Prognostic Significance of Complications after Curative Surgery for Gastric Cancer

Background

Postoperative complications such as anastomotic leakage were reported to be a major independent prognostic factor for long-term survival in gastrointestinal malignancies. This study sought to clarify the prognostic significance of postoperative inflammatory complications specifically for patients with gastric cancer.

Methods

This study included 1,395 patients who underwent curative resection for gastric cancer from 2005 to 2008. Complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) and disease-specific mortality (DSM) were compared between complication and no-complication groups. Presence of complications was modeled by the Cox proportional hazard model for OS and the Fine and Gray competing risk regression model for DSM to assess the correlation between complication and prognosis.

Results

The median follow-up time was 3.1 years. Two hundred seven patients (14.8 %) had complications of grade 2 or higher. Of 131 patients who died within this period, 87 died of gastric cancer. The 3-year OS in the complication group was 84.1 % compared to 93.1 % in the no-complication group (P < 0.0001). The cumulative incidence of DSM was also significantly worse in patients with complications (P < 0.0001). Multivariate analysis identified the same significant increasing risk of complication for both OS (hazard ratio 1.88; 95 % confidence interval 1.26–2.80) and DSM (hazard ratio 1.90; 95 % confidence interval 1.19–3.02).

Conclusions

Postoperative complications that can cause prolonged inflammation have an obvious impact not only on the OS but also on the DSM of patients with gastric cancer even if the tumor is resected curatively.     

Comparison of the Loss of Renal Function after Cold Ischemia Open Partial Nephrectomy,Warm Ischemia Laparoscopic Partial Nephrectomy and Laparoscopic Partial Nephrectomy Using Microwave Coagulation

Purpose

Nephron sparing surgery is an effective surgical option in patients with renal cell carcinoma. Laparoscopic partial nephrectomy involves clamping and unclamping techniques of the renal vasculature. This study compared the postoperative renal function of partial nephrectomy using an estimation of the glomerular filtration rate (eGFR) for a Japanese population in 3 procedures; open partial nephrectomy in cold ischemia (OPN), laparoscopic partial nephrectomy in warm ischemia (LPN), and microwave coagulation using laparoscopic partial nephrectomy without ischemia (MLPN).

Materials and Methods

A total of 57 patients underwent partial nephrectomy in Yokohama City University Hospital from July 2002 to July 2008. 18 of these patients underwent OPN, 17 patients received MLPN, and 22 patients had LPN. The renal function evaluation included eGFR, as recommended by The Japanese Society of Nephrology.

Results

There was no significant difference between the 3 groups in the reduction of eGFR. eGFR loss in the OPN group was significantly higher in patients that experienced over 20 minutes of ischemia time. eGFR loss in LPN group was significantly higher in patients that experienced over 30 minutes of ischemia time.

Conclusion

This study showed that all 3 procedures for small renal tumor resection were safe and effective for preserving postoperative renal function.Key Words: eGFR, Partial nephrectomy, Renal function, Laparoscopic partial nephrectomy     

The colon displays an absorptive capacity of tacrolimus

PURPOSE: In our previous study, blood levels of orally administered tacrolimus were significantly higher in short bowel piglets than in control animals. It has been reported that the blood levels of tacrolimus are influenced by the metabolic activity of intestinal CYP3A4. If tacrolimus may be absorbed in the colon, direct administration of drug into this organ might be useful to augment bioavailability since the expression of CYP3A4 is low at this site. In the present study we evaluated the absorptive capacity of tacrolimus in the colon. MATERIALS AND METHODS: Piglets were divided into four groups: groups 1 and 2 were controls (n = 11 and 3, respectively); group 3 underwent resection of the entire small intestine (n = 8); and group 4 had a catheter placed in the cecum (n = 4). In groups 1 and 3, tacrolimus was administered orally; in group 2 it was given intravenously; and in group 4 it was injected into cecum through the catheter from postoperative days 3 to 7. On day 7, blood samples were obtained for drug measurements to calculate the area under the concentration time curve (AUC) values. RESULTS: The trough level and AUC values of tacrolimus in group 4 as well as in group 3 were significantly higher than those in group 1. In Group 4 animals showed a 60-minute time to peak concentration. CONCLUSIONS: Tacrolimus is absorbed by the colon. Since the blood levels were not influenced by the metabolic activity in the graft bowel, direct administration of tacrolimus into the colon might be useful in small intestinal transplantation.     

