1,721,029 research outputs found
Prevention of peritoneal carcinomatosis from colorectal cancer: a critical issue.
No full text[No abstract available
Benefits of minimally invasive surgery in the treatment of gastric cancer
Full text linkWe read with great interest the article that retrospectively analyzed 814 patients with primary gastric cancer, who underwent minimally invasive R0 gastrectomy between 2009 and 2014 by grouping them in laparoscopic vs robotic procedures. The results of the study highlighted that age, American Society of Anesthesiologists status, gastrectomy type and pathological T and N status were the main prognostic factors of minimally invasive gastrectomy and showed how the robotic approach may improve long-term outcomes of advanced gastric cancer. According to most of the current literature, robotic surgery is associated with a statistically longer operating time when compared to open and laparoscopic surgery; however, looking at the adequacy of resection, defined by negative surgical margins and number of lymph nodes removed, it seems that robotic surgery gives better results in terms of the 5-year overall survival and recurrence-free survival. The robotic approach to gastric cancer surgery aims to overcome the difficulties and technical limitations of laparoscopy in major surgery. The three-dimensional vision, articulation of the instruments and good ergonomics for the surgeon allow for accurate and precise movements which facilitate the complex steps of surgery such as lymph node dissection, esophagus-jejunal anastomosis packaging and reproducing the technical accuracy of open surgery. If the literature, as well as the analyzed study, offers us countless data regarding the short-term oncological results of robotic surgery in the treatment of gastric cancer, satisfactory data on long-term follow-up are lacking, so future studies are necessary
Thoracic Duct Embolization for Delayed Chyle Leak After Lewis-Tanner Esophagectomy
Full text linkPatient: Male, 54-year-old Final Diagnosis: Chyle leak Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Radiology • Surgery OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including chyle leak (CL). CL has an incidence rate of 1–9% and is associated with a higher rate of postsurgical morbidity and mortality. It usually occurs in the early postoperative period; delayed CL is less common and is thought to be due to an occult leak or late diagnosis. CASE REPORT: A 54-year-old man with adenocarcinoma of the esophagus underwent Lewis-Tanner esophagectomy after neoadjuvant chemotherapy with FLOT. During en bloc lymphadenectomy, the main thoracic duct was identified, clipped, and divided. The postoperative course was uneventful. One month after hospital discharge, he was readmitted with severe abdominal, scrotal, and lower-limb edema. A chest-abdomen CT scan revealed massive pleural effusion with left shift and compression of the mediastinum. The patient was initially treated with fasting and fat-free total parenteral nutrition, and the drain output was 2800–3000 mL/dL. Lymphoscintigraphy with ethiodized oil eventually revealed a thoracic duct leak, and lymphatic embolization was successfully performed with a 4-mm metallic spiral and glue. Drain output dramatically reduced, and after 11 days the thoracic drain was removed and the patient was safely discharged. CONCLUSIONS: Thoracic duct embolization seems be an effective therapy in treating high-output (>1000 mL/dL) CL that has occurred more than 2 weeks after esophagectomy. It can be considered as a first-line treatment due to its simplicity and effectiveness
[Immunomorphology of lymph nodes and prognosis in lung cancer].
No full textMany studies have investigated locoregional immune responses and long-term survival in various types of cancer; few have focused on lung cancer. This study was designed to assess the prognostic value of immunomorphologic changes in locoregional lymph nodes in patients resected for bronchogenic carcinoma. In a retrospective analysis, immune responses in locoregional lymph nodes were studied histologically in 172 selected patients. Lymph node morphology was studied according to the system of Cottier et al.: sinus histiocytosis (SH) and paracortical lymphoid cell hyperplasia (PCA) were considered as a cellular immune response, and follicular hyperplasia of the cortical area (CA) as a humoral reaction. The survival rate was estimated by the Kaplan-Meier product-limit method. Log-rank test and Cox proportional-hazards model were used to determine statistical significance in univariate and multivariate survival analysis. 35.5% of the patients had no evident response in regional nodes; 19.8% had a marked cellular response; 11% a marked humoral response; and 33.7% a mixed cellular-humoral response. A nodal cellular response improved long-term survival rates even in patients with regional node metastases. Multivariate analysis identified an independent variable as having high prognostic value: lymph node immunoreactivity. Lymph node immunoreactivity significantly influences long-term survival after curative surgery for lung cancer and may be useful in stratifying patients for prospective trials of adjuvant treatment including immunotherapy
Gabexate Mesilate (FOY)Inhibition af amylase an phospholypase A2 activity in sow pancreatic juice
No full textWe designed this study in sows to investigate the enzyme inhibitory action of gabexate mesylate (GM) directly in the pancreatic juice. We studied 16 sows, each weighing about 130 kg. The pancreatic duct was identified and cannulated to collect the pancreatic juice. Sows in the treated group received intravenous GM infusion at a dose of 1000 mg over 24 h. Control sows underwent the same sampling schedule while receiving physiological solution. GM inhibited the two pancreatic enzymes amylase and phospholipase A2 (PA2) in pancreatic juice. Thus, the enzyme inhibition in the pancreatic gland itself and the central role of PA2 inhibition in the enzyme cascade responsible for activating other proteases confirm the therapeutic use of GM in acute pancreatitis
Dual-layer sandwich mesh repair in the treatmentof major diaphragmatic eventration in an adult
No full textTotal eventration of a hemidiaphragm is a rare anomaly in adults. This condition could be subsequent to primary or acquired phrenic nerve palsy, but often it presents as a pure degenerative muscular disease without evident signs of denervation. Surgical repair is indicated only in cases of progressive exertional dyspnea, recurrent respiratory infections, or both. Routine surgical techniques counted are plication or incision, followed by double-breast suturing performed through a low posterolateral thoracotomy or minimally invasive access. We report a case of left major eventration in a 58-year-old woman in which the vanishing of most of the diaphragmatic tissue represented an extreme condition incompatible with the performance of a standard procedure
Effects of gabexate mesilate (FOY) on amylase and phospholipase a2 in human serum and pancreatic juice.
