Non-cardia gastric adenocarcinoma more than 5 years after laparoscopic sleeve gastrectomy: A case report and literature review

Obesity is associated with an increased risk of several cancers including adenocarcinomas of the esophagus and gastric cardia but not with distal gastric cancer (GC). Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure. We report the fifth case in the medical literature of non-cardia gastric adenocarcinoma 63 months after LSG in a 26-year-old woman with no known recognizable risk factors. Among these five cases, the median (range) age at time of diagnosis of GC was 47 (26-64) years, the body mass index (BMI) prior to LSG was 47 (35.3-65.1) kg/m², the BMI at time of cancer diagnosis was 32 (29.3-47.0) kg/m², and the interval between LSG and diagnosis was 54 (9-63) months. Nonetheless, the link between LSG and the risk of GC remains skeptical and is discussed.     

Indications for laparoscopic colorectal resections--also for cancers?

In the last decade, laparoscopy has dramatically changed colonic surgery. Laparoscopic procedures are applied to the treatment of almost all colonic diseases, including both benign and malignant lesions. Significant benefits can be expected with a laparoscopic approach relative to decreased pain, ileus, length of hospital stay, disability, and possibly, adhesion formation and subsequent bowel obstruction, and improved cosmesis. However, all those benefits are secondary in the treatment of cancer; tumor-free survival must be the primary goal. Early comparative studies have shown that laparoscopic colectomy for cancer is safe, feasible, and an oncologic adequate resection can be performed with acceptable operative times and conversion rates. The most recent results of prospective randomized trials are now showing similar survival and cure rates after laparoscopic colectomy. There is evidence that laparoscopic colectomy for curable cancer results in equivalent cancer related survival compared to open colectomy when performed by experienced surgeons. The surgical techniques are demanding and require a level of standardization to achieve success. Laparoscopic colorectal surgery for cancer will have a definite role in the future.     

Tea for Tooth

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Writing for publication: a new skill for nurses?

In this article, we outline a voluntary staff development course – Writing for Publication – and its operation in the context of changing policy, practice and professional demands. One year from course completion we are in a position to discuss its success. We argue that, in a small but significant way, a paradigm shift in nursing is reflected in requests for the course, and for places on it. Clearly, there are new professional needs to be met.     

Endovascular training for obstetrician‐gynecologists: Suggestions for credentialing

This article suggests guidelines for training and credentialing of obstetrician‐gynecologists to perform endovascular procedures. It concentrates on the performance of uterine artery embolization for symptomatic myomata. Comparison is made between other recommended case numbers for credentialing of surgeons, radiologists, and cardiologists. Educational courses are discussed, as are the credits obtained for a typical uterine artery embolization. Two paradigms of endovascular credentialing are appropriate for comparison: Cardiology standards for coronary artery interventions and vascular surgery standards for endovascular stent placement. Both require a course including laboratory and participation in 100 cases, 50 of which as primary operator. In addition, many countries require a certificate of fluoroscopy safety. A credentialing board will be created to verify both the standards and completion of course requirement and proctored cases. Credentialing will benefit both patients and obstetrician gynecologists who will be able to provide continuity of care not currently available. The gynecologist will be able to manage all complications, including myomata, which cannot be done under current circumstances.     

Bariatric surgery for morbid obesity--a cure for metabolic syndrome?

At present there is no single medication that targets the metabolic syndrome directly. Bariatric surgery, a treatment option for morbidly obese individuals who fail medical therapy, has been shown to be very effective in treating multiple aspects of the metabolic syndrome. The decrease in insulin resistance is because of significant weight loss and by enhancing secretion of gut hormones such as glucagon-like peptide-1 (GLP-1).