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Sample records for curative distal gastrectomy

  1. Cutaneous metastases from gastric adenocarcinoma 15 years after curative gastrectomy.

    PubMed

    Liu, Fang; Yan, Wen Liang; Liu, Haibo; Zhang, Min; Sang, Hong

    2015-01-01

    We report the case of a 38-year-old man, who developed cutaneous metastases in the left inguinal groove 15 years after curative gastrectomy for advanced gastric adenocarcinoma. Histopathologic examination revealed poorly differentiated adenocarcinoma cells. They were stained positive for villin, CDX-2, CKpan (AE1/ AE3), CEA, CK8/18, CK19, CK7, EMA, Ki-67 (50%), and negative for S-100, CK20, CD34, GCDFP-15 and TTF-1. The patient underwent local excision, after the presence of other metastases was excluded. Nevertheless, local recurrence developed at the surgical bed one year later and PET/CT revealed metastases to lymph nodes, bone and skin. He died 2 years after the appearance of cutaneous metastases. We have reviewed the literature and described the immunohistochemical characteristics of cutaneous metastases from gastric adenocarcinoma. PMID:26312672

  2. Current status in remnant gastric cancer after distal gastrectomy

    PubMed Central

    Ohira, Masaichi; Toyokawa, Takahiro; Sakurai, Katsunobu; Kubo, Naoshi; Tanaka, Hiroaki; Muguruma, Kazuya; Yashiro, Masakazu; Onoda, Naoyoshi; Hirakawa, Kosei

    2016-01-01

    Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis. PMID:26937131

  3. Secondary omental infarction related to open and laparoscopic-assisted distal gastrectomy: report of two cases.

    PubMed

    Park, Kyung Eun; Chung, Dong Jin; Kim, Wook; Hahn, Seong-Tae; Lee, Jae Moon

    2011-01-01

    Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

  4. Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach

    PubMed Central

    You, Yung Hun; Ahn, Dae Ho

    2015-01-01

    Purpose Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon. Materials and Methods Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups. Results MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity. Conclusions This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon. PMID:26819806

  5. Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

    PubMed Central

    Qi, Jin; Zhang, Peng; Wang, Yanan; Chen, Hao; Li, Yumin

    2016-01-01

    Background/Aims Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer. Methodology A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis. Results Ten retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0

  6. A drainage operation for injury to the pancreas preserved the distal pancreas, spleen and the residual stomach after distal gastrectomy: a case report.

    PubMed

    Watanabe, Toshihiro; Kimura, Wataru; Yano, Mitsumasa; Hachiya, Osamu; Ma, Jinfeng; Fuse, Akira

    2007-01-01

    We experienced a case in which a drainage operation for injury of the pancreas preserved the distal pancreas, spleen and the residual stomach after distal gastrectomy for complete laceration of the stomach. A 23-year-old male was crushed by a large truck while driving a car without a seat belt. Abdominal computed tomography (CT) scan showed a low-density area in and around the body of the pancreas, which suggested contusion of the pancreatic parenchyma. An emergent operation was indicated due to free air and massive bleeding in the abdominal cavity and liver damage. At the operation, the antrum of the stomach was completely lacerated and distal gastrectomy was performed. Drains were set around the body of the pancreas. Distal pancreatectomy with splenectomy would have led to total gastrectomy because of lack of blood supply to the residual stomach after distal gastrectomy. We limited the drainage operation for pancreatic trauma. As a result, the pancreatic body and tail were preserved, which is thought to be a much better long-term result for this patient. PMID:18251137

  7. Risk Factors for Food Residue after Distal Gastrectomy and a New Effective Preparation for Endoscopy: The Water-Intake Method

    PubMed Central

    Cho, Sung-Bum; Yoon, Kyoung-Won; Park, Seon-Young; Lee, Wan-Sik; Park, Chang-Hwan; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu

    2009-01-01

    Background/Aims Food residue is frequently observed in the gastric remnant after distal gastrectomy, despite adequate preparation. We devised a water-intake method to reduce food residue in the gastric remnant by drinking large quantities of water in a short time. The aims of this study were to identify the risk factors for food residue and to study the effectiveness of this new method for endoscopy preparation. Methods A cohort of 708 patients who underwent distal gastrectomy for gastric cancer was reviewed prospectively. Sixty patients with large amounts of food residue were randomly divided into two groups: a water-intake group (n=40) and a prolonged fasting group (n=20). Results The incidences of a large amount of food residue were 15.7%, 5.8%, 7.5%, and 2.8% at 3, 12, 24, and 36 months, respectively, after distal gastrectomy. Independent risk factors for food residue were endoscopy at 3 months, diabetes mellitus, a body mass index of <19.5, and laparoscopic surgery. The proportion of successful preparations at follow-up endoscopy was higher for the water-intake group (70%) than for the prolonged fasting group (40%, p=0.025). Conclusions The water-intake method can be recommended as a preparation for endoscopy in patients who have had repetitive food residue or risk factors after distal gastrectomy. PMID:20431744

  8. Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer.

