1
|
Jin BC, Seo SY, Kim SW. Rare case of beet juice mimicking gastrointestinal bleeding: diagnostic implication. Endoscopy 2024; 56:E234-E235. [PMID: 38458242 PMCID: PMC10923637 DOI: 10.1055/a-2268-6016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Byung Chul Jin
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea (the Republic of)
| | - Seung Young Seo
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea (the Republic of)
| | - Sang-Wook Kim
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea (the Republic of)
| |
Collapse
|
2
|
Héroin L, Christmann PY, Habersetzer F, Mayer P. Black esophagus: complete esophageal necrosis with lower esophageal perforation. Endoscopy 2024; 56:E53-E54. [PMID: 38262452 PMCID: PMC10805582 DOI: 10.1055/a-2226-0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Lucile Héroin
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
- Digestive Endoscopy, IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - Pierre-Yves Christmann
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
- Digestive Endoscopy, IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - François Habersetzer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
- Digestive Endoscopy, IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
- Inserm U1110, Institute for Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| | - Pierre Mayer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
- Digestive Endoscopy, IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| |
Collapse
|
3
|
Wang S, Du K, Duan M, Xu Y, Guo Z, Gong J, Zhu W, Li Y. Reversal Surgery for Split Stoma with Peristomal Incision is Associated with Improved Postoperative Outcome in Patients with Crohn's Disease. J INVEST SURG 2024; 37:2363179. [PMID: 38862416 DOI: 10.1080/08941939.2024.2363179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Temporary stoma formation is common in Crohn's disease (CD), while stoma reversal is associated with postoperative morbidity. This study aimed to evaluate the postoperative outcomes of split stoma reversal, SSR (i.e., exteriorization of proximal and distal ends of the stoma through a small common opening) and end stoma closure, ESC (i.e., the proximal stump externalized, and distal end localized abdominally. METHODS Patients with CD who underwent stoma reversal surgeries between January 2017 and December 2021 were included. Demographic, clinical, and postoperative data were collected and analyzed to evaluate outcomes of reversal surgery. RESULTS A total of 255 patients who underwent stoma reversal surgeries met the inclusion criteria. SSR was superior to ESC in terms of operative time (80.0 vs. 120.0, p = 0.0004), intraoperative blood loss volume (20.0 vs. 100.0, p = 0.0002), incision length (3.0 vs. 15.0, p < 0.0001), surgical wound classification (0 vs. 8.3%, p = 0.04), postoperative hospital stay (7.0 vs. 9.0, p = 0.0007), hospital expense (45.6 vs. 54.2, p = 0.0003), and postoperative complications (23.8% vs. 44.3%, p = 0.0040). Although patients in the ESC group experienced more surgical recurrence than those in the SSR group (8.3% vs. 3.2%) during the follow-up, the Kaplan-Meier curve analysis revealed no statistical difference (p = 0.29). CONCLUSIONS The split stoma can be recommended when stoma construction is indicated in patients with Crohn's disease.
Collapse
Affiliation(s)
- Shixian Wang
- Department of General Surgery, Jinling Medical School of Nanjing Medical University, Nanjing, China
| | - Kangling Du
- Department of General Surgery, Jinling Medical School of Nanjing Medical University, Nanjing, China
| | - Ming Duan
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yihan Xu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhen Guo
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weiming Zhu
- Department of General Surgery, Jinling Medical School of Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yi Li
- Department of General Surgery, Jinling Medical School of Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| |
Collapse
|
4
|
Mallela VR, Kasi PB, Shetti D, Trailin A, Cervenkova L, Palek R, Daum O, Liska V, Hemminki K, Ambrozkiewicz F. Small nucleolar RNA expression profiles: A potential prognostic biomarker for non-viral Hepatocellular carcinoma. Noncoding RNA Res 2024; 9:1133-1139. [PMID: 39022679 PMCID: PMC11254499 DOI: 10.1016/j.ncrna.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a challenging cancer with high mortality rates, limited predictability, and a lack of effective prognostic indicators. The relationship between small nucleolar RNAs (snoRNAs) and HCC is poorly understood. Based on the literature data, snoRNA studies were primarily focused on viral-related causes of HCC, such as Hepatitis B or C viruses (HBV or HCV). According to these studies, we selected four snoRNAs (snoRA12, snoRA47, snoRA80E, and snoRD126) for exploration in the context of non-viral-related causes, including non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver diseases (NAFLD), and alcohol steatohepatitis. The primary goal of this study was to gain a deeper understanding of how snoRNA expression affects patient outcomes and whether it can serve as a prognostic tool for non-viral HCC. We conducted a study on tissue samples from 35 HCC patients who had undergone resection at Pilsen University Hospital. SnoRA12, snoRA47, snoRA80E, and snoRD126 were studied by quantitative real-time PCR (qRT-PCR) in tumor and non-tumor adjacent tissue (NTAT) samples. Kaplan-Meier analysis was performed to assess the association of snoRNAs expression levels with patient outcomes: time to recurrence (TTR), disease-free survival (DFS) and overall survival (OS). In tumor tissues, snoRA12, snoRA47 and snoRA80E were upregulated, while snoRD-126 was downregulated compared to NTAT. Low expression of snoRA47 and snoRD126 in patients was associated with longer TTR and DFS. The individual expression of snoRA12 and snoRA80E did not show associations with TTR and DFS. However, a combination of medium expression of snoRD126 and snoRA80E was associated with longer TTR and DFS, while high and low expressions of the combined snoRA126 and snoRA80E showed no significant association with TTR, DFS, and OS. Conversely, a combination of high expression of snoRA12 and snoRD126 was associated with shorter TTR. In conclusion, the results indicate that snoRA47 and snoRD126 exhibit good prognostic power specifically for non-viral related HCC. Both snoRA47 and snoRD126 showed favorable prognostication in single and combined analysis when assessing patient outcomes. Also, in combination analysis, snoRA80E and snoRA12 showed favorable prognosis, but not alone.
Collapse
Affiliation(s)
- Venkata Ramana Mallela
- Laboratory of Translational Cancer Genomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
| | - Phanindra Babu Kasi
- Laboratory of Translational Cancer Genomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden
| | - Dattatrya Shetti
- Laboratory of Translational Cancer Genomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
| | - Andriy Trailin
- Laboratory of Translational Cancer Genomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
| | - Lenka Cervenkova
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
| | - Richard Palek
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
- Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 323 00, Pilsen, Czech Republic
| | - Ondřej Daum
- Sikl's Institute of Pathology, Faculty of Medicine and Teaching Hospital in Pilsen, Charles University, Ul. Dr. E. Beneše 13, 30599, Pilsen, Czech Republic
- Bioptická Laboratoř S.r.o., Mikulášské Nám. 4, 32600, Pilsen, Czech Republic
| | - Vaclav Liska
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
- Department of Surgery, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 323 00, Pilsen, Czech Republic
| | - Kari Hemminki
- Laboratory of Translational Cancer Genomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
- Department of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Filip Ambrozkiewicz
- Laboratory of Translational Cancer Genomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 1665/76, 323 00, Pilsen, Czech Republic
| |
Collapse
|
5
|
Ali H, Inayat F, Jahagirdar V, Jaber F, Afzal A, Patel P, Tahir H, Anwar MS, Rehman AU, Sarfraz M, Chaudhry A, Nawaz G, Dahiya DS, Sohail AH, Aziz M. Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality. World J Methodol 2024; 14:91810. [DOI: 10.5662/wjm.v14.i3.91810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus.
AIM To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States.
METHODS A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality.
RESULTS A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06).
CONCLUSION Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.
Collapse
Affiliation(s)
- Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Vinay Jahagirdar
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States
| | - Arslan Afzal
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Pratik Patel
- Division of Gastroenterology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
| | - Hamza Tahir
- Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, United States
| | - Muhammad Sajeel Anwar
- Department of Internal Medicine, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Attiq Ur Rehman
- Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Muhammad Sarfraz
- Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Ahtshamullah Chaudhry
- Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology, and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
| | - Amir H Sohail
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
| |
Collapse
|
6
|
Wu SZ. Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen-apposing metal stent for malignant biliary obstruction: A promising procedure. World J Clin Cases 2024; 12:5859-5862. [DOI: 10.12998/wjcc.v12.i26.5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/19/2024] [Accepted: 06/07/2024] [Indexed: 07/19/2024] Open
Abstract
In this editorial, we comment on the article by Peng et al. Palliative drainage for biliary obstruction resulting from unresectable malignant lesions includes internal and external drainage. The procedures of biliary drainage are usually guided by fluoroscopy or transcutaneous ultrasound, endoscopic ultrasound (EUS), or both. Endoscopic retrograde cholangiopancreatography (ERCP) has been primarily recommended for the management of biliary obstruction, while EUS-guided biliary drainage and percutaneous transhepatic biliary drainage (PTBD) are alternative choices for cases where ERCP has failed or is impossible. PTBD is limited by shortcomings of a higher rate of adverse events, more reinterventions, and severe complications. EUS-guided biliary drainage has a lower rate of adverse events than PTBD. EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) enables EUS-guided biliary-enteric anastomosis to be performed in a single step and does not require prior bile duct puncture or a guidewire. The present meta-analysis showed that ECE-LAMS has a high efficacy and safety in relieving biliary obstruction in general, although the results of LAMS depending on the site of biliary obstruction. This study has highlighted the latest advances with a larger sample-based comprehensive analysis.
Collapse
Affiliation(s)
- Si-Ze Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
| |
Collapse
|
7
|
Zhang Y, Cui YF. Severe acute pancreatitis complicated with intra-abdominal infection secondary to trauma: A case report. World J Clin Cases 2024; 12:5821-5831. [DOI: 10.12998/wjcc.v12.i25.5821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/12/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Pancreatic trauma (PT) is rare among traumatic injuries and has a low incidence, but it can still lead to severe infectious complications, resulting in a high mortality rate. Acute pancreatitis (AP) is a common complication after PT, and when combined with organ dysfunction and sepsis, it will result in a poorer prognosis.
CASE SUMMARY We report a 25-year-old patient with multiple organ injuries, including the pancreas, due to abdominal trauma, who developed necrotising pancreatitis secondary to emergency caesarean section, combined with intra-abdominal infection (IAI). The patient underwent performed percutaneous drainage, pancreatic necrotic tissue debridement, and abdominal infection foci debridement on the patient.
