ABSTRACT
BACKGROUND: Although more than 50 methods of gastric replacement after total gastrectomy have been used, none of them has demonstrated a substantial nutritional advantage. The Roux-en-Y esophagojejunostomy is still the preferred type of reconstruction, more because of its simplicity than the lack of postprandial disturbances. STUDY DESIGN: A randomized controlled trial was conducted to compare two reconstructive procedures, Roux-en-Y esophagojejunostomy (n = 24) and Hunt-Rodino-Lawrence pouch (HRL, n = 24), by evaluating nutritional status (body weight, arm circumference, and serum nutritional parameters), nutritional habits (number of meals, energy intake, and postprandial disturbances), and emptying time of the jejunal loop. RESULTS: Twenty-seven patients were studied two years after operation (12 had undergone Roux-en-Y and 15 had undergone HRL). No difference was found in either postoperative morbidity or mortality, emptying time, frequency of meals, or variation of body weight. Postprandial disturbances were more frequent in patients having Roux-en-Y. In a subset of patients, there was a correlation between nutrient intake and change of body weight, but not between nutrient intake and type of reconstruction. CONCLUSIONS: The simple use of a reservoir such as the HRL pouch after total gastrectomy is of no benefit to the patient as compared with the Roux-en-Y reconstruction.
Subject(s)
Anastomosis, Roux-en-Y , Esophagostomy/methods , Gastrectomy , Jejunostomy/methods , Nutritional Status , Female , Humans , Male , Middle Aged , Postoperative Period , Treatment OutcomeABSTRACT
The treatment of chronic arm lymphedema following axillary dissection for breast cancer is still a therapeutic challenge. To examine other treatment options, we undertook a pilot study on the efficacy of ultrasound therapy (UST) in management of these patients. Fifty patients with post-surgical arm lymphedema and without regional irradiation underwent ultrasound treatment (2 cycles at 4 month intervals) and the results were compared up to 1 year with 100 other patients treated by standardized mechanical pressure therapy (MPT) using a pneumatic pump. In this report we evaluate 96 patients who have been followed after 1 year, 31 of whom belong to UST group and 65 to the MPT group. UST did not show a statistically significant difference in whole arm reduction of lymphedema although there was initially a greater reduction in size after the first 4 months of treatment. The addition of an elastic sleeve did not improve lymphedema in either group. Advantages of UST were an overall shorter length of treatment, a tendency to greater softening of the arm, patient satisfaction by avoidance of an uncomfortable and constrictive device and better relief of osteomyofascial pain, greater scapulohumeral motion, and less intercostobrachial pain-dysesthesia.
Subject(s)
Breast Neoplasms/surgery , Lymph Node Excision/adverse effects , Lymphedema/therapy , Mastectomy/adverse effects , Ultrasonic Therapy , Arm , Axilla , Chronic Disease , Female , Follow-Up Studies , Humans , Lymphedema/etiology , Pilot Projects , Pressure , Treatment OutcomeABSTRACT
The behaviour of intracellular lipids (Sudan black B), PAS positivity peroxidase and hydrolytic enzymes (acid and alkaline phosphatase, aspecific esterases) was studied in normal and tumour cells from serous effusions. It is suggested that the practical application of such method to the diagnosis of effusions should be checked over a wider range of case material.