    PubMed

    Hotta, T; Taniguchi, K; Kobayashi, Y; Johata, K; Sahara, M; Naka, T; Terashita, S; Yokoyama, S; Matsuyama, K

    2001-01-01

    We evaluated postoperative function in 98 patients who underwent surgery for early gastric cancer between 1995 and 1998 to compare the results of pylorus-preserving procedures to those of conventional distal gastrectomy with Billroth I (B-I). The pylorus-preserving procedures included endoscopic mucosal resection (EMR), performed in 12 patients; local resection (Local), performed in 14 patients; segmental resection (Seg), performed in 8 patients; and pylorus-preserving gastrectomy (PPG), performed in 19 patients. B-I was performed in 45 patients. The nutritional status and serum albumin (Alb) levels after PPG, the hemoglobin (Hb) levels after EMR, Local, and PPG, and the present/preoperative body weight ratios after EMR, Local, Seg, and PPG were superior to those after B-I. The time before oral intake was recommenced after EMR and Local, the volume of oral intake tolerated after EMR, Local, Seg, and PPG, and the postoperative hospital stay after EMR were all superior to those after B-I. Moreover, significantly fewer patients suffered reflux symptoms after EMR, Local, and PPG, abdominal fullness after EMR, and early dumping syndrome after EMR, Local, and PPG than after B-I. There was also less evidence of gastritis after EMR, Local, and PPG, and of bile reflux after EMR, Local, and PPG, than after B-I. These findings indicate that pylorus-preserving procedures may result in a better postoperative quality of life for selected patients with early gastric cancer.

  9. Strategic approach to concurrent aberrant left gastric vein and aberrant left hepatic artery in laparoscopic distal gastrectomy for early gastric cancer: A case report

    PubMed Central

    Kuwada, Kazuya; Kikuchi, Satoru; Hori, Naoto; Kubota, Tetsushi; Nishizaki, Masahiko; Kagawa, Shunsuke; Fujiwara, Toshiyoshi

    2015-01-01

    Abstract An aberrant left gastric vein (ALGV) directly entering the lateral segment of the liver is a rare variation in the portal vein system, whereas an aberrant left hepatic artery (ALHA) arising from the left gastric artery is observed relatively frequently. Here we report a case in which both ALGV and ALHA were encountered before laparoscopic distal gastrectomy with curative lymphadenectomy for gastric cancer. We accurately diagnosed these vessel anomalies preoperatively on abdominal contrast‐enhanced CT. During surgery, we divided the ALGV at the point of entry to the liver and preserved the ALHA by dividing the branches toward the stomach, in consideration of curability and safety. The postoperative course was uneventful overall, although temporary mild liver dysfunction was observed. This case highlights the importance of preoperative evaluation and preparation in a rare case of concurrent ALGV and ALHA. PMID:26708584

  10. Factors Influencing Clinicians' Choice of Adjuvant S-1 versus Capecitabine plus Oxaliplatin after Curative Gastrectomy in Patients with Gastric Cancer

    PubMed Central

    Lee, Ha Yeon; Hwang, In Gyu; Park, Song-Ee; Kim, Moon Jin; Park, Se Hoon; Kang, Jung Hun; Kim, Young Saing; Oh, Sung Yong; Won, Young-Woong; Lee, Soon Il; Ji, Jun Ho; Chi, Kyong-Choun

    2016-01-01

    Purpose: Two recent randomized, phase III trials in Asia (ACTS-GC and CLASSIC) documented the survival benefit of postoperative chemotherapy after D2 lymph node dissection in patients with gastric cancer. We sought to determine what factors influenced clinicians' choices of either S-1 or capecitabine plus oxaliplatin (CAPOX) as adjuvant therapy after curative D2 gastrectomy. Materials and Methods: We retrospectively reviewed the clinicopathologic factors and adjuvant treatments for 435 patients from nine centers in Korea who were treated with either S-1 or CAPOX adjuvant chemotherapy after undergoing curative D2 gastrectomy between January 2013 and July 2014. Results: Of the 435 patients, 204 (46.9%) were treated with S-1 and 231 (53.1%) were treated with CAPOX. The median age at diagnosis was 61 years (range, 30-88). CAPOX was prescribed more often for patients who were 65 years of age or younger than for patients who were age 65 or older (77.1% vs. 22.9%, P<0.0001). Of the patients in stage II, 121 (60.8%) were treated with S-1 and 78 (39.2%) were given CAPOX; however, of those in stage III, 83 (35.2%) received S-1 and 153 (64.8%) were treated with CAPOX (P<0.0001). Conclusions: Clinicians only preferred CAPOX for younger patients with stage III gastric cancer after curative D2 gastrectomy. However, for elderly patients, clinicians more chose S-1 regardless of the stage.

  11. Laparoscopy assisted distal gastrectomy for T1 to T2 stage gastric cancer: a pilot study of three ports technique.

    PubMed

    Amin, Anwar Tawfik; Gabr, Adel; Abbas, Hamza

    2015-03-01

    Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision laparoscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gastrectomy. In a trial to overcome SILS difficulties, the authors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports laparoscopic gastrectomy. The patient's demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically feasible procedure; however, a prospective randomized controlled trial comparing three ports LADG with conventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy. PMID:25663585

  12. Long-term clinical outcomes of laparoscopy-assisted distal gastrectomy versus open distal gastrectomy for early gastric cancer: A comprehensive systematic review and meta-analysis of randomized control trials.

