glomerular filtration rate (eGFR), calculated using the MDRD-4 formula. All the variables were obtained at three times: on the first visit to the surgeon's office (baseline), the day before surgery (preoperative), and 12 months after surgery. Fifty patients underwent a LSG, 44 females (88%) and 6 males (12%), with a mean age 49.2 ± 6.4 years and mean BMI of 48.4 ± 7.7 kg/m(2). MDRD-4 values presented a significant reduction (69.4 ml/min/m(2) at baseline vs 62.5 ml/min/m(2) preoperatively; CI95% (2.2-11.3 ml/min/m(2)); p = 0.01). Comparing pre- and postoperative values, a significant reduction could be determined in creatinine (0.89 mg/dl preoperatively vs 0.71 mg/dl postoperatively; p = 0.01), urea (36.1 mg/dl preoperatively vs 29.8 mg/dl postoperatively; p = 0.023), and a significant increase in MDRD-4 (62.5 ml/min/m(2) preoperatively vs 77.6 ml/min/m(2) postoperatively; p < 0.001). In patients over 40 years, renal function is going to deteriorate as long as the excess of weight persists. Laparoscopic sleeve gastrectomy has shown to improve the renal function 12 months after surgery.

  5. Clinical effect of laparoscopic surgery in treatment of common bile duct stones after subtotal gastrectomy

    Directory of Open Access Journals (Sweden)

    LEI Ting

    2017-08-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of laparoscopic surgery in the treatment of common bile duct stones after subtotal gastrectomy. MethodsA retrospective analysis was performed for the clinical data of 46 patients with gallstones and common bile duct stones after subtotal gastrectomy who underwent surgical treatment in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2010 to October 2016. Among these patients, 25 underwent laparoscopic cholecystectomy+common bile duct exploration (laparoscopic group, and 21 underwent open cholecystectomy+common bile duct exploration (open group. The surgical conditions and postoperative complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsNo patients died during the perioperative period and 2 patients (8.0% in the laparoscopic group were converted to open surgery. There were significant differences between the laparoscopic group and the open group in time to ambulation after surgery (1.2±0.6 d vs 2.4±1.2 d, t=4.395, P<0.001, time to passage of gas by anus after surgery (1.8±0.5 d vs 2.8±0.8 d, t=5.168, P<0.001, and length of postoperative hospital stay (5.2±1.1 d vs 7.5±2.3 d, t=4.439, P<0.001. There were no significant differences between the two groups in time of operation, intraoperative blood loss, hospital costs, T tube placement, and rate of residual stones (all P>0.05. After surgery, 2 patients (8.0% in the laparoscopic group and 3 (14.3% in the open group experienced complications, and there was no significant difference between the two groups (P=0.495. ConclusionLaparoscopic surgery is safe and feasible in the treatment of common bile duct stones after subtotal gastrectomy and has the advantages of minimally invasive surgery.

  6. Women and radicalization

    OpenAIRE

    Badran, Margot

    2006-01-01

    The paper focuses on women and radicalization within the context of Muslim societies (majority, minority, and half Muslim) societies and groups, mainly in Asia and Africa. The basic argument advanced in this paper is that Islamic feminism with its gender-egalitarian discourse and practices has a major role to play in the empowerment of Muslim women—and of men and society as a whole—and should be brought to bear in devising policy, strategy, and tools.

  7. Probability and radical behaviorism

    Science.gov (United States)

    Espinosa, James M.

    1992-01-01

    The concept of probability appears to be very important in the radical behaviorism of Skinner. Yet, it seems that this probability has not been accurately defined and is still ambiguous. I give a strict, relative frequency interpretation of probability and its applicability to the data from the science of behavior as supplied by cumulative records. Two examples of stochastic processes are given that may model the data from cumulative records that result under conditions of continuous reinforcement and extinction, respectively. PMID:22478114

  8. Probability and radical behaviorism

    OpenAIRE

    Espinosa, James M.

    1992-01-01

    The concept of probability appears to be very important in the radical behaviorism of Skinner. Yet, it seems that this probability has not been accurately defined and is still ambiguous. I give a strict, relative frequency interpretation of probability and its applicability to the data from the science of behavior as supplied by cumulative records. Two examples of stochastic processes are given that may model the data from cumulative records that result under conditions of continuous reinforc...

  9. Radical chic, javisst!

    NARCIS (Netherlands)

    Hartle, J.F.

    2012-01-01

    Det är lätt att raljera över engagerade människor, i synnerhet när engagemanget framstår som ytligt och chict snarare än grundläggande och autentiskt. Men vad ligger bakom ett sådant avfärdande? Johan Frederik Hartle läser om Tom Wolfes klassiska essä "Radical Chic" och visar hur Wolfe −− genom att

  10. Radical substitution with azide

    DEFF Research Database (Denmark)

    Pedersen, Christian Marcus; Marinescu, Lavinia Georgeta; Bols, Mikael

    2005-01-01

    and the substrate. A primary deuterium kinetic isotope effect was found for the azidonation of benzyl ethers both with TMSN3-PhI(OAc)2 and with IN3. Also a Hammett free energy relationship study of this reaction showed good correlation with sigma+ constants giving with rho-values of -0.47 for TMSN3-PhI(OAc)2 and -0.......39 for IN3. On this basis a radical mechanism of the reaction was proposed....

  11. [Radical prostatectomy - pro robotic].

    Science.gov (United States)

    Gillitzer, R

    2012-05-01

    Anatomical radical prostatectomy was introduced in the early 1980s by Walsh and Donker. Elucidation of key anatomical structures led to a significant reduction in the morbidity of this procedure. The strive to achieve similar oncological and functional results to this gold standard open procedure but with further reduction of morbidity through a minimally invasive access led to the establishment of laparoscopic prostatectomy. However, this procedure is complex and difficult and is associated with a long learning curve. The technical advantages of robotically assisted surgery coupled with the intuitive handling of the device led to increased precision and shortening of the learning curve. These main advantages, together with a massive internet presence and aggressive marketing, have resulted in a rapid dissemination of robotic radical prostatectomy and an increasing patient demand. However, superiority of robotic radical prostatectomy in comparison to the other surgical therapeutic options has not yet been proven on a scientific basis. Currently robotic-assisted surgery is an established technique and future technical improvements will certainly further define its role in urological surgery. In the end this technical innovation will have to be balanced against the very high purchase and running costs, which remain the main limitation of this technology.

  12. 胃癌根治术术后恢复期的饮食指导%Dietary Guidance of Gastrectomy Postoperative in Recovery

    Institute of Scientific and Technical Information of China (English)

    刘颖

    2015-01-01

    Objective To investigate the dietary guidance of gastric cancer patients after radical surgery in convalescence. Methods 140 patients with gastric cancer routine surgery in January 2013~January 2014 in our hospital,given a reasonable dietary guidance,to observe the eating and body nutritional status. Results This group of patients at admission to reduce the consumption recovery ratio,but 98.57%of the patients at discharge energy intake to meet their physical needs. Conclusion Gastrectomy patients in the postoperative recovery period,giving it a reasonable diet guidance help patients nutritional intake,which can accelerate the recovery of the body.%目的:探讨行胃癌根治术患者术后恢复期的饮食指导。方法选择2013年1月~2014年1月我院收治的140例行胃癌根治术的患者,给予合理饮食指导,观察其进食及身体营养情况。结果本组患者恢复期进食量比入院时减少,但出院时98.57%的患者摄入能量满足其身体需要。结论对行胃癌根治术的患者,在术后恢复期,给予其合理的饮食指导,有助于患者营养的摄入,能加速其身体的恢复。

  13. [A case of partial hepatectomy and gastrectomy for hepatocellular carcinoma with direct invasion to the stomach].

    Science.gov (United States)

    Yoshida, Yuta; Murakami, Masahiro; Shimizu, Junzo; Kawada, Masahiro; Yasuyama, Akinobu; Yoshikawa, Yukihiro; Watase, Chikashi; Nishigaki, Takahiko; Kim, Ho Min; Hitora, Toshiki; Oda, Naofumi; Hirota, Masaki; Yoshikawa, Masato; Morishima, Hirotaka; Ikenaga, Masakazu; Mikata, Shoki; Matsunami, Nobuteru; Hasegawa, Junichi

    2014-11-01

    An 81-year-old man treated with chronic hepatitis C virus (HCV)-related hepatitis and hepatocellular carcinoma (HCC) was diagnosed in 2010 with HCC recurrence (subclass S2) on computed tomography (CT). He refused surgery and was followed up without treatment. In 2012, he was admitted to our hospital because of hematemesis. Gastrointestinal endoscopy revealed a large tumor in the upper gastric corpus, and pathological examination of the tumor revealed HCC; hence, we diagnosed the patient with direct HCC invasion to the stomach. Although active bleeding from the tumor was controlled, he experienced repeated episodes of hematemesis, and the tumor increased in size. Therefore, partial hepatectomy and gastrectomy were performed. It was confirmed that the tumor invaded the stomach wall. Although surgery was effective for gastrointestinal bleeding caused by HCC invasion, the patient died 12 months after surgery because of multiple liver metastases and exacerbated liver failure.

  14. [A rare case of digestive tract hemorrhage of extraluminal origin after total gastrectomy].

    Science.gov (United States)

    Caprino, Paola; Alfieri, Sergio; Rotondi, Fabio; Di Miceli, Dario; Sofo, Luigi; Pacelli, Fabio; Battista Doglietto, Giovanni

    2003-01-01

    The authors report on a case of digestive bleeding (melaena and enterorrhagia) in a patient undergoing total gastrectomy for gastric cancer and later splenectomy for subcapsular haematoma in a different hospital. The source of bleeding was not intraluminal; the bleeding arose from double erosion of the gastroduodenal artery in the tract above the anterior surface of the pancreas, close to the dehiscent duodenal stump. The blood flowed mainly into the enteric district through the open stump thus causing the clinical signs described. The diagnosis was made during an emergency surgical operation for haemorrhagic shock. The patient underwent haemostasis with two stitches on the gastroduodenal artery, external drainage of the duodenum with a Petzer tube, laparostomy of the infected area and ileostomy. After three months he had completely recovered.

  15. A Fatal Case of Wernicke’s Encephalopathy after Sleeve Gastrectomy for Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K. Manatakis

    2014-01-01

    Full Text Available Wernicke’s encephalopathy is an acute neuropsychiatric disorder, due to thiamine (vitamin B1 deficiency. It is traditionally described in chronic alcohol abusers; however obesity surgery is an emerging cause, as the number of bariatric procedures increases. A high index of clinical suspicion is required, since initial symptoms may be nonspecific and the classic triad of ophthalmoplegia, gait and stance disorders, and mental confusion is present only in one-third of patients. Laboratory tests can be within normal range and typical MRI brain lesions are found only in 50% of cases. Aggressive supplementation with intravenous thiamine should not be delayed until confirmation of diagnosis, as it may fully reverse symptoms, but almost half the patients will still display permanent neurological deficit. We present our experience with a fatal case of Wernicke’s encephalopathy, following laparoscopic sleeve gastrectomy for morbid obesity.

  16. [Mechanical versus manual suture in the jejunal esophageal anastomosis after total gastrectomy in gastric cancer].

    Science.gov (United States)

    Celis, J; Ruiz, E; Berrospi, F; Payet, E

    2001-01-01

    To compare the leakage rate of esophagojejunal anastomosis performed with stapler or hand sutures. We studied a series of 367 patients who underwent total gastrectomy for gastric cancer at the Instituto de Enfermedades Neoplásicas (Lima-Peru) from 1986 to 1999. In 197 patients esophagojejunal anastomosis was performed with stapler and in 170 with manual sutures. There were no differences between both groups with regard to age, TNM stage, operating time and hospital stay. There were 8 anastomotic leakage (4.1%) in the stapler group and 4 (2.4%) in the hand sutures group (p> 0.05). Of these 12 cases, 2 patients (16%) died of causes directly related to the leak of the esophagojejunal anastomosis. There were no statistical differences in the rate of leakage of the esophagojejunal anastomosis performed with stapler or hand sutures, thus both techniques should be accepted as standard procedures.

  17. Short-term pilot study of the effect of sleeve gastrectomy on food preference.

    Science.gov (United States)

    Ammon, Brandon S; Bellanger, Drake E; Geiselman, Paula J; Primeaux, Stefany D; Yu, Ying; Greenway, Frank L

    2015-06-01

    The effect of vertical sleeve gastrectomy (VSG) on food preference has not been examined in humans, but VSG decreases preference for fat and calorically dense foods in rodents. A validated Food Preference Questionnaire (FPQ) assessed food preference changes before and 6 weeks after VSG in humans. The FPQ was completed before and 43 ± 19 days (Mean ± SD) after VSG. Fifteen subjects (14 females) completed the study. Hedonic ratings decreased for foods high in fat and sugar (p = 0.002) and high in fat and complex carbohydrate (p = 0.007). Fat preference (p = 0.048) decreased, VSG reduced preference for calorically dense foods high in fat, sugar, and complex carbohydrate, and these changes may contribute to the weight loss with VSG.

  18. Changes in Gut Hormones After Roux en Y Gastric bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding

    Directory of Open Access Journals (Sweden)

    Miroslav Ilić

    2015-12-01

    Full Text Available The obesity epidemic has burdened healthcare systems worldwide. Bariatric surgery is currently the most effective method for long-term weight loss in obese adults, but the exact mechanism of weight loss is poorly understood. Bariatric procedures were initially classified by their presumed mechanism of action into restrictive, malabsoptive, or mixed procedures; however, due to recent advancements in the field of neuroendocrinology, hormones are increasing being recognized as important regulators of satiation, hunger, and energy expenditure. Studies examining changes in gut hormones following bariatric surgery have yielded conflicting results and the relationship between these hormones and weight loss is nothing but clear. This review will summarize the effect of Roux en Y gastric bypass, sleeve gastrectomy and adjustable gastric banding on various gut hormones including ghrelin, cholecystokinin, glucagon-like polypeptide-1, peptide YY3, and pancreatic polypeptide. Furthermore, the relationship between these hormones and weight loss will be examined.

  19. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Liu, Shirley Yuk-Wah; Wong, Simon Kin-Hung; Ng, Enders Kwok-Wai

    2015-01-01

    The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing.