CONCLUSION We report a case of severe AP and IAI secondary to trauma. This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery, and a better outcome was obtained.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Surgery, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin 300070, China
| | - Yun-Feng Cui
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| |
Collapse
|
8
|
Wishahi M, Kamal NM, Hedaya MS. Enhanced recovery after surgery: Progress in adapted pathways for implementation in standard and emerging surgical settings. World J Clin Cases 2024; 12:5636-5641. [DOI: 10.12998/wjcc.v12.i25.5636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 07/12/2024] Open
Abstract
The concept of enhanced recovery after surgery (ERAS) has been practiced for decades and has been implemented in numerous surgical specialties. ERAS is a global surgical quality improvement initiative, and it is an element in the field of perioperative care. ERAS had shown significant clinical outcomes, patient-reported satisfaction, and improvements in medical service cost. ERAS has been developed for specific surgical procedures, but with the fast progress of newly introduced surgical procedures, the original ERAS have been developed and modified. Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status, including but not limited to pediatric surgery, laparoscopic and robotic assisted surgery, bariatric surgery, thoracic surgery, and renal transplantation. The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative, operative, and post-operative pathways. ERAS costs are higher than traditional care, but the patient’s clinical outcome and satisfaction are higher. ERAS is in progress in the fields of anesthetic tasks, pediatric surgery, and organ transplantation. Although ERAS has shown significant clinical outcomes, there are needs to modify the protocol for specific cases, hospital facilities, resources, and nurses training on elements of ERAS. Several challenges and limitations exist in the implementation of ERAS that deserve consideration, it includes: Frailty, maximizing nutrition, prehabilitation, treating preoperative anemia, and enhancing ERAS adoption globally are all included.
Collapse
Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
| | - Nabawya M Kamal
- Department of Anaesthesia and Surgical Intensive Care, Theodor Bilharz Research Institute, Cairo 12411, Egypt
| | | |
Collapse
|
9
|
Lytvyak E, Zarrinpar A, Ore CD, Lee E, Yazdani-Boset K, Horgan S, Grunvald E. Stronger control of eating 3 months after sleeve gastrectomy predicts successful weight loss outcomes at one year. OBESITY PILLARS 2024; 11:100111. [PMID: 38770521 PMCID: PMC11103426 DOI: 10.1016/j.obpill.2024.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
Background Weight loss response to sleeve gastrectomy (SG) is variable and predicting the effectiveness of surgery is challenging and elusive. The aim of our study was to assess and quantify the association between eating control and weight loss outcomes and identify the control of eating (CoE) attributes during the early postoperative period that might predict good vs. poor response to SG at one year. Methods A prospective longitudinal cohort study using the Control of Eating Questionnaire (CoEQ) was designed as a series before and at 3-, 6-, and 12-months post-SG. Primary outcomes were changes in CoE attributes and percent of total weight loss (%TWL) 12-months post-surgery. Subjects were categorized based on %TWL as good (GR, ≥25 %) or poor responders (PR, <25 %). A receiver operating characteristic and logistic regression analyses were performed. Results We included 41 participants (80.5% females, 51.2% Hispanic, mean age 41.7±10.6, median baseline body mass index (BMI) 43.6 kg/m2 [range 35.2-66.3]) who completed the CoEQ at all four timepoints. The "Difficulty to control eating" score at 3 months revealed the highest area under the curve (AUC) (AUC 0.711; 95%CI 0.524-0.898; p=0.032). In a trade-off between a high Youden index and high sensitivity, the "Difficulty to control eating" score of 7 at 3 months was identified as the optimal cut-off for distinguishing between GRs and PRs. Score ≤7 at 3 months was strongly independently associated with a successful weight loss target of 25%TWL at one-year post-SG (Relative Risk 4.43; 95%CI 1.06-18.54; p=0.042). Conclusion "Difficulty to control eating" score at 3 months post-SG is an independent early predictor of optimal response (achieving a successful TWL target of ≥25 % at one-year post-SG). Our results support the utility of this easy-to-administer validated tool for predicting the effectiveness of SG and may assist in identifying individuals with suboptimal response early and helping them with interventions to attain optimal weight loss targets.
Collapse
Affiliation(s)
- Ellina Lytvyak
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 112 Street, Edmonton, Alberta, T6G 2T4, Canada
| | - Amir Zarrinpar
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Cecilia Dalle Ore
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA
| | | | - Santiago Horgan
- Bariatric and Metabolic Institute, Division of Minimally Invasive Surgery, University of California San Diego, 4303 La Jolla Village Drive, Suite 2110, San Diego, CA, 92122, USA
| | - Eduardo Grunvald
- School of Medicine, University of California San Diego, La Jolla, CA, USA
- Division of General Internal Medicine, University of California San Diego, La Jolla, CA, USA
- Bariatric and Metabolic Institute, Division of Minimally Invasive Surgery, University of California San Diego, 4303 La Jolla Village Drive, Suite 2110, San Diego, CA, 92122, USA
| |
Collapse
|
10
|
Wang Y, Wang C, Zhong R, Wang L, Sun L. Research progress of DNA methylation in colorectal cancer (Review). Mol Med Rep 2024; 30:154. [PMID: 38963030 PMCID: PMC11240861 DOI: 10.3892/mmr.2024.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024] Open
Abstract
DNA methylation is one of the earliest and most significant epigenetic mechanisms discovered. DNA methylation refers, in general, to the addition of a methyl group to a specific base in the DNA sequence under the catalysis of DNA methyltransferase, with S‑adenosine methionine as the methyl donor, via covalent bonding and chemical modifications. DNA methylation is an important factor in inducing cancer. There are different types of DNA methylation, and methylation at different sites plays different roles. It is well known that the progression of colorectal cancer (CRC) is affected by the methylation of key genes. The present review did not only discuss the potential relationship between DNA methylation and CRC but also discussed how DNA methylation affects the development of CRC by affecting key genes. Furthermore, the clinical significance of DNA methylation in CRC was highlighted, including that of the therapeutic targets and biomarkers of methylation; and the importance of DNA methylation inhibitors was discussed as a novel strategy for treatment of CRC. The present review did not only focus upon the latest research findings, but earlier reviews were also cited as references to older literature.
Collapse
Affiliation(s)
- Yuxin Wang
- Emergency Department, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Chengcheng Wang
- Comparative Medicine Department of Researching and Teaching, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Ruiqi Zhong
- Comparative Medicine Department of Researching and Teaching, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Liang Wang
- Comparative Medicine Department of Researching and Teaching, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Lei Sun
- Emergency Department, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| |
Collapse
|
11
|
Soldera J. Navigating treatment resistance: Janus kinase inhibitors for ulcerative colitis. World J Clin Cases 2024; 12:5468-5472. [DOI: 10.12998/wjcc.v12.i24.5468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/20/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
The management of refractory ulcerative colitis (UC) and acute severe UC (ASUC) is challenging due to the lack of standardized approaches in cases resistant to multiple treatments. In this editorial, I investigate the efficacy and safety of Janus kinase inhibitors, particularly upadacitinib and tofacitinib, in controlling severe and refractory disease. I highlight a notable case report by Xu et al, which explores the case of a patient with primary nonresponse to two classes of biologics and two fecal microbiota transplants who exhibited a remarkable response to upadacitinib. Furthermore, I discuss the use of tofacitinib in refractory UC and ASUC, either as monotherapy or in combination with biologics, which has shown promising response rates. Additionally, emerging evidence of upadacitinib efficacy in ASUC is presented. Overall, these cases emphasize the complex nature of managing refractory ASUC and the potential of small-molecule therapies to achieve remission. Further research is needed to refine treatment strategies for patients with treatment-resistant UC.
Collapse
Affiliation(s)
- Jonathan Soldera
- Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| |
Collapse
|
12
|
Messaoud O, Jidal M, Ouali KE, Masrouri R, Boujida I, Zouaidia F, Laamrani FZ, Aoufir OE, Jroundi L. Acute abdomen revealing abdominal tuberculosis complicated by a proximal jejunal perforation: Case report. Radiol Case Rep 2024; 19:3301-3307. [PMID: 38817639 PMCID: PMC11137354 DOI: 10.1016/j.radcr.2024.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
Abdominal tuberculosis (TB) remains a significant health concern globally, particularly in regions with high endemicity such as North Africa and Morocco. Despite advances in diagnostic modalities, the nonspecific presentation of abdominal TB poses challenges for timely diagnosis and management. Here, we report a case of abdominal TB in a critically state of a young man from Morocco, presenting with acute abdominal pain and signs of sepsis. Radiological investigations revealed features suggestive of intestinal perforation complicating peritoneal TB. Urgent laparotomy confirmed the diagnosis, yet the patient succumbed to advanced sepsis postoperatively. This case underscores the complexity of abdominal TB diagnosis and management, necessitating a high index of suspicion and multidisciplinary collaboration. With evolving surgical techniques and ongoing research efforts, optimizing strategies for early detection and treatment of abdominal TB remains imperative, particularly in endemic regions.
Collapse
Affiliation(s)
- Ola Messaoud
- Emergency Radiology Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Manal Jidal
- Emergency Radiology Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Kenza El Ouali
- General Surgery C Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Rahal Masrouri
- General Surgery B Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Ismail Boujida
- Histopathology Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Fouad Zouaidia
- Histopathology Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Fatima Z. Laamrani
- Emergency Radiology Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Omar El Aoufir
- Emergency Radiology Department, University Hospital Ibn Sina, Rabat, Morocco
| | - Laila Jroundi
- Emergency Radiology Department, University Hospital Ibn Sina, Rabat, Morocco
| |
Collapse
|
13
|
Trieu E, Ramirez-Caban LC, Shockley ME. Review of sustainable practices for the gynecology operating room. Curr Opin Obstet Gynecol 2024; 36:324-329. [PMID: 38837721 DOI: 10.1097/gco.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement. RECENT FINDINGS From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an 'off' setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals. SUMMARY This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.
Collapse
Affiliation(s)
- Elissa Trieu
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
| | | | | |
Collapse
|
14
|
Thakur S, Sheppard JD, Eslani M, Pavilack MA, Philippy B, Ramanathan GC, Cheung AY. Operating Room Waste Generated From Corneal and Conjunctival Surgeries. Cornea 2024; 43:1031-1039. [PMID: 38713489 DOI: 10.1097/ico.0000000000003560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Indexed: 05/08/2024]
Abstract
PURPOSE The purposes of this study were to bring awareness to the surgical waste generated from corneal and conjunctival surgeries and to compare those findings with the waste generated from cataract surgeries. METHODS This was an observational prospective pilot cohort study at a tertiary corneal/anterior segment private practice. All waste related to cataract, cornea, and conjunctival surgical procedures (including anesthesia waste and corneal tissue storage) was weighed. The primary outcome was total waste generated while other outcomes included surgical setting (ambulatory surgical center, hospital, and minor operating room) and comparison of corneal/conjunctival surgeries with cataract surgery. RESULTS Surgical waste data were collected from 119 surgeries (82 corneal/conjunctival surgeries and 37 cataract surgeries). Hospital surgeries produced more waste than ambulatory surgical center and minor operating room surgeries. Penetrating keratoplasty (2.22 kg, P = 0.483) and Descemet stripping only (2.11 kg, P = 0.326) procedures generated comparable mean waste with cataract surgery (2.07 kg) while endothelial keratoplasties produced more ( P < 0.001, 0.002). (Deep) anterior lamellar keratoplasty results depended on the surgical setting. All conjunctival surgeries produced less waste than cataract surgery. CONCLUSIONS In comparison with cataract surgery, keratoplasties overall produced comparable or more waste while conjunctival surgeries produced less waste. The surgical setting and type of anesthesia played a substantial role in the amount of waste generated. Assessing waste production from different ophthalmic surgeries may increase awareness of the negative environmental impact of surgical waste and promote practice or legal changes to improve environmental sustainability.
