10,809 research outputs found
Laparoscopic circular stapled longitudinal extramucosal pyloroplasty: An alternative technique for pyloric disruption
No full textOBJECTIVES Oesophagectomy with gastric pull-up is the most common surgical procedure for oesophageal cancer. Pyloroplasty may be performed to facilitate stomach emptying, but its role is still controversial. When laparoscopic mobilization of the stomach is performed, conventional extramucosal pyloroplasty may be difficult to carry out; therefore, we describe a new technique for mechanical pyloric disruption. METHODS We conceived the laparoscopic longitudinal extramucosal partial section of the anterior pyloric wall using a circular stapler. We performed it in 6 patients undergoing oesophagectomy for cancer, with the laparoscopic abdominal step before thoracotomy. RESULTS The procedure was easy and safe and without intraoperative complications in all patients. Postoperative video-oesophagogram showed regular anastomosis and graft emptying. CONCLUSIONS Our preliminary experience has led us to conclude that circular stapler longitudinal extramucosal pyloroplasty is an easy, safe and quick procedure that can be performed in laparoscopic surgery. Moreover, it seems to ensure a regular emptying of the graft as standard pyloroplasty does
Malignant ascites: pathophysiology and treatment.
No full textMalignant ascites (MA) accompanies a variety of abdominal and extra-abdominal tumors. It is a primary cause of morbidity and raises several treatment challenges. MA has several symptoms, producing a significant reduction in the patient’s quality of life: loss of proteins and electrolyte disorders cause diffuse oedema, while the accumulation of abdominal fluid facilitates sepsis. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk. A Pubmed, Medline, Embase, and Cochrane Library review of medical, interventional and surgical treatments of MA has been performed. Medical therapy, primarily paracentesis and diuretics, are first-line treatments in managing MA. Paracentesis is widely adopted but it is associated with significant patient discomfort and several risks. Diuretic therapy is effective at the very beginning of the disease but efficacy declines with tumor progression. Intraperitoneal chemotherapy, targeted therapy, immunotherapy and radioisotopes are promising medical options but their clinical application is not yet completely elucidated, and further investigations and trials are necessary. Peritoneal–venous shunts are rarely used due to high rates of early mortality and complications. Laparoscopy and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed as palliative therapy. Literature on the use of laparoscopic HIPEC in MA includes only reports with small numbers of patients, all showing successful control of ascites. To date, none of the different options has been subjected to evidence-based clinical trials and there are no accepted guidelines for the management of MA
Interview of author Walter Satterthwait
No full textWalter Satterthwait, author of a series of contemporary crime novels, talks about his protagonists Joshua Croft and Rita Mondragon, and his novels set in Santa Fe, New Mexico. Satterthwait describes how he came to writing crime stories and why he chose to use a Latina as a main character. He describes his exposure to different cultures, his childhood of frequent moves, how he came to writing, and how he developed his characters. Satterthwait is interviewed by Diana Rivera at the 2005 Left Coast Crime Conference held in El Paso, Texas
Anuson Walter Vella
No full textCremation volume for Vella, Walter F. (Walter Francis), 1924-1980, American author on Thailand; comprises condolences and papers on Thailand by both crematee and others
To drain or not to drain elective uncomplicated laparoscopic cholecystectomy? A systematic review and meta‐analysis
No full textAbstract Laparoscopic cholecystectomy (LC) has largely replaced conventional cholecystectomy in the past decade. However, there are still limited data about the value of prophylactic sub-hepatic drainage for elective uncompli- cated LC. We carried out a systematic review of the litera- ture in order to perform a meta-analysis about this issue. An unrestricted search in MEDLINE, EMBASE and Cochrane Library up to 31 December 2013 was performed. Overall, seven high-methodological quality randomized controlled trials (RCTs) were included in the meta-analysis, resulting in 1310 patients totally. The incidence of abdominal collec- tions, wound infection and overall mortality according to the presence or absence of the sub-hepatic drainage were meta- analyzed. Sub-hepatic drainage showed an increase in the abdominal collection rate in patients who underwent elec- tive uncomplicated LC (OR 1.56, 95% CI 1.00–2.43) if compared to patients without drainage. A non-significant correlation was found in overall mortality and infection rates. The meta-analysis shows that the presence of the sub-hepatic drainage does not reduce the incidence of abdominal collection after uncomplicated LC, whereas it does not influence wound infection and mortality rates, postoperative pain and hospital stay