    PubMed

    Lu, Wei; Gao, Jian; Yang, Jingyun; Zhang, Yijian; Lv, Wenjie; Mu, Jiasheng; Dong, Ping; Liu, Yingbin

    2016-07-01

    The objective of this study was to compare long-term surgical outcomes and complications of laparoscopy-assisted distal gastrectomy (LADG) with open distal gastrectomy (ODG) for the treatment of early gastric cancer (EGC) based on a review of available randomized controlled trials (RCTs) evaluated using the Cochrane methodology.RCTs comparing LADG and ODG were identified by a systematic literature search in PubMed, Cochrane Library, MEDLINE, EMBASE, Scopus, and the China Knowledge Resource Integrated Database, for papers published from January 1, 2003 to July 30, 2015. Meta-analyses were performed to compare the long-term clinical outcomes.Our systematic literature search identified 8 eligible RCTs including 732 patients (374 LADGs and 358 ODGs), with low overall risk of bias. Long-term mortality and relapse rate were comparable for both techniques. The long-term complication rate was 8.47% in LADG groups and 13.62% in the ODG group, indicating that LADG was associated with lower risk for long-term complications (RR = 0.63; 95%CI = 0.39-1.00; P = 0.03).In the treatment of EGC, LADG lowered the rate of long- and short-term complications and promoted earlier recovery, with comparable oncological outcomes to ODG. PMID:27399073

  13. Oncologic value of laparoscopy-assisted distal gastrectomy for advanced gastric cancer: A systematic review and meta-analysis

    PubMed Central

    Aurello, Paolo; Sagnotta, Andrea; Terrenato, Irene; Berardi, Giammauro; Nigri, Giuseppe; D'Angelo, Francesco; Ramacciato, Giovanni

    2016-01-01

    BACKGROUND: The oncologic validity of laparoscopic-assisted distal gastrectomy (LADG) in the treatment of advanced gastric cancer (AGC) remains controversial. This study is a systematic review and meta-analysis of the available evidence. MATERIALS AND METHODS: A comprehensive search was performed between 2008 and 2014 to identify comparative studies evaluating morbidity/mortality, oncologic surgery-related outcomes, recurrence and survival rates. Data synthesis and statistical analysis were carried out using RevMan 5.2 software. RESULTS: Eight studies with a total of 1456 patients were included in this analysis. The complication rate was lower in LADG [odds ratio (OR) 0.59; 95% confidence interval (CI) = 0.42-0.83; P < 0.002]. The in-hospital mortality rate was comparable (OR 1.22; 95% CI = 0.28-5-29, P = 0.79). There was no significant difference in the number of harvested lymph nodes, resection margins, cancer recurrence rate, cancer-related mortality or overall and disease-free survival (OS and DFS, respectively) rates between the laparoscopic and the open groups (P > 0.05). CONCLUSION: The current study supports the view that LADG for AGC is a feasible, safe and effective procedure in selected patients. Adequate lymphadenectomy, resection margins, recurrence, cancer-related mortality and long-term outcomes appear equivalent to open distal gastrectomy (ODG). PMID:27279389

  14. Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife

    PubMed Central

    Hirasaki, Shoji; Kanzaki, Hiromitsu; Matsubara, Minoru; Fujita, Kohei; Matsumura, Shuji; Suzuki, Seiyuu

    2008-01-01

    AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer. METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD. RESULTS: The CR rate (40% in the EMR group vs 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT-ESD group (57.6 ± 31.9 min vs 21.1 ± 12.2 min). No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% vs EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups. CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. The long-term outcome needs to be evaluated in the future. PMID:18442204

  15. Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma.

    PubMed

    Ishikawa, Makoto; Kitayama, Joji; Kaizaki, Shoichi; Nakayama, Hiroshi; Ishigami, Hironori; Fujii, Shin; Suzuki, Hiroyuki; Inoue, Tomomi; Sako, Akihiro; Asakage, Masahiro; Yamashita, Hiroharu; Hatono, Kenji; Nagawa, Hirokazu

    2005-11-01

    To determine the clinical efficacy of Roux-en-Y reconstruction (RY) after distal gastrectomy, we compared postoperative outcomes of patients who underwent RY or conventional Billroth I reconstruction (B-I). A total of 50 patients were prospectively randomized to either B-I or RY reconstruction, and complications, postoperative course, and nutritional status were compared. Bile reflux and inflammation in the remnant stomach and lower esophagus were evaluated by postoperative follow-up endoscopy at 6 months. Operative time and blood loss as well as postoperative nutrition did not show significant differences between the two groups. As anticipated, 5 of 24 patients with RY reconstruction developed gastrojejunal stasis in the early postoperative period, which led to a longer postoperative hospital stay as compared with the B-I group (mean +/- S.D; B-I; 19.0 +/- 6.2, RY; 31.8 +/- 21.7 days) (P < 0.05). Endoscopic examination revealed that the frequency of bile reflux (P < 0.01) and degree of inflammation in the remnant stomach (P < 0.05) were less in the RY group than in the B-I group. However, inflammatory findings in the lower esophagus were observed in 7 (27%) of B-I, and 8 (35%) of the RY group, suggesting that late phase esophagitis was not improved in the RY group. Roux-en-Y reconstruction was effective in preventing duodenogastric reflux and resulting gastritis, but it did not prevent esophagitis. Because RY reconstruction induces the frequent complication of Roux-en-Y stasis, causing longer postoperative hospital stay, this method has limited advantages over B-I anastomosis after distal gastrectomy.