Collapse
Affiliation(s)
- Shambhawi Thakur
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA
| | - John D Sheppard
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA
- Virginia Eye Consultants/EyeCare Partners, Norfolk, VA
- Lions Medical Eye Bank & Research Center of Eastern Virginia, Norfolk, VA
| | - Medi Eslani
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, CA
| | - Mark A Pavilack
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA
- Lions Medical Eye Bank & Research Center of Eastern Virginia, Norfolk, VA
- Tidewater Eye Centers/EyeCare Partners, Virginia Beach, VA; and
| | | | | | - Albert Y Cheung
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA
- Virginia Eye Consultants/EyeCare Partners, Norfolk, VA
| |
Collapse
|
15
|
Jena SS, Mehta NN, Yadav A, Nundy S. Peri-operative outcomes of pancreaticoduodenectomy comparing an isolated Roux loop or single loop for reconstruction: An ambispective observational study. Pancreatology 2024; 24:805-811. [PMID: 38811279 DOI: 10.1016/j.pan.2024.05.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/08/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND A post-operative pancreatic fistula is a major cause of morbidity and mortality in patients undergoing pancreaticoduodenectomy. We compared two methods of reconstruction of pancreaticojejunal anastomosis, an isolated loop with a single loop, to assess their effects on the incidence and severity of fistula. METHODS The data was collected in an ambispective manner. The drain fluid was sent for amylase measurement on post-operative day 3 and a fistula was defined and classified according to the 2016 modification of the International Study Group for Pancreatic Surgery definition. The patients were divided into the isolated (Group I) and single (Group II) loop groups and compared for the incidence and severity of clinically relevant fistula along with other parameters. RESULTS A total of 349 (Group I: 201, Group II: 148) patients were included in the study. The incidence of clinically relevant fistula was comparable (p = 0.206). Grade C fistula was found to be lower in the group I (7 % vs 11.6 %, p = 0.137), in patients with a soft pancreas (8.5 % vs 18.3 %, p = 0.049) and pancreatic duct diameter less than 5 mm (9.8 % vs 17.2 %, p = 0.036). The operative time was lower in Group I than in Group II (438 min vs 478, p < 0.001). CONCLUSION We found that the incidence of clinically relevant fistula was similar in both the groups but the isolated reconstruction method reduced the incidence of severe fistula. In patients with a smaller pancreatic duct, soft pancreas echotexture and obesity, it provides a safer alternative and can be performed in less time than a single loop reconstruction.
Collapse
Affiliation(s)
- Suvendu Sekhar Jena
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, 110060, India.
| | - Naimish N Mehta
- Center for Digestive Sciences, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Amitabh Yadav
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, 110060, India
| | - Samiran Nundy
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, 110060, India
| |
Collapse
|
16
|
Villar A, Mendes B, Viègas M, de Aquino Alexandre AL, Paladini S, Cossatis J. The relationship between periodontal disease and cancer: Insights from a Systematic Literature Network Analysis. Cancer Epidemiol 2024; 91:102595. [PMID: 38878682 DOI: 10.1016/j.canep.2024.102595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024]
Abstract
This paper investigates the relationship between periodontal disease and various cancer types. It provides a comprehensive overview of the existing knowledge about the interaction between periodontal disease and carcinogenesis, explores the underlying biological mechanisms of this connection, and consider the impact of these findings on healthcare practices and future research directions. Utilizing Systematic Literature Network Analysis, which combines bibliometric analysis with Systematic Literature Review, this study analyzes 164 documents from 2000 to 2023. Focus is placed on the 38 most globally cited papers, enabling a targeted and comprehensive analysis of the predominant research within this scope. This review highlights that colorectal, oral, pancreatic, lung, and gastrointestinal cancers have consistent associations with periodontal disease. On the other hand, hematological, breast and prostate cancers show associations with periodontal disease, but these links are less pronounced and more variable, indicating the need for targeted research in these domains. These insights emphasize the necessity for a multidisciplinary healthcare approach, recognizing the systemic implications of periodontal disease.
Collapse
Affiliation(s)
- Alice Villar
- Universidade Veiga de Almeida (UVA), R. Dezenove de Fevereiro, 172 - Botafogo, Rio de Janeiro, RJ 22280-030, Brazil.
| | - Bruna Mendes
- University Castelo Branco (UCB), Av. de Santa Cruz, 1631 - Realengo, Rio de Janeiro, RJ 21710-255, Brazil
| | - Mirna Viègas
- University Castelo Branco (UCB), Av. de Santa Cruz, 1631 - Realengo, Rio de Janeiro, RJ 21710-255, Brazil
| | | | - Stefania Paladini
- School of Arts, Social Sciences, and Management, Queen Margaret University, Musselburgh, East Lothian, UK
| | - João Cossatis
- University Castelo Branco (UCB), Av. de Santa Cruz, 1631 - Realengo, Rio de Janeiro, RJ 21710-255, Brazil
| |
Collapse
|
17
|
Gross M, Huber S, Arora S, Ze'evi T, Haider SP, Kucukkaya AS, Iseke S, Kuhn TN, Gebauer B, Michallek F, Dewey M, Vilgrain V, Sartoris R, Ronot M, Jaffe A, Strazzabosco M, Chapiro J, Onofrey JA. Automated MRI liver segmentation for anatomical segmentation, liver volumetry, and the extraction of radiomics. Eur Radiol 2024; 34:5056-5065. [PMID: 38217704 PMCID: PMC11245591 DOI: 10.1007/s00330-023-10495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To develop and evaluate a deep convolutional neural network (DCNN) for automated liver segmentation, volumetry, and radiomic feature extraction on contrast-enhanced portal venous phase magnetic resonance imaging (MRI). MATERIALS AND METHODS This retrospective study included hepatocellular carcinoma patients from an institutional database with portal venous MRI. After manual segmentation, the data was randomly split into independent training, validation, and internal testing sets. From a collaborating institution, de-identified scans were used for external testing. The public LiverHccSeg dataset was used for further external validation. A 3D DCNN was trained to automatically segment the liver. Segmentation accuracy was quantified by the Dice similarity coefficient (DSC) with respect to manual segmentation. A Mann-Whitney U test was used to compare the internal and external test sets. Agreement of volumetry and radiomic features was assessed using the intraclass correlation coefficient (ICC). RESULTS In total, 470 patients met the inclusion criteria (63.9±8.2 years; 376 males) and 20 patients were used for external validation (41±12 years; 13 males). DSC segmentation accuracy of the DCNN was similarly high between the internal (0.97±0.01) and external (0.96±0.03) test sets (p=0.28) and demonstrated robust segmentation performance on public testing (0.93±0.03). Agreement of liver volumetry was satisfactory in the internal (ICC, 0.99), external (ICC, 0.97), and public (ICC, 0.85) test sets. Radiomic features demonstrated excellent agreement in the internal (mean ICC, 0.98±0.04), external (mean ICC, 0.94±0.10), and public (mean ICC, 0.91±0.09) datasets. CONCLUSION Automated liver segmentation yields robust and generalizable segmentation performance on MRI data and can be used for volumetry and radiomic feature extraction. CLINICAL RELEVANCE STATEMENT Liver volumetry, anatomic localization, and extraction of quantitative imaging biomarkers require accurate segmentation, but manual segmentation is time-consuming. A deep convolutional neural network demonstrates fast and accurate segmentation performance on T1-weighted portal venous MRI. KEY POINTS • This deep convolutional neural network yields robust and generalizable liver segmentation performance on internal, external, and public testing data. • Automated liver volumetry demonstrated excellent agreement with manual volumetry. • Automated liver segmentations can be used for robust and reproducible radiomic feature extraction.
Collapse
Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Sandeep Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Tal Ze'evi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Tom Niklas Kuhn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Gebauer
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Michallek
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valérie Vilgrain
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Riccardo Sartoris
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Maxime Ronot
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Ariel Jaffe
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - John A Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
18
|
Shah J. The perfect tool for endoscopic necrosectomy: Miracle or a mirage? Gastrointest Endosc 2024; 100:247-249. [PMID: 39025593 DOI: 10.1016/j.gie.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
19
|
Greig P, Sotiriou A, Kailainathan P, Carvalho CYM, Onwochei DN, Thurley N, Desai N. Evaluation of neuraxial analgesia on outcomes for patients undergoing robot assisted abdominal surgery. J Clin Anesth 2024; 95:111468. [PMID: 38599160 DOI: 10.1016/j.jclinane.2024.111468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
STUDY OBJECTIVE Following robot assisted abdominal surgery, the pain can be moderate in severity. Neuraxial analgesia may decrease the activity of the detrusor muscle, reduce the incidence of bladder spasm and provide effective somatic and visceral analgesia. In this systematic review, we assessed the role of neuraxial analgesia in robot assisted abdominal surgery. DESIGN Systematic review. SETTINGS Robot assisted abdominal surgery. PATIENTS Adults. INTERVENTIONS Subsequent to a search of the electronic databases, observational studies and randomized controlled trials that assessed the effect of neuraxial analgesia instituted at induction of anesthesia or intraoperatively in adult and robot assisted abdominal surgery were considered for inclusion. The outcomes of observational studies as well as randomized controlled trials which were not subjected to meta-analysis were presented in descriptive terms. Meta-analysis was conducted if an outcome of interest was reported by two or more randomized controlled trials. MAIN RESULTS We included 19 and 11 studies that investigated spinal and epidural analgesia in adults, respectively. The coprimary outcomes were the pain score at rest at 24 h and the cumulative intravenous morphine consumption at 24 h. Spinal analgesia with long acting neuraxial opioid did not decrease the pain score at rest at 24 h although it reduced the cumulative intravenous morphine consumption at 24 h by a mean difference (95%CI) of 14.88 mg (-22.13--7.63; p < 0.0001, I2 = 50%) with a low and moderate quality of evidence, respectively, on meta-analysis of randomized controlled trials. Spinal analgesia with long acting neuraxial opioid had a beneficial effect on analgesic indices till the second postoperative day and a positive influence on opioid consumption up to and including the 72 h time point. The majority of studies demonstrated the use of spinal analgesia with long acting neuraxial opioid to lead to no difference in the incidence of postoperative nausea and vomiting, and the occurrence of pruritus was found to be increased with spinal analgesia with long acting neuraxial opioid in recovery but not at later time points. No difference was revealed in the incidence of urinary retention. The evidence in regard to the quality of recovery-15 score at 24 h and hospital length of stay was not fully consistent, although most studies indicated no difference between spinal analgesia and control for these outcomes. Epidural analgesia in robot assisted abdominal surgery was shown to decrease the pain on movement at 12 h but it had not been studied with respect to its influence on the pain score at rest at 24 h or the cumulative intravenous morphine consumption at 24 h. It did not reduce the pain on movement at later time points and the evidence related to the hospital length of stay was inconsistent. CONCLUSIONS Spinal analgesia with long acting neuraxial opioid had a favourable effect on analgesic indices and opioid consumption, and is recommended by the authors, but the evidence for spinal analgesia with short acting neuraxial opioid and epidural analgesia was limited.
