Predictive Ability of the Five-time Chair Stand Test for Postoperative Pneumonia after Minimally Invasive Esophagectomy for Esophageal Cancer

Annals of Surgical Oncology - The revised sarcopenia guidelines proposed handgrip strength (HGS) and five-time chair stand test (5-CST) as the primary parameters of muscle function. HGS and 5-CST...     

Successful perioperative infection control measures after gastroenterological surgery reduced the number of cases of methicillin-resistant Staphylococcus aureus or Clostridioides (Clostridium) difficile infection to almost zero over a 30-year period: a single-department experience

To investigate changes in the incidence of postoperative infections in the surgical department of a teaching hospital. During the 30-year period from September 1987 to August 2017, 11,568 gastroenterological surgical procedures were performed in our surgical department. This 30-year period was divided into seven periods (A–G), ranging from 2 to 7 years each and based on the infection control methods used in each period. We then compared the rates of incisional surgical site infection (SSI) and organ/space SSI; remote infection (RI) including respiratory tract infection (RTI), intravascular catheter-related infection, and urinary tract infection (UTI); and antibiotic-associated colitis caused by methicillin-resistant Staphylococcus aureus (MRSA) enteritis or Clostridioides (Clostridium) difficile-associated disease (CDAD) among the seven periods. In periods B (September 1990–August 1997) and E (November 2004–July 2007), when a unique antibiotic therapy devised in our department was in use, MRSA was isolated from only 0.3% and 0.4% of surgical patients, respectively, and these rates were significantly lower than those in the other periods (p < 0.05). The rate of CDAD increased during period F (August 2007–July 2014), but in period G (August 2014–August 2017), restrictions were placed on the use of antibiotics with a strong anti-anaerobic action and, in this period, the rate of CDAD was only 0.04%, which was significantly lower than that in period F (p < 0.05). Limiting the use of antibiotics that tend to disrupt the intestinal flora may reduce the rates of MRSA infection and CDAD after gastroenterological surgery.     

Dipeptidyl Peptidase-4 Inhibitor (Vildagliptin) Improves Glycemic Control After Meal Tolerance Test by Suppressing Glucagon Release

Aim

We aimed to evaluate changes in insulin and glucagon secretion, as well as glucose levels, with a meal tolerance test (MTT) before and after 6 months of treatment with vildagliptin in a clinical setting.

Materials and Methods

Participants were 15 patients with uncontrolled type 2 diabetes mellitus (glycated hemoglobin [HbA_1c] over 6.9 % for more than 3 months). MTTs were conducted before and 6 months after addition of vildagliptin (50 mg twice daily [bid]). Blood samples were collected immediately before, and 1 and 2 h after the test meal for measurement of blood glucose concentration, immune-reactive insulin (IRI), and glucagon. HbA_1c was measured at 6 months.

Results

Mean age of participants was 55.5 ± 2.8 years, and ten (66.7 %) were male. Mean HbA_1c significantly improved from 7.6 to 6.8 % at 6 months after addition of vildagliptin. Blood glucose at 1 and 2 h after the test meal was significantly reduced after addition of vildagliptin, while the reduction in glucagon showed borderline significance and IRI showed no difference. In a comparison of blood glucose-related parameters between subgroups based on median glucose change in area under the curve during MTT (ΔAUC_0–2h), glucagon ΔAUC_0–2h was significantly lower in the group with more improved glucose levels (ΔAUC_0–2h ≥65 mg/dL), but that of IRI did not differ.

Conclusion

Suppression of glucagon release by vildagliptin may improve glycemic control without increasing insulin levels in patients with type 2 diabetes.     

Multiple Hepatic Vein Reconstruction Using an All-in-one Sleeve Patch Graft Technique in Living Donor Liver Transplantation: A Case Report

Maintaining hepatic inflow and appropriate venous drainage is important for maximizing the capacity of the retrieved graft in liver transplantation. Here, we report a successful case of multiple hepatic vein (HV) reconstruction using an all-in-one sleeve patch graft of the autologous great saphenous vein to ensure adequate blood flow through the HV. A patient with hepatocellular carcinoma caused by hepatitis C virus–induced cirrhosis underwent living donor liver transplantation using a right lobe graft. A preoperative dynamic computed tomography scan and intraoperative findings revealed that the graft had three middle HV tributaries, a superficial vein, segment VIII HV (V8), and segment V HV (V5). The openings of the superficial vein and V8 were located very close to that of the right hepatic vein (RHV) in the cutting surface. Each HV had significant diameter and drainage territory requiring reconstruction. An autologous great saphenous vein was used to create a sleeve patch to incorporate the close-packed HV openings. The autologous sleeve patch graft was sutured to the openings of the RHV and the superficial vein and the hole created on the sleeve patch graft was anastomosed to the openings of V8 directly on the back table to create an all-in-one sleeve patch. For the V5 reconstruction, the recipient's intrahepatic portal vein graft was used to create an interpositional conduit from the recipient's V5 to the inferior vena cava. The postoperative course was uneventful and postoperative studies revealed good graft function with excellent blood flow in the HV.     