Effects of dietary potassium on the hemodynamics and plasma norepinephrine kinetics in patients with essential hypertension

The effects of dietary potassium on the hemodynamics and plasma norepinephrine (NE) kinetics were studied in 10 patients with borderline hypertension. Potassium supplement (96 mEq daily for 5-7 days) induced a significant (p less than 0.05) fall in blood pressure and a slight decrease in cardiac output. Both urine volume and urinary sodium excretion increased significantly (p less than 0.05) for a first few days following the potassium supplement. The baseline values of the half-time of the rapid NE removal from plasma was significantly delayed in the hypertensive patients (1.05 +/- 0.06 min, p less than 0.05) when compared with those (0.88 +/- 0.04) in normal controls. Potassium supplement induced a significant rise in both plasma NE levels and NE outflow rate (p less than 0.01) in the hypertensive patients, while their half-times were significantly shortened (0.89 +/- 0.07 min, p less than 0.01). The pressor responsiveness to exogenously infused NE tended to diminish during the potassium supplement. These findings indicate that a high potassium intake might accelerate the slowed neuronal NE uptake in the hypertensive patients, while a potassium-induced fall in blood pressure might exert a baroreflex stimulation of NE release. As a net result, an increased NE outflow into the circulation has been confirmed. It is likely that a natriuresis-induced volume contraction might be a predominant factor responsible for the early reduction of blood pressure during the high potassium intake.     

Peculiar mechanisms of graft recovery through anti-inflammatory responses after rat lung transplantation from donation after cardiac death

BackgroundAlthough lung transplantation from donation after cardiac death (DCD), especially uncontrolled DCD, is limited by warm ischemic periods, the molecular mechanism of warm ischemia–reperfusion-injury (IRI) has not been well elucidated. The purpose of this study was to clarify the particular longitudinal mechanisms of molecular factors involved in warm IRI.MethodsCold ischemic-time (CIT)-group lungs were retrieved and subjected to 3-h of cold preservation, whereas warm ischemic-time (WIT)-group lungs were retrieved after 3-h of warm ischemia. Orthotopic rat lung transplantation was performed and the grafts were reperfused for 1 or 4-h. The graft functions, gene expression, and activation of inflammatory molecules in the grafts were analyzed. Exhaled-carbon-monoxide-concentration (ExCO-C) was measured during reperfusion.ResultsOnly the WIT-group showed obvious primary graft dysfunction at 1-h reperfusion, but the graft function was recovered during 4-h reperfusion. Most of pro-inflammatory cytokines and stress-induced molecules showed different expression and activation patterns between CIT and WIT groups. In the WIT-group, the expressions of anti-inflammatory molecules, IL-10 and HO-1, were significantly increased at 1-h reperfusion compared to the CIT-group, and these high levels were maintained through 4-h reperfusion. Furthermore, ExCO-C levels in the WIT-group increased immediately after reperfusion compared to the CIT-group.ConclusionsThis study indicates that warm IRI may involve a different mechanism than cold IRI and anti-inflammatory pathways may play important roles in the graft recovery after lung transplantation from uncontrolled DCD.     

Evaluation of complications related to therapeutic colonoscopy using the bipolar snare

Background

The complications with therapeutic colonoscopy reported to date have been associated with the monopolar snare, and the frequency of complications related to use of the bipolar snare is uncertain. This study aimed too investigate the incidence of bleeding and perforation associated with the bipolar snare and to identify the risk factors for bleeding.

Methods

Between October 2001 and December 2008, all patients with colorectal polyps treated using the bipolar snare were enrolled in this retrospective study. Clinical data were assembled from an electronic database. The incidence of bleeding and perforation was investigated, and the risk factors for bleeding also were determined using multivariate analysis.