Collapse
Affiliation(s)
- P Greig
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - A Sotiriou
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - P Kailainathan
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - C Y M Carvalho
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - D N Onwochei
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom
| | - N Thurley
- Bodleian Health Care Libraries, University of Oxford, United Kingdom
| | - N Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom.
| |
Collapse
|
20
|
Windermere SA, Mehkri Y, Yan SC, Grady C, Christie C, Goutnik M, Galochkina Z, Roy A, Vaziri S, Rahman M. Risk factors and outcomes associated with external ventricular drain related hemorrhage. Clin Neurol Neurosurg 2024; 243:108386. [PMID: 38901374 DOI: 10.1016/j.clineuro.2024.108386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE The objective of this study was to determine risk factors predictive of external ventricular drain (EVD)-related hemorrhage and the association of such hemorrhages with mortality, discharge disposition, length of stay (LOS), and total cost. METHODS After Institutional Review Board approval, data was collected retrospectively for adult patients requiring EVD placement from 2015 to 2018 at the authors' institution. Collected data included demographic patient information, peri-procedural factors, and relevant post-procedural measures. Computerized tomography (CT) images and associated radiologic reports were independently reviewed, identifying hemorrhages accompanying EVD placement. RESULTS From this 487-patient sample, 85 (17.5 %) patients had hemorrhages, including asymptomatic hemorrhages identified on imaging alone. A univariable analysis of patient parameters in the overall cohort was performed to identify possible predictors of hemorrhage. Age (p = 0.002), Charlson Comorbidity Index (CCI) (p < 0.001), platelet count (p = 0.002), presence of uremia (p = 0.035), and the number of times the EVD was replaced (p < 0.001) were associated with hemorrhage in univariable models. The experience of the resident surgeon based on post-graduate year (PGY level) and the number of attempts/passes needed for EVD placement were not associated with hemorrhage risk. Significant predictor of hemorrhage confirmed in a multivariable analysis only included the number of times the EVD was replaced (OR = 2.78, adjusted p < 0.001). Outcomes between EVD-related hemorrhage versus no hemorrhage groups, including mortality, discharge disposition, LOS, and cost, were compared. EVD-related hemorrhage was found to be associated with increased mortality (OR = 3.58, adjusted p < 0.001) and decreased likelihood of discharge home (OR = 0.13, adjusted p = 0.030) in the associated multivariable regressions. CONCLUSION The number of times an EVD was replaced was associated with EVD-related hemorrhage outcome. EVD-related hemorrhage is associated with increased mortality and a decreased likelihood of being discharged home.
Collapse
Affiliation(s)
- Sonora Andromeda Windermere
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA; Department of General Surgery, University of Florida, Gainesville, FL, USA.
| | - Yusuf Mehkri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Sandra C Yan
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Clare Grady
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Carlton Christie
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael Goutnik
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Zhanna Galochkina
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Arkaprava Roy
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Maryam Rahman
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| |
Collapse
|
21
|
Soedarsono S, Marthaty SSI, Auditiawan CR, Widyoningroem A. Pulmonary and intestinal tuberculosis with COVID-19 complicated with fluidopneumothorax and colovesical fistula: The importance of diagnosis complexity in line with clinical setting. Radiol Case Rep 2024; 19:3162-3169. [PMID: 38779192 PMCID: PMC11109314 DOI: 10.1016/j.radcr.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
The complication of hydropneumothorax and colovesical fistula is rare, especially in patients with tuberculosis (TB) and COVID-19. This particular situation poses a management difficulty, and can significantly threaten the patient's life without a clear diagnosis and timely treatment. We report a 28-year-old woman with pulmonary and intestinal TB with COVID-19 complicated with hydropneumothorax and colovesical fistula (CVF) which worsened her condition. Treatment for this patient was given according to the diagnosis. Her condition improved and she was discharged after 30 days of hospitalization, while elective surgery for CVF was not performed because there were no clinical symptoms complained of by this patient after completing TB treatment (9 months after hospital discharge). This case report highlights the importance of considering pulmonary and intestinal TB with COVID-19 as the cause of hydropneumothorax and CVF. Early and complex diagnosis is essential for proper management, as well as the efficacy of medical therapy and treatment for controlling such advanced stages of the disease. A complex condition with many symptoms can overlap with other diseases. Clinicians should consider the clinical symptoms, radiological imaging, and standard or supporting examination for accurate diagnosis to find the etiology of the diseases. Complete treatment for TB should be considered as the treatment choice (nonsurgical therapy) for CVF caused by TB before deciding on surgical intervention.
Collapse
Affiliation(s)
- Soedarsono Soedarsono
- Sub-pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
- Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Sri Sarwosih Indah Marthaty
- Sub-pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
- Dr. Ramelan Navy Hospital, Surabaya, Indonesia
| | - Caesar Rozaq Auditiawan
- Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Anita Widyoningroem
- Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
- Department of Radiology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| |
Collapse
|
22
|
Wang C, Huang T, Wang X. Efficacy and safety of transanal opening of intersphincteric space in the treatment of high complex anal fistula: A meta‑analysis. Exp Ther Med 2024; 28:306. [PMID: 38873039 PMCID: PMC11170326 DOI: 10.3892/etm.2024.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
The best treatment of high complex anal fistula (HCAF) is to avoid anal incontinence while improving the cure rate. On this basis, several surgical procedures for preserving the anal sphincter have been proposed. The purpose of the present study was to evaluate the efficacy and safety of transanal opening of intersphincteric space for treating HCAF. PubMed, Cochrane Library, China National Knowledge Infrastructure and the Wanfang databases were searched to collate all the articles on transanal opening of intersphincteric space for treating HCAF. A total of two researchers independently completed the whole process, from screening and inclusion to data extraction and the data was included in the RevMan 5.3 software for analysis. The main outcomes included the patients' essential characteristics, primary healing rate, management after recurrence, final healing rate, anal incontinence score before and after surgery, postoperative complication rate and types of complications. A total of six articles were included in this meta-analysis. The results showed that the weighted final healing rate of patients following transanal opening of intersphincteric space was 89% [risk differences (RD)=0.89; 95% confidence interval (CI)=0.86-0.92; I2=0%; P<0.00001]. The results of the anal incontinence score showed that there was no significant difference between the results before and after transanal opening of intersphincteric space surgery mean differences [(MD)=-0.04, Cl=-0.10-0.02, I2=0%; P=0.21]. Only 11 patients were reported to have complications, including urinary retention and bleeding following transanal opening of intersphincteric space with a complication rate of 8% (11/138) and the weighted average complication rate was 6% (RD=0.06,95% CI=0.02-0.10; I2=9%; P=0.003). Transanal opening of intersphincteric space has a high cure rate, a favorable anal incontinence score, fewer types of postoperative complications and a low complication rate; it can be used as a minimally invasive and sphincter-preserving surgical method for treating HCAF and is worthy of further promotion and research in clinical practice.
Collapse
Affiliation(s)
- Chunqiang Wang
- Department of Anorectal Surgery, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang 311200, P.R. China
| | - Tianye Huang
- Department of Anorectal Surgery, Linyi Central Hospital, Linyi, Shandong 276401, P.R. China
| | - Xuebing Wang
- Department of Anorectal Surgery, Taian Municipal Hospital, Taian, Shandong 271021, P.R. China
| |
Collapse
|
23
|
Ayoobi Yazdi N, Daneshvar M, Rasuli B, Moradi A, Azizi M. Benign hepatic schwannoma in a patient with chronic hepatitis B infection: A case report. Radiol Case Rep 2024; 19:3146-3151. [PMID: 38779190 PMCID: PMC11109288 DOI: 10.1016/j.radcr.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
A primary benign hepatic schwannoma is an extremely rare disease with a good prognosis. A 55-year-old man with chronic hepatitis B was referred to our hospital because of jaundice, weight loss, and a hepatic lesion found during an ultrasound examination. Magnetic resonance image revealed a 55 × 120 mm solid mass lesion in the segment V and VIII of the liver. The mass extended directly to the segmental biliary ducts and common hepatic duct, causing obstruction of the biliary duct and upstream dilatation, particularly in the left liver lobe. Following the insertion of a percutaneous transhepatic biliary drainage, a biopsy was performed under ultrasound guidance. Histological examination confirmed a benign schwannoma, identified by characteristic pathological findings and positive immunoreactions with S-100 protein, but negative for c-kit, CD117, or CD34. The patient's tumor was removed and upon examination, it was discovered to be a mass filled with pinkish-yellow fluid, measuring 12 × 5 × 5 cm. This is the first known case of a benign schwannoma in the liver parenchyma of a patient with chronic hepatitis B. Furthermore, most previous cases of benign liver schwannomas have reported a smaller size than this case, which is slightly larger.