  20. Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and a call for prevention

    Directory of Open Access Journals (Sweden)

    Parveen Bhatia

    2015-01-01

    Full Text Available Postoperative portomesenteric venous thrombosis (PMVT is being increasingly reported after bariatric surgery. It is variable and often a nonspecific presentation along with its potential for life-threatening and life-altering outcomes makes it imperative that it is prevented, detected early and treated optimally. We report the case of a 50-year-old morbidly obese man undergoing a laparoscopic sleeve gastrectomy who developed symptomatic PMVT two weeks postsurgery, which was successfully treated by anticoagulant therapy. We provide postulates to the etiopathological mechanism for this thrombotic entity. The growing recognition that obesity and bariatric surgery create a procoagulant state regionally and systemically provides impetus for designing the ideal protocol for PMVT prophylaxis, which could be more common than currently believed. We support the early screening for PMVT in the postbariatric surgical patient with unexplainable or intractable abdominal symptoms. The role of routine surveillance and the ideal duration of post-PMVT anticoagulation is yet to be elucidated.

  1. [Tsukamurella tyrosinosolvens cultured from sputum of a patient who received total gastrectomy for gastric cancer].

    Science.gov (United States)

    Matsumoto, Takemasa; Shiraishi, Motokimi; Yoshimura, Hisae; Sogen, Keiji; Harada, Taishi; Yoshimura, Chikara; Aramaki, Ryutaro; Yamamoto, Fumio; Kuraki, Takashige; Watanabe, Kentaro

    2006-07-01

    A 79-year old woman underwent total gastrectomy under the diagnosis of gastric cancer in Feb. 2003. In the beginning of Jan. 2005, she noticed hemosputum and was admitted to our hospital. Chest radiograph and CT disclosed bilateral upper lobe-dominant nodular opacities in the subpleural areas and ground-glass opacities in right S6. Transbronchial lung biopsy was performed, but no useful information for the diagnosis was obtained. Ziehl-Neelsen stain was negative for the smear of the sputum at admission, but weakly stained acid-fast bacilli were grown in the MGIT culture. By the analysis of mycolic acid and menaquinone of the cell membrane, the bacilli were identified as Tsukamurella. Since she was asymptomatic and repeated sputum examination revealed negative bacilli, she has been observed at the outpatient clinic without any treatment.

  2. The Use of Serum Uric Acid Concentration as an Indicator of Laparoscopic Sleeve Gastrectomy Success

    Science.gov (United States)

    Menenakos, Evangelos; Doulami, Georgia; Tzanetakou, Irene P.; Natoudi, Maria; Kokoroskos, Nikolaos; Almpanopoulos, Konstantinos; Leandros, Emmanouil; Zografos, George; Theodorou, Dimitrios

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) effectively reduces weight by restricting gastric capacity and altering gut hormones levels. We designed a prospective study to investigate the correlation of serum uric acid (SUA) concentration and weight loss. SUA and body mass index (BMI) were measured preoperatively and on first postoperative month and year in patients who underwent LSG in our department of bariatric surgery. Data on 55 patients were analyzed. Preoperative SUA concentration had a significant positive correlation with percentage of total weight loss (TWL) on first postoperative month (P = 0.001) and year (P = 0.002). SUA concentration on first postoperative month had a positive correlation with percentage of TWL on first postoperative year (P = 0.004). SUA concentration could be used as a predictor of LSG's success and could help in early detection of patients with rapid loss of weight, in order to prevent complications. PMID:25594659

  3. Traumatic Neuroma around the Celiac Trunk after Gastrectomy Mimicking a Nodal Metastasis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jung Hyeok; Ryu, Seung Wan; Kang, Yu Na [Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2007-06-15

    Traumatic neuroma is a well-known disorder that occurs after trauma or surgery involving the peripheral nerve and develops from a nonneoplastic proliferation of the proximal end of a severed, partially transected, or injured nerve. However, in the abdomen, traumatic neuromas have been sporadically reported to occur in the bile duct. We present here a case of traumatic neuroma around the celiac trunk after gastrectomy that mimicks a nodal metastasis. In conclusion, the imaging finding of traumatic neuroma around the celiac trunk was a homogeneous hypovascular mass without narrowing or irregularity of encased arteries and without increased uptake on PET-CT. Although from a clinical standpoint, establishing an accurate preoperative diagnosis is difficult to perform, the presence of a traumatic neuroma should be included in the differential diagnosis of a mass around the celiac trunk in a patient that has undergone celiac nodal dissection.

  4. Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

    Directory of Open Access Journals (Sweden)

    Yosuke Kodama

    Full Text Available BACKGROUND: Both gastric bypass (GB and duodenal switch with sleeve gastrectomy (DS have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls, and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models.

  5. Robotic digestive tract reconstruction after total gastrectomy for gastric cancer: a simple way to do it.

    Science.gov (United States)

    Barchi, Leandro Cardoso; Jacob, Carlos Eduardo; Franciss, Maurice Youssef; Kappaz, Guilherme Tommasi; Rodrigues Filho, Edison Dias; Zilberstein, Bruno

    2016-12-01

    Intracorporeal digestive tract reconstruction after minimally invasive total gastrectomy may be challenging, even when using the da Vinci® Surgical System. This may be due to intrinsic difficulties during oesophago-jejunal anastomosis (EJA). The aim of this study was to describe a simple way to perform digestive tract reconstruction after robotic total gastrectomy (RTG) for gastric cancer and the results of its application in a small series of cases. In the last 2 years, six patients with gastric adenocarcinoma have been treated by RTG, four male and two female, with mean age of 59.8 (range 48-74) years. The tumour was located in the gastric body in three patients, the gastric antrum in two patients and the fundus in one patient with no need of splenectomy. In all cases, D2 lymphadenectomy was completed. A modified robotic reconstruction technique proposed by the authors was used in these operations, which consists in a latero-lateral EJA using a linear stapler. An entero-enterostomy is also performed in the upper abdomen. The mean operative time was 408 (range 340-481) min. The mean time for digestive tract reconstruction was 57 (range 47-68) min. There were no conversions to open or laparoscopic surgery. The number of lymph nodes removed varied in the range 28-52 (average 40). There was no mortality. Postoperative staging showed three T1N0M0s, one T2N0M0, one T3N0M0 and one T3N2M0. This series, which despite being small, demonstrates that this robotic reconstruction technique is safe, with no major complications, demands a relatively short time for its accomplishment, even when dealing with initial experience. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  6. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Shi Liangrong; Wu Jun; Jiang Jingting; Wu Changping

    2013-01-01

    Objective:To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods:Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on lfuorouracil drugs. Results:No severe complications was observed in all study subjects with 14 complete remission (60.9%), 5 particle remission (21.7%) and 4 progressive diseases (17.4%), while 1, 2 and 3 years of survival rates as well as median survival time being (87±7)%,(47±11)%, (13±9)% and (22.1±5.1) months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly inlfuence the prognosis (χ2=9.752, P=0.002), and the subgroups analysis relieved the signiifcant difference (χ2=5.828, P=0.016, log-rank test) with 3 cm being the cut-off value. Conclusion:CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  7. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Directory of Open Access Journals (Sweden)

    Liangrong Shi

    2013-09-01

    Full Text Available Objective: To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods: Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on fluorouracil drugs. Results: No severe complications was observed in all study subjects with 14 complete remission (60.9 % , 5 particle remission (21.7 % and 4 progressive diseases (17.4 % , while 1, 2 and 3 years of survival rates as well as median survival time being (87±7 %,(47±11 % , (13±9 % and (22.1±5.1 months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly influence the prognosis (χ2 = 9.752, P = 0.002, and the subgroups analysis relieved the significant difference (χ2 = 5.828, P = 0.016, log-rank test with 3 cm being the cut-off value. Conclusion: CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  8. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Zubiaga, Lorea; Diez, María; Arroyo, Antonio; Calero, Alicia; Calpena, Rafael

    2014-05-01

    A common complication after bariatric surgery is hair loss, which is related to rapid weight reduction, but zinc, iron, and other micronutrient deficiencies can also be involved. Little is studied after laparoscopic sleeve gastrectomy (LSG). A prospective observational study was performed of 42 morbidly obese females undergoing LSG. Incidence of hair loss was monitored. Micronutrients were investigated preoperatively and three, six, and 12 months after surgery. Sixteen patients (41%) reported hair loss in the postoperative course. A significant association was observed between hair loss and zinc levels (P = 0.021) but mean zinc levels were within the normal range in patients reporting hair loss. Only three patients (7.7%) presented low zinc levels, all of them reporting hair loss. There was also a significant association between iron levels and alopecia (P = 0.017), but mean values of the patients with hair loss were within normal range. Only four patients (10.2%) presented low iron levels, all of them presenting hair loss. A variable consisting of the addition of zinc + iron showed a significant association with hair loss (P = 0.013). A cutoff point was established in 115 (odds ratio, 4; P = 0.006). All the patients but two reporting hair loss presented addition levels under 115. This variable showed sensibility 88 per cent, specificity 84 per cent, positive predictive value 79 per cent, and negative predictive value 91 per cent to predict hair loss. Hair loss is a frequent condition after sleeve gastrectomy. In most cases, iron and zinc levels are within the normal range. The variable addition (zinc + iron) is a good predictor of hair loss. Patients with addition levels below 115 are fourfold more susceptible to present hair loss. In these cases, zinc supplements achieve the stop of hair loss in most cases.

  9. Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis.

    Directory of Open Access Journals (Sweden)

    Weizhi Wang

    Full Text Available OBJECTIVE: To expand the current knowledge on the feasibility and safety of laparoscopic total gastrectomy (LTG for gastric cancer in comparison with open total gastrectomy (OTG. BACKGROUND: Additional studies comparing laparoscopic versus open total gastric resection have been published, and it is necessary to update the meta-analysis of this subject. METHODS: Original articles compared LTG and OTG for gastric cancer, which published in English from January 1990 to July 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, proximal resection margin, analgesic medication, first flatus day, first oral intake, postoperative hospital stay, postoperative complications, hospital mortality, 5-year overall survival (OS and disease-free survival (DFS were compared using STATA version 10.1. RESULTS: 17 studies were selected in this analysis, which included a total of 2313 patients (955 in LTG and 1358 in OTG. LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. The number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar. CONCLUSION: LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time. There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG. A positive trend was indicated towards LTG. So LTG can be performed as an alternative to OTG by the experienced surgeons in high-volume centers. Whereas, due to the relative small sample size of long-term outcomes and lack of randomized control trials, more studies are

  10. Intra-thoracic Sleeve Migration (ITSM): an Underreported Phenomenon After Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Saber, Alan A; Shoar, Saeed; Khoursheed, Mousa

    2017-08-01

    Despite its technical simplicity, laparoscopic sleeve gastrectomy (LSG) complications are increasingly reported. Intra-thoracic sleeve migration (ITSM ) is a rare complication after LSG which has been inconsistently addressed in the literature. The purpose of this study was to emphasize ITSM occurrence after LSG and evaluate the perioperative factors associated with its development. Between January and July 2016, LSG patients diagnosed with ITSM at two bariatric surgery departments were identified. Perioperative factors were assessed for all the patients and compared between two groups, LSG alone and LSG with concomitant hiatal hernia (HH) repair (HHR). A total of 19 patients (6 males and 13 females) were included. Central obesity was present in 18 patients (94.7%). Nine patients (47.4%) had concomitant hiatal hernia repair during their original LSG. Post-LSG GERD (94.7%) (38.9% de novo and 61.1% recurrent) and post-LSG constipation (57.9%) were commonly associated with ITSM. Severe refractory GERD was the most common presentation for ITSM (94.7%), followed by epigastric pain (47.4%), persistent nausea/vomiting (36.8%), and dysphagia (21.1%). Time interval between primary LSG and ITSM diagnosis ranged from 1 day to 3 years. Patients with LSG and concomitant HHR presented with higher post-LSG BMI compared to the LSG patients (37 ± 6.4 kg/m(2) vs. 30.1 ± 6.3 kg/m(2), p = 0.03). All the patients underwent successful reduction of ITSM and subsequent HHR. Central obesity, chronic constipation, post-LSG GERD, and concomitant HHR are commonly seen in post-laparoscopic sleeve gastrectomy intra-thoracic sleeve migration.

  11. Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Shuhei Komatsu; Yoshiaki Kuriu; Masayoshi Nakanishi; Hitoshi Fujiwara; Toshiya Ochiai; Yukihito Kokuba; Eigo Otsuji; Daisuke Ichikawa; , Kazuma Okamoto; Daito Ikoma; Masahiro Tsujiura; Yukihisa Nishimura; Yasutoshi Murayama; Atsushi Shiozaki; Hisashi Ikoma

    2012-01-01

    AIM:To re-evaluate the recent clinicopathological features of remnant gastric cancer (RGC) and to develop desirable surveillance programs.METHOIDS:Between 1997 and 2008,1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery,Kyoto Prefectural University of Medicine,Japan.Of these,33 patients underwent gastrectomy with lymphadenectomy for RGC.Regarding the initial gastric disease,there were 19 patients with benign disease and 14 patients with gastric cancer.The hospital records of these patients were reviewed retrospectively.RESULTS:Concerning the initial gastric disease,the RGC group following gastric cancer had a shorter interval [P < 0.05; gastric cancer vs benign disease:12 (2-22) vs 30 (4-51) years] and were more frequently reconstructed by Billroth- I procedure than those following benign lesions (P < 0.001).Regarding reconstruction,RGC following Billroth-Ⅱ reconstruction showed a longer interval between surgical procedures [P < 0.001; Billroth- 11 vs Billroth- Ⅰ:32 (5-51) vs 12 (2-36) years] and tumors were more frequently associated with benign disease (P < 0.001) than those following Billroth- I reconstruction.In tumor location of RGC,after Billroth- I reconstruction,RGC occurred more frequently near the suture line and remnant gastric wall.After Billroth- Ⅱ reconstruction,RGC occurred more frequently at the anastomotic site.The duration of followup was significantly associated with the stage of RGC (P < 0.05).Patients diagnosed with early stage RGC such as stage I -Ⅱ tended to have been followed up almost every second year.CONCLUSION:Meticulous follow-up examination and early detection of RGC might lead to a better prognosis.Based on the initial gastric disease and the procedure of reconstruction,an appropriate follow-up interval and programs might enable early detection of RGC.