  16. A comparison between two methods for tumor localization during totally laparoscopic distal gastrectomy in patients with gastric cancer

    PubMed Central

    Lee, Chang Min; Park, Sungsoo; Park, Seong-Heum; Jang, You Jin; Kim, Seung-Joo; Mok, Young-Jae; Kim, Chong-Suk

    2016-01-01

    Purpose The aim of this study was to compare two methods of tumor localization during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods From March 2014 to November 2014, patients in whom TLDG had been engaged for middle third gastric cancer enrolled in this study. The patients were allocated to either the radiography or endoscopy group based on the type of tumor localization technique. Clinicopathologic outcomes were compared between the 2 groups. Results The accrual was suspended in November 2014 when 39 patients had been enrolled because a failed localization happened in the radiography group. The radiography and endoscopy groups included 17 (43.6 %) and 22 patients (56.4 %), respectively. Mean length of the proximal resection margin did not differ between the radiography and endoscopy groups (4.0 ± 2.6 and 2.8 ± 1.2 cm, respectively; P = 0.077). Mean localization time was longer in the radiography group than in the endoscopy group (22.7 ± 11.4 and 6.9 ± 1.8 minutes, respectively, P < 0.001). There were no statistically significant differences in the incidence of severe complications between the 2 groups (5.9% and 4.5%, respectively, P = 0.851). Conclusion As an intraoperative tumor localization for TLDG, radiologic method was unsafe even though other comparable parameters were not different from that of endoscopy group. Moreover, intraoperative endoscopic localization may be advantageous because it is highly accurate and contributes to reducing operation time. PMID:27617251

  17. Entirely Laparoscopic Gastrectomy and Colectomy for Remnant Gastric Cancer with Gastric Outlet Obstruction and Transverse Colon Invasion

    PubMed Central

    Kim, Hyun Il

    2015-01-01

    It is well known that gastrectomy with curative intent is the best way to improve outcomes of patients with remnant gastric cancer. Recently,several investigators reported their experiences with laparoscopic gastrectomy of remnant gastric cancer. We report the case of an 83-year-old female patient who was diagnosed with remnant gastric cancer with obstruction. She underwent an entirely laparoscopic distal gastrectomy with colectomy because of direct invasion of the transverse colon. The operation time was 200 minutes. There were no postoperative complications. The pathologic stage was T4b (transverse colon) N0M0. Our experience suggests that laparoscopic surgerycould be an effective method to improve the surgical outcomes of remnant gastric cancer patients. PMID:26819808

  18. Gastrectomy for gastric carcinoma with situs inversus totalis: case report and literature review

    PubMed Central

    Zhu, H; Yang, K; Hu, JK

    2015-01-01

    Background: Situs inversus totalis (SIT), a rare congenital anomaly, is characterized by a complete mirror image transposition of the thoracic and abdominal viscera. We report the case of a 66-year-old woman with SIT who was diagnosed with gastric antral carcinoma. Curative distal gastrectomy with Billroth-I anastomosis was performed. Description of the case: A 66-year-old woman visited our outpatient department complaining of abdominal pain in the left upper quadrant for about one year. Physical examination revealed that the apex beat was in the right fifth intercostal space, just at the midclavicular line while a soft systolic murmur was audible at the upper right sternal border. The abdominal examination was unremarkable. The preoperative diagnosis was confirmed by gastroscopy and biopsy. Preoperative echocardiogram revealed the presence of dextrocardia and atrial septal defect. Preoperative contrasted computed tomography showed a complete right-left reversal of the thoracic and abdominal organs and thickened wall of gastric antrum without distant metastasis. Laparotomy through a midline incision confirmed the complete mirror-image transposition of the abdominal visceral organs and a 4-cm tumor with serosal involvement at the gastric antrum. Curative distal gastrectomy with D2 lymphadenectomy and Billroth-I anastomosis was performed. The patient had a rapid recovery and was discharged without any complications. The final staging of this case was pT4aN1M0, stage IIIa and she received chemotherapy with the SOX regimen for three cycles. Fifteen months after the operation, the patient is alive without any signs of recurrence. Conclusions: The incidence of gastric cancer with SIT is very rare. Appropriate diagnostic modalities are very helpful for the diagnosis and preoperative planning. Gastrectomy with D2 lymphadenectomy in patients with SIT can be performed successfully with sufficient preoperative evaluation, comprehensive knowledge of anatomy, and meticulous

  19. [Pylorus-preserving gastrectomy in treating middle-third early gastric cancer].

    PubMed

    Zhou, Jin; Wang, Yunliang; Zhu, Xingguo; Li, Dechun

    2016-02-01

    Compared with distal gastrectomy, pylorus-preserving gastrectomy is less invasive which can decrease incidence of dumping syndrome, diarrhea and body weight lost, cholecystitis and gallstone, reflux gastritis and esophagitis and remnant gastric cancer. Based on new Japanese Gastric Cancer Treatment Guideline and new progression in the world, we give a review mainly basic characteristics, indications, operation details and short- and long-time outcomes after pylorus-preserving gastrectomy. PMID:26831891

  20. Comparison of Delta-Shape Anastomosis and Extracorporeal Billroth I Anastomosis after Laparoscopic Distal Gastrectomy for Gastric Cancer: A Systematic Review with Meta-Analysis of Short-Term Outcomes