Collapse
Affiliation(s)
- Niloofar Ayoobi Yazdi
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Daneshvar
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Rasuli
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohamad Moradi
- Department of General Surgery Division of HPB and Transplantation Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Azizi
- Department of Pathology, Cancer Institute, Imam Khomeini hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
24
|
Fukushima N, Masuda T, Tsuboi K, Yuda M, Takahashi K, Yano F, Eto K. Prognostic significance of preoperative osteosarcopenia on patient' outcomes after emergency surgery for gastrointestinal perforation. Surg Today 2024; 54:907-916. [PMID: 38683358 DOI: 10.1007/s00595-024-02849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 05/01/2024]
Abstract
PURPOSE Sarcopenia is a prognostic predictor in emergency surgery. However, there are no reports on the relationship between osteopenia and in-hospital mortality. This study clarified the effect of preoperative osteosarcopenia on patients with gastrointestinal perforation after emergency surgery. METHODS We included 216 patients with gastrointestinal perforations who underwent emergency surgery between January 2013 and December 2022. Osteopenia was evaluated by measuring the pixel density in the mid-vertebral core of the 11th thoracic vertebra. Sarcopenia was evaluated by measuring the area of the psoas muscle at the level of the third lumbar vertebra. Osteosarcopenia is defined as the combination of osteopenia and sarcopenia. RESULTS Osteosarcomas were identified in 42 patients. Among patients with osteosarcopenia, older and female patients and those with an American Society of Anesthesiologists Physical Status of ≥ 3 were significantly more common, and the body mass index, hemoglobin value, and albumin level were significantly lower in these patients than in patients without osteosarcopenia. Furthermore, the osteosarcopenia group presented with more postoperative complications than patients without osteosarcopenia (P < 0.01). In the multivariate analysis, age ≥ 74 years old (P = 0.04) and osteosarcopenia (P = 0.04) were independent and significant predictors of in-hospital mortality. CONCLUSION Preoperative osteosarcopenia is a risk factor of in-hospital mortality in patients with gastrointestinal perforation after emergency surgery.
Collapse
Affiliation(s)
- Naoko Fukushima
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
- Department of Surgery, Fuji City General Hospital, 50, Takashimatyo, Fuji-shi, Shizuoka, 417-8567, Japan.
| | - Takahiro Masuda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuto Tsuboi
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
- Department of Surgery, Fuji City General Hospital, 50, Takashimatyo, Fuji-shi, Shizuoka, 417-8567, Japan
| | - Masami Yuda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keita Takahashi
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Fumiaki Yano
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| |
Collapse
|
25
|
Tang Y, Liu R, Liu H, Peng R, Su B, Tu D, Wang S, Chen C, Jiang G, Jin S, Cao J, Zhang C, Bai D. Effects of Indocyanine Green (ICG) Imaging-Assisted Cholecystectomy on Intraoperative and Postoperative Complications: A meta-Analysis. Surg Innov 2024; 31:362-372. [PMID: 38656291 DOI: 10.1177/15533506241246335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Accurate recognition of Calot's triangle during cholecystectomy is important in preventing intraoperative and postoperative complications. The use of indocyanine green (ICG) fluorescence imaging has become increasingly prevalent in cholecystectomy procedures. Our study aimed to evaluate the specific effects of ICG-assisted imaging in reducing complications. MATERIALS AND METHODS A comprehensive search of databases including PubMed, Web of Science, Europe PMC, and WANFANGH DATA was conducted to identify relevant articles up to July 5, 2023. Review Manager 5.3 software was applied to statistical analysis. RESULTS Our meta-analysis of 14 studies involving 3576 patients compared the ICG group (1351 patients) to the control group (2225 patients). The ICG group had a lower incidence of postoperative complications (4.78% vs 7.25%; RR .71; 95%CI: .54-.95; P = .02). Bile leakage was significantly reduced in the ICG group (.43% vs 2.02%; RR = .27; 95%CI: .12-.62; I2 = 0; P = .002), and they also had a lower bile duct drainage rate (24.8% vs 31.8% RR = .64, 95% CI: .44-.91, P = .01). Intraoperative complexes showed no statistically significant difference between the 2 groups (1.16% vs 9.24%; RR .17; 95%CI .03-1.02), but the incidence of intraoperative bleeding is lower in the ICG group. CONCLUSION ICG fluorescence imaging-assisted cholecystectomy was associated with a range of benefits, including a lower incidence of postoperative complications, decreased rates of bile leakage, reduced bile duct drainage, fewer intraoperative complications, and reduced intraoperative bleeding.
Collapse
Affiliation(s)
- Yuhong Tang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Renjie Liu
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Huanxiang Liu
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Rui Peng
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Bingbing Su
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daoyuan Tu
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Shunyi Wang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chen Chen
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Guoqing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| | - Shengjie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| | - Jun Cao
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| | - Dousheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
- Subei People's Hospital Hepatobiliary Surgery, Institute of General Surgery, Yangzhou, China
| |
Collapse
|
26
|
Scatton O, Turco C, Savier E, Pelissié J, Legallais C, Sakka M, Aoudjehane L, Wendum D, Migliazza J, Spiritelli S, Conti F, Goumard C. Preclinical validation of a customized circuit for ex situ uninterrupted cold-to-warm prolonged perfusion of the liver. Artif Organs 2024; 48:876-890. [PMID: 38553992 DOI: 10.1111/aor.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 07/23/2024]
Abstract
CONTEXT Clinical adoption of ex situ liver perfusion is growing. While hypothermic perfusion protects against ischemia-reperfusion injury in marginal grafts, normothermic perfusion enables organ viability assessment and therefore selection of borderline grafts. The combination of hypothermic and normothermic perfusion, known as "cold-to-warm," may be the optimal sequence for organ preservation, but is difficult to achieve with most commercial perfusion systems. We developed an adaptable customized circuit allowing uninterrupted "cold-to-warm" perfusion and conducted preclinical studies on healthy porcine livers and discarded human livers to demonstrate the circuit's efficacy. METHODS In collaboration with bioengineers, we developed a customized circuit that adapts to extracorporeal circulation consoles used in cardiovascular surgery and includes a proprietary reservoir enabling easy perfusate change without interrupting perfusion. This preclinical study was conducted on porcine and human livers. Perfusion parameters (pressures, flows, oxygenation) and organ viability were monitored. RESULTS The customized circuit was adapted to a LivaNova S5® console, and the perfusions were flow-driven with real-time pressure monitoring. Ten porcine liver and 12 discarded human liver perfusions were performed during 14 to 18 h and 7 to 25 h, respectively. No hyperpressure was observed (porcine and human portal pressure 2-6 and 2-8 mm Hg; arterial pressure 10-65 and 20-65 mm Hg, respectively). No severe histological tissue injury was observed (Suzuki score ≤ 3 at the end of perfusion). Seven (70%) porcine livers and five (42%) human livers met the UK viability criteria. CONCLUSION The customized circuit and system design enables smooth uninterrupted "cold-to-warm" perfusion not present in current commercial perfusion systems.
Collapse
Affiliation(s)
- Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris, France
| | - Célia Turco
- INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris, France
- Liver Transplantation Unit, Department of Digestive and Oncologic Surgery, University Hospital of Besançon, Besançon, France
| | - Eric Savier
- Department of Hepatobiliary Surgery and Liver Transplantation, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris, France
| | - Jérôme Pelissié
- Department of Extracorporeal Perfusion and Vascular Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Legallais
- Department of Metabolic Biochemistry, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Medhi Sakka
- Department of Metabolic Biochemistry, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lynda Aoudjehane
- INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris, France
- INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France
| | - Dominique Wendum
- Department of Pathology, Saint-Antoine Hospital (AP-HP), Paris, France
| | - John Migliazza
- Department of Discovery, Research and Development, LivaNova PLC, London, UK
| | - Sandra Spiritelli
- Department of Discovery, Research and Development, LivaNova PLC, London, UK
| | - Filomena Conti
- INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris, France
- Department of Medical Liver Transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Claire Goumard
- Department of Hepatobiliary Surgery and Liver Transplantation, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris, France
| |
Collapse
|
27
|
Magyar CTJ, Gaviria F, Li Z, Choi WJ, Ma AT, Berzigotti A, Sapisochin G. Surgical Considerations in Portal Hypertension. Clin Liver Dis 2024; 28:555-576. [PMID: 38945643 DOI: 10.1016/j.cld.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This review provides an in-depth exploration of portal hypertension (PH) and its implications in various surgical procedures. The prevalence of clinically significant PH is 50% to 60% in compensated cirrhosis and 100% in decompensated cirrhosis. The feasibility and safety of hepatic and nonhepatic surgical procedures in patients with PH has been shown. Adequate preoperative risk assessment and optimization of PH are integral parts of patient assessment. The occurrence of adverse outcomes after surgery has decreased over time in this specific population, due to the development of techniques and improved perioperative multidisciplinary care.
Collapse
Affiliation(s)
- Christian Tibor Josef Magyar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Felipe Gaviria
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Zhihao Li
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Woo Jin Choi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Ann Thu Ma
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gonzalo Sapisochin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
| |
Collapse
|
28
|
Xiong H, He Z, Wei Y, Li Q, Xiao Q, Yang L, Deng X, Wu K, Wang K, Deng X. Probiotic Compounds Enhanced Recovery after Surgery for Patients with Distal Gastric Cancer: A Prospective, Controlled Clinical Trial. Ann Surg Oncol 2024; 31:5240-5251. [PMID: 38739239 DOI: 10.1245/s10434-024-15394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) for radical distal gastrectomy needs to be improved urgently. We investigated the effects of probiotic compounds (including Lactobacillus plantarum, L. rhamnosus, L. acidophilus, and Bifidobacterium animalis subsp.lactis) on enhance recovery after gastrectomy. METHODS The patients in this prospective study were divided into probiotic group (PG group, n = 36) and placebo group (CG group, n = 38), taking corresponding capsule according to the protocol during the perioperative period. We compared the trends in perioperative hematologic findings and the postoperative outcomes. Patients' feces were collected for bacterial 16S rRNA sequencing. Patients were followed up at 1 month postoperatively. RESULTS After the application of probiotics, the patients' postoperative inflammatory response level was reduced, and the trend of postoperative NLR decrease was significantly faster in the patients of the PG group than in the CG group (P = 0.047, partial η2 = 0.054). The trend of postoperative increase in serum albumin concentration in the patients of the PG group was significantly better than that in the CG group (P = 0.016, partial η2 = 0.078). In addition, patients in the PG group met discharge criteria earlier postoperatively and had fewer medical expenses. The quality of life of PG group was improved postoperatively. Postoperative inflammation-related markers, including the ratio of Firmicutes/Bacteroidetes, were increasing in untreated patients. In addition, the postoperative microbial diversity and abundance in the PG group remained stable. CONCLUSIONS Probiotic compounds can reduce the inflammatory response after gastrectomy and enhance the recovery of the DGC patients by maintaining the stability of the gut microbiota.