  12. 探讨乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的效果%To Explore the Curative Effect of Radical Mastoidectomy Combine With Tympanoplasty Treatment Cholesteatoma Otitis Media

    Institute of Scientific and Technical Information of China (English)

    姚旭光; 孙福生

    2015-01-01

    Objective Observation curative effect of radical mastoidectomy with tympanoplasty for cholesteatoma otitis media effect.Methods Selected 90 patients with cholesteatoma otitis media were divided into two groups, the control group adopt mastoidotympanectomy, and the study group adopt mastoid effect a radical cure joint tympanoplasty.Results The study group normal rate was higher than the control group, the team plane form bones guide poor total period, complications and recurrence rates were better than the control group,P<0.05, had difference statistically significance.Conclusion The curative effect of radical mastoidectomy with tympanoplasty for cholesteatoma otitis media with good effect, less complications, low recurrence rate.%目的 观察乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的效果.方法 将90例胆脂瘤中耳炎患者分为两组,对照组行乳突根治术,研究组行乳突根治联合鼓室成形术治.结果 研究组外耳道形态正常率高于对照组,气骨导差总改善率、并发症发生率和复发率均优于对照组, P<0.05,差异具有统计学意义.结论 乳突根治联合鼓室成形术治疗胆脂瘤中耳炎效果好,并发症少,复发率低.

  13. Catalysis of Radical Reactions: A Radical Chemistry Perspective.

    Science.gov (United States)

    Studer, Armido; Curran, Dennis P

    2016-01-04

    The area of catalysis of radical reactions has recently flourished. Various reaction conditions have been discovered and explained in terms of catalytic cycles. These cycles rarely stand alone as unique paths from substrates to products. Instead, most radical reactions have innate chains which form products without any catalyst. How do we know if a species added in "catalytic amounts" is a catalyst, an initiator, or something else? Herein we critically address both catalyst-free and catalytic radical reactions through the lens of radical chemistry. Basic principles of kinetics and thermodynamics are used to address problems of initiation, propagation, and inhibition of radical chains. The catalysis of radical reactions differs from other areas of catalysis. Whereas efficient innate chain reactions are difficult to catalyze because individual steps are fast, both inefficient chain processes and non-chain processes afford diverse opportunities for catalysis, as illustrated with selected examples.

  14. The location of protein S8 and surrounding elements of 16S rRNA in the 70S ribosome from combined use of directed hydroxyl radical probing and X-ray crystallography.

    Science.gov (United States)

    Lancaster, L; Culver, G M; Yusupova, G Z; Cate, J H; Yusupov, M M; Noller, H F

    2000-05-01

    Ribosomal protein S8, which is essential for the assembly of the central domain of 16S rRNA, is one of the most thoroughly studied RNA-binding proteins. To map its surrounding RNA in the ribosome, we carried out directed hydroxyl radical probing of 16S rRNA using Fe(II) tethered to nine different positions on the surface of protein S8 in 70S ribosomes. Hydroxyl radical-induced cleavage was observed near the classical S8-binding site in the 620 stem, and flanking the other S8-footprinted regions of the central domain at the three-helix junction near position 650 and the 825 and 860 stems. In addition, cleavage near the 5' terminus of 16S rRNA, in the 300 region of its 5' domain, and in the 1070 region of its 3'-major domain provide information about the proximity to S8 of RNA elements not directly involved in its binding. These data, along with previous footprinting and crosslinking results, allowed positioning of protein S8 and its surrounding RNA elements in a 7.8-A map of the Thermus thermophilus 70S ribosome. The resulting model is in close agreement with the extensive body of data from previous studies using protein-protein and protein-RNA crosslinking, chemical and enzymatic footprinting, and genetics.

  15. New method of lymph node tracing in gastrectomy for advanced gastric carcinoma%进展期胃癌根治术中淋巴结示踪新方法

    Institute of Scientific and Technical Information of China (English)

    Huaiwu Jiang; Zonglin Li; Jin Chen; Shiming Xiao; Liang Luo

    2012-01-01

    Objective: The aim of this study was to explore a new method of lymph node tracing in radical gastrectomy for advanced gastric carcinoma (AGC). Methods: Ninety-two patients who suffered from gastric angle carcinoma with metastasis in No. 3 group lymph nodes were carried out radical gastrectomy. During the operation methylene blue was injected inside or around the circum of the metastatic No. 3 group lymph nodes. Secondary sentinel lymph nodes (SSLNs) were the nearest blue lymph nodes to No. 3 group lymph nodes that were searched in 5 to 10 min after injecting methylene blue. These SSLNs were resected and carried out hematoxylin-eosin (HE) staining as well as immunohistochemistry (IHC) staining to demonstrate whether there were metastasis. Results: SSLNs were found successfully in 76 patients with a positive rate of 82.6% (76/92) by methylene blue staining, among which, 34 patients were demonstrated existing metastasis in SSLNs by HE staining, 26 patients were demonstrated existing metastasis in SSLNs by IHC staining which were not demonstrated existing metastasis by HE staining. Totally, 60 patients were demonstrated existing metastasis in SSLNs by HE staining and IHC staining with a positive rate of 78.9% (60/76). 136 SSLNs were found in total and 104 SSLNs were demonstrated existing metastasis with a positive rate of 76.4% (104/136). There were 14, 18, 10, 80, 6 and 8 SSLNs in No. 4, No. 5, No. 6, No. 7,No. 8 and No. 9 group lymph nodes respectively. And there were 10, 18, 8, 62, 2 and 4 SSLNs were demonstrated existing metastasis with a positive rate of 71.4%, 100%, 80.0%, 77.5%, 33.3% and 50.0% in No. 4, No. 5, No. 6, No. 7, No. 8 and No.9 group lymph nodes respectively. However, there were no significant correlations between the tumor's size and the positive rate of SSLN as well as the degree of tumor's differentiation and the positive rate of SSLN. Conclusion: The technique of SSLN tracing expands the application range of sentinel lymph node (SLN) tracing and

  16. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer.

    Science.gov (United States)

    Sugimoto, Motokazu; Kinoshita, Takahiro; Shibasaki, Hidehito; Kato, Yuichiro; Gotohda, Naoto; Takahashi, Shinichiro; Konishi, Masaru

    2013-11-01

    Laparoscopic distal gastrectomy for gastric cancer has been firmly established in recent decades but still is a difficult procedure, especially for obese patients, as with open surgery. This study aimed to evaluate the perioperative outcome of total laparoscopic distal gastrectomy (TLDG) for early gastric cancer patients with a body mass index (BMI) exceeding 25 kg/m(2) and to consider countermeasures to this. Perioperative outcomes were compared between 42 patients with a BMI exceeding 25 kg/m(2) [overweight or obese group (OWG)] and 174 patients with a BMI lower than 25 kg/m(2) [normal or underweight group (NWG)] who underwent TLDG between September 2010 and December 2012. The BMI was 26.0 ± 1.4 kg/m(2) in the OWG group and 22.0 ± 2.1 kg/m(2) in the NWG group (P obese patients, TLDG was managed safely. The procedure was considered to be difficult but sufficiently feasible.

  17. Focal fat deposition developed in the segment IV of the liver following gastrectomy mimicking a hepatic metastasis: Two case reports

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Beom Seok; Lim, Joon Seok; Kim, Myeong Jin; Kim, Ki Whang; Hyung, Woo Jin [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2012-10-15

    We present two cases of focal fat deposition developed at the posterior area of the segment IV in the liver, following gastrectomy in patients with gastric cancer. There was no focal lesion in this area of the liver at preoperative computed tomography (CT) in both cases, and the aberrant right gastric vein (ARGV) was found on the retrospective review of this CT. After gastrectomy, a focal, low attenuating lesion was developed in this area on a follow up CT in both cases, which was confirmed as a focal fat deposition, by other imaging studies. In addition to its typical imaging findings, confirmation of the presence of the ARGV also supported this lesion to be a focal fat deposition. Furthermore, understanding of our cases may be of help to prevent us from unnecessary invasive procedures, such as liver biopsy.

  18. Effects of Different Operative Procedures on the Digestive and Nutritional Status of Patients Treated with a Gastrectomy for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    Han Liang; Xishan Hao

    2006-01-01

    Postgastrectomy syndromes evoked by the loss of several gastric functions after total or subtotal gastrectomy are very common. Different kinds of reconstruction have been developed to overcome the problem. Patients with preservation of a duodenal passage and jejunal interposition with or without a pouch show a better quality of life and minimal symptoms postoperatively. A jejunal interposition with or without a pouch after proximal or distal subtotal gastrictomy seems to improve the nutritional condition and quality of life. The prognostic nutritional index (PNI), Visick score, Spitzer index and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire (QLQ-C30) are available to evaluate the quality of life and nutritional status after gastrectomy.

  19. Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach.

    Science.gov (United States)

    Zhu, Qian-Lin; Zheng, Min-Hua; Feng, Bo; Lu, Ai-Guo; Wang, Min-Liang; Li, Jian-Wen; Hu, Wei-Guo; Zang, Lu; Mao, Zhi-Hai; Dong, Feng; Ma, Jun-Jun; Zong, Ya-Ping

    2008-06-07

    Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity, a shorter treatment time, and similar outcomes. However, simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature. Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort. He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected. The operation time was 270 min and the estimated blood loss was 120 mL. The patient required parenteral analgesia for less than 24 h. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 7. He was discharged on postoperative day 13. With the advances in laparoscopic technology and experience, simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.

  20. Radically innovative steelmaking technologies

    Science.gov (United States)

    Szekely, Julian

    1980-09-01

    The steel industry is faced with serious problems caused by the increasing cost of energy, labor and capital and by tough overseas competition, employing new highly efficient process plants. The very high cost of capital and of capital equipment renders the construction of new green field site plants, exemplifying the best available technology economically unattractive. For this reason, over the long term the development radically innovative steelmaking technologies appears to be the only satisfactory resolution of this dilemma. The purpose of this article is to present a critical review of some of the radically innovative steelmaking technologies that have been proposed during the past few years and to develop the argument that these indeed do deserve serious consideration at the present time. It should be stressed, however, that these innovative technologies can be implemented only as part of a carefully conceived long range plan, which contains as a subset short term solutions, such as trigger prices improved investment credits, and so forth and intermediate term solutions, such as more extensive use of continuous casting, external desulfurization and selective modernization in general.

  1. One Year Follow-up Results after Sleeve Gastrectomy in Type 2 Diabetes Mellitus Patients with Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Dejeu Viorel

    2016-06-01

    Full Text Available Background and aims: Bariatric surgery has been shown to be superior to nonsurgical approaches in terms of weight loss and remission of type 2 diabetes (T2DM and metabolic syndrome. This prospective, single-center, follow-up study assessed percentage of excessive weight loss (%EWL, glycosylated hemoglobin (HbA1c levels, prescribed antidiabetes drugs and diabetes remission rates in obese T2DM patients who underwent laparoscopic sleeve gastrectomy.

  2. Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Hai-Tao Wang; Qi-Cheng Lu; Qing Wang; Rong-Chao Wang; Yun Zhang; Hai-Long Chen; Hong Zhao; Hai-Xin Qian

    2008-01-01

    AIM: To investigate the role of the duodenum in the regulation of plasma ghrelin levels and body mass index (BMI), and the correlation between them after subtotal gastrectomy.METHODS: Forty-two patients with To-1No-1M0 gastric cancer were divided into two groups after gastrectomy according to digestive reconstruction pattern,Billroth I group (n = 23) and Billroth Ⅱ group (n = 19).Ghrelin levels were determined with radioimmunoassay (RIA) before and on d 1, 7, 30 and 360 after gastrectomy,and BMI was also measured.RESULTS: The two groups had identical postoperative trends in ghrelin alterations during the early stage, both decreasing sharply to a nadir on d 1 (36.7% vs 35.7%),then markedly increasing on d 7 (51.0% vs 51.1%). On d 30, ghrelin levels in the Billroth I group were slightly higher than those in the Billroth Ⅱ group. However,those of the Billroth I group recovered to 93.6% on d 360, which approached, although lower than, the preoperative levels, and no statistically significant difference was observed. Those of the Billroth Ⅱ group recovered to only 81.6% and manifested significant discrepancy with preoperative levels (P = 0.033).Compared with preoperative levels, ghrelin levels of the two groups decreased by 6.9% and 18.4% and BMI fell by 3.3% and 6.4%, respectively. The linear regression correlations were revealed in both groups between decrease of ghrelin level and BMI (R12 = 0.297, P = 0.007;R22 = 0.559, P < 0.001).CONCLUSION: Anatomically and physiologically, the duodenum compensatively promotes ghrelin recovery and accordingly enhances BMI after gastrectomy.Regarding patients with insufficient ghrelin secretion,ghrelin is positively associated with BMI.

  3. Billroth II with Braun Enteroenterostomy Is a Good Alternative Reconstruction to Roux-en-Y Gastrojejunostomy in Laparoscopic Distal Gastrectomy

    OpenAIRE

    Long-Hai Cui; Sang-Yong Son; Ho-Jung Shin; Cheulsu Byun; Hoon Hur; Sang-Uk Han; Yong Kwan Cho

    2017-01-01

    Background. Although Billroth II (BII) reconstruction is simpler and faster than Billroth I or Roux-en-Y (RY) reconstruction in patients undergoing totally laparoscopic distal gastrectomy (TLDG), BII reconstruction is associated with several complications, including more severe bile reflux. BII Braun anastomosis may be a better alternative to RY reconstruction. Methods. This retrospective study included 56 consecutive patients who underwent TLDG for gastric cancer, followed by BII Braun or RY...

  4. Phase I Clinical Research of Jejunal Interposition in Adenocarcinoma of the Esophagogastric Junction II/III Proximal Gastrectomy

    Directory of Open Access Journals (Sweden)

    Kai Tao

    2016-01-01

    Full Text Available Objective. To investigate the feasibility and specific methods of single-tract jejunal interposition between esophagus and remnant stomach (ers-STJI in adenocarcinoma of the esophagogastric junction (AEG II/III proximal gastrectomy. Methods. 15 AEG II/III gastric cancer (GC patients in phase T1-3N0M0 with tumor size <5 cm were selected and they underwent proximal gastrectomy with ers-STJI from August 2013 to August 2014. Results. All of the 15 patients successfully completed GC R0 proximal gastrectomy with ers-STJI and no operative death or no significant complication occurred; one patient had anastomotic inflammatory granuloma. The digestive tract reconstruction time was 29.5 ± 5.7 min; the intraoperative blood loss was 96.7 ± 20.2 mL, and the number of lymph node dissections was 21.3 ± 3.0; the postoperative flatus time was 48.2 ± 11.9 h; the average length of hospital stay was 10.7 ± 2.3 d, and the average hospital stay cost was 60 ± 3 thousands. All of the patients were followed up for 12 months, and their postoperative single food intake, body weight, hemoglobin, and albumin were all recovered to the preoperative levels. Conclusions. The applications of ers-STJI in proximal gastrectomy were safe and feasible, and the length of jejunal interposition could be 15–25 cm.

