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1.
Khirurgiia (Mosk) ; (9): 20-27, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33029998

RESUMO

OBJECTIVE: To develop original technologies that simplify and increase an effectiveness of stomach resection in case of «difficult¼ duodenal ulcers. MATERIAL AND METHODS: Healing of gastroduodenostomy was experimentally observed under tension of anastomosed segments. In the first group (12), gastric resection was performed in a volume of 2/3 without tension of the anastomosed sections using a two-row suture. In the second group (12), stomach resection was accompanied by modeling of tension of the anastomosed sections under a pressure equal to 2.5-3.6 N (245-350 g). In the third group (12), gastric resection was performed in the same fashion as in the second group, but gastroduodenostomy was sutured using a single-row everted seams and hypotraction serous-muscular sutures. The results of Billroth-I gastrectomy using traditional (n=86) (classic double-row Lambert-Albert suture) and developed technologies (n=112) were analyzed in patients with complicated gastric and duodenal ulcers. RESULTS: The obvious advantages of the developed technologies have been experimentally proved for gastric resection under tension of anastomosed sections. There was no inconsistency of gastroduodenostomy, whereas traditional two-row suture was followed by this complication in 58,3% of cases. A favorable course was based on the relatively low inhibition of tissue blood supply in regenerating structures that was manifested by significantly less redox potential. Reduced lipid peroxidation and phospholipase activity in tissue structures along the suture line was also recorded. We obtained the positive clinical results of this approach in patients with complicated course of duodenal ulcer. Billroth-I gastrectomy was performed in all patients. Gastroduodenostomy failure was absent. Overall postoperative morbidity was 6,3%. In case of double-row anastomosis, suture failure occurred in 9,3% of cases, incidence of complications - 57,0%. This procedure was performed for gastric ulcer as a rule. CONCLUSION: The developed technologies greatly simplify resection of stomach and duodenum in the most difficult atypical conditions and ensure physiological Billroth-I surgery. The obvious benefit of this technology is simplified resection per se that makes it accessible to novice surgeons.


Assuntos
Gastroenterostomia , Estômago/cirurgia , Úlcera Duodenal , Gastrectomia , Humanos , Suturas
2.
Nihon Shokakibyo Gakkai Zasshi ; 117(9): 796-801, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32908110

RESUMO

The patient was a male in his 70s with a history of distal gastrectomy and Billroth-I reconstruction. He was suspected of having esophageal achalasia and was started on calcium blockers in X-2 year. The symptoms worsened, and he presented to our hospital in X year. We diagnosed esophageal achalasia (Chicago classification ver. 3.0;type I), and conducted per-oral endoscopic myotomy (POEM). His postoperative course was uneventful with no postoperative symptoms. In cases of esophageal achalasia following distal gastrectomy, it is important to consider adhesions, mobility of the remaining stomach, and preservation of the short gastric artery and vein. Since the Heller-Dor operation can be difficult, POEM may be a reasonable alternative in these cases.


Assuntos
Acalasia Esofágica , Miotomia , Gastrectomia , Humanos , Masculino , Estômago , Resultado do Tratamento
3.
Eur J Endocrinol ; 183(5): R119-R132, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869608

RESUMO

Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Fraturas Ósseas/etiologia , Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
4.
Chirurgia (Bucur) ; 115(4): 423-431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876015

RESUMO

Post-gastrectomy complications have been the associated sequelae after curative gastrectomy for long time. They include a conundrum of symptoms ranging from serious metabolic alterations to disorders attributed to mechanical and neural factors after reconstruction of the digestive continuity. Though, with the advancement in the surgical expertise and techniques and shift towards medical and endoscopic management for benign gastro-duodenal ulcer disease, there has been a decline in the incidence of these complications; they continue to raise "red flags" after major oncologic gastric resections. Identification of these symptoms and protocol based management of the same is of utmost importance in the surgical armamentarium of trainees and practicing physicians and surgeons.