Collapse
Affiliation(s)
- Huan Xiong
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhipeng He
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yuan Wei
- Department of Ophthalmology, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, People's Republic of China
| | - Qiang Li
- Department of Vascular Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, People's Republic of China
| | - Qun Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine, Zhuzhou, Hunan, People's Republic of China
| | - Liang Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xi Deng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Kai Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Keqiang Wang
- Department of General Surgery, Yingtan 184 Hospital, Yingtan, Jiangxi, People's Republic of China.
| | - Xiaorong Deng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China.
| |
Collapse
|
29
|
Muehlenberg K, Pfeifer L, Pech O. [86-year-old patient with acute swallowing difficulties]. Dtsch Med Wochenschr 2024; 149:869-870. [PMID: 39013406 DOI: 10.1055/a-2305-4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Affiliation(s)
- Klaus Muehlenberg
- Klinik für Gastroenterologie und interventionelle Endoskopie; Krankenhaus Barmherzige Brüder, Regensburg
| | - Lukas Pfeifer
- Klinik für Gastroenterologie und interventionelle Endoskopie; Krankenhaus Barmherzige Brüder, Regensburg
| | - Oliver Pech
- Klinik für Gastroenterologie und interventionelle Endoskopie; Krankenhaus Barmherzige Brüder, Regensburg
| |
Collapse
|
30
|
Ribeiro T, Castanheira-Rodrigues S, Bastos P, Cristino H, Fernandes A, Rodrigues-Pinto E, Bispo M, Rio-Tinto R, Vilas-Boas F. Portuguese Pancreatic Club Perspectives on Endoscopic Ultrasound-Guided and Surgical Treatment of Pancreatic Neuroendocrine Tumors. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:225-235. [PMID: 39022303 PMCID: PMC11250664 DOI: 10.1159/000534032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 07/20/2024]
Abstract
Pancreatic neuroendocrine tumors (panNETs) are a group of neoplasms with heterogenous biological and clinical phenotypes. Although historically regarded as rare, the incidence of these tumors has been increasing, mostly owing to improvements in the detection of small, asymptomatic tumors with imaging. The heterogeneity of these lesions creates significant challenges regarding diagnosis, staging, and treatment. Endoscopic ultrasound (EUS) has improved the characterization of pancreatic lesions. Furthermore, EUS nowadays has evolved from a purely diagnostic modality to allow the performance of minimally invasive locoregional therapy for pancreatic focal lesions. The choice of treatment as well as the treatment goals depend on several factors, including tumor secretory status, grading, staging, and patient performance status. Surgery has been the mainstay for the management of these patients, particularly for localized, low-grade, large panNETs >2 cm. Over the last decade, a significant body of evidence has been accumulated evaluating the role of EUS for the ablative therapy of panNETs, namely by the use of chemoablative agents and radiofrequency. Although endoscopic techniques are not routinely recommended by international guidelines, they may be considered for the treatment of smaller lesions in patients who are unwilling or unfit for pancreatic surgery. In this review, we summarize the existing evidence on the interventional techniques for the treatment of patients with panNETs, focusing on the EUS-guided and surgical approaches.
Collapse
Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | - Pedro Bastos
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Humberto Cristino
- Department of General Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Eduardo Rodrigues-Pinto
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Miguel Bispo
- Digestive Oncology Unit, Gastroenterology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Rio-Tinto
- Digestive Oncology Unit, Gastroenterology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Filipe Vilas-Boas
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| |
Collapse
|
31
|
Gornals JB. EUS-guided radiofrequency ablation in pancreatic cancer: Promising but still questionable! Gastrointest Endosc 2024; 100:259-261. [PMID: 39025594 DOI: 10.1016/j.gie.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute; Universitat de Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
32
|
Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer. Fam Cancer 2024; 23:323-339. [PMID: 38619782 PMCID: PMC11255004 DOI: 10.1007/s10689-024-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/16/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths and is associated with a poor prognosis. The majority of these cancers are detected at a late stage, contributing to the bad prognosis. This underscores the need for novel, enhanced early detection strategies to improve the outcomes. While population-based screening is not recommended due to the relatively low incidence of PDAC, surveillance is recommended for individuals at high risk for PDAC due to their increased incidence of the disease. However, the outcomes of pancreatic cancer surveillance in high-risk individuals are not sorted out yet. In this review, we will address the identification of individuals at high risk for PDAC, discuss the objectives and targets of surveillance, outline how surveillance programs are organized, summarize the outcomes of high-risk individuals undergoing pancreatic cancer surveillance, and conclude with a future perspective on pancreatic cancer surveillance and novel developments.
Collapse
Affiliation(s)
- Aleksander M Bogdanski
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Albers-Warlé KI, Reijnders-Boerboom GTJA, Bijkerk V, Torensma B, Panhuizen IF, Snoeck MMJ, Fuchs-Buder T, Keijzer C, Dahan A, Warlé MC. A Practical Dosing Algorithm for Deep Neuromuscular Blockade during Total Intravenous Anesthesia: ROCURITHM. Anesthesiology 2024; 141:365-374. [PMID: 38728093 DOI: 10.1097/aln.0000000000005050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The number of trials investigating the effects of deep neuromuscular blockade (NMB) on surgical conditions and patient outcomes is steadily increasing. Consensus on which surgical procedures benefit from deep NMB (a posttetanic count [PTC] of 1 to 2) and how to implement it has not been reached. The European Society of Anaesthesiology and Intensive Care does not advise routine application but recommends use of deep NMB to improve surgical conditions on indication. This study investigates the optimal dosing strategy to reach and maintain adequate deep NMB during total intravenous anesthesia. METHODS Data from three trials investigating deep NMB during laparoscopic surgery with total intravenous anesthesia (n = 424) were pooled to analyze the required rocuronium dose, when to start continuous infusion, and how to adjust. The resulting algorithm was validated (n = 32) and compared to the success rate in ongoing studies in which the algorithm was not used (n = 180). RESULTS The mean rocuronium dose based on actual bodyweight for PTC 1 to 2 was (mean ± SD) 1.0 ± 0.27 mg · kg-1 ·h-1 in the trials, in which mean duration of surgery was 116 min. An induction dose of 0.6 mg ·kg-1 led to a PTC of 1 to 5 in a quarter of patients after a mean of 11 min. The remaining patients were equally divided over too shallow (additional bolus and direct start of continuous infusion) or too deep; a 15-min wait after PTC of 0 for return of PTC to 1 or higher. Using the proposed algorithm, a mean 76% of all 5-min measurements throughout surgery were on target PTC 1 to 2 in the validation cohort. The algorithm performed significantly better than anesthesiology residents without the algorithm, even after a learning curve from 0 to 20 patients (42% on target, P ≤ 0.001, Cohen's d = 1.4 [95% CI, 0.9 to 1.8]) to 81 to 100 patients (61% on target, P ≤ 0.05, Cohen's d = 0.7 [95% CI, 0.1 to 1.2]). CONCLUSIONS This study proposes a dosing algorithm for deep NMB with rocuronium in patients receiving total intravenous anesthesia. EDITOR’S PERSPECTIVE
Collapse
Affiliation(s)
| | | | - Veerle Bijkerk
- Department of Anesthesiology, Radboudumc, Nijmegen, The Netherlands
| | - Bart Torensma
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ivo F Panhuizen
- Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc M J Snoeck
- Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Thomas Fuchs-Buder
- Département d'Anesthésie et de Réanimation, Centre Hospitalier Universitaire Nancy/Brabois, Nancy, France
| | | | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
34
|
Troka M, Szepietowska K, Lubowiecka I. Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour. J Mech Behav Biomed Mater 2024; 156:106578. [PMID: 38781775 DOI: 10.1016/j.jmbbm.2024.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.
Collapse
Affiliation(s)
- Mateusz Troka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland.
| |
Collapse
|
35
|
Tuan HX, Tuan TA, Tam NT, Cong HD, Duy NQ, Hung ND, Ceugnart L, Duc NM. An infrequent case of retroperitoneal synovial sarcoma. Radiol Case Rep 2024; 19:3456-3460. [PMID: 38872739 PMCID: PMC11169068 DOI: 10.1016/j.radcr.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
Synovial sarcoma (SS) is an uncommon malignant tumor, ranking third in prevalence within the soft tissue sarcomas group. The vast majority of synovial sarcomas are present in the extremities, with only 15% developing in the retroperitoneal space. Retroperitoneal synovial sarcoma (RSS) is an infrequent case of SS, with only about 20 cases reported in the literature. Diagnosing RSS before treatment remains challenging because of its nonspecific clinical symptoms. The disease is often detected at a later stage, leading to additional damage to other organs as well as complicated and ineffective treatment. Consequently, the 5-year survival rate is only 20%-29%. This report introduces a case of RSS in a 19-year-old male patient with imaging characteristics on computed tomography (CT) and magnetic resonance (MR).
Collapse
Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Danang, Vietnam
| | - Trinh Anh Tuan
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen-Thi Tam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ho Duc Cong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ngo Quang Duy
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Department of Radiology, Ha Giang General Hospital, Ha Giang, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Luc Ceugnart
- Departement of Radiology, Centre Oscar Lambret, Lille, France
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| |
Collapse
|
36
|
Bareiß S, Merkel S, Krautz C, Weber GF, Grützmann R, Brunner M. Prognostic role of nutrition parameters on short- and long-term outcome in patients with primary resectable pancreatic ductal adenocarcinoma. Clin Nutr ESPEN 2024; 62:296-302. [PMID: 38878292 DOI: 10.1016/j.clnesp.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Nutrition status of patients with pancreatic ductal adenocarcinoma (PDAC) has gained an increasing importance - especially in the preoperative setting. The aim of the present study was to evaluate different preoperative nutritional parameters including body composition parameters regarding their impact on short- and long-term outcome in patients with resectable PDAC. METHODS This retrospective single center study included 162 patients, who underwent primary resection of PDAC from January 2003 to December 2018 at the University Hospital of Erlangen. The influence of different preoperative nutrition parameters as well as different CT-based body composition parameters on short- (major morbidity, postoperative pancreatic fistula (POPF) and longer hospital stay) as well as on long-term outcome (overall and disease-free survival) were tested using multiple regression analysis. RESULTS Major morbidity and POPF occurred in 30% respectively 18%. Median length of hospital stay was 18 days. Median overall and disease free survival were 20.3 respectively 12.0 months. Multivariate analysis revealed among the different nutritional parameters following independent predictors: PMTH (psoas muscle thickness/height) for major morbidity (HR 2.1, p = 0.038), PMA (psoas muscle area) for a prolonged hospital stay >18 days (HR 7.3, p = 0.010) and NRS (nutritional risk score) for overall survival (HR 1.7, p = 0.043). CONCLUSION In our cohort, nutritional parameters played a minor role in predicting short- and long-term outcome in patients with primary resectable PDAC, as there were only significant associations between selected psoas muscle parameters and short-term outcome parameters and the nutritional risk score (NRS) with the overall survival.