  5. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2013-10-15

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  6. The Quality of Life of Gastric Cancer Patients with and without Duodenal Passage Reconstructions after Total Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Dongsheng Li; Huimian Xu

    2005-01-01

    OBJECTIVE To evaluate the Quality of Life of the patients who received a total gastrectomy with different kinds of reconstruction methods.METHODS Patients who received a total gastrectomy between May 1999 to May 2003 were followed-up via questionnaires. Fifty-nine who were alive more than 2 years with no sigh of recurrence were enrolled in this study. The patients were divided into 2 groups as follows: a group treated with reconstruction with a duodenal passage after total gastrectomy (gastric substitute, GS); and a group receiving reconstruction without duodenal passage after total gastrectomy (Jejenal pouch, JP). Follow-up feedback data of 14 items from the patients were analyzed, comparing the Quality of Life (QOL) between the 2 groups.RESULTS Six months after operation, the most common symptoms of all patients were reflux and loss of body weight, but there was no statistically significant differences in the 14 items related to the special post-operation symptoms between the 2 groups. At 12 months after the operations,there were significant differences between the 2 groups in body weight (P=0.01), eating time (P=0.034<0.05), and frequency of food intake (P=0.040<0.05); At 24 months after the operations, the only difference between the 2 groups was body weight gain (P=0.025<0.05). The JP group was better than the GS group.CONCLUSION The JP reconstruction pattern is superior to a simple GS in gain of body weight, volume of food intake and frequency of food intake, soon after the operation.

  7. [Effectiveness of chemoradiotherapy for a patient with local recurrence of advanced gastric cancer followed by curable gastrectomy].

    Science.gov (United States)

    Natsume, Soichiro; Iwasaki, Yoshiaki; Yajima, Kazuhito; Yuu, Ken; Oohinata, Ryouki; Ishiyama, Satoshi; Takahashi, Keiichi; Maeda, Yoshiharu

    2014-11-01

    We report here the effectiveness of chemoradiotherapy for a patient with local recurrence followed by curable gastrectomy. A 57-year-old man presented with a history of total gastrectomy with distal pancreatectomy and splenectomy, D2 lymphadenectomy, and Roux-en-Y reconstruction for advanced gastric cancer arising from the cardia. Esophageal intramural metastasis and lymph node metastasis around the right recurrent nerve were detected by chest-abdominal computed tomography and gastrointestinal endoscopy 27 months after the initial gastrectomy. Stable disease was achieved following 7 courses of chemotherapy using S-1 plus CDDP. Concurrent chemoradiotherapy including administration of S-1 and radiation of total 50 Gy (2 Gy/25 Fr) was selected for local tumor control. The patient was not able to eat solid food because of esophageal stenosis from regrowth of intramural metastasis of the esophagus 60 months after the chemotherapy. A WallFlex™ Duodenal Stent was placed to improve the dysphagia 67 months after chemotherapy. The patient died from recurrence of gastric cancer 69 months after completion of the initial chemotherapy and 2 months after the stent insertion.

  8. Moment Matrices, Border Bases and Real Radical Computation

    OpenAIRE

    Lasserre, Jean-Bernard; Laurent, Monique; Mourrain, Bernard; Rostalski, Philipp; Trébuchet, Philippe

    2013-01-01

    International audience; In this paper, we describe new methods to compute the radical (resp. real radical) of an ideal, assuming it complex (resp. real) variety is finite. The aim is to combine approaches for solving a system of polynomial equations with dual methods which involve moment matrices and semi-definite programming. While the border basis algorithms of [17] are efficient and numerically stable for computing complex roots, algorithms based on moment matrices [12] allow the incorpora...

  9. Radicals in Berkeley?

    Science.gov (United States)

    Linn, Stuart

    2015-04-03

    In a previous autobiographical sketch for DNA Repair (Linn, S. (2012) Life in the serendipitous lane: excitement and gratification in studying DNA repair. DNA Repair 11, 595-605), I wrote about my involvement in research on mechanisms of DNA repair. In this Reflections, I look back at how I became interested in free radical chemistry and biology and outline some of our bizarre (at the time) observations. Of course, these studies could never have succeeded without the exceptional aid of my mentors: my teachers; the undergraduate and graduate students, postdoctoral fellows, and senior lab visitors in my laboratory; and my faculty and staff colleagues here at Berkeley. I am so indebted to each and every one of these individuals for their efforts to overcome my ignorance and set me on the straight and narrow path to success in research. I regret that I cannot mention and thank each of these mentors individually.

  10. Comparison of Quality of Life and Nutritional Status in Gastric Cancer Patients Undergoing Gastrectomies.

    Science.gov (United States)

    Lim, Hee-Sook; Cho, Gyu-Seok; Park, Yoon-Hyung; Kim, Soon-Kyung

    2015-07-01

    The aim of this study was to compare the quality of life (QoL) depending on the postoperative survival period or nutritional status in gastric cancer patients. Surviving gastric cancer patients (n = 222) after the gastrectomy were included in the study at Soonchunhyang University Bucheon Hospital from April 2010 to August 2012. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and a gastric cancer-specific module, the EORTC QLQ-STO22, were used to assess the QoL. The postoperative survival period of the patients fell into two groups; the less-than-1-year group or the more-than-1-year group, and the nutritional status of the patients fell into three groups by a score of patient generated-subjective global assessment (SGA)-A, B, and C. As a result, the rate of malnutrition was 34.5% in the less-than-1-year group and 19.8% in the more-than-1-year group, respectively. Score for the fatigue (p = 0.006), loss of appetite (p = 0.002), reflux (p = 0.027) and body image (p = 0.004) in which the QoL was significantly lower in the less-than-1-year group than in the more-than-1-year group. The score of QoL according to the nutritional status of all subjects, overall health status (p = 0.043), physical functioning (p = 0.016), fatigue (p = 0.006), pain (p = 0.028), loss of appetite (p = 0.017), reflux (p = 0.003), eating restriction (p = 0.002), anxiety (p = 0.010), and body image (p = 0.001) was significantly lower in the SGA-C group than in other SGA groups. These results suggest that the nutritional status of the gastrectomy patients with stomach cancer may impact on their QoL. It is necessary to to develop nutritional intervention to improve QoL in gastric cancer patients with postoperative malnutrition.

  11. Radical chic? Yes we are!

    OpenAIRE

    Hartle, J.F.

    2012-01-01

    Ever since Tom Wolfe in a classical 1970 essay coined the term "radical chic", upper-class flirtation with radical causes has been ridiculed. But by separating aesthetics from politics Wolfe was actually more reactionary than the people he criticized, writes Johan Frederik Hartle.

  12. Melatonin scavenges phenylglyoxylic ketyl radicals.

    Science.gov (United States)

    Sersen, F; Vencel, T; Annus, J

    2004-12-01

    The antioxidant properties of melatonin were tested in this work by EPR technique. It was found that melatonin scavenges phenylglyoxylic ketyl radicals. Its effectiveness was 10-times lower than that of vitamin C. A new method of generation of phenylglyoxylic ketyl radicals by spontaneous decomposition of D,L-2,3-diphenyltartaric acid in propan-2-ol was used.

  13. Acylated and desacyl ghrelin are associated with hepatic lipogenesis, β-oxidation and autophagy: role in NAFLD amelioration after sleeve gastrectomy in obese rats.

    Science.gov (United States)

    Ezquerro, Silvia; Méndez-Giménez, Leire; Becerril, Sara; Moncada, Rafael; Valentí, Víctor; Catalán, Victoria; Gómez-Ambrosi, Javier; Frühbeck, Gema; Rodríguez, Amaia

    2016-12-23

    Bariatric surgery improves non-alcoholic fatty liver disease (NAFLD). Our aim was to investigate the potential role of ghrelin isoforms in the resolution of hepatic steatosis after sleeve gastrectomy, a restrictive bariatric surgery procedure, in diet-induced obese rats. Male Wistar rats (n = 161) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions [fed ad libitum a normal (ND) or a high-fat (HFD) diet or pair-fed]. Obese rats developed hepatosteatosis and showed decreased circulating desacyl ghrelin without changes in acylated ghrelin. Sleeve gastrectomy induced a dramatic decrease of desacyl ghrelin, but increased the acylated/desacyl ghrelin ratio. Moreover, sleeve gastrectomy reduced hepatic triglyceride content and lipogenic enzymes Mogat2 and Dgat1, increased mitochondrial DNA amount and induced AMPK-activated mitochondrial FFA β-oxidation and autophagy to a higher extent than caloric restriction. In primary rat hepatocytes, the incubation with both acylated and desacyl ghrelin (10, 100 and 1,000 pmol/L) significantly increased TG content, triggered AMPK-activated mitochondrial FFA β-oxidation and autophagy. Our data suggest that the decrease in the most abundant isoform, desacyl ghrelin, after sleeve gastrectomy contributes to the reduction of lipogenesis, whereas the increased relative acylated ghrelin levels activate factors involved in mitochondrial FFA β-oxidation and autophagy in obese rats, thereby ameliorating NAFLD.

  14. The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon's Experience While Introducing the Robotic Technology in a Bariatric Surgery Department.

    Science.gov (United States)

    Vilallonga, Ramon; Fort, José Manuel; Gonzalez, Oscar; Caubet, Enric; Boleko, Angeles; Neff, Karl John; Armengol, Manel

    2012-01-01

    Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases.

  15. Acylated and desacyl ghrelin are associated with hepatic lipogenesis, β-oxidation and autophagy: role in NAFLD amelioration after sleeve gastrectomy in obese rats

    Science.gov (United States)

    Ezquerro, Silvia; Méndez-Giménez, Leire; Becerril, Sara; Moncada, Rafael; Valentí, Víctor; Catalán, Victoria; Gómez-Ambrosi, Javier; Frühbeck, Gema; Rodríguez, Amaia

    2016-01-01

    Bariatric surgery improves non-alcoholic fatty liver disease (NAFLD). Our aim was to investigate the potential role of ghrelin isoforms in the resolution of hepatic steatosis after sleeve gastrectomy, a restrictive bariatric surgery procedure, in diet-induced obese rats. Male Wistar rats (n = 161) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions [fed ad libitum a normal (ND) or a high-fat (HFD) diet or pair-fed]. Obese rats developed hepatosteatosis and showed decreased circulating desacyl ghrelin without changes in acylated ghrelin. Sleeve gastrectomy induced a dramatic decrease of desacyl ghrelin, but increased the acylated/desacyl ghrelin ratio. Moreover, sleeve gastrectomy reduced hepatic triglyceride content and lipogenic enzymes Mogat2 and Dgat1, increased mitochondrial DNA amount and induced AMPK-activated mitochondrial FFA β-oxidation and autophagy to a higher extent than caloric restriction. In primary rat hepatocytes, the incubation with both acylated and desacyl ghrelin (10, 100 and 1,000 pmol/L) significantly increased TG content, triggered AMPK-activated mitochondrial FFA β-oxidation and autophagy. Our data suggest that the decrease in the most abundant isoform, desacyl ghrelin, after sleeve gastrectomy contributes to the reduction of lipogenesis, whereas the increased relative acylated ghrelin levels activate factors involved in mitochondrial FFA β-oxidation and autophagy in obese rats, thereby ameliorating NAFLD. PMID:28008992

  16. Surface functionalized SiO2 nanoparticles with cationic polymers via the combination of mussel inspired chemistry and surface initiated atom transfer radical polymerization: Characterization and enhanced removal of organic dye.

    Science.gov (United States)

    Huang, Qiang; Liu, Meiying; Mao, Liucheng; Xu, Dazhuang; Zeng, Guangjian; Huang, Hongye; Jiang, Ruming; Deng, Fengjie; Zhang, Xiaoyong; Wei, Yen

    2017-03-28

    Monodispersed SiO2 particles functionalized with cationic polymers poly-((3-acrylamidopropyl)trimethylammonium chloride) (PAPTCl) were prepared using mussel inspired surface modification strategy and surface initiated atom transfer radical polymerization (SI-ATRP). Fourier transform infrared spectroscopy, transmission electron microscope, thermogravimetric analysis, X-ray photoelectron spectroscopy, and zeta potential were employed to characterize these SiO2 samples. The adsorption performance of the functionalized SiO2 (donated as SiO2-PDA-PAPTCl) towards anionic organic dye Congo red (CR) was investigated to evaluate their potential environmental applications. We demonstrated that the surface of SiO2 particles can be successfully functionalized with cationic PAPTCl. The adsorption capability of as-prepared SiO2 was found to increases from 28.70 and 106.65mg/g after surface grafted with cationic polymers. The significant enhancement in the adsorption capability of SiO2-PDA-PAPTCl is mainly attributed to the introduction of cationic polymers. More importantly, this strategy is expected to be promising for fabrication of many other functional polymer nanocomposites for environmental applications due to the universality of mussel inspired chemistry and well designability and good monomer adaptability of SI-ATRP.

  17. A surgical rat model of sleeve gastrectomy with staple technique: long-term weight loss results.

    Science.gov (United States)

    Patrikakos, Panagiotis; Toutouzas, Konstantinos G; Perrea, Despoina; Menenakos, Evangelos; Pantopoulou, Alkistis; Thomopoulos, Theodore; Papadopoulos, Stefanos; Bramis, John I

    2009-11-01

    Sleeve gastrectomy (SG) is one of the surgical procedures applied for treating morbid obesity consisting of removing the gastric fundus and transforming the stomach into a narrow gastric tube. The aim of this experimental study is to create a functional model of SG and to present the long-term weight loss results. Twenty adult Wistar rats were fed with high fat diet for 12 weeks before being divided randomly in two groups of ten rats each. One group underwent SG performed with the use of staples, and the other group underwent a sham operation (control group). The animals' weight was evaluated weekly for 15 weeks after the operation. All animals survived throughout the experiment. After the operation both groups started to lose weight with maximum weight loss on the seventh postoperative day (POD) for the sham-operated group and on the 15th POD for the SG group. Thereafter, both groups started to regain weight but with different rates. By the fourth postoperative week (POW), the average weight of the sham group did not differ statistically significantly compared to the preoperative weight, while after the eighth POW, rats' average weight was statistically significantly increased compared to the preoperative value. On the other hand, average weight of the SG group was lower postoperatively until the end of the study compared to the preoperative average weight. We have created a surgical rat model of experimental SG model, enabling the further study of biochemical and hormonal parameters.

  18. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Mauro Montuori

    2017-01-01

    Full Text Available Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%. All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85. We recorded one death (16.67% due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44. Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.