    PubMed Central

    Hu, Geng-yuan; Tao, Feng; Ji, Ke-wei; Wang, Wei

    2016-01-01

    Objective The aim of this systematic review and meta-analysis is to evaluate the safety and relative benefits of delta-shape anastomosis (DA) by comparing to conventional laparoscopy-assisted distal gastrectomy with Billroth I gastroduodenostomy (LADG BI). Methods Studies and relevant literature regarding DA versus LADG BI were searched in the electronic databases. Operation time, postoperative complications, estimated blood loss, number of retrieved lymph nodes, time to first flatus, time to oral intake, length of postoperative hospitalization in DA and LADG BI were pooled and compared using meta-analysis. Weighted mean differences (WMDs) and odds ratios (ORs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of DA. Results Eight studies of 1739 patients were included in the meta-analysis. Compared with LADG BI, DA had shorter postoperative hospitalization (WMD = -0.47, 95%CI: -0.69 to -0.25, P<0.01), less blood loss (WMD = - 25.90, 95%CI: -43.11 to -8.70, P<0.01), shorter time to oral intake (WMD = -0.25, 95%CI: -0.49 to -0.01, P = 0.04), and more retrieved lymph nodes (WMD = 1.36, 95%CI: 0.30 to 2.43, P = 0.01). Operation time (WMD = -0.07, 95%CI -15.58 to 15.43, P = 0.99), overall postoperative complication rate (OR = 1.05, 95%CI: 0.74 to 1.49, P = 0.63), surgical complication rate (OR = 1.02, 95%CI: 0.70 to 1.49, P = 0.90), nonsurgical complication rate (OR = 1.21, 95%CI: 0.54 to 2.72, P = 0.64), leakage rate (OR = 2.54, 95%CI: 0.92 to 7.01, P = 0.07), stricture rate (OR = 0.36, 95%CI: 0.09 to 1.44, P = 0.15), wound complication rate (OR = 0.71, 95%CI: 0.33 to 1.55, P = 0.39), time to first flatus (WMD = -0.10, 95%CI: -0.27 to 0.07, P = 0.26), and proximal surgical margin (WMD = -0.25, 95%CI: -1.14 to 0.65, P = 0.59) was not statistically different. Conclusion Compared with LADG BI, DA is a safe and feasible procedure, with significantly reduced blood loss, time to oral intake, and postoperative hospitalization. PMID:27631378

  1. [Effect of gastrectomy on release of gut hormones].

    PubMed

    Misumi, A; Harada, K; Mizumoto, S; Yoshinaka, I; Maeda, M; Nakashima, Y; Ogawa, M

    1991-09-01

    We investigated the effect of gastrectomy on the digestive system in 87 postoperative long-term survivors under test meal or egg yolk load. After test meal, gastrin and secretin responses were decreased in each of groups of proximal gastrectomy (PG), distal gastrectomy with Billroth-I (DG-B1), that with Billroth-II (DG-B2), total gastrectomy with interposition (TG-I), and that with Roux-Y (TG-RY). However, sufficient acid-secretors after partial gastrectomy showed secretin responses comparable to controls. Furthermore, cases of total gastrectomy given betain-hydrochloride with test meal increased secretin responses. Serum glucose response was higher in the TG-RY group while insulin response was high in the TG-RY and DG-B2 groups, compared with controls. GLI response was high in all groups compared with controls. Postgastrectomy gallstone occurred in 11.6%. Yolk-induced contraction of the gallbladder was decreased, and CCK release increased, for several years postoperatively. Gallbladder contraction with CCK was reduced for one year postoperatively. The contraction was reduced in persons with gallstone than those without it. This study shows that the digestive function after gastrectomy depends on acidification and duodenal passage of food, and that reduced contraction with CCK plays an important role in hypokinesis of the gallbladder. PMID:1944181

  2. Non-Randomized Confirmatory Trial of Laparoscopy-Assisted Total Gastrectomy and Proximal Gastrectomy with Nodal Dissection for Clinical Stage I Gastric Cancer: Japan Clinical Oncology Group Study JCOG1401

    PubMed Central

    Kataoka, Kozo; Mizusawa, Junki; Katayama, Hiroshi; Nakamura, Kenichi; Morita, Shinji; Yoshikawa, Takaki; Ito, Seiji; Kinoshita, Takahiro; Fukagawa, Takeo; Sasako, Mitsuru

    2016-01-01

    Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospective study evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. A non-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy and laparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japanese institutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints are overall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. The UMIN Clinical Trials Registry number is UMIN000017155. PMID:27433394

  3. Pylorus-Preserving Gastrectomy for Gastric Cancer.

    PubMed

    Oh, Seung-Young; Lee, Hyuk-Joon; Yang, Han-Kwang

    2016-06-01

    Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG. PMID:27433390

  4. Pylorus-Preserving Gastrectomy for Gastric Cancer

    PubMed Central

    Oh, Seung-Young; Yang, Han-Kwang

    2016-01-01

    Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG. PMID:27433390

  5. Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy.

    PubMed

    Takiguchi, Shuji; Takata, Akihiro; Murakami, Kohei; Miyazaki, Yasuhiro; Yanagimoto, Yoshitomo; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Mori, Masaki; Doki, Yuichiro

    2014-04-01

    Loss of body weight is a common (and the most serious) sequela after gastrectomy. It impairs quality of life, increases various diseases including infection, and may affect long-term survival. Ghrelin, an intrinsic ligand of the growth hormone secretagogue receptor, was discovered in the stomach in 1999. In addition to growth hormone secretion, ghrelin has pleiotropic functions including appetite stimulation, increasing bowel movement and absorption, and anti-inflammatory reactions. In consequence, ghrelin comprehensively leads positive energy balance and weight gain. The fundic gland of the stomach produces the majority of ghrelin, and plasma ghrelin declines to 10-30 % of the preoperative level after total gastrectomy and 50-70 % after distal gastrectomy. Although plasma ghrelin is never restored after total gastrectomy, it gradually recovers to the preoperative level within a few years after distal gastrectomy. Chronic gastritis due to Helicobacter pylori infection and vagotomy are additional factors that perturb the ghrelin secretion of gastric cancer patients after gastrectomy. A randomized clinical trial that revealed that recombinant ghrelin administration successfully increased both food intake and appetite, and ameliorated weight loss after total gastrectomy. Ghrelin administration could thus be a promising strategy to transiently improve the nutritional status of patients who who have undergone gastrectomy, but its effect in the long term remains unclear. Further studies are warranted to elucidate the mechanism of ghrelin and to create and evaluate the analogs that could be administered orally or subcutaneously.