Collapse
Affiliation(s)
- Sophie Bareiß
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Susanne Merkel
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Christian Krautz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Georg F Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany.
| |
Collapse
|
37
|
Elisa Z, Camilla P, Giulia M, Nicola Z, Daniela C, Francesca G, Marco G, Claudio C, Alessandro P, Fabio B, Antoniello LM, Piergiorgio G. Concordance in Intraoperative Surgeons' Opinion in the Diagnosis and Management of Acute Appendicitis: The Role of Training. JOURNAL OF SURGICAL EDUCATION 2024; 81:1083-1088. [PMID: 38908992 DOI: 10.1016/j.jsurg.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Acute appendicitis is a wide spectrum disease, from simple inflammation to evident intestinal perforation. The correct interpretation of the degree of inflammation is crucial to guarantee appropriate treatment and adherence to protocols and guidelines. In order to investigate this concordance, the authors compared the definition of appendicitis and the predicted treatment among all surgeons affiliated to a single Pediatric Surgery School (consisting of 8 different centers). DESIGN Twenty-two short recordings of intra-operative manipulation of appendices were shown to 56 surgeons, blindly to clinical information. Four items were collected and analyzed: classification of appendicitis, type and length of predicted antibiotic therapy, day of re-alimentation. Data were analyzed to identify the concordance kappa coefficient, stratified according to expertise of the responding surgeon. RESULTS The 1232 evaluations obtained in all valued items low overall concordance. Subgroup analysis identified a good agreement between younger surgeons only in the choice of antibiotic (k 0.47). However, if the centers were divided between University and non-University Hospitals, a strong agreement was found in the former both for classification (k 0.45 vs 0.32) and type of antibiotic (k 0.42 vs 0.24). CONCLUSIONS The overall concordance between surgeons in different centers in the diagnostic classification and predicted treatment of appendicitis is quite low. University Hospital have a highest concordance in both items at all levels of expertise; it might be postulated that teaching to younger surgeon increase the comparison between experts and finally the concordance and adherence to protocols within the center.
Collapse
Affiliation(s)
- Zambaiti Elisa
- Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Torino, TO, Italy.
| | - Pagliara Camilla
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy; Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, TS, Italy
| | - Mottadelli Giulia
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy; Umberto Bosio Center for Digestive Diseases, Pediatric Surgery Unit, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy
| | - Zampieri Nicola
- Department of Surgery, Policlinico G.B.Rossi, University of Verona, Verona, VR, Italy
| | - Codrich Daniela
- Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, TS, Italy
| | - Grandi Francesca
- Complex Operative Unit-Pediatric Surgery, Hospital of Bolzano, Bolzano, BZ, Italy
| | - Gasparella Marco
- Pediatric Surgery Unit, Ca' Foncello Hospital, Treviso, TV, Italy
| | - Carlini Claudio
- Umberto Bosio Center for Digestive Diseases, Pediatric Surgery Unit, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy
| | - Pane Alessandro
- Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Torino, TO, Italy
| | - Beretta Fabio
- Pediatric Surgery Unit, Presidio Ospedaliero Santa Chiara, Trento, TN, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy
| | - Gamba Piergiorgio
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy
| |
Collapse
|
38
|
Hu XS, Wang Y, Pan HT, Zhu C, Chen SL, Zhou S, Liu HC, Pang Q, Jin H. “Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma. World J Gastrointest Surg 2024; 16:2167-2174. [DOI: 10.4240/wjgs.v16.i7.2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention.
AIM To summarize and share the application experience of the emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV.
METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.
RESULTS Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of “hepatic hilum area dissection priority, liver posterior separation first”. The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications.
CONCLUSION The emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.
Collapse
Affiliation(s)
- Xiao-Si Hu
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Yong Wang
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Hong-Tao Pan
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Chao Zhu
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Shi-Lei Chen
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Shuai Zhou
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Hui-Chun Liu
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Qing Pang
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Hao Jin
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| |
Collapse
|
39
|
Wu XW, Yang DQ, Wang MW, Jiao Y. Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:1973-1980. [DOI: 10.4240/wjgs.v16.i7.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/22/2024] Open
Abstract
Among minimally invasive surgical procedures, colorectal surgery is associated with a notably higher incidence of incisional hernia (IH), ranging from 1.7% to 24.3%. This complication poses a significant burden on the healthcare system annually, necessitating urgent attention from surgeons. In a study published in the World Journal of Gastrointestinal Surgery, Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence. This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery, emphasizing the impact of obesity, surgical site infection, and the choice of incision location on its development. Furthermore, we summarize the currently available preventive measures for IH. Given the low surgical repair rate and high recurrence rate associated with IH, prevention deserves greater research and attention compared to treatment.
Collapse
Affiliation(s)
- Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
40
|
Kehagias D, Lampropoulos C, Kehagias I. Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer: A glimpse into the future. World J Gastrointest Surg 2024; 16:1960-1964. [DOI: 10.4240/wjgs.v16.i7.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/04/2024] [Accepted: 05/21/2024] [Indexed: 07/22/2024] Open
Abstract
Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer (LARC) for many years. Their main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative complications. Currently, pelvic exenteration (PE) with or without neoadjuvant treatment is a curative treatment when negative resection margins are achieved. The traditional open approach has been favored by many surgeons. However, the technological advancements in minimally invasive surgery have radically changed the surgical options. Recent studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE. A recent retrospective study entitled “Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer: A 9-year review” was published in the World Journal of Gastrointestinal Surgery. As we read this article with great interest, we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for LARC. Currently, the small number of suitable patients, limited surgeon experience, and steep learning curve are hindering the establishment of minimally invasive PE.
Collapse
Affiliation(s)
- Dimitrios Kehagias
- Department of General Surgery, General University Hospital of Patras, Patras 26504, Greece
| | | | - Ioannis Kehagias
- Division of Bariatric and Metabolic Surgery, Department of Surgery, University of Patras, Patras 26504, Greece
| |
Collapse
|
41
|
Fu Z, Wang MW, Liu YH, Jiao Y. Impact of immunotherapy on liver metastasis. World J Gastrointest Surg 2024; 16:1969-1972. [DOI: 10.4240/wjgs.v16.i7.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/09/2024] [Accepted: 05/28/2024] [Indexed: 07/22/2024] Open
Abstract
This editorial discusses the article “Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis” published in the latest edition of the World Journal of Gastrointestinal Surgery. Immunotherapy has achieved outstanding success in tumor treatment. However, the presence of liver metastasis (LM) restrains the efficacy of immunotherapy in various tumors, including lung cancer, colorectal cancer, renal cell carcinoma, melanoma, and gastric cancer. A decrease in CD8+ T cells and nature killer cells, along with an increase in macrophages and regulatory T cells, was observed in the microenvironment of LM, leading to immunotherapy resistance. More studies are necessary to determine the best strategy for enhancing the effectiveness of immunotherapy in patients with LM.
Collapse
Affiliation(s)
- Zhuo Fu
- Medical College, Inner Mongolia Minzu University, Tongliao 028000, Inner Mongolia Autonomous Region, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Ya-Hui Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
42
|
Chisthi MM. Unveiling the potential of electrocautery-enhanced lumen-apposing metal stents in endoscopic ultrasound-guided biliary drainage. World J Gastrointest Surg 2024; 16:1956-1959. [DOI: 10.4240/wjgs.v16.i7.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 07/22/2024] Open
Abstract
This editorial delves into Peng et al's article, published in the World Journal of Gastrointestinal Surgery. Peng et al's meta-analysis investigates the effectiveness of electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) in ultrasound-guided biliary drainage for alleviating malignant biliary obstruction. Examining 14 studies encompassing 620 participants, the research underscores a robust technical success rate of 96.7%, highlighting the efficacy of ECE-LAMS, particularly in challenging cases which have failed endoscopic retrograde cholangio pancreatography. A clinical success rate of 91.0% underscores its impact on symptom alleviation, while a reasonably tolerable adverse event rate of 17.5% is observed. However, the 7.3% re-intervention rate stresses the need for post-procedural monitoring. Subgroup analyses validate consistent outcomes, bolstering the applicability of ECE-LAMS. These findings advocate for the adoption of ECE-LAMS as an appropriate approach for biliary palliation, urging further exploration in real-world clinical contexts. They offer valuable insights for optimizing interventions targeting malignant biliary obstruction management.
Collapse
Affiliation(s)
- Meer M Chisthi
- Department of General Surgery, Government Medical College Pathanamthitta, Konni 689691, Kerala, India
| |
Collapse
|
43
|
Koo JGA, Liau MYQ, Kryvoruchko IA, Habeeb TAAM, Chia C, Shelat VG. Pancreatic pseudocyst: The past, the present, and the future. World J Gastrointest Surg 2024; 16:1986-2002. [DOI: 10.4240/wjgs.v16.i7.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 07/22/2024] Open
Abstract
A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.
Collapse
Affiliation(s)
- Jonathan GA Koo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Igor A Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv 61022, Ukraine
| | - Tamer AAM Habeeb
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Christopher Chia
- Department of Gastroenterology, Woodlands General Hospital, Singapore 737628, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| |
Collapse
|
44
|
Schlottmann F. Endoscopic submucosal dissection for early gastric cancer: A major challenge for the west. World J Gastrointest Surg 2024; 16:1965-1968. [DOI: 10.4240/wjgs.v16.i7.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 07/22/2024] Open
Abstract
Gastric cancer (GC) is the 5th most common cancer and the 3rd most common cause of cancer mortality worldwide. Two main endoscopic resective techniques exist for early GC (EGC): Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). ESD has been widely embraced in the last decade because it allows radical en bloc resections and is associated with better outcomes, as compared to EMR. However, the lack of training opportunities and flat learning curve due to low volume of EGC cases represent major obstacles to obtain proficiency on ESD in the West. As this procedure is highly efficient for the treatment of EGC, dedicated training programs with a stepwise approach and updated guidelines for ESD embracement are needed in Western countries.
Collapse
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, United States
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires 1640-C1118AAT, Argentina
| |
Collapse
|
45
|
Zhao CJ, Ren C, Yuan Z, Bai GH, Li JY, Gao L, Li JH, Duan ZQ, Feng DP, Zhang H. Spleen volume is associated with overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with portal hypertension. World J Gastrointest Surg 2024; 16:2054-2064. [DOI: 10.4240/wjgs.v16.i7.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/06/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Portal shunt and immune status related to the spleen are related to the occurrence of hepatic encephalopathy (HE). It is unknown whether spleen volume before transjugular intrahepatic portosystemic shunt (TIPS) is related to postoperative HE.
AIM To investigate the relationship between spleen volume and the occurrence of HE.
METHODS This study included 135 patients with liver cirrhosis who underwent TIPS, and liver and spleen volumes were elevated upon computed tomography imaging. The Kaplan-Meier curve was used to compare the difference in the incidence rate of HE among patients with different spleen volumes. Univariate and multivariate Cox regression analyses were performed to identify the factors affecting overt HE (OHE). Restricted cubic spline was used to examine the shapes of the dose-response association between spleen volumes and OHE risk.