Assuntos
Gastrectomia/efeitos adversos , Síndromes Pós-Gastrectomia/diagnóstico , Síndromes Pós-Gastrectomia/terapia , Humanos , Gastropatias/cirurgia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
5.
Anticancer Res ; 40(10): 5807-5813, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988909

RESUMO

BACKGROUND/AIM: The survival benefit of negative resection margins in patients who undergo gastrectomy with positive peritoneal lavage cytology (CY1) is unknown. PATIENTS AND METHODS: We reviewed the medical records of 128 patients with CY1 but no other distant metastases who had undergone R1 gastrectomy, 21 of whom had positive margins. We compared overall survival (OS) according to margin status. RESULTS: The positive-margin group had poorer performance status scores (p=0.02), higher number of patients had undergone limited lymphadenectomy (p=0.01), had type 4 tumors (p=0.01), and undifferentiated type (p=0.02). Median OS was 19.0 and 16.9 months in the groups with negative and positive margins, respectively (HR=1.26, 95%CI=0.75-2.12, p=0.39). An inverse probability of treatment weighted analysis showed an OS of 13.1 and 11.9 months for the groups with negative and positive margins, respectively (HR=0.83, 95%CI=0.43-1.63, p=0.59). CONCLUSION: The prognoses of patients with CY1 and negative or positive margins may be equivalent.


Assuntos
Citodiagnóstico , Gastrectomia , Prognóstico , Neoplasias Gástricas/cirurgia , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Lavagem Peritoneal/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Taxa de Sobrevida
7.
JAMA ; 324(9): 879-887, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870301

RESUMO

Importance: Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with these conditions choose to undergo bariatric surgery. Summaries of the expanding evidence for both the benefits and risks of bariatric surgery are needed to better guide shared decision-making conversations. Observations: There are approximately 252 000 bariatric procedures (per 2018 numbers) performed each year in the US, of which an estimated 15% are revisions. The 1991 National Institutes of Health guidelines recommended consideration of bariatric surgery in patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 40 or higher or 35 or higher with serious obesity-related comorbidities. These guidelines are still widely used; however, there is increasing evidence that bariatric procedures should also be considered for patients with type 2 diabetes and a body mass index of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes. Substantial evidence indicates that surgery results in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions, regardless of the type of procedures used. The 2 most common procedures used currently, the sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes and similar safety through at least 5-year follow-up. However, emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable weight loss and glycemic control. Although safety is a concern, current data indicate that the perioperative mortality rates range from 0.03% to 0.2%, which has substantially improved since early 2000s. More long-term randomized studies are needed to assess the effect of bariatric procedures on cardiovascular disease, cancer, and other health outcomes and to evaluate emerging newer procedures. Conclusions and Relevance: Modern bariatric procedures have strong evidence of efficacy and safety. All patients with severe obesity-and especially those with type 2 diabetes-should be engaged in a shared decision-making conversation about the risks and benefits of surgery compared with continuing usual medical and lifestyle treatment, and the decision about surgery should be driven primarily by informed patient preferences.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Perda de Peso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/etiologia , Feminino , Gastrectomia , Humanos , Hipertensão/etiologia , Masculino , Obesidade Mórbida/complicações , Síndromes da Apneia do Sono/etiologia
8.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933905

RESUMO

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke's encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67-200).


Assuntos
Gastrectomia/efeitos adversos , Perda Auditiva/etiologia , Complicações Pós-Operatórias/etiologia , Encefalopatia de Wernicke/complicações , Adulto , Feminino , Gastrectomia/métodos , Humanos , Encefalopatia de Wernicke/diagnóstico
9.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(6): 916-918, 2020 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895210

RESUMO

Obesity and its complications, such as type 2 diabetes, hypertension, hyperlipidemia, nonalcoholic fatty liver, are serious global public health problems. Endoscopic sleeve gastroplasty (ESG) can reduce the length and width of the stomach by simulating the anatomical structure of surgical sleeve gastrectomy to reduce the capacity of the stomach, and is safe and effective to reduce weight. ESG has the advantages of non- invasiveness, no gastrectomy, repeatability, simple operation, no incision scar, few complications, short hospital stay and quick postoperative recovery. As an intermediate means of medical treatment and surgery, ESG provides a new method for weight loss for obese patients who cannot tolerate or are unwilling to undergo surgery. Herein we trace the origin of ESG, analyze the unique advantages of ESG suture, explore the technical improvement in the development of ESG, and briefly describe the weight reduction effect of ESG and compare the curative effect of ESG with laparoscopic sleeve gastrectomy. ESG has undergone rapid development and maturity but also faces such challenges as the lack of established standard procedures, unclear weight reduction mechanism, and clarification of the indications for operation. Still, ESG is expected to become the mainstream technique for weight reduction.