  6. Hiatal Hernia as a Total Gastrectomy Complication

    PubMed Central

    Santos, Bruna do Nascimento; de Oliveira, Marcos Belotto; Peixoto, Renata D'Alpino

    2016-01-01

    Introduction According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication. PMID:27293395

  7. [Urgent gastrectomy in a patient who developed perforated gastric cancer during preoperative chemotherapy with S-1 plus cisplatin].

    PubMed

    Okabe, Yasuyuki; Yajima, Kazuhito; Ishikawa, Takashi; Kosugi, Shin-ichi; Sakamoto, Kaoru; Sato, Yu; Kanda, Tatsuo; Wakai, Toshifumi

    2014-01-01

    A 66 -year-old man presenting with a chief complaint of upper abdominal pain was diagnosed as having an advanced adenocarcinoma, type 2, of the lower third of the stomach after endoscopy was performed. An abdominal computed tomography( CT)scan revealed 4 lymph node metastases at the infrapyloric nodes(station No. 6)and the nodes around the proximal splenic artery(station No. 11p)and the abdominal aorta(station No. 16a2). The clinical stage was determined to be T3(SS)N2M1(LYM), Stage IV. Gastrectomy with D2 plus para-aortic node dissection was scheduled after 2 courses of S-1 plus cisplatin(CDDP)with curative intent. On day 14 after starting S-1 therapy, the patient complained of severe abdominal pain and peritoneal irritation of acute onset. Because the abdominal CT scan showed a large amount of intra-abdominal free air, we performed an urgent laparotomy with a tentative diagnosis of perforation of the gastric cancer. On laparotomy, we found a perforated malignant ulcer, 5 cm in maximum diameter, in the lesser curvature of the stomach; therefore, distal gastrectomy with D1 plus lymphadenectomy and reconstruction using the Roux-en-Y method were performed. At the end of the surgery, a macroscopic residual tumor remained in the para-aortic lymph node. The postoperative course was uneventful, and the patient was discharged on day 23 after surgery. In the present case, despite the performance of urgent gastrectomy while the patient was receiving strong chemotherapy, perioperative management was successful, with no serious postoperative complication or adverse events as a result of the chemotherapy.

  8. Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection

    PubMed Central

    Kawashima, Hiroshi; Toyoda, Sho; Okumura, Satoshi; Yamamoto, Kansuke; Mizumura, Naoto; Ito, Aya; Maehira, Hiromitsu; Imagawa, Atsuo; Ogawa, Masao; Kawasaki, Masayasu; Kameyama, Masao

    2016-01-01

    An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices.

  9. Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection.

    PubMed

    Yuu, Ken; Kawashima, Hiroshi; Toyoda, Sho; Okumura, Satoshi; Yamamoto, Kansuke; Mizumura, Naoto; Ito, Aya; Maehira, Hiromitsu; Imagawa, Atsuo; Ogawa, Masao; Kawasaki, Masayasu; Kameyama, Masao

    2016-01-01

    An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices. PMID:27651972

  10. Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection

    PubMed Central

    Kawashima, Hiroshi; Toyoda, Sho; Okumura, Satoshi; Yamamoto, Kansuke; Mizumura, Naoto; Ito, Aya; Maehira, Hiromitsu; Imagawa, Atsuo; Ogawa, Masao; Kawasaki, Masayasu; Kameyama, Masao

    2016-01-01

    An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices. PMID:27651972

  11. Positive impact of adding No.14v lymph node to D2 dissection on survival for distal gastric cancer patients after surgery with curative intent

    PubMed Central

    Liang, Yuexiang; Wu, Liangliang; Wang, Xiaona; Ding, Xuewei; Liu, Hongmin; Li, Bin; Wang, Baogui; Pan, Yuan; Zhang, Rupeng; Liu, Ning

    2015-01-01

    Background D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), while the necessity of No.14v lymph node (14v) dissection for distal GC is still controversial. Methods A total of 920 distal GC patients receiving at least a D2 lymph node dissection in Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital were enrolled in this study, of whom, 243 patients also had the 14v dissected. Other 677 patients without 14v dissection were used for comparison. Results Forty-five (18.5%) patients had 14v metastasis. There was no significant difference in 3-year overall survival (OS) rate between patients with and without 14v dissection. Following stratified analysis, in TNM stages I, II, IIIa and IV, 14v dissection did not affect 3-year OS; in contrast, patients with 14v dissection had a significant higher 3-year OS than those without in TNM stages IIIb and IIIc. In multivariate analysis, 14v dissection was found to be an independent prognostic factor for GC patients with TNM stage IIIb/IIIc disease [hazard ratio (HR), 1.568; 95% confidence interval (CI): 1.186-2.072; P=0.002]. GC patients with 14v dissection had a significant lower locoregional, especially lymph node, recurrence rate than those without 14v dissection (11.7% vs. 21.1%, P=0.035). Conclusions Adding 14v to D2 lymphadenectomy may be associated with improved 3-year OS for distal GC staged TNM IIIb/IIIc. PMID:26752932