RESULTS The results showed that 37 (27.2%) of 135 patients experienced OHE during a 1-year follow-up period. Compared with preoperative spleen volume (901.30 ± 471.90 cm3), there was a significant decrease in spleen volume after TIPS (697.60 ± 281.0 cm3) in OHE patients. As the severity of OHE increased, the spleen volume significantly decreased (P < 0.05). Compared with patients with a spleen volume ≥ 782.4 cm3, those with a spleen volume < 782.4 cm3 had a higher incidence of HE (P < 0.05). Cox regression analysis showed that spleen volume was an independent risk factor for post-TIPS OHE (hazard ratio = 0.494, P < 0.05). Restricted cubic spline model showed that with an increasing spleen volume, OHE risk showed an initial increase and then decrease (P < 0.05).
CONCLUSION Spleen volume is related to the occurrence of OHE after TIPS. Preoperative spleen volume is an independent risk factor for post-TIPS OHE.
Collapse
Affiliation(s)
- Chun-Juan Zhao
- College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Chao Ren
- College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Zhen Yuan
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, NHC Key Laboratory of Pneumoconiosis, MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Guo-Hui Bai
- College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Jin-Yu Li
- Department of Oncological and Vascular Intervention, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Long Gao
- Department of Oncological and Vascular Intervention, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Jin-Hui Li
- College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Ze-Qi Duan
- First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Dui-Ping Feng
- Department of Oncological and Vascular Intervention, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Hui Zhang
- College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Shanxi Key Laboratory of Intelligent Imaging and Nanomedicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
- Intelligent Imaging Big Data and Functional Nano-imaging Engineering Research Center of Shanxi Province, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| |
Collapse
|
46
|
Onteddu NKR, Mareddy NSR, Vulasala SSR, Onteddu J, Virarkar M. Revolutionizing palliative care: Electrocautery-enhanced lumen-apposing metal stents in endoscopic-ultrasound-guided biliary drainage for malignant obstructions. World J Gastrointest Surg 2024; 16:2358-2361. [DOI: 10.4240/wjgs.v16.i7.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 07/22/2024] Open
Abstract
Patients with malignant biliary obstruction, following endoscopic retrograde cholangiopancreatography (ERCP) failure could be referred for endoscopic-ultrasound-guided biliary drainage through electrocautery-enhanced (ECE) lumen-apposing metal stent (LAMS) placement. However, the efficacy and safety of ECE-LAMS in this scenario have remained debatable due to minimal scientific evidence. The current confirmed 91.0% clinical success, 96.7% technical success, 7.3% reintervention rate, and 17.5% adverse events, following the treatment of malignant biliary obstruction with ECE-LAMS delivery. Finally, ECE-LAMS proved to be a generalizable strategy for managing biliary obstruction for patients who were excluded from ERCP.
Collapse
Affiliation(s)
- Nirmal Kumar Reddy Onteddu
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| | | | - Sai Swarupa R Vulasala
- Department of Diagnostic Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| | - Jayabharath Onteddu
- Department of Public Health Sciences, University of Florida, Gainesville, FL 32611, United States
| | - Mayur Virarkar
- Department of Diagnostic Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| |
Collapse
|
47
|
Liu CH, Chen ZW, Yu Z, Liu HY, Pan JS, Qiu SS. Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis. World J Gastrointest Surg 2024; 16:2080-2087. [DOI: 10.4240/wjgs.v16.i7.2080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Currently, endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy (LC) is the main treatment for cholecystolithiasis combined with choledocholithiasis. However, the treatment is unsatisfactory, and the development of better therapies is needed.
AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.
METHODS Patients (n = 243) with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force) between January 2019 and December 2023 were included in the study; 111 patients (control group) underwent ERCP + LC and 132 patients (observation group) underwent LC + laparoscopic common bile duct exploration (LCBDE). Surgical success rates, residual stone rates, complications (pancreatitis, hyperamylasemia, biliary tract infection, and bile leakage), surgical indicators [intraoperative blood loss (IBL) and operation time (OT)], recovery indices (postoperative exhaust/defecation time and hospital stay), and serum inflammatory markers [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were compared.
RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups. However, the complication rate, IBL, OT, postoperative exhaust/defecation time, and hospital stays were significantly reduced in the observation group compared with the control group. Furthermore, CRP, TNF-α, and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.
CONCLUSION These results indicate that LC + LCBDE is safer than ERCP + LC for the treatment of cholecystolithiasis combined with choledocholithiasis. The surgical risks and postoperative complications were lower in the observation group compared with the control group. Thus, patients may recover quickly with less inflammation after LCBDE.
Collapse
Affiliation(s)
- Chao-Hui Liu
- Department of General Surgery, The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force), Quanzhou 362000, Fujian Province, China
| | - Zhi-Wei Chen
- Department of General Surgery, The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force), Quanzhou 362000, Fujian Province, China
| | - Zhe Yu
- Department of General Surgery, Anxi Hospital of Traditional Chinese Medicine, Quanzhou 362499, Fujian Province, China
| | - Hong-Yu Liu
- Department of General Surgery, The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force), Quanzhou 362000, Fujian Province, China
| | - Jian-Sheng Pan
- Department of General Surgery, The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force), Quanzhou 362000, Fujian Province, China
| | - Shuang-Shuang Qiu
- Department of General Surgery, The Affiliated Haixia Hospital of Huaqiao University (910th Hospital of Joint Logistic Support Force), Quanzhou 362000, Fujian Province, China
| |
Collapse
|
48
|
Lv YJ, Xu GX, Lan JR. Impact of frailty on postoperative outcomes after hepatectomy: A systematic review and meta-analysis. World J Gastrointest Surg 2024; 16:2319-2328. [DOI: 10.4240/wjgs.v16.i7.2319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/28/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.
AIM To study the influence of frailty on postoperative outcomes, such as mortality, rate of complications, and length of hospitalization, following hepatectomy.
METHODS PubMed, EMBASE, and Scopus databases were searched for observational studies with adult (≥ 18 years) patients after planned/elective hepatectomy. A random-effects model was used for all analyses, and the results are expressed as weighted mean difference (WMD), relative risk (RR), or hazards ratio (HR) with 95% confidence interval (CI).
RESULTS Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality (RR = 2.76, 95%CI: 2.10-3.64), mortality at 30 d (RR = 4.60, 95%CI: 1.85-11.40), and mortality at 90 d (RR = 2.52, 95%CI: 1.70-3.75) in the postoperative period. Frail patients had a poorer long-term survival (HR = 2.89, 95%CI: 1.84-4.53) and higher incidence of “any” complications (RR = 1.69, 95%CI: 1.40-2.03) and major (grade III or higher on the Clavien-Dindo scale) complications (RR = 2.69, 95%CI: 1.85-3.92). Frailty was correlated with markedly lengthier hospital stay (WMD = 3.65, 95%CI: 1.45-5.85).
CONCLUSION Frailty correlates with elevated risks of mortality, complications, and prolonged hospitalization, which need to be considered in surgical management. Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.
Collapse
Affiliation(s)
- Yao-Jia Lv
- Day Surgery Ward, Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Guang-Xing Xu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jia-Rong Lan
- Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou 313000, Zhejiang Province, China
| |
Collapse
|
49
|
Konishi T, Manabe N, Haruma K, Fujiwara H, Fujiwara H, Takaoka M, Akiyama T, Kato K, Hata J, Yamatsuji T. A case of hemorrhagic Meckel's diverticulum diagnosed by transabdominal ultrasound. Clin J Gastroenterol 2024:10.1007/s12328-024-02019-5. [PMID: 39046660 DOI: 10.1007/s12328-024-02019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024]
Abstract
A 23-year-old man with a history of anemia of unknown cause was referred to our hospital. He had experienced melena three times: at 6 months, 10 years, and 20 years of age. He underwent upper and lower gastrointestinal endoscopy at 10 and 20 years of age, and small intestinal capsule endoscopy twice at 20 years of age, but the site of bleeding could not be identified. At first, a transabdominal ultrasound was performed for suspected Meckel's diverticulum. A cystic diverticulum was found in the ileum, with an apertural diameter of 5 mm and a total size of 4 cm. The cyst showed an area of loss of wall stratification, which appeared to be an ulcer scar. Based on these observations, we diagnosed anemia resulting from a hemorrhagic Meckel's diverticulum and performed laparoscopic resection. Postoperative histopathology revealed ectopic gastric mucosa and ulcer formation within the Meckel's diverticulum, which was thought to be the cause of the bleeding. Meckel's diverticulum should be considered in cases of hemorrhage in young patients. A transabdominal ultrasound as a screening test detected a diverticulum with an ulcer scar in the ileum, which led to the identification of the underlying disease.
Collapse
Affiliation(s)
- Takako Konishi
- Department of Surgery, Kawasaki Medical School, Okayama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-Ku, Okayama, 700-8505, Japan.
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan
| | - Hideyo Fujiwara
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | | | | | - Takashi Akiyama
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Katsuya Kato
- Department of Radiology, Kawasaki Medical School, Okayama, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-Ku, Okayama, 700-8505, Japan
| | | |
Collapse
|
50
|
Broekman M, Genders CMS, Geitenbeek RTJ, Havenga K, Kruijff S, Klaase JM, Viddeleer AR, Consten ECJ. Unraveling the role of computed tomography derived body composition metrics on anastomotic leakages rates in rectal cancer surgery: A protocol for a systematic review and meta-analysis. PLoS One 2024; 19:e0307606. [PMID: 39046997 DOI: 10.1371/journal.pone.0307606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Anastomotic leakage is a major concern following total mesorectal excision for rectal cancer, affecting oncological outcomes, morbidity an treatment costs. Body composition has been suggested to influence anastomotic leakage rates. However, literature on how body composition impact anastomotic leakage rates is conflicting. This systematic review aims to evaluate the role of computed tomography derived body composition metrics on anastomotic leakage rates in rectal cancer patients. METHODS Databases PubMed/MEDLINE, Cochrane Library, web of science, and EMBASE, will be systematically searched for papers from January 2010 onwards. Study selection, data collection and quality assessment will be independently performed by three research fellows. Outcomes described in three or more studies will be included in the meta-analysis. The Q-test and I2 statistic will be used to assess statistical heterogeneity between studies. Publication bias will be examined by visual inspection of funnel plots and quantified by Egger's test. Sensitivity analyses will be conducted to examine the robustness of the meta-analysis. Reporting of the findings will be in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. CONCLUSIONS This systematic review will synthesize the current evidence and will identify knowledge gaps. Results of the systematic review will aid health care professional in pre-operative decision making and will be distributed through a peer-reviewed publication and presentation of results at international meetings. TRIAL REGISTRATION PROSPERO protocol number: CRD42023471537.
Collapse
Affiliation(s)
- Mark Broekman
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Ritchie T J Geitenbeek
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Klaas Havenga
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Alain R Viddeleer
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther C J Consten
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| |
Collapse
|