  19. Morbid obesity and subsequent pancreatic cancer: pylorus-preserving pancreatoduodenectomy after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Küper, Markus A; Königsrainer, Ingmar; Schmidt, Diethard; Kramer, K Michael; Granderath, Frank A; Schneider, Joachim; Löb, Stefan; Zieker, Derek; Hartmann, Jörg T; Zdichavsky, Marty; Königsrainer, Alfred; Brücher, Björn L D M

    2009-03-01

    Morbid obesity is a recognized risk factor for gastrointestinal cancer. Little is known about pancreatic cancer developing after gastric bypass surgery or about surgery for this type of tumor following bariatric surgery. This report describes a case of pancreatic head cancer identified 3 months after laparoscopic sleeve gastrectomy for morbid obesity. During routine follow-up, mild abdominal pain and elevated pancreatic enzymes prompted computed tomography, which revealed mild edematous pancreatitis. Hyperbilirubinemia developed, and magnetic resonance imaging showed a pancreatic head tumor. CA19-9 was elevated. After a pylorus-preserving pancreatic head resection, the postoperative course was uneventful. The patient received adjuvant chemotherapy. Unfortunately, at the time of writing (9 months postoperatively), a local recurrence and hepatic metastases were diagnosed. Patients treated with bariatric surgery who develop new symptoms or report constant mild symptoms should be evaluated using endoscopy and radiomorphological imaging. Interdisciplinary obesity treatment can then offer significant benefits for the patient, particularly in the case of pancreatic cancer, which is still difficult to diagnose. In addition, there is a need for epidemiological studies of patients who undergo bariatric surgery and subsequently develop cancer.

  20. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cheong Ah Oh; Dae Hoon Kim; Seung Jong Oh; Min Gew Choi; Jae Hyung Noh; Tae Sung Sohn; Jae Moon Bae; Sung Kim

    2012-01-01

    AIM:To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS:From January 2008 through June 2008,669 patients who underwent curative gastrectomy for gastric cancer were included in a retrospective study.Medical records of consecutive patients were collected and analyzed to determine postoperative wound complication rates.The NRI was assessed on the fifth postoperative day and other possible risk factors for the incidence of wound complications were analyzed to identify the factors affecting postoperative wound complications.Patients with other postoperative complications were excluded from the study.RESULTS:On the 5th postoperative day,the NRI showed a malnutrition rate of 84.6% among postoperative patients.However,postoperative wound complications occurred in only 66/669 (9.86%) patients.Of the patients with wound complications,62/66 (94%)belonged to the malnourished group (NRI < 97.5),and 4/66 (6%) patients to the non-malnourished group (NRI ≥ 97.5).The only factor correlated with wound complications was the NRI on the 5th postoperative day (odds ratio of NRI ≥ 97.5 vs NRI < 97.5:0.653; 95%confidence interval:0.326-0.974; P =0.014) according to univariate analysis as well as multivariate analysis.CONCLUSION:This study suggests that malnutrition immediately after surgery may play a significant role in the development of wound complications.

  1. [Case of Colon Metastasis from Early Gastric Cancer 4 Years after Laparoscopic Assisted Distal Gastrectomy].

    Science.gov (United States)

    Ikeda, Kosuke; Sato, Tsutomu; Maezawa, Yukio; Kano, Kazuki; Satoyoshi, Tetsuta; Segami, Kenki; Nakajima, Tetsushi; Ogata, Takashi; Cho, Haruhiko; Yoshikawa, Takaki

    2016-11-01

    A 69-year-old woman who underwent laparoscopic assisted distal gastrectomy for early gastric cancer(pathological T1bN1M0)in June 2011was admitted to the hospital because of abdominal pain in May 2015.A n abdominal CT scan showed ileus caused by a transverse colon tumor and ascending colon perforation.We performed emergency right hemicolectomy and diverting ileostomy.The postoperative pathological findings revealed poorly differentiated adenocarcinoma and signetring cell carcinoma similar to the gastric cancer resected 4 years ago.Immunohistochemical findings showed that the colon tumor was positive for CK7, but negative for CK20 and expressed a gastric mucin phenotype.From these findings, the colon tumor was diagnosed as a metastasis from early gastric cancer.Colon metastasis from early gastric cancer is rare and the diagnosis is difficult in some cases.We herein report this case and discuss the clinical and pathologic features of colon metastasis from gastric cancer.

  2. Dry beriberi preceded Wernicke′s encephalopathy: Thiamine deficiency after laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Debopam Samanta

    2015-01-01

    Full Text Available In recent times, pediatric obesity has become widely prevalent. If first-line treatment with lifestyle modification fails, bariatric surgery may be indicated for severely obese patients. Many patients now travel abroad to get these surgeries done. Some of these patients receive inadequate postoperative care. We described a morbidly obese 17-year-old girl who had a laparoscopic sleeve gastrectomy procedure for weight loss. Due to severe nausea, she stopped her multivitamin supplementation. Within a few weeks, she developed symptoms of dry beriberi was soon followed by classic symptoms of Wernicke′s encephalopathy. The prompt diagnosis was made with confirmation from serum thiamine level and brain magnetic resonance imaging. Thiamine supplementation reversed ophthalmological symptoms promptly. However, the patient needed inpatient rehabilitation for neuropathy. This case describes that thiamine deficiency can occur after restrictive bariatric surgery, despite lower risk of malnutrition in the absence of intestinal bypass procedure. This report highlights that in the presence of risk factors: dietary noncompliance, inadequate follow-up, and severe nausea with and without vomiting can precipitate the development of Wernicke′s encephalopathy, even after restrictive surgery. Physicians may increasingly encounter thiamine and other nutrient deficiencies in increasing numbers due to increasing prevalence of obesity disorders and availability of bariatric surgeries. This report also emphasized the importance of identifying vague sensory symptoms in thiamine deficiency.

  3. Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

    Institute of Scientific and Technical Information of China (English)

    Giuseppe S Sica; Edoardo Iaculli; Livia Biancone; Sara Di Carlo; Rosa Scaramuzzo; Cristina Fiorani; Paolo Gentileschi; Achille L Gaspari

    2011-01-01

    AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit.METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality.RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series.CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer.

  4. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Min-Chan Kim; Ghap-Joong Jung; Hyung-Ho Kim

    2005-01-01

    AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (<200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

  5. Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

    Science.gov (United States)

    Sica, Giuseppe S; Iaculli, Edoardo; Biancone, Livia; Carlo, Sara Di; Scaramuzzo, Rosa; Fiorani, Cristina; Gentileschi, Paolo; Gaspari, Achille L

    2011-01-01

    AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit. METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality. RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series. CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer. PMID:22147966

  6. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Alter the Gut-Brain Communication

    Directory of Open Access Journals (Sweden)

    L. A. Ballsmider

    2015-01-01

    Full Text Available This study investigated the anatomical integrity of vagal innervation of the gastrointestinal tract following vertical sleeve gastrectomy (VSG and Roux-en-Y gastric bypass (RYGB operations. The retrograde tracer fast blue (FB was injected into the stomach to label vagal neurons originating from nodose ganglion (NG and dorsal motor nucleus of the vagus (DMV. Microglia activation was determined by quantifying changes in the fluorescent staining of hindbrain sections against an ionizing calcium adapter binding molecule 1 (Iba1. Reorganization of vagal afferents in the hindbrain was studied by fluorescent staining against isolectin 4 (IB4. The density of Iba1- and IB4-immunoreactivity was analyzed using Nikon Elements software. There was no difference in the number of FB-labeled neurons located in NG and DMV between VSG and VSG-sham rats. RYGB, but not RYGB-sham rats, showed a dramatic reduction in number of FB-labeled neurons located in the NG and DMV. VSG increased, while the RYGB operation decreased, the density of vagal afferents in the nucleus tractus solitarius (NTS. The RYGB operation, but not the VSG procedure, significantly activated microglia in the NTS and DMV. Results of this study show that the RYGB, but not the VSG procedure, triggers microglia activation in vagal structures and remodels gut-brain communication.

  7. Using Distonic Radical Ions to Probe the Chemistry of Key Combustion Intermediates: The Case of the Benzoxyl Radical Anion

    Science.gov (United States)

    Li, Cong; Lam, Adrian K. Y.; Khairallah, George N.; White, Jonathan M.; O'Hair, Richard A. J.; da Silva, Gabriel

    2013-04-01

    The benzoxyl radical is a key intermediate in the combustion of toluene and other aromatic hydrocarbons, yet relatively little experimental work has been performed on this species. Here, a combination of electrospray ionization (ESI), multistage mass spectrometry experiments, and density functional theory (DFT) calculations are used to examine the formation and fragmentation of a benzoxyl (benzyloxyl) distonic radical anion. Excited 4-carboxylatobenzoxyl radical anions were produced via two methods: (1) collision induced dissociation (CID) of the nitrate ester 4-(nitrooxymethyl)benzoate, -O2CC6H4CH2ONO2, and (2) reaction of ozone with the 4-carboxylatobenzyl radical anion, -O2CC6H4CH2 •. In neither case was the stabilized -O2CC6H4CH2O• radical anion intermediate detected. Instead, dissociation products at m/ z 121 and 149 were observed. These products are attributed to benzaldehyde (O2 -CC6H4CHO) and benzene (-O2CC6H5) products from respective loss of H and HCO radicals in the vibrationally excited benzoxyl intermediate. In no experiments was a product at m/ z 120 (i.e., -O2CC6H4 •) detected, corresponding to absence of the commonly assumed phenyl radical + CH2=O channel. The results reported suggest that distonic ions are useful surrogates for reactive intermediates formed in combustion chemistry.

  8. The Role of Free Radicals and Antioxidant in Abortion

    Directory of Open Access Journals (Sweden)

    Aloysius Suryawan

    2013-04-01

    Full Text Available BACKGROUND: Free radicals and antioxidant exist in balance under normal condition. In prooxidant condition, excessive free radicals can initiate a state of oxidative stress (OS followed by capillary endothelial cell damage, a process involved in the pathophysiology of abortion. CONTENT: Abortion is a common complication of pregnancy and occurs in 25% of women. Many factors can cause abortion including fetal factor, implantation process and hormonal status. Combination those factors with OS influence the entire reproductive life of a woman. Antioxidant can neutralize free radicals and used to reduce OS especially in recurrent abortion. SUMMARY: Antioxidant therapy is a very interesting field in abortion especially used as prevention approach mainly caused by the high cost of infertility treatment methods. KEYWORDS: free radical, antioxidant, abortion.

  9. Free radicals and male reproduction.

    Science.gov (United States)

    Agarwal, Ashok; Allamaneni, Shyam S R

    2011-03-01

    Male factor accounts for almost 50% cases of infertility. The exact mechanism of sperm dysfunction is not known in many cases. Extensive research in the last decade has led to the identification of free radicals (reactive oxygen species) as mediators of sperm dysfunction in both specific diagnoses and idiopathic cases of male infertility. Elevated levels of reactive oxygen species are seen in up to 30-80% of men with male infertility. The role of free radicals has been studied extensively in the process of human reproduction. We know now that a certain level of free radicals is necessary for normal sperm function, whereas an excessive level of free radicals can cause detrimental effect on sperm function and subsequent fertilisation and offspring health. Oxidative stress develops when there is an imbalance between generation of free radicals and scavenging capacity of anti-oxidants in reproductive tract. Oxidative stress has been shown to affect both standard semen parameters and fertilising capacity. In addition, high levels of free radicals have been associated with lack of or poor fertility outcome after natural conception or assisted reproduction. Diagnostic techniques to quantify free radicals in infertile patients can assist physicians treating patients with infertility to plan for proper treatment strategies. In vivo anti-oxidants can be used against oxidative stress in male reproductive tract. Supplementation of in vitro anti-oxidants can help prevent the oxidative stress during sperm preparation techniques in assisted reproduction.

  10. Guest Editorial: Processes of Radicalization and De-Radicalization

    Directory of Open Access Journals (Sweden)

    Donatella Della Porta

    2012-05-01

    Full Text Available The study of radicalization and de-radicalization, understood as processes leading towards the increased or decreased use of political violence, is central to the question of how political violence emerges, how it can be prevented, and how it can be contained. The focus section of this issue of the International Journal of Conflict and Violence addresses radicalization and de-radicalization, seeking to develop a more comprehensive understanding of the processes, dynamics, and mechanisms involved and taking an interdisciplinary approach to overcome the fragmentation into separate disciplines and focus areas. Contributions by Pénélope Larzillière, Felix Heiduk, Bill Kissane, Hank Johnston, Christian Davenport and Cyanne Loyle, Veronique Dudouet, and Lasse Lindekilde address repressive settings, legitimacy, institutional aspects, organizational outcomes, and dynamics in Europe, Asia, Africa, and North and South America.

  11. 胃癌合并2型糖尿病患者行腹腔镜与开腹全胃切除术的疗效比较%Curative effect of laparoscopic gastrectomy and total gastrectomy for patients with gastric cancer accompanying type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    滕达; 李松岩; 宁宁; 杜晓辉

    2013-01-01

    Objective To find out the best procedure for patients with gastric cancer accompanying type 2 diabetes mellitus (DM) by comparing the curative effect of laparoscopic gastrectomy and laparoscopic total gastrectomy. Methods Clinical data about 76 patients with gastric cancer accompanying DM admitted to our hospital from June 2008 to June 2010 were retrospectively analyzed. The patients were divided into laproscopic gastrectomy group (n=38) and laproscopic total gastrectomy group (n=38). The curative effect of the two procedures was compared. Results The effective rate was 73.7%and 57.9%for the laparoscopic total gastrectomy group and laparoscopic gastrectomy group, respectively (P<0.05). The incision size was smaller, blood loss was less, the postoperative anal exhaust time and feeding time were shorter, the number of white blood cells and neutrophils was lower in laparoscopic total gastrectomy group than in laparoscopic gastrectomy group (P <0.05). Conclusion The curative effect of laparoscopic total gastrectomy is better than that of laparoscopic gastrectomy for patients with gastric cancer accompanying type 2 DM.%  目的比较腹腔镜和开腹手术治疗胃癌合并2型糖尿病患者的临床疗效,寻求最佳的治疗方法.方法以解放军总医院2008年6月-2010年6月治疗的76例胃癌合并糖尿病患者为研究对象,对其临床资料进行回顾性分析.开腹手术组(open surgery,OS)38例;腹腔镜手术组(laparoscopic surgery,LAP)38例.对两组手术方法及临床疗效等进行比较.结果腹腔镜手术组有效率为73.7%,开腹手术组为57.9%,差异有统计学意义(P<0.05);在切口大小、出血量、术后肛门排气时间、进食时间及白细胞和中性粒细胞计数等数据进行比较,腹腔镜手术组均优于开腹组(P<0.05).结论在胃癌合并2型糖尿病患者的治疗中,腹腔镜全胃切除术较开腹手术疗效显著.

