Delayed gastric emptying in gastroesophageal reflux disease: the role of malrotation

The association between gastroesophageal reflux (GER) and intestinal malrotation (IM) has been well described. Delayed or impaired gastric emptying in IM is thought to be a contributing factor in the development of gastroesophageal reflux disease (GERD). The current study assessed the role of malrotation in delayed gastric emptying in children with GERD. We also evaluated the interactions between GERD, malrotation, gastric pH abnormalities, and gastric dysmotility. Sixty-seven patients between 1 and 5 years of age (mean 3.08±1.2) and with symptoms of GER, such as emesis, reactive or recurrent lung disease, and/or growth retardation, were studied in 2001–2005. Upper and lower gastrointestinal contrast studies were performed for the diagnosis of malrotation. Gastric motility was evaluated with a liquid gastric emptying protocol. GER was documented by upper gastrointestinal studies, scintigraphy, and/or 24-h pH monitoring. In our series of 44 children with GERD, there was an unexpectedly high incidence of IM: 54.5% (24/44). IM has previously been known to occur in 25% of patients with GERD. GERD was found in 24 (82.7%) of 29 patients with IM. Mean nuclear gastric emptying (MNGE) was 51.6±8.04 min in patients with isolated GERD and 96.6±20.5 min in children with IM and GERD. There was a statistically significant difference in MNGE time (p<0.05) between children with primary GERD and in those with GERD and IM. Esophageal pH monitoring showed that mean fraction time below pH 4 was 7.06±1.1% in patients with isolated GERD and 14.7±4.1% in patients with IM and GERD. GERD is common in children between 1 and 5 years old. Using gastric emptying studies and esophageal pH monitoring, we have shown that gastric dysmotility and esophageal pH abnormalities are highly prevalent, especially in children with malrotation compared with children with isolated GERD. These findings suggest that malrotation is an important factor responsible for delayed gastric emptying in GERD. Hence, we recommend that all infants and children with GERD and delayed gastric emptying undergo careful evaluation for malrotation.     

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: an anatomical and technical study

OBJECTIVE: To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery. MATERIALS AND METHODS: The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1-2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2-3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA. RESULTS: The average diameter of the MA proximal to the infraorbital artery branch was 2.6+/-0.3 mm. The average diameter of the P2 was 2.2+/-0.2 mm. The average length of the graft was 47+/-5.2 mm. CONCLUSION: As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to "ECA to PCA" bypass.     

Efficacy of intraperitoneal cisplatin as consolidation therapy in patients with pathologic complete remission following front-line therapy for epithelial ovarian cancer. Consolidative intraperitoneal cisplatin in ovarian cancer

OBJECTIVE: The aim of this study is to evaluate the efficacy of intraperitoneal cisplatin as consolidation treatment in epithelian ovarian cancer patients with complete pathologic response following front-line platin-based chemotherapy. PATIENTS AND METHODS: Thirty patients who had no evidence of disease as assessed by second-look laparotomy following chemotherapy for stage III epithelial ovarian cancer were given three courses of intraperitoneal cisplatin (100 mg/m(2)) with three weekly intervals as consolidation therapy. RESULTS: Median age was 50 years. After a median follow-up period of 37 months, 16 patients are being followed with no evidence of disease. Eleven patients developed recurrent disease. Median disease-free survival was 50 months. Median overall survival is not reached. WHO grades 3-4 toxicity criteria were emesis in 19 patients (63.3%), abdominal pain in 5 (16.7%) and nephrotoxicity in 2 (6.7%) patients. Catheter-related complications were infection/peritonitis in one and catheter malfunction in one patient. There were no serious hematologic side effects that required transfusions or caused treatment delays. None of the patients developed serious neurologic toxicity. Treatment had to be stopped early in four patients who refused further treatment due to abdominal pain, nausea ::and vomiting. Dose reductions were required in five patients.CONCLUSION: Our results suggest that intraperitoneal cisplatin is a feasible regimen that may provide a favorable outcome in terms of progression-free survival in patients with a complete pathologic response following front-line treatment for ovarian cancer. Further randomized trials are required to evaluate the role of consolidation treatment in this setting.     

Ovarian transplantation in humans: indications, techniques and the risk of reseeding cancer

Laboratory research on ovarian cryopreservation and transplantation began in the 1950s leading to clinical studies in the 2000s. The research that was performed during this half century indicated that cryopreserved ovarian tissue has the potential to restore fertility in women who face premature ovarian failure due to chemotherapy, radiotherapy or surgery. To date, ovarian function has been restored in at least four women. Even though no pregnancies have been reported so far from these clinical studies, animal studies indicate that this is a valid prospect for humans. Future clinical trials will determine on a larger number of patients the longevity of ovarian grafts, normality of hormone production and ovarian follicle development, possibility and safety of pregnancy, and the safety of auto-transplantation in cancer patients. However, the major improvement in the efficiency of ovarian transplantation is anticipated to come from research exploring the revascularization process.     