Assuntos
Diabetes Mellitus Tipo 2 , Gastroplastia , Gastrectomia , Humanos , Laparoscopia , Obesidade Mórbida , Resultado do Tratamento , Perda de Peso
10.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 426-434, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879068

RESUMO

For resectable gastric cancer, although radical surgery is still the main treatment, methods of operation and the curative effect of operation are still in the stage of exploration for metastatic gastric cancer. Radiotherapy, chemotherapy and molecular targeted therapy also play an important role in prolonging the survival period of patients with gastric cancer. Postoperative radiotherapy and chemotherapy can prolong the survival time, but for patients with locally advanced gastric cancer, the preoperative radiotherapy and chemotherapy can also further improve the survival period of patients compared with direct operation. In addition, with the development and using of molecular targeted drugs, such as antiangiogenic agents, immunosuppressive drugs and so on, the survival period of patients with gastric cancer has been further extended.


Assuntos
Neoplasias Esplênicas , Neoplasias Gástricas/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica , Gastrectomia , Humanos , Terapia Neoadjuvante
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 757-765, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810947

RESUMO

Objective: To understand the perceptions, attitudes and treatment selection of Chinese surgeons for proximal gastrectomy (PG) and digestive tract reconstruction. Methods: A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade IIIA (provincial and prefecture-level) tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2) Surgeons with senior attending physician, associate chief physician and chief physician. The "Questionnaire Star" platform was used to design a questionnaire about cognition, attitude and treatment choice of "proximal gastrectomy and digestive tract reconstruction". The questionnaire contained 32 questions, such as the basic information of surgeons, the current status of gastric cancer surgery, the selection and management of surgical methods and related details for proximal gastric cancer, the choice of proximal gastrectomy and reconstruction of digestive tract, the related complications and nutritional status monitoring after proximal gastrectomy. A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25, 2019. Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables. Results: A total of 47 grade IIIA hospitals were included, and 76 questionnaires were sent out. The proportions of recovered and valid questionnaires were both 100%. For early and middle stage adenocarcinoma of esophagogastric junction (AEG), especially those smaller than 4 cm, 72.37% (55/76) of surgeons preferred proximal gastrectomy, while 22.37% (17/76) of surgeons chose total gastrectomy. For early AEG, 90.79% (69/76) of surgeons thought that endoscopic submucosal dissection (ESD) or proximal gastrectomy could be considered. For AEG below T3 stage and shorter than 4 cm, 60.53% (46/76) of surgeons gave priority to proximal gastrectomy, and 60.53% (46/76) of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy, and the residual stomach should not be less than half stomach. Considering anti-reflux effect, postoperative weight recovery, clinical efficacy, wide application and easy popularization, surgeons preferred double-tract reconstruction. The surgeons in tumor hospitals had a higher approval rate for the application of proximal gastrectomy and the fact that the Kamikawa anastomosis was the most difficult to promote than the surgeons in provincial/municipal general hospitals. The surgeons with an annual surgical volume of more than 200 were more likely to choose proximal gastrectomy for early and middle stage AEG patients and the proportion was as high as 8/9. From the perspective of good clinical results, wide range of application, and easy popularization, the surgeons with a higher ratio (60.00%, 15/25) of double-tract reconstruction were those surgeons with 50-100 operations per year. Conclusions: The general level of cognition and acceptability of Chinese surgeons for proximal gastrectomy and reconstruction of digestive tract is suboptimal. In the future, it is urgent to promote the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy" so as to guide and optimize treatment in proximal gastric cancer.


Assuntos
Gastrectomia , Neoplasias Gástricas , Estudos Transversais , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Cirurgiões , Inquéritos e Questionários , Resultado do Tratamento
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 766-773, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810948