Results

This study collected 4,719 patients with 10,513 lesions. Perforation occurred for eight patients (0.17%) and bleeding in 66 patients (1.4%). Age younger than 60?years was a significant risk factor for bleeding (P?P?P?P?P?Conclusions The complication rates for the bipolar snare appear to be comparable with those for the monopolar snare based on comparison of the results reported in the literature. Age (<60?years), lesion size (??10?mm), macroscopic type (pedunculated), and lesion location (rectum) are independent risk factors for bleeding.     

Clinicoanatomical studies on the dorsal subsegmental bile duct of the right anterior superior segment of the human liver

BACKGROUND: The dorsal subsegmental intrahepatic bile duct in the right anterior superior segment (B8c) sometimes joins the posterior sectorial duct. In such cases it can be misidentified as the right posterior superior segmental duct (B7). However, there are no published studies on the confluent pattern of B8c. MATERIALS AND METHODS: We studied B8c in the resected liver of 107 patients (65 with bile duct carcinoma and 42 with gallbladder carcinoma) who had undergone right hepatectomy or more extensive right-sided liver resection. RESULTS: B8c was identified in all cases. It joined the right posterior sectorial duct or B7 in 18 cases (16.8%). In 12 cases B8c joined independently the posterior sectorial duct or B7. In 6 cases B8c joined the posterior sectorial duct after making the common duct with the lateral subsegmental duct in the anterior superior or anterior inferior segment (B8b or B5c). CONCLUSIONS: B8c does not join the anterior sectorial bile duct in every sixth case.     

Ascending aortic aneurysm associated with a quadricuspid aortic valve

We report here a rare case of ascending aortic aneurysm associated with a tricuspitalized quadricuspid aortic valve. A 45-year-old man had a fusiform ascending aortic aneurysm with aortic valve regurgitation. Transthoracic echocardiography revealed grade III aortic regurgitation. Chest computed tomography showed an ascending aortic aneurysm with a diameter of 48 mm. Surgery revealed that the aortic valve was a tricuspitalized quadricuspid aortic valve with an accessory cusp between the right coronary cusp and left coronary cusp.     

Effects of Prolonged Tendon Vibration Stimulation on Eccentric and Concentric Maximal Torque and Emgs of the Knee Extensors

The purpose of present study was to compare the effect of Ia afferent attenuation on the activity of alpha motor neuron (MN) during concentric and eccentric action. Eight male subjects were enrolled in the present study. The experiments consisted of two sessions of MVC measurements, since all subjects performed both maximal concentric and eccentric action. EMG signals were simultaneously measured. To establish the baseline of strength, subjects were asked to perform MVC of knee extension in each session. After finishing the measurements, 20 min of vibration stimulation was applied. Immediately after finishing vibration stimulation, the MVC and AEMG were again measured. The means of MVC for concentric knee extension at pre and post- vibration stimulation were 192.2 ± 49.3 Nm and 162.3 ± 47.9 Nm, respectively. The means of MVC for eccentric knee extension at pre and post-vibration stimulation were 299.7 ± 77.0 Nm and 247.3 ± 88. 6 Nm, respectively. Two-factor repeated ANOVA detected significant differences in the MVC. Both main effects for pre-post condition (F(1,7)=, p = 0.0033) and action (F(1,7)=26.35, p = 0.0013) were noted. No interaction effect (action x condition) was noted. The means of AEMG (vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF)) at pre and post -vibration stimulation were decreased. Two-factor repeated ANOVA detected significant differences in AEMG (VM and VL). Both main effects for pre-post condition (VL;F(1,7)=7.27, p = 0.0308, VM; F(1,7)=9.55, p = 0.0175) and action (F(1,7)=12.40, p = 0.0097) were noted in the VL and the VM but not in the RF. Furthermore, significant interaction (action x condition) effect was noted in the VM (F(1,7)=7.03, p = 0.0328) but not in the VL. The MVC and the EMG activity of the VL in response to the prolonged vibration stimulation were significantly reduced in eccentric contraction over concentric contraction. These results represented that a deactivation effect on the alpha MN of the VL during eccentric action was greater than that of concentric action.

Key points

• A deactivation effect on the alpha motor neuron of the vastus lateralis during eccentric action was greater than that of maximal concentric action.

Key words: Concentric contraction, MVC, Vibration stimulation, QF