  12. Bursectomy at radical gastrectomy

    PubMed Central

    Kayaalp, Cuneyt

    2015-01-01

    Radical gastrectomy with extended lymph node dissection and prophylactic resection of the omentum, peritoneum over the posterior lesser sac, pancreas and/or spleen was advocated at the beginning of the 1960s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However, omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursa omentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended. PMID:26523213

  13. Bursectomy at radical gastrectomy.

    PubMed

    Kayaalp, Cuneyt

    2015-10-27

    Radical gastrectomy with extended lymph node dissection and prophylactic resection of the omentum, peritoneum over the posterior lesser sac, pancreas and/or spleen was advocated at the beginning of the 1960s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However, omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursa omentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended. PMID:26523213

  14. Case for sleeve gastrectomy.

    PubMed

    Corcelles, Ricard; Lacy, Antonio

    2016-07-01

    During the last 10 years, laparoscopic sleeve gastrectomy (LSG) has progressively increased in popularity as a primary procedure because of its simplicity, safety, and effectiveness to achieve sustained weight loss over time. The efficacy of LSG in the metabolic control of type 2 diabetes (T2D) is the result of various mechanisms not thoroughly elucidated. Thus, excellent short-term outcomes have been published in glycemic control after SG at comparable rates to Roux-en-Y gastric bypass (RYGB). Unfortunately, head-to-head comparative studies between SG and RYGB are limited and long-term follow-up data is not abundant. The aim of this manuscript is to describe current evidence on the clinical impact of SG on T2D as well as to provide a critical appraisal of the available published data. PMID:27568474

  15. Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report.

    PubMed

    Hagiwara, Chie; Yajima, Kazuhito; Iwasaki, Yoshiaki; Oohinata, Ryouki; Yuu, Ken; Ishiyama, Satoshi; Amaki, Misato; Nakano, Daisuke; Yamaguchi, Tatsuro; Matsumoto, Hiroshi; Takahashi, Keiichi

    2016-02-01

    We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80-year-old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux-en-Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.

  16. Sleeve gastrectomy with anti-reflux procedures

    PubMed Central

    Santoro, Sergio; Lacombe, Arnaldo; de Aquino, Caio Gustavo Gaspar; Malzoni, Carlos Eduardo

    2014-01-01

    Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors. PMID:25295447

  17. Intrathoracic Hernia after Total Gastrectomy.

    PubMed

    Tashiro, Yoshihiko; Murakami, Masahiko; Otsuka, Koji; Saito, Kazuhiko; Saito, Akira; Motegi, Kentaro; Date, Hiromi; Yamashita, Takeshi; Ariyoshi, Tomotake; Goto, Satoru; Yamazaki, Kimiyasu; Fujimori, Akira; Watanabe, Makoto; Aoki, Takeshi

    2016-01-01

    Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation. PMID:27403095

  18. Intrathoracic Hernia after Total Gastrectomy

    PubMed Central

    Tashiro, Yoshihiko; Murakami, Masahiko; Otsuka, Koji; Saito, Kazuhiko; Saito, Akira; Motegi, Kentaro; Date, Hiromi; Yamashita, Takeshi; Ariyoshi, Tomotake; Goto, Satoru; Yamazaki, Kimiyasu; Fujimori, Akira; Watanabe, Makoto; Aoki, Takeshi

    2016-01-01

    Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation. PMID:27403095

  19. Systematic review on quality of life outcomes after gastrectomy for gastric carcinoma

    PubMed Central

    Shan, Bernard; Shan, Leonard; Morris, David; Golani, Sanjeev

    2015-01-01

    Background Despite advances in chemotherapy and radiotherapy, gastrectomy is the only curative intervention for gastric carcinoma. This study reviews post-operative health-related quality of life (HRQOL) after gastrectomy. Methods A literature search was conducted on PubMed for all studies published after January 2000 matching strict eligibility criteria. Bibliographies of included studies were also reviewed. Quality appraisal and data tabulation were performed using pre-determined forms. Results were synthesised by narrative review according to PRISMA guidelines with full tabulation of results of all included studies. Results A total of 21 studies (3,575 patients) were included. Post-operative HRQOL improvements were demonstrated across most or all domains in different HRQOL instruments. Patients experienced declines in HRQOL 1 month after surgery, but reached at least pre-operative levels with recovery by 1 year. The greatest improvements were demonstrated in the emotional health domain with favourable functional benefits. Partial gastrectomy appears to be superior to total gastrectomy in physical, emotional and functional health domains. However, patients remain susceptible to gastrointestinal symptoms following surgery, which negatively impact upon HRQOL. Post-operative complications did not appear to affect HRQOL. Most studies were prospective, but data is heterogeneous. Conclusions Gastrectomy results in significant HRQOL benefits across a broad range of health domains. This is critical outcome of surgery and an important consideration in pre-operative decision making. PMID:26487949

  20. Data Curation

    ERIC Educational Resources Information Center

    Mallon, Melissa, Ed.

