Influence of aortic dissection on the clotting-fibrinolysis system and platelet function

Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. This study was designed to clarify the influence of acute aortic dissection on the clotting-fibrinolysis system and platelet function. From January 1993 to December 1994 21 patients with proven Stanford type B aortic dissection underwent a series of tests and procedures at our institution. There were 6 women and 15 men, aged 37–74 years (mean 62 years). All patients were admitted within 14 days of onset of dissection. No patient had complications requiring surgery and none died during the observation period. We observed a severe inflammatory reaction with activation of the clotting-fibrinolysis system immediately after onset of dissection. The platelet maximum aggregation rates were also decreased transiently after onset of the dissection. D-dimer values remained elevated throughout, the observation period. A rational approach to the surgical treatment of acute aortic dissection should involve coping with its activated clotting-fibrinolysis system and platelet dysfunction in addition to tissue friability.     

Comparison of Billroth I and Roux-en-Y Reconstruction after Distal Gastrectomy for Gastric Cancer: One-year Postoperative Effects Assessed by a Multi-institutional RCT

Purpose

This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer.

Methods

The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group.

Results

The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis.

Conclusions

RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.