RESUMO

Objective: To verify clinical applicability of the non-special perioperative administration for enhanced recovery after surgery (ERAS) proposed by Japanese scholars in Chinese gastric cancer patients. Methods: The main measures of the non-special perioperative administration for ERAS are as follows: (1) discussion of multiple disciplinary team before surgery; (2) rehabilitation education for patients; (3) no routine bowel preparation before surgery; (4) placement of nasogastric tube for decompression routinely before operation and removal as early as 24 hours after surgery; (5) appropriate rehydration; (6) antibiotic prophylaxis before surgery; (7) place abdominal drainage tubes when necessary; (8) epidural patient-controlled analgesia and oral medication for postoperative pain management; (9) start low-molecular-weight heparin injection 48h after surgery and ambulation every day to prevent deep vein thrombosis; (10) postoperative dietary management and supplement with parenteral nutrition intermittently; (11) remove Foley catheter about 24 hours after surgery. A retrospective cohort study was performed, including 203 patients undergoing radical gastrectomy at Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital from January 2017 to December 2018. Inclusion criteria were patients who were ≤75 years old without distant metastasis by preoperative examination, were diagnosed as gastric adenocarcinoma by postoperative histopathology and had complete clinicopathological and follow-up data. Patients with history of other malignancies and gastrectomy, extensive implantation of the abdominal cavity or malignant ascites by intraoperative exploration, death within 1 month after surgery, and residual gastric cancer were excluded. The perioperative management methods were chosen by patients. There were 123 patients who followed non-special perioperative administration for ERAS (non-special preparation group) and 80 patients who underwent traditional perioperative management (traditional method group). The primary outcomes (postoperative hospital stay, time to the first flatus, time to the first fluid diet, time to the first ambulatory activity, morbidity of postoperative complication, mortality, and readmission rate) and secondary outcomes (operative time, intraoperative blood loss and postoperative pain score) were compared between the two groups. Results: Compared to the traditional method group, the non-special preparation group had shorter time to the first flatus [(3.6±1.1) days vs. (4.8±1.4) days, t=3.134, P=0.003], shorter time to the first liquid diet [(2.6±0.9) days vs. (5.5±1.6) days, t=15.105, P<0.001], shorter time to the first ambulatory activity [(1.9±0.5) days vs. (4.1±1.1) days, t=8.543, P<0.001] and shorter postoperative hospital stay [(9.6±2.3) days vs. (12.9±2.3) days, t=5.020, P<0.001]. Besides, incidences of pancreatic leakage [6.5% (8/123) vs. 16.3% (13/80), χ(2)=4.964, P=0.026], lymphatic leakage [1.6% (2/123) vs. 13.8% (11/80), χ(2)=11.887, P=0.001], peritoneal effusion [2.4% (3/123) vs. 10.0% (8/80), χ(2)=4.032, P=0.045], and gastroparesis [0.8% (1/123) vs. 7.5% (6/80), χ(2)=4.657, P=0.031] in the non-special preparation group were significantly lower. The overall morbidity of postoperative complications and incidences of pulmonary infection and intestinal adhesion were not significantly different between the two groups (all P>0.05). As for the secondary outcomes, compared to the traditional method group, the non-special preparation group had less intraoperative blood loss [(80.4±24.4) ml vs. (100.5±19.4) ml, t=3.134, P=0.003] and lower postoperative pain score [postoperative day 1: (4.4±0.3) vs. (5.3±0.8), t=2.504, P=0.037],while the difference in operative time was not significant (P>0.05). Conclusion: The non-special perioperative administration for ERAS proposed by Japanese scholars is effective and safe, which has certain clinical applicability and value for Chinese patients with gastric cancer.


Assuntos
Laparoscopia , Neoplasias Gástricas , Recuperação Pós-Cirúrgica Melhorada , Gastrectomia , Humanos , Tempo de Internação , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(31): e21532, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756202

RESUMO

RATIONALE: Gastric cancer usually spread via blood circulation to liver, lung, bone, and kidney after recurrence, but it is extremely rare in clinical practice that gastric carcinoma metastasizes to the skin and colon without metastasis to common sites like liver or lung. PATIENT CONCERNS: A 57-year-old man was admitted to the hospital with altered bowel habit and hematochezia for 2 weeks. DIAGNOSES: The patient was diagnosed with advanced gastric cancer at stage IIIA (pT3N2M0) two and a half years ago. Cutaneous metastasis from gastric cancer was confirmed by cutaneous biopsy 2 years following curative gastrectomy. Unfortunately, colonic metastasis from gastric cancer was found by PET-CT 6 months after the diagnosis of cutaneous metastasis. INTERVENTIONS: The patient was given chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for the skin metastasis. Right hemicolectomy was performed when the malignant tumor of the colon was found, in order to relieve the symptom, and improve the quality of life. OUTCOMES: The patient was treated with chemoradiotherapy in a local hospital, the peritoneal carcinomatosis occurred 5 months after the second operation, and died 9 months after the diagnosis of colonic metastasis. LESSONS: Our case represents a rare condition that solitary cutaneous and colonic metastasis from gastric cancer can occur after surgical resection and systemic chemotherapy. Its unique clinicopathological features can extend our insights on gastric cancer, and it may provide clinicians with some positive clinical experience for identifying and treating this disease.