Effect of human pancreatic juice and bile on the tensile strength of suture materials

BACKGROUND: Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. METHODS: Plain and chromic catgut, polyglactin 910, polyglycolic acid, polydioxanone, polypropylene, and silk sutures were incubated in pancreatic juice and bile that was collected from patients. Fifteen samples of each type of suture material were placed in human juices for 1, 3, and 7 days. Tensile strengths were measured with a tensionmeter. RESULTS: Plain and chromic catgut disintegrated in pancreatic juice and pancreatic juice plus bile mixture. Polyglycolic acid and polyglactin 910 suture materials were vulnerable to pancreatic juice within 7 days. Polydioxanone retained most of its initial strength in pancreatic juice and bile. Polypropylene and silk retained 84% and 92% of their initial strength, respectively. CONCLUSIONS: We found that polidioxanone was the strongest suture material in pancreatic juice.     

Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience

BACKGROUND: Division of the sternum is primarily a blind procedure in reoperation and carries an increased risk of injury for major cardiac structures in the presence of adhesions between the posterior table and the heart. METHODS: Two hundred patients were randomly divided into two groups. Cardiopulmonary bypass was established through the femoral artery and vein in group 1 (n = 100) patients before sternal reentry. Carpentier dual-stage femoral venous return cannula was used in all group 1 patients. Cardiopulmonary bypass was performed after sternal reentry in group 2 (n = 100) patients. RESULTS: Six severe cardiac injuries developed in group 2. Cardiopulmonary bypass time was 93 +/- 9 minutes in group 1 and 71 +/- 11 minutes in group 2 (p = 0.011), and the operation time was 155 +/- 23 minutes in group 1 and 185 +/- 32 minutes in group 2 (p = 0.024). Inotropic therapy was required in 52 patients in group 1 and 76 patients in group 2 (p = 0.032). Average chest drainage was 450 +/- 135 mL in group 1 and 850 +/- 250 mL in group 2 (p < 0.001). Average fresh whole blood transfusion was 3.3 +/- 1.2 U in group 1 and 5.8 +/- 0.9 U in group 2 (p = 0.033). Average intensive care unit stay was 2.2 +/- 1.3 days in group 1 and 4.5 +/- 2.3 days in group 2 (p = 0.025). Average hospital stay was 7.3 +/- 2.4 days in group 1 and 9.1 +/- 3.1 days for group 2 (p = 0.011). CONCLUSIONS: Cardiopulmonary bypass by bicaval Carpentier femoral venous cannula before resternotomy not only allows adequate cardiopulmonary bypass flow but also significantly reduces the risk of cardiac injury and catastrophic hemorrhage and allows safe reopening. Although this procedure increases cardiopulmonary bypass time, the operation time, bleeding, and blood transfusion requirement are significantly reduced.     

Erythropoietin exerts neuroprotection after acute spinal cord injury in rats: effect on lipid peroxidation and early ultrastructural findings

Lipid peroxidation has been reported to play an important role in spinal cord injury (SCI). Erythropoietin (EPO) is a hematopoietic growth factor that stimulates proliferation and differentiation of erythroid precursor cells and is also known to exert neurotrophic activity in the central nervous system. The purpose of this study was to investigate the effectiveness of recombinant human EPO in attenuating the severity of experimental SCI. Rats were divided into seven groups. Controls (1) received only laminectomy. The trauma-only group (2) underwent 50-g/cm contusion injury and had no medication. In group 3, 30 mg/kg of methylprednisolone was introduced. The vehicle group (4) received vehicle solution containing human serum albumin, which is a solvent of EPO. Groups 5, 6, and 7 received 100 IU/kg, 1,000 IU/kg, and 5,000 IU/kg of EPO, respectively. All treatments were given as single doses, intraperitoneally, immediately after injury. Thiobarbituric acid-reactive substances were estimated to demonstrate lipid peroxidation, and ultrastructure was evaluated by electron microscopy. The results showed that lipid peroxidation by-products increased after injury. Administration of EPO and methylprednisolone sodium succinate (MPSS) reduced thiobarbituric acid-reactive substances after trauma. The best biochemical results were obtained with 5,000 IU/kg of EPO. Electron microscopic findings showed that EPO protected the spinal cord from injury. Although 1,000 IU/kg and 5,000 IU/kg of EPO inhibited lipid peroxidation better than MPSS, ultrastructural neuroprotection was similar.