Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers

Introduction

Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and gastroesophageal junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL).

Methods

A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and gastroesophageal junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications.

Results

In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response.

Conclusions

Minimally invasive Ivor Lewis esophagectomy for distal esophageal and gastroesophageal junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.

     

Enteral administration of high-fat nutrition before and directly after hemorrhagic shock reduces endotoxemia and bacterial translocation

OBJECTIVE: To determine whether potential enhancement of endotoxin neutralization via high-fat enteral nutrition affects endotoxemia and bacterial translocation after hemorrhage. SUMMARY BACKGROUND DATA: Endotoxin and bacterial translocation due to gut barrier failure are important initiating events in the pathogenesis of sepsis after hemorrhage. Systemic inhibition of endotoxin activity attenuates bacterial translocation and distant organ damage. Triacylglycerol-rich lipoproteins constitute a physiological means of binding and neutralizing endotoxin effectively. We hypothesized that enhancement of triacylglycerol-rich lipoproteins via high-fat enteral nutrition would reduce endotoxemia and prevent bacterial translocation. METHODS: A rat model of nonlethal hemorrhagic shock was used. Hemorrhagic shock (HS) rats were divided into 3 groups: rats starved overnight (HS-S); rats fed with a low-fat enteral diet (HS-LF), and rats receiving a high-fat enteral diet (HS-HF). RESULTS: Circulating triacylglycerol and apolipoprotein B, reflecting the amount of triacylglycerol-rich lipoproteins, were elevated in HS-HF rats compared with both HS-S rats (P 相似文献   

High-fat enteral nutrition reduces endotoxin, tumor necrosis factor-alpha and gut permeability in bile duct-ligated rats subjected to hemorrhagic shock

BACKGROUND/AIMS: Cholestatic patients are prone to septic complications after major surgery due to an increased susceptibility to endotoxin and hypotension. High-fat enteral nutrition reduces endotoxin after hemorrhagic shock. However, it is unknown whether this nutritional intervention is protective in biliary obstruction. We investigated the effect of high-fat enteral nutrition on endotoxin, tumor necrosis factor-alpha (TNF-alpha) and intestinal permeability in cholestatic rats subjected to hemorrhagic shock. METHODS: Bile duct-ligated (BDL) rats were fasted or fed with low-fat or high-fat enteral nutrition before hemorrhagic shock. Blood and tissue samples were taken after 90 min. RESULTS: Plasma endotoxin decreased after hemorrhagic shock in BDL-rats fed with high-fat nutrition compared to fasted (P<0.01) and low-fat treated rats (P<0.05). Additionally, circulating TNF-alpha was reduced in BDL-rats pretreated with high-fat nutrition compared to fasted rats (P<0.01). The increased intestinal permeability to macromolecules was reduced by high-fat enteral nutrition, whereas bacterial translocation did not significantly change. Simultaneously, tight junction distribution in ileum and colon was disrupted in non-treated BDL-rats but remained unchanged in high-fat pretreated BDL-rats. CONCLUSIONS: High-fat enteral nutrition protects against endotoxin-mediated complications independently of intraluminal bile. These results provide a potential new strategy to prevent endotoxin-mediated complications in cholestatic patients undergoing major surgery.     

Apoplectic lymphocytic hypophysitis. Case report

Pituitary apoplexy has not been reported in the setting of lymphocytic hypophysitis. The authors present the case of a woman with sudden vision loss and headache. Magnetic resonance imaging revealed focal hemorrhages in a sellar lesion with suprasellar extension. The results of histopathological analysis were consistent with lymphocytic hypophysitis.     

Anal erotic instrumentation

Anal sexual eroticism is a fact of modern life and a part of the male homosexual relationship. A delineation of surgical problems associated with anal erotic instrumentation with enema is presented. The cases of three patients with rectal perforation are described.     

Surgical treatment of scoliosis using a controlled dynamic device]

The article reports about the development of the original implanted device, ensuring externally controlled dynamic correction of scoliosis. The construction has been utilized with 6 patients with scoliosis of the IV degree. In 5 cases after operation was achieved the spine distraction of 10-37 mm. As the result, there was obtained an additional correction of the correcting arch from 6 degrees to 17 degrees as compared with achieved in the process of the operation.     

Small B-cell Lymphoma Presenting as Diffuse Dural Thickening with Cranial Neuropathies

The authors present a rare case of diffuse hypertrophy of the pachymeninges due to lymphomatous dural infiltration. This lymphoma arose late after orthotopic liver transplant, was Epstein–Barr virus (EBV)-negative, and arose in a setting of prior hepatitis C infection, a condition that may contribute to development of some non-Hodgkin's lymphomas. Biopsy of the dura demonstrated a small B-cell lymphoma, immunophenotypically most similar to those of mucosa-associated lymphoid tissues (MALT). Rapid expansion of the dura in this case resulted in profound hyperesthesia of the scalp, progressive blindness, deafness, and ataxia. As expected for MALT-lymphomas clinical symptoms responded well to cranial radiation.     

The Quest for a Unified Model of Anesthetic Action: A Century in Claude Bernard's Shadow

An accepted truism among clinicians and researchers attributes the persistence of the quest for a unitary mechanism of anesthetic action to the lasting influence of Hans Meyer and Ernest Overton. This article presents a different view: the experiments that led to the Meyer-Overton rule were the consequence-not the source-of a unitary paradigm that was formulated by Claude Bernard a quarter of a century earlier. Bernard firmly believed that the sensitivity to anesthesia was a fundamental criterion that separated 'true life' from 'mere chemistry.' Bernard's scientific authority in the context of 19 century natural philosophy is responsible for establishing a unified (i.e., unitary mechanism and universality across life forms) paradigm of anesthetic action. Meyer and Overton's work was targeted at systematizing and solidifying existing knowledge within this paradigm, not at discovering novelty, and its publication did not substantially affect contemporary research. Claude Bernard's paradigm, by contrast, still influences investigations of mechanisms of anesthetic action.     

眼底图像检验系统对眼底的临床观察与研究

目的观察眼底图像检验系统应用于临床眼底检查的有效性和安全性。方法将60名男女志愿者(120眼)随机均分为小瞳(免散瞳)组和散瞳组,对两组视盘、边界、中心凹、血管的成像清晰度进行比对分析。结果有别于目前进口与国产的眼底照相机所获取图像的差异性,眼底图像检验系统对眼底的检测比直接检眼镜更优,不差于眼底照相机,在临床上可获得更真实的图像。结论眼底图像检验系统可应用于临床,可作为免散瞳和便携的检眼镜,以眼底为特征的观察有临床价值与诊断意义。