  12. Endoscopic management of a gastric leak after laparoscopic sleeve gastrectomy using the over-the-scope-clip (Ovesco® system

    Directory of Open Access Journals (Sweden)

    Yurena Caballero

    Full Text Available Laparoscopic sleeve gastrectomy is currently used for the management of morbid obesity. Gastric fistula is the primary life-threatening complication, and its resolution continues to be a strong challenge for surgeons. Multiple treatment options are available, ranging from conservative therapy to endoscopic use of clips or stents, and even surgical reoperation involving total gastrectomy or conversion to a different bariatric technique. The applicability of each individual option will depend on the type of fistula and the patient clinical status. A clinical case is reported of a 29-year-old male patient with a body mass index at 49% who following laparoscopic sleeve gastrectomy had a delayed gastric fistula that failed to respond to conservative management but was successfully treated using the over-the-scope clip (Ovesco® system.

  13. Comparison between total laparoscopy and laparoscopy-assisted distal gastrectomy for gastric cancer. A meta-analysis based on Japanese and Korean articles.

    Science.gov (United States)

    Xiao, Shuo-Meng; Gao, Xiao-Jin; Zhao, Ping

    2014-11-01

    To assess the safety and feasibility of total laparoscopy distal gastrectomy (TLDG). This meta-analysis was conducted between April and July 2013 in Sichuan Cancer Hospital, Chengdu, China. We searched PubMed, EMBASE and China Knowledge Resource Integrated Database updated until May 2013. Eight retrospective studies and one prospective study involving 2,046 total patients were included. The results showed that TLDG was associated with lower blood loss (mean difference=-22.39, p=0.04). and a greater number of harvested lymph nodes (mean difference=2.74, p=0.02). There was no significant difference between the 2 groups in operation time, time to first flatus, length of postoperative hospital stay, and postoperative complications. Compared with laparoscopy-assisted distal gastrectomy, TLDG resulted in reduced blood loss, and a greater number of harvested lymph nodes. Total laparoscopy distal gastrectomy is safe and feasible for gastric cancer. 

  14. Gas-phase reactivity of peptide thiyl (RS•), perthiyl (RSS•), and sulfinyl (RSO•) radical ions formed from atmospheric pressure ion/radical reactions.

    Science.gov (United States)

    Tan, Lei; Xia, Yu

    2013-04-01

    In this study, we demonstrated the formation of gas-phase peptide perthiyl (RSS•) and thiyl (RS•) radical ions besides sulfinyl radical (RSO•) ions from atmospheric pressure (AP) ion/radical reactions of peptides containing inter-chain disulfide bonds. The identity of perthiyl radical was verified from characteristic 65 Da (•SSH) loss in collision-induced dissociation (CID). This signature loss was further used to assess the purity of peptide perthiyl radical ions formed from AP ion/radical reactions. Ion/molecule reactions combined with CID were carried out to confirm the formation of thiyl radical. Transmission mode ion/molecule reactions in collision cell (q2) were developed as a fast means to estimate the population of peptide thiyl radical ions. The reactivity of peptide thiyl, perthiyl, and sulfinyl radical ions was evaluated based on ion/molecule reactions toward organic disulfides, allyl iodide, organic thiol, and oxygen, which followed in order of thiyl (RS•) > perthiyl (RSS•) > sulfinyl (RSO•). The gas-phase reactivity of these three types of sulfur-based radicals is consistent with literature reports from solution studies.

  15. CONTINENT RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. P. Sernyak

    2014-07-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  16. CONTINENT RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. P. Sernyak

    2013-01-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  17. Redox Properties of Free Radicals.

    Science.gov (United States)

    Neta, P.

    1981-01-01

    Describes pulse radiolysis as a useful means in studing one-electron redox potentials. This method allows the production of radicals and the determination of their concentration and rates of reaction. (CS)

  18. Reprodcutive results of radical trachelectomy

    National Research Council Canada - National Science Library

    Martínez-Chapa, Arnulfo; Alonso-Reyes, Nelly; Luna-Macías, Miguel

    2015-01-01

    .... Between March 1999 and December 2013, 27 cases with cervical cancer in early stages were treated with vaginal or abdominal radical trachelectomy in the ISSSTE Regional Hospital in Monterrey, NL (Mexico...

  19. Resonance Raman study of benzyl radical

    DEFF Research Database (Denmark)

    Langkilde, F.W.; Bajdor, K.; Wilbrandt, R.

    1992-01-01

    Time-resolved resonance Raman spectra are obtained of benzyl radicals created by laser flash photolysis of benzylchloride and diphenylacetone in solution. The spectra are obtained in resonance with the intense 2 2A2-1 B-2(2) transition of benzyl. The strong Raman bands are assigned to totally...... symmetric a1 modes. The remaining observed bands are tentatively assigned to fundamental modes of b1, a2, and b2 symmetry, and to overtones and combinations. The resonance Raman spectra are found to be quite different from previous fluorescence spectra of benzyl, and the origins of these differences...

  20. PubMed Included a Bibliometric Analysis of the Gastrectomy%PubMed收录胃切除术相关文献的计量学分析

    Institute of Scientific and Technical Information of China (English)

    麻立民; 王文亮

    2015-01-01

    On PubMed indexed nearly 10 years gastrectomy literature year, country, journal source, prolific author, main keyword statistics, and analyze the data in order to identify relevant literature gastrectomy distribution characteristics and research status.%对PubMed收录的近10年胃切除术相关文献的年份、国别、期刊来源、多产作者、主要主题词进行统计,并对有关数据进行分析,以明确胃切除术相关文献分布特点和研究现状。

  1. Clinical Outcomes of the Marginal Ulcer Bleeding after Gastrectomy: As Compared to the Peptic Ulcer Bleeding with Nonoperated Stomach

    Directory of Open Access Journals (Sweden)

    Woo Chul Chung

    2012-01-01

    Full Text Available Background. Marginal ulcer is a well-known complication after gastrectomy. Its bleeding can be severe, but the severity has rarely been reported. We aim to evaluate the clinical outcomes of marginal ulcer bleeding (MUB as compared to peptic ulcer bleeding (PUB with nonoperated stomach. Methods. A consecutive series of patients who had nonvariceal upper gastrointestinal bleeding and admitted to the hospital between 2005 and 2011 were retrospectively analyzed. A total of 530 patients were enrolled in this study, and we compared the clinical characteristics between 70 patients with MUB and 460 patients with PUB. Results. Patients with MUB were older (mean age: 62.86±10.59 years versus 53.33±16.68 years, P=0.01. The initial hemoglobin was lower (8.16±3.05 g/dL versus 9.38±2.49 g/dL, P=0.01, and the duration of admission was longer in MUB (7.14±4.10 days versus 5.90±2.97 days, P=0.03. After initial hemostasis, the rebleeding rate during admission was higher (16.2% versus 6.5%, P=0.01 in MUB. However, the mortality rate did not differ statistically between MUB and PUB groups. Helicobacter pylori-positive rate with MUB was lower than that of PUB (19.4% versus 54.4%, P=0.01. Conclusions. Clinically, MUB after gastrectomy is more severe than PUB with nonoperated stomach. Infection with H. pylori might not appear to play an important role in MUB after gastrectomy.

  2. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  3. THE INFLUENCE OF AEROBIC EXERCISE ON FATIGUE, ACTIVITIES OF DAILY LIVING AND AEROBIC FITNESS IN POST GASTRECTOMY INDIVIDUALS UNDERGOING CHEMOTHERAPY

    Directory of Open Access Journals (Sweden)

    M. Sivaprasad

    2015-12-01

    Full Text Available Background: Gastric cancer is the second most common cancer among men and third most among women in world wide. For over 100 years, gastric cancer has remained one of the most important malignant diseases with significant, geographical, ethnic and socio-economic differences in distribution. The main aim of the study is to evaluate the effectiveness of supervised aerobic exercises on severity of fatigue, activities of daily living and aerobic fitness in post gastrectomy individuals undergoing chemotherapy. Methods: Total sixty patient’s age 30 to 68 years post gastrectomy individuals undergoing chemotherapy included for study. These patients were randomly allocated to intervention group (n=30, which underwent a 4- weeks training programme of supervised aerobic exercises & control group (n=30 that received standard care and unsupervised aerobic exercise protocol. Primary outcome was change in fatigue levels as determined by fatigue severity scale in before and after the intervention program. Secondary outcomes were activities of daily living and aerobic fitness as assessed by the dukes activity status index and six minute walk test by using cahalin formula. Paired sample t- test was used to analyse changes from before and after intervention programme. Result: There is a statistically significant (p<.000 improvement in both variables from baseline to 4th week in experimental group and control group but compared to control group, experimental group shows highly significant values in all parameters. Conclusion: Aerobic exercise proved to be effective in improving aerobic fitness, activities of daily living and decreasing the fatigue in post gastrectomy individuals undergoing chemotherapy

  4. Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study.

    Science.gov (United States)

    Morales-Conde, Salvador; Del Agua, Isaías Alarcón; Moreno, Antonio Barranco; Macías, María Socas

    2017-04-01

    Laparoscopic approach is the gold standard for surgical treatment of morbid obesity. The single-port (SP) approach has been demonstrated to be a safe and effective technique for the treatment of morbid obesity in several case control studies. Compare conventional multiport laparoscopy (LAP) with an SP approach for the treatment of morbid obesity using sleeve gastrectomy in terms of postoperative pain using a visual analog scale (VAS) 0-100, surgical outcome, weight loss, and aesthetical satisfaction at 6 months after surgery. University Hospital, Spain. Randomized, controlled pilot study. The trial enrolled patients suitable for bariatric surgery, with a body mass index lower than 50 kg/m(2) and xiphoumbilical distance lower than 25 cm. Patients were randomly assigned to receive LAP or SP sleeve gastrectomy. A total of 30 patients were enrolled; 15 were assigned to LAP group and 15 to SP group. No patients were lost during follow-up. Baseline characteristics were similar in both groups. A significantly higher level of pain during movement was noted for the patients in the LAP group on the first (mean VAS 49.3±12.2 versus 34.1±8.9, P = .046) and second days (mean VAS 35.9±10.2 versus 22.1±7.9, P = .044) but not the third day (mean VAS 20.1±5.2 versus 34.12.9 ±4.3, P = .620). No differences regarding pain at rest, operative time, complications, or weight loss at 6 months were observed. Higher aesthetical satisfaction was noticed in SP group. In selected patients, SP surgery presented less postoperative pain in sleeve gastrectomy compared with the conventional laparoscopic approach with similar surgical results. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study.

    Science.gov (United States)

    Cianchi, Fabio; Indennitate, Giampiero; Trallori, Giacomo; Ortolani, Manuela; Paoli, Beatrice; Macrì, Giuseppe; Lami, Gabriele; Mallardi, Beatrice; Badii, Benedetta; Staderini, Fabio; Qirici, Etleva; Taddei, Antonio; Ringressi, Maria Novella; Messerini, Luca; Novelli, Luca; Bagnoli, Siro; Bonanomi, Andrea; Foppa, Caterina; Skalamera, Ileana; Fiorenza, Giulia; Perigli, Giuliano

    2016-09-20

    Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer. Between June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated. There were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 ± 0.5 cm and 3.0 ± 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 ± 3.7 and 30.5 ± 2.0, respectively; P = 0.02). The mean operative time was 262.6 ± 8.6 min in the laparoscopic group and 312.6 ± 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups. Within the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes.

  6. J-pouch versus Roux-en-Y reconstruction after gastrectomy: functional assessment and quality of life (randomized trial).

    Science.gov (United States)

    Zonča, Pavel; Malý, Tomáš; Ihnát, Peter; Peteja, Matus; Kraft, Otakar; Kuca, Kamil

    2017-01-01

    The aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy. This study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604). With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with (99m)Tc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated. In all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation) in the Roux-en-Y group and 89.4±37.8 minutes in the "J-pouch" group; the difference was statistically significant (PJ-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation) in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016). There were no important adverse events. After total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction. Whether these two observations have a direct causative link remains unanswered.

  7. [Clinical significance of a physical activity index based on calorimetry in the assessment of quality of life after total gastrectomy].

    Science.gov (United States)

    Sakamoto, K; Nakano, G; Kato, R; Suzuki, T; Nagamachi, Y; Nakamura, T; Hashimoto, I

    1987-04-01

    In order to characterize the objective diagnostic criteria concerning quality of life (QL) of patients after total gastrectomy, a physical activity index (PAI) or a concept of daily physical activity was developed. Sixty patients of gastric cancer, of whom 38 patients underwent long loop Roux-en-Y gastrojejunostomy (LLRY) procedure after total gastrectomy, 13 patients gastroduodenostomy (Billroth I) and 9 patients gastrojejunostomy (Billroth II) after subtotal gastrectomy, respectively, were evaluated as part of this study. In addition, 3 cases of pancreatoduodenectomy (PD) and 5 cases of total esophagectomy were also evaluated. The evaluation of QL was based upon a clinical assessment and administration of patient questionnaire. The assessment of the PAI was performed by measuring the individual's whole day energy expenditure based upon 24 hour heart rate ratio (24h-HRR) method and the basal metabolic energy expenditure. The daily physical activity was graded into four categories according to the PAI value; light, moderate, moderately heavy and heavy. The results obtained were as follows: The value of the energy expenditure predicted by 24h-HRR method and that based on the results of bicycle ergometry (VO2/HR method) showed close correlation. There was no significant difference in the whole day energy expenditure among four operative procedure groups (Billroth I, Billroth II, LLRY and total esophagectomy). More than 80 per cent of LLRY patients, whose QL was evaluated as "excellent" or "good", showed no less than "moderate" PAI. In addition, one of the four patients whose QL was "fair" was categorized into "light" and the remaining three were "moderate".(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Reactions of linoleic acid peroxyl radicals with phenolic antioxidants: a pulse radiolysis study

    Energy Technology Data Exchange (ETDEWEB)

    Erben-Russ, M.; Bors, W.; Saran, M.

