Background
The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and ...risk factors for internal hernia after gastrectomy for gastric cancer.
Methods
We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors.
Results
Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7%) and the median interval time was 450 days after gastrectomy. Fourteen (0.9%) of the 1510 patients who underwent open gastrectomy and 97 (2.0%) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0%), 9 (1.1%), 40 (3.1%), 56 (3.3%), 6 (2.3%), and 0 (0%) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2%) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2%), 27 (45.8%), and 0 (0%) were identified in jejunojejunostomy mesenteric, Petersen’s, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (
P
< 0.01), laparoscopic approach (
P
< 0.01), and totally laparoscopic approach (
P
= 0.03) were independent risk factors for internal hernia.
Conclusions
The potential spaces such as Petersen’s, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.
Most patients with gastric cancer rapidly lose weight after gastrectomy. Therefore, analysis of the effect of body mass index (BMI) on patients with gastric cancer survival should include ...postoperative BMI and BMI loss and preoperative BMI. This retrospective cohort study analyzed the effect of three BMI variables and their interaction on long-term outcomes.
Preoperative BMI analysis included 2,063 patients with gastric cancer who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. BMI at postoperative 6 to 12 months was available in 1,845 of these cases.
Patients with preoperative BMI 23.0 to <27.5 HR, 0.63; 95% confidence interval (CI), 0.48-0.82 for BMI 23.0 to <25.0 and HR, 0.57; 95% CI, 0.42-0.78 for BMI 25.0 to <27.5 and postoperative BMI 23.0 to <25.0 (HR, 0.67; 95% CI, 0.46-0.98) showed significantly better overall survival (OS) than pre- and postoperative patients with BMI 18.5 to <23.0, respectively. Postoperative underweight (BMI <18.5; HR, 1.74; 95% CI, 1.27-2.37) and postoperative severe BMI loss (>4.5; HR, 1.79; 95% CI, 1.29-2.50) were associated with higher mortality. Severe BMI loss and preoperative BMI <23.0 had an adverse synergistic effect; patients with BMI <23.0 were more vulnerable to severe BMI loss than those with BMI ≥23.0. Associations with cancer-specific survival were similar.
All three BMI variables were prognostic factors for survival of patients with gastric cancer. Preoperative BMI and severe BMI loss had an interaction.
Perioperative BMI and weight loss should be analyzed collectively in patients with gastric cancer undergoing gastrectomy.
.
Introduction: Systemic chemotherapy is typically administered following radical gastrectomy for advanced stage. To attenuate systemic side effects, we evaluated the effectiveness of regional ...chemotherapy using paclitaxel, albumin-paclitaxel, and liposome-encapsulated albumin-paclitaxel via subserosal injection in rat models employing nuclear medicine and molecular imaging technology. Method: Nine Sprague Dawley rats were divided into three groups: paclitaxel ( n = 3), albumin-paclitaxel nano-particles (APNs; n = 3), and liposome-encapsulated APNs ( n = 3). 123 IIodo-paclitaxel ( 123 II-paclitaxel) was synthesized by conventional electrophilic radioiodination using tert -butylstannyl substituted paclitaxel as the precursor. Albumin- 123 Iiodo-paclitaxel nanoparticles ( 123 IAPNs) were prepared using a desolvation technique. Liposome-encapsulated APNs (L- 123 IAPNs) were prepared by thin-film hydration using DSPE-PEG2000, HSPC, and cholesterol. The rats in each group were injected with each test drug into the subserosa of the stomach antrum. After predetermined times (30 min, 2, 4, 8 h, and 24 h), molecular images of nuclear medicine were acquired using single-photon emission computed tomography/computed tomography. Results: Paclitaxel, APNs, and L-APNs showed a high cumulative distribution in the stomach, with L-APNs showing the largest area under the curve. Most drugs administered via the gastric subserosal route are distributed in the stomach and intestines, with a low uptake of less than 1% in other major organs. The time to reach the maximum concentration in the intestine for L-APNs, paclitaxel, and APNs was 6.67, 5.33, and 4.00 h, respectively. Conclusion: These preliminary results imply that L-APNs have the potential to serve as a novel paclitaxel preparation method for the regional treatment of gastric cancer.
The duration of percutaneous transhepatic biliary drainage (PTBD) is a critical factor that determines the duration of treatment. This study aimed to evaluate factors affecting the PTBD duration in ...patients who underwent percutaneous treatment of common bile duct (CBD) stones. This study analyzed data of 169 patients who underwent percutaneous treatment of CBD stones from June 2009 to June 2019. Demographic data, characteristics of stone, procedure-related factors, and laboratory findings before the insertion of PTBD tubes were retrospectively evaluated. To assess the effect of confounding factors on the PTBD duration, multivariate linear regression analysis was applied, incorporating significant predictive factors identified in the univariate regression analysis. In the univariate regression analysis, the predictive factor that showed high correlation with the PTBD duration was the initial total bilirubin level (coefficient = 0.68, P < .001) followed by the short diameter of the largest stone (coefficient = 0.19, P = .056), and previous endoscopic sphincterotomy (coefficient = -2.50, P = .086). The multivariate linear regression analysis showed that the initial total bilirubin level (coefficient = 0.50, P < .001) and short diameter of the largest stone (coefficient = 0.16, P = .025) were significantly related to the PTBD duration. The total bilirubin level before PTBD tube insertion and the short diameter of the largest CBD stone were predictive factors for the PTBD duration in patients who underwent percutaneous CBD stone removal. Careful assessment of these factors might help in predicting the treatment period, thereby improving the quality of patient care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Three instrument arms are used in the current form of reduced-port robotic gastrectomy (RPRG) for gastric cancer. Based on our experience in performing reduced-port laparoscopic gastrectomy (RPLG), ...we have recently performed RPRG using two instrument arms.
