Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife

AIM： To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife （IT-ESD） for the treatment of patients with gastric remnant cancer. METHODS： Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection （EMR） or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection （CR） rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD. RESULTS： The CR rate （40% in the EMR group vs 82% in the IT-ESD group） was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT- ESD group （57.6 ± 31.9 min vs 21.1 ± 12.2 min）. No significant differences were found in the rate of underlying cardiopulmonary disease （IT-ESD group, 12% vs EMR group, 13%）, one-piece resection rate （100% vs 73%）, bleeding rate （18% vs 6.7%）, and perforation rate （0% vs 0%） between the two groups. CONCLUSION： IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. Thelong-term outcome needs to be evaluated in the future.     

关节镜下保留与切除残迹前交叉韧带重建的远期临床比较

目的 评估比较关节镜下保留与切除残迹的前交叉韧带(anterior cruciate ligament,ACL)重建的技术方法 与远期临床效果. 方法 自1999年10月至2005年5月采用经典的经胫骨技术,常规切除ACL残迹,4股胭绳肌腱移植物重建ACL术87例.自2005年6月至2010年5月采用由外向内建立骨隧道,保留ACL残迹,4股胭绳肌腱移植物重建ACL术221例.仅选择两种手术处理中单纯ACL重建,并有完整3年以上随访记录的患者进行对比分析,保留残迹组66例,切除残迹组39例. 结果 两组患者术后随访均为36～ 60个月,两组随访时间比较差异无统计学意义(P＞0.05).术前资料比较,两组在年龄、性别、损伤至手术时间、关节不稳定程度、膝关节功能评分等方面差异均无统计学意义(P＞0.05).随访资料比较,两组双侧股部周径差值、两组Lachman试验稳定程度差异均无统计学意义(P＞0.05).保留残迹组的关节活动度优于切除残迹组(P＜0.05),Lysholm评分显著高于切除残迹组(P＜0.05),前抽屉试验稳定性显著优于切除残迹组(P＜0.05),轴移试验稳定性显著优于切除残迹组(P＜0.05),国际膝关节文件编制委员会( IKDC)评级显著优于切除残迹组(P＜0.05). 结论 关节镜下由外向内建立骨隧道、保留残迹ACL重建术的远期临床效果,包括关节稳定性和关节功能,优于经典的经胫骨技术、切除残迹ACL重建术.     

残肝体积安全临界值的研究进展

肝脏切除术后发生肝功能代偿不全甚至肝衰竭与术后残肝体积大小密切相关。本文复习了相关文献,就近年国内外关于残肝体积研究的进展进行综述,主要包括肝体积与肝功能的关系、CT及三维重建技术在肝体积测量中的应用以及国内外残肝分数和标准残肝体积的研究等。     

Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen-thawed embryo transfer

A case of heterotopic triplet pregnancy after frozen-thawed embryo transfer is presented. The patient conceived after transfer of three frozen-thawed embryos at a fertility clinic where she had previously undergone laparoscopic left salpingectomy due to pyosalpinx. Approximately 4 weeks after the embryo transfer, she presented with a complaint of abnormal genital bleeding and was diagnosed by ultrasound as having a dichorionic twin pregnancy. One week later, she was referred to our hospital because of lower abdominal pain. Hematoperitoneum was suspected based on findings of low blood pressure and tachycardia. Diagnostic emergent laparoscopy demonstrated an ectopic pregnancy in the remnant isthmic portion of the left tube. Laparoscopic excision of the remnant fallopian tube was performed, but the procedure resulted in early-pregnancy loss of one of the twins. The risk of heterotopic pregnancy is not small under assisted reproductive technology. Attention should be paid to the risk of tubal pregnancy after transferring more than two embryos or controlled ovarian hyperstimulation, even after salpingectomy has been performed.     

L-精氨酸致大鼠残余肾代偿性增生与NO无关

目的　探讨L 精氨酸 (L arg)对肾大部切除大鼠 (SNx)残余肾代偿性增生的影响及其与一氧化氮 (NO)的关系。方法　采用 5 /6SNx为实验模型 ,实验组于手术后分别给予 1%L arg或NO供体Molsidomine(MSD)。实验分假手术 (Sham)、SNx、SNx L arg、SNx MSD 4组 ,观察指标为体重、残余肾重、肾重 /体重比 (KW/BW)、尿蛋白定量、血压、肌酐清除率 (Ccr)、残余肾代偿性增生比率 (CRG)、残余肾蛋白质、DNA含量、小管间质细胞增殖细胞核抗原 (PCNA)免疫组化表达、尿NO代谢产物NO-2 排泄量等。结果　L arg组大鼠尿残余肾代偿性增生指标 (KW、KW/BW、CRG、蛋白质、DNA及PCNA等 )较其对照组明显增加 (P分别小于 0 0 5 ,0 0 1) ,MSD组上述指标与SNx组相比无显著统计学差异 (P >0 0 5 )。L arg及MSD组NO-2 排泄量均较SNx组显著增加。结论　L arg可刺激大鼠残余肾代偿性增生 ,这种作用可能与NO无关     

270例胃切除术后的内镜下观察及临床分析

了解胃切除术后主要并发症的成因及在内镜下的表现。方法：分析２７０例胃切除术后因上消化道症状而行胃镜检查的结果。结果：本组中反流性食管炎占５．１９％,Ｂａｒｒｅｔｔ食管１．４８％,食管癌１．１１％,吻合口炎１５．９３％,残胃炎２８．８９％,胃及吻合口溃疡２６．６７％,胃癌１１．８５％,正常胃粘膜２８．８９％,缝线残留者２７．４７％。结论：术后残胃的主要并发症为炎症、溃疡、肿瘤。手术方式及缝线的选择均对术后并发症有影响,胃镜摘除术后残留缝线可减少部分并发症。     

Remnant cholesterol as a risk factor for all-cause and cardiovascular mortality in incident peritoneal dialysis patients

Background and aimsRemnant cholesterol (RC) adversely contributes to cardiovascular disease (CVD) and overall survival in various diseases. However, its role in CVD outcomes and all-cause mortality in patients undergoing peritoneal dialysis (PD) is limited. Therefore, we aimed to investigate the association between RC and all-cause and CVD mortality in patients undergoing PD.Methods and resultsBased on lipid profiles recorded using standard laboratory procedures, fasting RC levels were calculated in 2710 incident patients undergoing PD who were enrolled between January 2006 and December 2017 and followed up until December 2018. Patients were divided into four groups according to the quartile distribution of baseline RC levels (Q1: <0.40 mmol/L, Q2: 0.40 to <0.64 mmol/L, Q3: 0.64 to <1.03 mmol/L, and Q4: ≥1.03 mmol/L). Associations between RC and CVD and all-cause mortality were evaluated using multivariable Cox models. During the median follow-up period of 35.4 months (interquartile range, 20.9–57.2 months), 820 deaths were recorded, of which 438 were CVD-related. Smoothing plots showed non-linear relationships between RC and adverse outcomes. The risks of all-cause and CVD mortality increased progressively through the quartiles (log-rank, p < 0.001). Using adjusted proportional hazard models, a comparison of the highest (Q4) to lowest (Q1) quartiles revealed significant increases in the hazard ratio (HR) for all-cause mortality (HR 1.95 [95% confidence interval (CI), 1.51–2.51]) and CVD mortality risk (HR 2.60 [95% CI, 1.80–3.75]).ConclusionAn increased RC level was independently associated with all-cause and CVD mortality in patients undergoing PD, suggesting that RC was important clinically and required further research.