No full textThe precise inhibitory action of gabexate mesilate (GM) on the various pancreatic enzymes remains unclear. We designed this study to investigate the enzyme inhibitory action of GM in the serum and directly in the pancreatic juice.We observed 16 cases with postoperative pancreatic drainage. Patients were randomly assigned to one of two groups, to receive GM at a dose of 600 mg/24 hr (treated group: 8 patients) or a physiological solution (control group: 8 patients) by continuous intravenous infusion. In both groups pancreatic juice and serum were sampled three times: before infusion began (T0) and at 12 hr (T1) and 24 hr after infusion ended (T2). At the end of the study, seven patients received octreotide and the volume of pancreatic secretion was determined. No statistical difference was observed in serum amylase and phospholipase A2 activity in the treated and control groups. On the contrary, amylase and phospholipase A2 activity in the pancreatic juice diminished significantly only in the treated group, and in these patients a GMmetabolite was also detectable in the pancreatic secretion. The volume of pancreatic secretion decreased only after infusion of octreotide. The enzyme inhibition in the pancreatic gland itself and the central role of inhibition of phospholipase A2 in the enzyme cascade responsible for activating other proteases, confirm the therapeutic use of GM in acute pancreatitis. An association of GM and octreotide during acute pancreatitis should be useful because of their different mechanisms
LA peritonectomia con chemioipertermia intraperitoneale (HIPEC) nel trattamento della carcinosi peritoneale diffusa da carcinoma ovarico
No full textPerforated gastric cancer. A critical appraisal
Full text linkGastric cancer perforation is a life-threatening condition that accounts for less than 5% of all gastric cancer patients
and typically requires emergency surgery. However, preoperative diagnosis is difcult and management has a dual pur-
pose: to treat peritonitis and to achieve a curative resection. The optimal surgical strategy is still unclear and prognosis
remains poor. A search of the literature was performed using MEDLINE databases (Pubmed, EMBASE, Web of Science and
Cochrane) using terms such as “perforated gastric cancer”, “perforated gastric cancer and surgery”, “perforated gastric
tumour” and “gastric cancer perforated”. Case reports, other reviews, non-english written papers and papers written
before 2010 were excluded. Eight articles published between 2010 and 2020 matched the inclusion criteria for this
review. Perforated gastric cancer was more prevalent in elderly males. Distal stomach was most frequently involved.
Preoperative diagnosis was uncommon. Mortality rates ranged from 2 to 46%. Patients able to receive an R0 resection
demonstrated better long-term survival compared with patients who had simple closure procedures. Laparoscopic
procedure was mentioned only in one study. In an emergency situation, curative RO resection should always be ofered
in patients without multiple adverse factors. A surgical strategy using laparoscopic local repair as frst step of surgery to
resolve the peritonitis followed by a radical open or laparoscopic gastrectomy with lymphadenectomy could be con-
sidered. A balance between emergency and oncological needs should drive the surgical choice on a case by case basis
Dietary Protein Supplementation Helps in Muscle Thickness Regain after Abdominal Wall Reconstruction for Incisional Hernia
No full textA modern approach to incisional hernia is oriented toward midline restoration to re-establish abdominal wall physiology and to restore muscular strength. A high-protein diet has been demonstrated to improve muscle function and mass. The aim of this prospective study was to evaluate the effect of a high-protein diet on abdominal muscle remodeling in patients submitted to abdominal wall reconstruction (AWR). Forty-five patients submitted to elective AWR were prospectively divided into two groups depending on pre- and postoperative daily protein assumption: Group A patients were submitted to a standard 2300 kcal diet with 103 g of protein intake (males) and 1800 kcal diet with 80 g of protein intake (females) starting one month before surgery and lasting for three months postoperatively; Group B patients were submitted to the same dietary regimen plus 34 g of purified proteins daily. Patients underwent ultrasound scan preoperatively and three and six months after surgery, to evaluate the widest thickness of the rectus abdominis muscle on the transverse umbilical line. Three patients reporting hernia recurrence were excluded. No significant difference among the two groups in muscle thickness growth after surgery was observed at three months after surgery, even if a favorable trend in Group B was noted (10% vs 19%, P = not significant). At six months after surgery, Group B patients showed a significant difference in muscle thickening (13% vs 32%, P < 0.05 ). The study demonstrates a positive effect of a protein diet on the rectus abdominis muscle thickening after AWR. Further studies are needed
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