Assuntos
Neoplasias do Colo/secundário , Neoplasias Cutâneas/secundário , Neoplasias Gástricas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colectomia , Neoplasias do Colo/terapia , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Qualidade de Vida , Neoplasias Cutâneas/terapia , Neoplasias Gástricas/terapia
15.
Arq Bras Cir Dig ; 33(2): e1513, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844876

RESUMO

BACKGROUND: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. AIM: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. METHODS: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. RESULTS: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. CONCLUSION: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.


Assuntos
Gastrectomia/métodos , Refluxo Gastroesofágico/etiologia , Laparoscopia/efeitos adversos , Obesidade/cirurgia , Animais , Gastrectomia/efeitos adversos , Humanos , Obesidade Mórbida , Distribuição Aleatória , Ratos , Ratos Wistar
16.
Gan To Kagaku Ryoho ; 47(8): 1254-1257, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32829367

RESUMO

A 32-year-old woman was admitted our hospital due to epigastric discomfort. The patient diagnosed as having scirrhous carcinoma of the stomach by upper gastrointestinal scope. Peritoneal dissemination and ovarian metastasis were confirmed by the diagnostic laparoscopy. Therefore, combination chemotherapy with S-1 and intraperitoneal chemotherapy(ip)with docetaxel (DTX) was started. After 2 courses chemotherapy, laparoscopy was performed again. Peritoneal dissemination was scarred, but biopsy showed altered AE1/AE3 positive cells, and increased left ovarian metastasis, so systemic chemotherapy was changed to DCS chemotherapy and added DTX ip. After 4 courses chemotherapy and 7 months after the first diagnosis, subtotal gastrectomy, hysterectomy and bilateral adnexectomy were performed because the cytology and tumor marker remained within normal range. In histopathological diagnosis, the effect of chemotherapy was Grade 2 at the primary site and Grade 3 at the metastatic site. Nine years have passed since the initial diagnosis and she has no relapse with postoperative adjuvant chemotherapy.


Assuntos
Neoplasias Peritoneais/secundário , Neoplasias Gástricas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Combinação de Medicamentos , Feminino , Gastrectomia , Humanos , Recidiva Local de Neoplasia , Neoplasias Ovarianas , Ácido Oxônico , Tegafur
17.
Gan To Kagaku Ryoho ; 47(8): 1258-1260, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32829368

RESUMO

A 66-year-old man was diagnosed with advanced gastric cancer(L, Less, Type 2, T4a[SE], N2, M1[LYM], H0, P0, cStage Ⅳ)and received treatment with S-1/cisplatin as first-line chemotherapy. This treatment resulted in partial response(PR) after 3 months, with reduction in the sizes of metastatic lymph nodes surrounding the pancreatic head and paraaortic lesion. However, the sizes of metastatic lymph nodes increased after 7 months of chemotherapy. Ramucirumab/nab-paclitaxel was then administered as second-line chemotherapy, and the diameter of the metastatic lymph nodes subsequently decreased after 4 months of the regimen. However, progressive disease was observed at 7 months, and blood transfusion was required because of bleeding from the primary gastric tumor. Therefore, nivolumab was initiated as third-line chemotherapy 14 months after the first treatment. After nivolumab administration, a 28% reduction in metastatic lymph nodes was achieved within 3 months, together with the regression of the primary gastric tumor and improvement in anemia within 6 months. PR was achieved after 12 months of nivolumab administration, and effective disease control was maintained for 16 months without any adverse reaction to nivolumab.


Assuntos
Neoplasias Gástricas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Cisplatino , Gastrectomia , Humanos , Linfonodos , Metástase Linfática , Masculino , Nivolumabe
18.
Medicine (Baltimore) ; 99(34): e20748, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846750