Letter from Walter M. Weglyn to Frank Chin, May 30, 1989
No full textA letter from Walter M. Weglyn to Frank Chin praising him for his writings about Japanese Americans draft resisters during World War II.These materials are from box 73 and 74 of the Frank Chin Papers. The Frank Chin Papers contain personal and professional correspondence between Frank Chin and Michi Weglyn relating to particular projects on which either author was working as well as files related to the Day of Remembrance Tribute to Michi Weglyn
Laparoscopic vs. open loop ileostomy reversal: a meta-analysis of randomized and non-randomized studies
No full textPurpose The present meta-analysis compares laparoscopic loop ileostomy reversal (LLIR) with open loop ileostomy reversal (OLIR) to evaluate the advantages of the laparoscopic technique compared to the traditional open technique in ileostomy reversal.MethodsPrimary endpoints were hospital stay and overall complications. Secondary endpoints were operative time, EBL, readmission, medical complications, surgical complications, reoperation, wound infection, anastomotic leak, intestinal obstruction, and cost of the procedures. The included studies were also divided based on the type of anastomotic approach: extracorporeal laparoscopic loop ileostomy reversal (ELLIR) and intracorporeal laparoscopic loop ileostomy reversal (ILLIR).Results In the analysis, 4 studies were included. Three hundred fifty-four patients were enrolled. As primary outcomes, a significant difference was found in hospital stay between the LLIR and OLIR groups (MD = -0.67, 95% CI -1.16 to -0.19, P = 0.007). The overall complications outcome resulted in favor of the LLIR group (RR = 0.64, 95% CI 0.43-0.95, P = 0.03). As secondary outcomes, the operative time was in favor of the OLIR group (MD = 19.18, 95% CI 10.20-28.16, P < 0.001). Surgical complications were lower in the LLIR group than in the OLIR group. No other differences between the secondary endpoints were found. Subgroup analysis showed a significant difference in hospital stay between the ILLIR and OLIR groups (MD = -0.92, 95% CI -1.55 to -0.30, P = 0.004). The overall complications outcome significantly favored the ILLIR group (RR = 0.38, 95% CI 0.15-0.96, P = 0.04).Conclusion Our meta-analysis shows an advantage in terms of shorter post-operative hospitalization and reduction of complications of LLIR compared to OLIR. The sub-group analysis shows that performing an extracorporeal anastomosis exposes the same risks of the open technique
Letter from Michi and Walter Weglyn to Frank Chin, July 25, 1993
No full textA personal letter from Michi and Walter Weglyn to Frank Chin.These materials are from box 73 and 74 of the Frank Chin Papers. The Frank Chin Papers contain personal and professional correspondence between Frank Chin and Michi Weglyn relating to particular projects on which either author was working as well as files related to the Day of Remembrance Tribute to Michi Weglyn
[Preliminary experience in treatment of locally advanced gastric adenocarcinoma with peri-operative chemotherapy].
No full textRole of FDG-PET/CT in follow-up of patients treated with resective gastric surgery for tumour
No full textINTRODUCTION:
Gastric cancer has a poor prognosis and a high rate of recurrences after surgery. The optimal method for assessing early recurrences is not defined: conventional imaging (ultrasonography, CT and MRI) have difficulty in detecting them, because they don't give information regarding metabolic features or tumor response to chemotherapy. Actually 18F-fluorodeoxyglucose positron emission (18FDG-PET) has several indications for the primary staging and the follow-up of colon-rectal, lung, breast, neck cancers and lymphoma, but its clinical role in gastric cancer is not assessed. Our study analyzes the role of 18FDG-PET integrated with CT scan in the detection of gastric cancer recurrence.
MATERIALS AND METHODS:
We retrospectively reviewed 50 patients which underwent follow-up 18FDG-PET/CT from 2006 to 2009 after radical surgery for gastric adenocarcinoma. Each study was repeated every 6 months for the first two years after surgery and every 12 months for the subsequent three years.
RESULTS:
18FDG-PET/CT was positive for suspected neoplastic disease in 29 (58%) and negative in 21 (42%) patients, with 3 false positive and 3 false negative results. 18FDG-PET/CT showed highly effectiveness in early detection of recurrences, as observed in 17 patients that were totally asymptomatic, allowing the initiation of multimodal treatment resulting in an important increasing of survival.
CONCLUSIONS:
18FDG-PET-CT has a very good sensitivity (89.7%) and specificity (85.7%) in detecting local and distant recurrences during post-operative follow-up. Positive 18FDG-PET/CT findings may lead to an early change in the management of these patients, directing them towards rescue surgery or chemotherapy thereby improving their overall surviva
- …