From February 2018 to January 2019, we performed RPRG using two instrument arms for gastric cancer. One endoscope arm and two instrument arms of da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) were applied in robotic lymphadenectomy. A commercial multi-lumen single-port trocar was used for the endoscopy port.
A total of 18 patients underwent the planned robotic surgery using two instrument arms. Median operation time was 288.5 (213.0–446.0) minutes, and median hospital stay was 11.0 (7–18) days. Four patients experienced postoperative complications: one Clavien-Dindo grade IIIa, and the other three grade II. No mortality was reported. The number of retrieved lymph nodes did not differ between patients who underwent RPRG and RPLG (p = 0.412).
Gastric cancer surgery using two instrument arms of a robotic surgical system can be performed by surgeons with expertise of RPLG. If this technique is successfully introduced in robotic surgery, it is expected to shorten the path to pure single-port robotic gastrectomy.
A design of a new hybrid-type digital pulsewidth modulator (DPWM) with a wide frequency range of 1000:1, from 10 kHz to 10 MHz, is presented. The proposed DPWM has the maximum duty-cycle resolution ...of 11 bits and consumes the power of 17.5 μW at 10 kHz and 2.36 mW at 10 MHz, respectively. The proposed DPWM realizes the upper 5-bit resolution using a programmable digital counter and the lower 6-bit resolution using a current-integrating-type phase interpolator, employing an M2M-ladder current-steering digital-to-analog converter for low power consumption. The operating clock is generated in on-chip using a relaxation oscillator. The prototype integrated circuit fabricated in a 0.25-μm high-voltage complementary metal-oxide-semiconductor demonstrates that the proposed DPWM maintains a good linearity across the entire operating range.
This paper presents an energy-recycling class-D low-side gate driver integrated circuit (IC), which can also perform 5-to-15-V level upconversion using a bidirectional flyback converter topology. The ...gate driver itself is a mini switching regulator that operates at 5-15 MHz to generate 1-μs transition time gate-switching waveforms. In order to maintain uniform charging/discharging currents during transitions, the embedded flyback converter operates in a pulse-frequency modulation mode while charging and in a pulse width modulation mode while discharging the gate node. The required pulses with digitally programmable frequencies and duty cycles are efficiently generated by a custom-designed IC fabricated in a 0.25-μm HV CMOS technology. Also, the presented analysis guides a way to achieve the desired transition time with the maximum efficiency. The prototype IC demonstrates 37.5% energy recycling while driving a 15-V insulated-gate bipolar transistor power switch with 105-nC gate charge at 20 kHz.
A 9.2 GHz digital phase-locked loop (PLL) that realizes a peaking-free jitter transfer function is presented. In other words, the closed-loop transfer function of the proposed digital PLL does not ...possess a closed-loop zero and the PLL achieves fast settling without exhibiting overshoots. While most previously reported peaking-free PLLs require additional circuit components which may adversely affect clock jitter or increase hardware complexity, the presented PLL requires only a new type of digital loop filter. The analysis on the loop dynamics and design of the optimal loop filter are presented. As for the implementation, a low-power linear time-to-digital converter (TDC) is realized with a set of three binary phase-frequency detectors whose triggering clocks are dithered using a delta-sigma modulator and phase interpolators. A digitally controlled oscillator (DCO) is implemented as a transformer-tuned LC oscillator whose frequency is set by a ratio between two digitally controlled currents. The digital PLL prototype, fabricated in a 65 nm CMOS, demonstrates 1.2 ps rms integrated jitter at 9.2 GHz and 1.58 μs settling time with 700 kHz bandwidth while dissipating 63.9 mW at a 1.2 V nominal supply.
Background:
No consensus exists regarding the superiority of either of the two types of gastrointestinal anastomosis, which are isoperistaltic and antiperistaltic. This study aimed to compare the ...clinical outcomes between isoperistaltic and antiperistaltic anastomoses after total laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer.
Methods:
We retrospectively reviewed the medical records of patients with gastric cancer who underwent TLDG with Billroth II anastomosis between January 2014 and December 2018. The patients were divided into two groups according to the peristaltic direction of gastrointestinal anastomosis after TLDG. One group underwent isoperistaltic anastomosis (Iso group), and the other underwent antiperistaltic anastomosis (Anti group). Clinical outcomes were compared between the groups.
Results:
Of the 148 patients who underwent TLDG with Billroth II anastomosis, 124 were included in the Iso group and 24 were included in the Anti group. The Anti and Iso groups showed no significant difference with regard to the incidence of internal hernia (0.0 vs. 6.5%, respectively;
p
= 0.355). The incidence of bile reflux was more frequent in the Iso group than in the Anti group (
p
= 0.010), but food stasis was more common in the Anti group than in the Iso group (
p
= 0.006).
Conclusion:
In gastric cancer patients who underwent TLDG in which postoperative adhesion was minimized, antiperistaltic anastomosis may have created a physiologic barrier in gastrointestinal continuity. However, a large-scale study is necessary to validate the relationship between the digestive stream and the peristaltic direction.