RESUMO

INTRODUCTION: Obesity represents a risk factor in case of major hepatectomy, because the future liver remnant (FLR) must be proportional with body weight. To avoid post-hepatectomy liver failure, and further increase the ratio between FLR and body weight, we performed a bariatric procedure in the first stage of the ALPPS technique. PATIENT CONCERNS: Fifty-four-year-old woman, with morbid obesity (BMI 58.5) and type II diabetes mellitus, was scheduled for a major hepatectomy due to multiple colorectal liver metastases DIAGNOSIS:: Six months before, the patient was diagnosed with colorectal cancer and synchronous liver metastases. She was initially treated with sigmoidectomy and chemotherapy. After partial response of the liver metastases, we considered a liver resection but the FLR was very low, especially in relation to her BMI. INTERVENTION: We planned a novel approach and, for the first time, we performed a sleeve gastrectomy during the first stage of Tourniquet ALPPS (T-ALPPS). After achieving an adequate FLR, we successfully completed the major hepatectomy during the second stage of T-ALPPS. OUTCOME: The association between sleeve gastrectomy and T-ALPPS produced an increase of FLR/body weight ratio up to 0.8 that allowed completing a right trisectionectomy in the second stage of ALPPS. The major hepatectomy was performed without severe complications, and several months after surgery the patient is still alive without any recurrence Conclusion: Despite obesity represents a risk factor involved in the carcinogenesis, the role of the bariatric surgery in the oncological setting is not well established. In this clinical case, we benefited from the weight loss produced by bariatric surgery combined with an effective hypertrophy technique and chemotherapy. These findings suggest that bariatric surgery could be useful for obese patients with liver malignancy and need for extended hepatectomy.


Assuntos
Gastrectomia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Obesidade Mórbida/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/patologia
19.
Mymensingh Med J ; 29(3): 652-658, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844808

RESUMO

This prospective comparative study was done to compare the outcome of stapled closure of the duodenal stump with hand-sewn closure during gastric resection in terms of total operating time, postoperative duodenal stump leakage, postoperative hospital stay, and surgical cost. This study was conducted from January 2013 to August 2014. Patients who were admitted to the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with the indication of distal or total gastrectomy were included in the study. A total of 32 patients were enrolled in this study with 16 in each group, they were divided either into Group I (Hand Sewn) or Group II (stapling). Mean±SD age of Group I was 53.38±8.69 and Group II was 50.88±9.56 (p=0.445). Male patients were predominant than the female with a male: female ratio being 3.57:1. Mean±SD total operating time was 154.38±16.32 minutes and 136.88±17.40 minutes in Group I and Group II respectively (p=0.001). In Group I, 2(12.5%) patients and in Group II, 1(6.3%) patient had duodenal stump leakage which showed no statistically significant difference (p=0.999). Postoperative hospital stay had no statistically significant difference (p=0.923). The surgical cost had a significant difference (p=0.001) which is more in Group II. This study showed there was a significant reduction in total operating time but there was no significant difference in occurring of duodenal stump leakage or postoperative hospital stay. However, use of stapler hastens the surgeon's job and it relieves extra pressure of them.


Assuntos
Duodeno , Gastrectomia , Anastomose Cirúrgica , Bangladesh , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Grampeamento Cirúrgico , Técnicas de Sutura
20.
Geriatr Gerontol Int ; 20(10): 927-931, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32830911

RESUMO

AIM: This study aimed to investigate the potential risk factors for postoperative cognitive dysfunction (POCD) in elderly patients with gastric cancer (GC) after radical gastrectomy. METHODS: In total, 221 elderly patients with GC who were scheduled to undergo selective radical gastrectomy in our hospital were enrolled in this study. To define early POCD, the neuropsychological assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was carried out to evaluate the predicative and cut-off values of risk factors, including neutrophil-lymphocyte ratio (NLR) for early POCD. The univariate and multivariate logistic regression analyses were performed to investigate risk factors for early POCD. RESULTS: Of the 221 enrolled elderly patients with GC, 42 were identified as early POCD with an incidence of 19.0% (42 of 221). Receiver operating characteristic curve analysis indicated that NLR was a significant predictor for POCD with a cut-off value of 2.50 and an area under the curve of 0.711 (95% confidence interval: 0.624-0.798, P < 0.001). Preoperative NLR (≥2.50) was the only independent risk factor associated with POCD (odds ratio: 2.44, 95% confidence interval: 1.52-3.68, P = 0.013) by the multivariate logistic regression analysis. CONCLUSIONS: Preoperative NLR level was an independent risk factor for POCD in elderly patients with GC undergoing curative resection. Geriatr Gerontol Int 2020; 20: 927-931.


Assuntos
Linfócitos , Neutrófilos , Complicações Cognitivas Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Gastrectomia , Humanos , Incidência , Masculino , Testes Neuropsicológicos , Razão de Chances , Curva ROC , Fatores de Risco
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