An intra-abdominal desmoid tumor difficult to distinguish from a gastrointestinal stromal tumor: report of two cases

Desmoid tumors are benign fibroblastic neoplasms with no metastatic potential, but a propensity for local recurrence even after complete surgical resection. These lesions can develop at any site in the body, and commonly occur in the intra-abdominal area. Intra-abdominal desmoid tumors usually occur at the mesentery or retroperitoneum, and may morphologically mimic gastrointestinal stromal tumors (GISTs). Distinguishing between these tumors is important, because the therapies differ substantially, but is often difficult even with the use of CD117 staining. We herein report the cases of two patients with sporadic intra-abdominal desmoid tumors that were differentiated from GIST by immunohistological examination using beta-catenin and CD34. Desmoid tumors specifically express nuclear beta-catenin, and show no expression of CD34. We recommend staining for beta-catenin and CD34 when an intra-abdominal desmoid tumor is suspected.     

Spirometric and radiological evaluation of the remnant lung long after major pulmonary resection: can compensatory phenomena be recognized in clinical cases?

Purposes

The purpose of this study was to investigate the compensatory phenomena after lung resection in clinical cases by evaluating the spirometric and radiological parameters.

Methods

Forty patients undergoing lobectomy for stage IA lung cancer were divided into the following groups: (A) patients with <10 (n = 20) and (B) patients with ≥10 resected subsegments (n = 20). Comparisons were made of the predicted and observed postoperative values of spirometry and radiological parameters, such as lung volumetry and the “estimated lung weight”. Predicted values were based on the number of resected subsegments. The postoperative time to re-evaluation was at least 1 year for both groups.

Results

The predicted postoperative values of spirometry underestimated the actual values, and the differences were more significant in group B (forced vital capacity, p = 0.006, forced expiratory volume in 1 s, p = 0.011). Focusing on the remnant lungs on the surgical side, group B had significantly larger % postoperative lung volumes (161 ± 6.0 %) and % estimated lung weight (124 ± 5.4 %) than did group A (114 ± 3.8 %, p < 0.0001; 89.5 ± 4.4 %, p < 0.0001, respectively).

Conclusions

Major lung resection in clinical cases causes a compensatory restoration of the pulmonary function and tissue.     

Pure laparoscopic pancreas parenchymal dissection using CUSA for distal pancreatectomy

Although stapler dissection and closure is commonly used for laparoscopic distal pancreatectomy (LDP), it is risky in patients with thick pancreatic parenchyma or titanium allergy. We performed laparoscopic pancreatic parenchymal dissection with cavitron ultrasonic surgical aspirator (CUSA) successfully in a patient with titanium allergy. Slinging the pancreas with nylon tape delineates the surgical plane. Pancreatic parenchyma was transected by CUSA in an almost bloodless field. Pancreatic duct branches and vessels were adequately exposed and dissected with a vessel sealing system. The main pancreatic duct was closed with Hem-O-lock. CUSA is an alternative to stapler dissection during LDP in select patients.     

Therapeutic strategy for hemorrhagic radiation proctitis--the optimum condition of argon plasma coagulation (APC)]

AIM: This study was performed to clarify the optimum condition of argon plasma coagulation (APC) to treat hemorrhagic radiation proctitis. SUBJECTS: Among 25 patients with hemorrhagic radiation proctitis treated in the Cancer Institute Hospital between December 2000 and May 2004, 18 were followed-up for more than 6 months. The clinical courses of these 18 patients were analyzed retrospectively. METHODS: Proctoscopic findings of the hemorrhagic lesions were categorized as type-A (localized dilated veins, n = 6) , type-B (diffuse dilated veins, n = 6), and type-C (dilated veins associated with ulcers orerosions, n = 6). APC was applied for 5-10 seconds with the power of 40 W and the argon flow of 1.0 l/min (high power APC), or for 1-2 seconds with the power of 40 W and the argon flow of 0.6 l/min (low power APC). RESULTS: Type-A and B patients were successfully treated with either low or high power APC without any serious complications. But some type-C patients treated with high power APC showed serious complications such as proctovaginal fistula or prolonged ulceration. No recurrence patients were 89% (16/18) during the mean follow up period of 18 +/- 9.9 months. CONCLUSION: APC therapy for hemorrhagic radiation-proctitis was useful, but the pathologic healing process and consequence were different by rectal mucosal weakness. It is necessary for the therapeutic strategy to be put up and down according to proctoscopic findings. As for the optimum condision APC short cauterization by low power setting was more recommended.     

Microsurgical technique used in right anterior segmentectomy and pancreatoduodenectomy with reconstruction of the right posterior hepatic artery for widespread bile duct cancer involving the hepatic hilus

A microsurgical technique was used in performing anterior hepatic segmentectomy and pancreatoduodenectomy with reconstruction of the posterior hepatic artery in a 64-year-old man with widespread bile duct cancer from the intrapancreatic bile duct over the hepatic hilus. The anterior hepatic artery was obviously involved and the posterior hepatic artery just behind common hepatic duct was very close to the cancer. Microsurgical anastomosis between the remnant gastroduodenal artery and the posterior hepatic artery at the hepatic hilus made it possible to preserve the posterior segment of the liver and to perform a curative resection of the cancer. The patient had pyrexia because of suprahepatic abscess after the operation, but the abscess drained spontaneously. Postoperative arteriogram showed neither obstruction nor kinking of the reconstructed artery. He was discharged 2 months after surgery and has been enjoying a normal quality of life for 10 months since, with no signs of recurrence. It is suggested that a microsurgical technique is useful for performing an accurate anastomosis with good patency that allows not only a safe but also a highly curative operation for advanced bile duct cancer.