    1987-09-01

    Linoleic acid peroxyl radicals (LOO) can be viewed as model intermediates occurring during lipid peroxidation processes. Formation and reactions of these species were investigated in aqueous alkaline solution using pulse radiolysis combined with kinetic spectroscopy. Irradiation of linoleic acid in N/sub 2/O/O/sub 2/-saturated solutions leads to a mixture of peroxyl radical isomers; reaction of 13-hydroperoxylinoleic acid (13-LOOH) with azide radicals in N/sub 2/O-saturated solution produces 13-LOO radicals specifically. These peroxyl radicals cannot be observed directly, but their reactions with kaempferol and quercetin, acting as radical-scavenging antioxidants, produced strongly absorbing aroxyl radicals (ArO). The same aroxyl radicals were generated by OH and N/sub 3/ with rate constants exceeding 10/sup 9/ dm/sup 3/ mol/sup -1/ s/sup -1/. Applying a reaction scheme that includes competing generation and decay reactions of both LOO and ArO radicals, individual rate constants were derived for LOO reactions with the phenols (> 10/sup 7/ dm/sup 3/ mol/sup -1/ s-./sup 1/), with aroxyl radicals to form covalent adducts (> 10/sup 8/ dm/sup 3/ mol/sup -1/ s/sup -1/), as well as for their bimilecular decay (3.0 x 10/sup 8/ dm/sup 3/ mol/sup -1/ s/sup -1/). These results demonstrate high reactivity of fatty acid peroxyl radicals and flavone antioxidants in aqueous solution.

  9. The development of a small bowel volvulus in the early postoperative period following a distal gastrectomy: report of a case.

    Science.gov (United States)

    Sakamoto, T; Miyata, M; Nakamuro, M; Izukura, M; Kamiike, W; Matsuda, H

    1994-01-01

    A 51-year-old Japanese man who underwent a standard distal gastrectomy for cancer of the stomach developed abdominal pain when oral intake was commenced on the 6th postoperative day after an uneventful postoperative course. Complete obstruction of the jejunum led to a sudden deterioration in his general condition and a laparotomy was performed, revealing counterclockwise rotation of the mesenterium. The necrotic portion of the small intestine was removed, while 10 cm of the upper jejunum and 100 cm of the terminal ileum were preserved. His second postoperative course was uneventful apart from the development of "intestinal hurry," which is now under medical control 9 months after his second laparotomy.

  10. Efferent loop small intestinal vitamin D receptor concentration and bone mineral density after Billroth II (Polya) gastrectomy in humans.

    Science.gov (United States)

    Pazianas, M; Zaidi, M; Subhani, J M; Finch, P J; Ang, L; Maxwell, J D

    2003-04-01

    Animal studies have demonstrated that the highest concentration of vitamin D receptors (and greatest capacity for active calcium absorption) occurs in the proximal duodenum. By passing the duodenum following Polya/Billroth II gastrectomy could result in the development of a metabolic bone disease and low bone mineral density (BMD). We thus compared the vitamin D receptor (VDR) concentration in mucosal biopsies taken at endoscopy from two functionally corresponding areas of the small intestine: the jejunum (or efferent loop) in 21 patients with a history of Polya/Billroth II gastrectomy and the second part of the duodenum in age/sex-matched control subjects. We also measured the BMD by dual energy X-ray absorptiometry. The mean VDR concentration was not significantly different between the two groups (patients vs controls, fmol/mg protein, mean +/- SE: 34.99 +/- 2.57 vs 34.67 +/- 3.71; P = 0.22), even when subgrouped as males (36.22 +/- 3.16 vs 31.2 +/- 4.24; P = 0.351) or females (31.93 +/- 4.7 vs 43 +/- 6.76; P = 0.193). In Polya/Billroth II gastrectomy patients, the VDR concentration in the efferent loop declined with age (r = -0.78, P = 0.02). In the same group, BMD, as compared with matched controls, was significantly reduced at the lumbar spine (Z-score: patients vs controls: -1.138 vs 0.099, P = 0.01), but not at the femoral neck (Z-score: -0.69 vs 0.7, P = 0.084). There was no correlation between VDR and time since operation or BMD. These results suggest that following Polya/Billroth II gastrectomy, the functional capacity of the jejunal efferent loop in reference to VDR concentration is similar to that of the second part of the duodenum in normal subjects. Therefore, the reduced BMD in our patients, also a common finding in other studies, may not be secondary to the reduced capacity of the VDR system that facilitates the active calcium transport pathway in the proximal small intestine.

  11. Distal gastrectomy in pancreaticoduodenectomy is associated with accelerated gastric emptying, enhanced postprandial release of GLP-1, and improved insulin sensitivity

    DEFF Research Database (Denmark)

    Harmuth, Stefan; Wewalka, Marlene; Holst, Jens Juul

    2014-01-01

    OBJECTIVE: This study aims to investigate the relationship between gastric emptying, postprandial GLP-1 and insulin sensitivity after pancreaticoduodenectomy (PD). BACKGROUND: Abnormal glucose regulation is highly prevalent in patients with pancreatic neoplasm and resolves in some after PD......, the cause of which is unclear. The procedure is carried out with pylorus preservation (PPPD) or with distal gastrectomy (Whipple procedure). Accelerated gastric emptying and ensuing enhanced release of glucagon-like peptide-1 (GLP-1) conceivably play a role in glucose metabolism after PD. It was the purpose...

  12. Total gastrectomy for rare refractory gastroparesis in patient with syringomyelia: A good impact on quality of life

    Directory of Open Access Journals (Sweden)

    Maurizio Zizzo

    2015-12-01

    We report a case of a 67-year-old woman with a history of pain in the back-lumbar spine and lower limbs, paresthesia and urinary incontinence. MRI revealed syringomyelia, extended from T3 to the medullary cone. Neurological picture was worsened by progressive and increasingly debilitating gastrointestinal symptoms refractory to dietary changes and medical treatment. Blood tests, gastrointestinal investigations and imaging were all normal apart from scintigraphy which confirmed delayed gastric emptying. The neurological symptoms disappeared after removal of an hemangioblastoma of the medullary cone. The persistent gastroparesis was treated by total gastrectomy with complete resolution of the patient's gastrointestinal symptoms.

  13. A retrospective review of the medical management of hypertension and diabetes mellitus following sleeve gastrectomy.

    Science.gov (United States)

    Tritsch, Adam M; Bland, Christopher M; Hatzigeorgiou, Christos; Sweeney, Lori B; Phillips, Michael

    2015-04-01

    Bariatric surgery is being performed with increasing frequency in the USA as a definitive treatment for morbid obesity and associated comorbidities. Management strategies of type 2 diabetes mellitus (T2DM) and hypertension (HTN) medications in sleeve gastrectomy (SG) patients postoperatively are unclear, specifically in the immediate postoperative period and 6 months following surgery. From 01 June 2010 to 30 June 2011, at a single military medical facility, a retrospective review of 88 consecutive SG patients was conducted to examine the postoperative medical management of HTN and T2DM. Patient's HTN and T2DM medication regimens were evaluated for 6 months postoperatively. Categorical data was analyzed using chi-square, and continuous data was compared using the Student t test. Statistical analyses were completed with Stata, version 12. Fifty patients were prescribed an average of 2.21 HTN medications at baseline which was reduced to an average of 1.23 (p < 0.01) medications per patient at 1 month. Twenty-four patients received an average of 1.41 oral T2DM medications with a reduction to 0.70 (p < 0.01) on average at 1 month postoperatively. Medication changes persisted throughout the 6-month follow-up. Among T2DM patients requiring insulin therapy, the mean insulin dose was 42.1 units reduced to 16.8 units immediately postoperatively (p < 0.01) which persisted at 1 month. At 6 months, the mean insulin dose was 13.3 units. Medication adjustments for HTN and T2DM made immediately in the postoperative period following SG persisted throughout the 6-month follow-up period and in some patients, required further adjustments.

  14. Laparoscopic sleeve gastrectomy using 42-French versus 32-French bougie: the first-year outcome.

    Science.gov (United States)

    Spivak, Hadar; Rubin, Moshe; Sadot, Eran; Pollak, Esther; Feygin, Anya; Goitein, David

    2014-07-01

    The optimal size of bougie in laparoscopic sleeve gastrectomy (LSG) remains controversial. The aim of this study was to evaluate the first-year outcome of LSG using two different sizes of bougies. This study used a single institute retrospective case-control study of two groups of patients. Group A (N = 66) underwent LSG using 42-Fr and group B (N = 54) using 32-Fr bougies. A medication score was applied to assess the change in comorbid conditions. Groups A and B's age (39.5 ± 12 vs. 43.6 ± 12.3 years), weight (119 ± 17 vs. 120 ± 20), and BMI (42.8 ± 3.8 vs. 43.6 ± 6.9 kg/m(2)), respectively, were comparable (p = NS). Comorbid conditions were type 2 diabetes (T2DM) in 19 (29%) vs. 23 (43%) patients, hypertension in 22 (33%) vs. 18 (33%) patients, and gastroesophageal reflux (GERD) in 28 (42%) vs. 10 (19%) patients, respectively. At 1 year, group A vs. B BMI was (29.4 ± 5 vs. 30 ± 5 kg/m(2)) and excess weight loss was 67 vs. 65%, respectively (p = NS). Postoperatively, T2DM (79 vs. 83%), hypertension (82 vs. 61%), and GERD (82 vs. 60%) (p = NS), respectively, in groups A vs. B did not require previous medications anymore. Complications were comparable. Our data suggest that using a 42-Fr or 32-Fr bougie does not influence LSG first-year weight loss or resolution of comorbid conditions. Long-term data is needed to conclude this issue.

  15. The effect of vertical sleeve gastrectomy on food choice in rats.

    Science.gov (United States)

    Wilson-Pérez, H E; Chambers, A P; Sandoval, D A; Stefater, M A; Woods, S C; Benoit, S C; Seeley, R J

    2013-02-01

    Diets high in fat are implicated in the development and maintenance of obesity, and obese individuals display greater preferences for high-fat foods than do their lean counterparts. Weight-reduction bariatric surgery is associated with changes in food choice. In particular, after Roux-en-Y gastric bypass (RYGB), humans and rodents select or prefer foods that are lower in fat content. We asked whether a bariatric surgical procedure limited to the stomach, vertical sleeve gastrectomy (VSG), causes a similar reduction of fat intake/preference. Rats received VSG or Sham surgery or remained surgically naïve, and were assessed for food preference using three diet-choice paradigms. Using progressive-ratio (PR) and conditioned taste aversion paradigms, we further asked whether surgically induced changes in food choice are secondary to changes in the reward value of food and/or to the formation of a food aversion. Finally, food choice was compared between VSG- and RYGB-operated rats. VSG rats decreased their intake of dietary fat, and shifted their preference toward lower caloric-density foods. This change in food choice was not associated with changes in motivated responding on a PR schedule for either a fat or a carbohydrate food reinforcer. When VSG and RYGB were compared directly, both procedures caused comparable changes in food choice. The conditioned taste aversion paradigm revealed that VSG rats form an aversion to an intra-gastric oil administration whereas RYGB rats do not. VSG and RYGB, two anatomically distinct bariatric procedures, produce similar changes in food choice.

  16. Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center.

    Science.gov (United States)

    Tokunaga, Masanori; Hiki, Naoki; Fukunaga, Tetsu; Miki, Akira; Nunobe, Souya; Ohyama, Shigekazu; Seto, Yasuyuki; Yamaguchi, Toshiharu

    2009-02-01

    Laparoscopy-assisted gastrectomy (LAG) is increasingly performed in Japan by a number of surgeons. As this is a relatively new technique, a training system is important, however there has been little discussion about an educational system for teaching trainees to perform LAG and the ideal training system has not yet been established. Two hundred and sixty-three patients who underwent LAG at the Cancer Institute Hospital were included in this study. In all cases there was standardization of LAG (the way in which the surgical field was formed by the assistant and the way the operator dissected the lymph nodes was determined and all cases were performed using the same laparoscopic procedures) and a step-by-step training system was completed. Specialists performed the surgery in 213 patients (S group) while the remaining 50 patients had their surgery performed by trainees (T group). Early surgical outcomes were compared between specialists and trainees to clarify whether the standardization and our educational system are useful in maintaining the quality of LAG. T-group patients had significantly longer operation times than those of S-group (262.3 +/- 7.3 versus 233.3 +/- 3.7 min), however, the trainees reached the plateau of their learning curve earlier than previously reported. All other early surgical outcomes examined, including intraoperative blood loss (76.7 +/- 35.1 versus 64.9 +/- 7.7 ml), number of retrieved lymph nodes (33.4 +/- 1.4 versus 35.7 +/- 0.8), morbidity (8 versus 14%), and mortality (0% in both groups), were not significantly different between the two groups. The surgical results of T-group were almost equal to those of S-group, showing that our educational system is effective and surgical quality is maintained. Standardized laparoscopic procedures and sufficient intensive experience in the short term are requisites for effectively learning how to perform LAG.

  17. Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Umemura, Akira; Sasaki, Akira; Nitta, Hiroyuki; Baba, Shigeaki; Ando, Taro; Kajiwara, Takashi; Ishigaki, Yasushi

    2017-03-17

    This study aimed to assess the relationship between the metabolic effect after laparoscopic sleeve gastrectomy (LSG) in morbidly obese Japanese patients, with or without type 2 diabetes mellitus (T2DM), and improved pancreatic steatosis (PS). The study enrolled 27 morbidly obese Japanese patients who were undergoing LSG. Their clinical and metabolic effects were evaluated at baseline and six months after LSG. Pancreas volume (PV), pancreatic attenuation (PA), and splenic attenuation (SA) were measured using a 64-row computed tomography (CT). Changes in PV, PA-SA, and PA/SA were evaluated. The mean body-weight loss, body mass index loss, and percentage of excess weight loss (%EWL) were -34.4 kg (p < 0.001), -11.0 kg/m(2) (p < 0.001), and 43.7%, respectively. The mean PV was 96.7 mL at baseline, and it decreased six months after LSG (-16.3mL, p < 0.001). The mean PA significantly increased six months after LSG (9.5 HU, p < 0.001). PA-SA (-23.2 HU vs. -13.3 HU, p = 0.003), and PA/SA (0.54 vs. 0.73, p < 0.001) also significantly increased six months after LSG. In T2DM patients, decreased PV correlated with decreased fasting blood sugar, decreased insulin, and reduced liver volume. In conclusion, PV significantly decreased after LSG in morbidly obese Japanese patients, and that decrease correlated with improvements in PS. In addition, PS plays an important role of development and progression of insulin resistance and T2DM.

  18. Is resected stomach volume related to weight loss after laparoscopic sleeve gastrectomy?

    Science.gov (United States)

    Singh, Jagat Pal; Tantia, Om; Chaudhuri, Tamonas; Khanna, Shashi; Patil, Prateek H

    2014-10-01

    Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch for the treatment of super-obese or high-risk obese patients but is now most commonly performed as a standalone operation. The aim of this prospective study was to investigate outcomes after LSG according to resected stomach volume. Between May 2011 and April 2013, LSG was performed in 102 consecutive patients undergoing bariatric surgery. Two patients were excluded, and data from the remaining 100 patients were analyzed in this study. Patients were divided into three groups according to the following resected stomach volume: 700-1,200 mL (group A, n = 21), 1,200-1,700 mL (group B, n = 62), and >1,700 mL (group C, n = 17). Mean values were compared among the groups by analysis of variance. The mean percentage excess body weight loss (%EBWL) at 3, 6, 12, and 24 months after surgery was 37.68 ± 10.97, 50.97 ± 13.59, 62.35 ± 11.31, and 67.59 ± 9.02 %, respectively. There were no significant differences in mean %EBWL among the three groups. Resected stomach volume was greater in patients with higher preoperative body mass index and was positively associated with resected stomach weight. Mean %EBWL after LSG was not significantly different among three groups of patients divided according to resected stomach volume. Resected stomach volume was significantly greater in patients with higher preoperative body mass index.

  19. Increased glycine-amidated hyocholic acid correlates to improved early weight loss after sleeve gastrectomy.

    Science.gov (United States)

    Kindel, Tammy L; Krause, Crystal; Helm, Melissa C; McBride, Corrigan L; Oleynikov, Dmitry; Thakare, Rhishikesh; Alamoudi, Jawaher; Kothari, Vishal; Alnouti, Yazen; Kohli, Rohit

    2017-08-04

    Bile acids (BAs) are post-prandial hormones that play an important role in glucose and lipid homeostasis as well as energy expenditure. Total and glycine-amidated BAs increase after sleeve gastrectomy (SG) and correlate to improved metabolic disease. No specific bile acid subtype has been shown conclusively to mediate the weight loss effect. Therefore, the objective of this study was to prospectively evaluate the comprehensive changes in meal-stimulated BAs after SG and determine if a specific change in the BA profile correlates to the early weight loss response. Patients were prospectively enrolled at the University of Nebraska Medical Center who were undergoing a SG for treatment of morbid obesity. Primary and secondary plasma bile acids and their amidated (glycine, G-, or taurine, T-) subtypes were measured at fasting, 30 and 60 min after a liquid meal performed pre-op, and at 6 and 12 weeks post-op. Area under the curve (AUC) was calculated for the hour meal test for each bile acid subtype. BAs that were significantly increased post-op were correlated to body mass index (BMI) loss. Total BA AUC was significantly increased at 6 (p loss (p = 0.03). Increased G-hyocholic acid was significantly correlated to increased weight loss at both 6 (p = 0.05) and 12 weeks (p = 0.006). SG induced an early and persistent post-prandial surge in multiple bile acid subtypes. Increased G-hyocholic consistently correlated with greater early BMI loss. This study provides evidence for a role of BAs in the surgical weight loss response after SG.

  20. Perceived Social Support for Exercise and Weight Loss in Adolescents Undergoing Sleeve Gastrectomy.

    Science.gov (United States)

    Mackey, Eleanor Race; Olson, Alexandra; Merwin, Stephanie; Wang, Jichuan; Nadler, Evan P

    2017-08-02

    Bariatric surgery is an effective treatment for youth with severe obesity. However, outcomes are variable and there remains sparse understanding of predictors of weight loss following surgery. The current study examines the role of adolescent-reported pre-operative social support around exercise, binge eating, and exercise to predict excess body mass index (EBMI) loss from 3 to 12 months post-surgery. Participants were 101 adolescents ages 12-21 (M age = 16.6, SD = 1.8). Pre-operative body mass index (BMI) ranged from 35 to 87 (M = 50.3, SD = 8.6). Structural equation modeling (SEM) was used to evaluate a model of the association of adolescent report of perceived social support for exercise with less binge eating (items from the Eating Disorder Diagnostic Scale) and more self-reported exercise (items from the Youth Risk Behavior Surveillance System). The model was used to predict EBMI loss at 3, 6, 9, and 12 months post-surgery. Social support significantly predicted exercise and demonstrated a trend for predicting binge eating, such that more social support was associated with more exercise and a trend for less binge eating. Binge eating was associated with less EBMI loss. However, there was no association of exercise with EBMI loss. Pre-operative binge eating should be a target for identification and treatment prior to sleeve gastrectomy in adolescents. Although not directly or indirectly associated with EBMI loss, perceived social support around exercise was associated with increased exercise, which may make it a consideration for a target for intervention as well.

  1. Vertical sleeve gastrectomy reduces blood pressure and hypothalamic endoplasmic reticulum stress in mice

    Directory of Open Access Journals (Sweden)

    Anne K. McGavigan

    2017-03-01

    Full Text Available Bariatric surgery, such as vertical sleeve gastrectomy (VSG, causes remarkable improvements in cardiometabolic health, including hypertension remission. However, the mechanisms responsible remain undefined and poorly studied. Therefore, we developed and validated the first murine model of VSG that recapitulates the blood pressure-lowering effect of VSG using gold-standard radiotelemetry technology. We used this model to investigate several potential mechanisms, including body mass, brain endoplasmic reticulum (ER stress signaling and brain inflammatory signaling, which are all critical contributors to the pathogenesis of obesity-associated hypertension. Mice fed on a high-fat diet underwent sham or VSG surgery and radiotelemeter implantation. Sham mice were fed ad libitum or were food restricted to match their body mass to VSG-operated mice to determine the role of body mass in the ability of VSG to lower blood pressure. Blood pressure was then measured in freely moving unstressed mice by radiotelemetry. VSG decreased energy intake, body mass and fat mass. Mean arterial blood pressure (MAP was reduced in VSG-operated mice compared with both sham-operated groups. VSG-induced reductions in MAP were accompanied by a body mass-independent decrease in hypothalamic ER stress, hypothalamic inflammation and sympathetic nervous system tone. Assessment of gut microbial populations revealed VSG-induced increases in the relative abundance of Gammaproteobacteria and Enterococcus, and decreases in Adlercreutzia. These results suggest that VSG reduces blood pressure, but this is only partly due to the reduction in body weight. VSG-induced reductions in blood pressure may be driven by a decrease in hypothalamic ER stress and inflammatory signaling, and shifts in gut microbial populations.

  2. Sleeve Gastrectomy in Rats Improves Post-Prandial Lipid Clearance by Reducing Intestinal Triglyceride Secretion

    Science.gov (United States)

    Stefater, MA; Sandoval, DA; Chambers, AP; Wilson-Pérez, HE; Hofmann, SM; Jandacek, R; Tso, P; Woods, SC; Seeley, RJ

    2011-01-01

    Background & Aims Post-prandial hyperlipidemia is a risk factor for atherosclerotic heart disease and is associated with the consumption of high-fat diets and obesity. Bariatric surgeries result in superior and more durable weight loss than dieting. These surgeries are also associated with multiple metabolic improvements, including reduced plasma lipid levels. We investigated whether the beneficial effects of vertical sleeve gastrectomy (VSG) on plasma lipid levels are weight-independent. Methods VSG was performed on Long-Evans rats with diet-induced obesity and pair-fed and ad libitum-fed rats that received sham operations (controls). We measured fasting and post-prandial levels of plasma lipid. To determine hepatic and intestinal triglyceride secretion, we injected the lipase inhibitor poloxamer 407 alone, or before oral lipid gavage. 13C-Triolein was used to estimate post-prandial uptake of lipid in the intestine. Results Rats that received VSG and high-fat diets (HFDs) had markedly lower fasting levels of plasma triglyceride, cholesterol, and phospholipid than obese and lean (pair-fed) controls that were fed HFD. Rats that received VSG had a marked, weight-independent reduction in secretion of intestinal triglycerides. VSG did not alter total intestinal triglyceride levels or size of the cholesterol storage pool, nor did it affect the expression of genes in the intestine that control triglyceride metabolism and synthesis . VSG did not affect fasting secretion of triglyceride, liver weight, hepatic lipid storage, or transcription of genes that regulate hepatic lipid processing. Conclusions VSG reduced post-prandial levels of plasma lipid, independently of body weight. This resulted from reduced intestinal secretion of triglycerides following ingestion of a lipid meal and indicates that VSG has important effects on metabolism. PMID:21699773

  3. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia.

    Science.gov (United States)

    Stamou, Konstantinos M; Menenakos, Evangelos; Gomatos, Ilias P; Panousopoulos, Sotirios-George D; Smparounis, Spyridon; Leandros, Emmanuel; Zografos, George

    2011-10-01

    Splenic arterial demarcation has been observed during laparoscopic sleeve gastrectomy (LSG). The present study aims to detect its actual incidence during LSG and clarify its clinical significance. This is a prospective observational study of 287 consecutive patients that underwent LSG by the same surgical team over 3 years. In all patients, the gastric fundus was mobilized using a standard technique. Before withdrawal of the pneumoperitoneum, the spleen was exposed and carefully inspected for evidence of arterial demarcation. Patients with a clear demarcation were followed with Doppler ultrasound. Computed tomography scan with oral contrast was performed to rule out septic complications. Median preoperative body mass index was 46 kg/m(2) (range 35.1-78). Median operative time was 58 min (range 42-185), median hospital stay was 3 days (range 3-45), and overall morbidity rate was 8.6%. Intraoperative demarcation of the upper splenic pole was evident in 12 patients (4.1%). Eleven patients had uneventful postoperative course. One patient raised temperature of 38.5°C at the 7th postoperative day and was readmitted for further treatment. Once afebrile, the patient was discharged on the 10th postoperative day and continued on prophylactic low molecular weight heparin (tinzaparin, 7,500 U sc.) for 20 days. Splenic discoloration following LSG is an uncommon complication with minimal clinical significance, which could be related to hematoma, venous congestion, or ischemia. The possibility of a late splenic abscess cannot be ruled out. No risk factors can be identified preoperatively.

  4. Laparoscopic Gastric Plication (LGCP) Vs Sleeve Gastrectomy (LSG): A Single Institution Experience.

    Science.gov (United States)

    Verdi, Daunia; Prevedello, Luca; Albanese, Alice; Lobba, Andrea; Foletto, Mirto

    2015-09-01

    Laparoscopic greater curvature plication (LGCP) and laparoscopic sleeve gastrectomy (LSG) both reduce gastric capacity, either by in-folding (LGCP) or removing (LSG) the greater curvature. While mid and long-term results of LSG are well known, LGCP is still considered investigational. The aim of this study was to compare the effectiveness of LGCP and LSG in terms of weight loss and safety. Forty-five obese LGCP patients (6 males and 39 females) were matched with 45 LSG patients. The two groups were matched according to sex, age ± 10 years and BMI ± 1 kg/m(2). Surgical complication rate, redo surgery need, excess BMI loss (%EBL) and mean BMI at 3 and 6 months were compared. LGCP and LSG mean age was 37.8 and 40 years, while the mean preoperative BMI was 40.65 and 41 kg/m(2), respectively. There was no difference in operative time, complication rate, mean BMI and %EBL at 3 months. Redo surgery rate was higher in LGCP group (LGCP 60 % vs LSG 8.8 %, P < 0.0001). The mean time to redo surgery was longer in LSG group (23 ± 6.61 vs 17.3 ± 7.67 months, P = 0.0003). The mean BMI at 6 months was lower in LSG group (32 ± 5.7 vs 34.6 ± 5.3, P = 0.028). The mean %EBL at 6 months was higher in LSG group (57 ± 30.89 vs 40.2 ± 25, P = 0.0057). LGCP patients required more redo surgery. Weight loss was greater in LSG group at 6-month follow-up.

  5. Effectiveness of a team participation training course for laparoscopy-assisted gastrectomy.

    Science.gov (United States)

    Kinoshita, Takahiro; Kanehira, Eiji; Matsuda, Minoru; Okazumi, Shinichi; Katoh, Ryoji

    2010-03-01

    Laparoscopy-assisted distal gastrectomy (LADG) for stomach cancer is increasingly performed in Japan and Korea. However, the procedure still is considered to be complicated, and the optimal education system for trainees has not been established to date. The authors organized a 1-day professional training course termed the LADG Basic Lab Course for LADG beginners. The participants were required to apply as a team of two surgeons and two operating nurses. The training course consisted of lectures and a live porcine lab emphasizing use of the ultrasonically activated device and the flexible laparoscope as well as team cooperation. The quality and effectiveness of the course were evaluated 6-10 months (mean, 8.2 +/- 2.2 months) after the course using a survey form sent to a representative surgeon of each institution. From May 2007 to July 2008, a total of 80 colleagues (47 surgeons and 33 nurses) from 20 different centers in Japan participated in the training course. These surgeons represented 12.4 +/- 6.2 postgraduate years of education and had performed 2.7 +/- 4.9 LADGs before taking the course. In the follow-up evaluation, 12 institutions (60%) completed the survey forms. The mean operation time was reduced for eight respondents (66.7%). The number of LADGs performed per month increased in 50% of the respondents' institutions. The degree of lymph node dissection in LADG was extended for 66.7% of the respondents. The respondents answered that 100% of the first operators showed improvement in skills, as did 59.5% of the scope operators and 59.5% of the nurses. The training course was an effective means of introducing LADG to each institution. Training courses emphasizing explanations of key devices and teamwork may be effective for the introduction of advanced laparoscopic surgeries.

  6. The chemistry of separations ligand degradation by organic radical cations

    Energy Technology Data Exchange (ETDEWEB)

    Mezyk, S.P.; Horne, G.P. [California State University at Long Beach, Long Beach, CA 90840 (United States); Mincher, B.J.; Zalupski, P.R. [Idaho National Laboratory, Idaho Falls, ID 83415 (United States); Cook, A.R.; Wishart, J.F. [Chemistry Department, Brookhaven National Laboratory, New York, 11973 (United States)

    2016-07-01

    Solvent based extractions of used nuclear fuel use designer ligands in an organic phase extracting ligand complexed metal ions from an acidic aqueous phase. These extractions will be performed in highly radioactive environments, and the radiation chemistry of all these complexing agents and their diluents will play a major role in determining extraction efficiency, separation factors, and solvent-recycle longevity. Although there has been considerable effort in investigating ligand damage occurring in acidic water radiolysis conditions, only minimal fundamental kinetic and mechanistic data has been reported for the degradation of extraction ligands in the organic phase. Extraction solvent phases typically use normal alkanes such as dodecane, TPH, and kerosene as diluents. The radiolysis of such diluents produce a mixture of radical cations (R{sup .+}), carbon-centered radicals (R{sup .}), solvated electrons, and molecular products such as