    2012-01-01

    In their Top Trends of 2012, the Association of College and Research Libraries (ACRL) named data curation as one of the issues to watch in academic libraries in the near future (ACRL, 2012, p. 312). Data curation can be summarized as "the active and ongoing management of data through its life cycle of interest and usefulness to scholarship,…

  1. Robotic gastrectomy with transvaginal specimen extraction for female gastric cancer patients

    PubMed Central

    Zhang, Shu; Jiang, Zhi-Wei; Wang, Gang; Feng, Xiao-Bo; Liu, Jiang; Zhao, Jian; Li, Jie-Shou

    2015-01-01

    AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction (TVSE) for gastric cancer patients. METHODS: Between July and November 2014, eight female patients who were diagnosed with gastric adenocarcinoma underwent a TVSE following a full robot-sewn gastrectomy. According to the tumor location, the patients were allocated to two different groups; two patients received robotic total gastrectomy with TVSE and the other six received robotic distal gastrectomy with TVSE. RESULTS: Surgical procedures were successfully performed in all eight cases without conversion. The mean age was 55.3 (range, 42-69) years, and the mean body mass index was 23.2 (range, 21.6-26.0) kg/m2. The mean total operative time and blood loss were 224 (range, 200-298) min and 62.5 (range, 50-150) mL, respectively. The mean postoperative hospital stay was 3.6 (range, 3-5) d. The mean number of lymph nodes resected was 23.6 (range, 17-27). None was readmitted within 30 d of postoperation. During the follow-up, no stricture developed nor was any anastomotic leakage detected. CONCLUSION: It is possible to perform a TVSE following a full robot-sewn gastrectomy with standard D2 lymph node resection for female gastric cancer patients. PMID:26715817

  2. Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

    PubMed Central

    Marano, Alessandra; Choi, Yoon Young; Kim, Yoo Min; Kim, Jieun; Noh, Sung Hoon

    2013-01-01

    Purpose To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes. PMID:24156033

  3. Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma in the West: A Case–Control Study

    PubMed Central

    Kelly, Kaitlyn J.; Selby, Luke; Chou, Joanne F.; Dukleska, Katerina; Capanu, Marinela; Coit, Daniel G.; Brennan, Murray F.; Strong, Vivian E.

    2016-01-01

    Introduction Data on laparoscopic gastrectomy in patients with gastric cancer in the Western hemisphere are lacking. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for gastric adenocarcinoma at a Western center. Methods Eighty-seven consecutive patients who underwent laparoscopic gastrectomy from November 2005 to April 2013 were compared with 87 patients undergoing open resection during the same time period. Patients were matched for age, stage, body mass index, and procedure (distal subtotal vs. total gastrectomy). Endpoints were short- and long-term perioperative outcomes. Results Overall, 65 patients (37 %) had locally advanced disease, and 40 (23 %) had proximal tumors. The laparoscopic approach was associated with longer operative time (median 240 vs.165 min; p < 0.01), less blood loss (100 vs.150 mL; p < 0.01), higher rate of microscopic margin positivity (9 vs.1 %; p = 0.04), decreased duration of narcotic and epidural use (2 vs. 4 days, p = 0.04, and 3 vs. 4 days, p = 0.02, respectively), decreased minor complications in the early (27 vs. 16 %) and late (17 vs. 7 %) postoperative periods (p < 0.01), decreased length of stay (5 vs. 7 days; p = 0.01), and increased likelihood of receiving adjuvant therapy (82 vs. 51 %; p < 0.01). There was no difference in the number of lymph nodes retrieved (median 20 in both groups), major morbidity, or 30-day mortality. Conclusions Laparoscopic gastrectomy for gastric adenocarcinoma is safe and effective for select patients in the West. PMID:25631063

  4. Short-Term Outcomes of Laparoscopic Total Gastrectomy Performed by a Single Surgeon Experienced in Open Gastrectomy: Review of Initial Experience

    PubMed Central

    Song, Jeong Ho; Choi, Yoon Young; Kim, Dong Wook; Hyung, Woo Jin; Noh, Sung Hoon

    2015-01-01

    Purpose Laparoscopic total gastrectomy (LTG) is more complicated than laparoscopic distal gastrectomy, especially during a surgeon's initial experience with the technique. In this study, we evaluated the short-term outcomes of and learning curve for LTG during the initial cases of a single surgeon compared with those of open total gastrectomy (OTG). Materials and Methods Between 2009 and 2013, 134 OTG and 74 LTG procedures were performed by a single surgeon who was experienced with OTG but new to performing LTG. Clinical characteristics, operative parameters, and short-term postoperative outcomes were compared between groups. Results Advanced gastric cancer and D2 lymph node dissection were more common in the OTG than LTG group. Although the operation time was significantly longer for LTG than for OTG (175.7±43.1 minutes vs. 217.5±63.4 minutes), LTG seems to be slightly superior or similar to OTG in terms of postoperative recovery measures. The operation time moving average of 15 cases in the LTG group decreased gradually, and the curve flattened at 54 cases. The postoperative complication rate was similar for the two groups (11.9% vs. 13.5%). No anastomotic or stump leaks occurred. Conclusions Although LTG is technically difficult and operation time is longer for surgeons experienced in open surgery, it can be performed safely, even during a surgeon's early experience with the technique. Considering the benefits of minimally invasive surgery, LTG is recommended for early gastric cancer. PMID:26468413

  5. Helicobacter pylori infection after gastrectomy and vagotomy in duodenal ulcer patients.

    PubMed

    Sito, E; Konturek, P C; Konturek, S J; Bielański, W; Stachura, J

    1996-03-01

    The eradication of Helicobacter pylori (Hp) is known to reduce the recurrence rate of duodenal ulcer (DU) to similar extent as gastrectomy but it is not clear what is the prevalence of Hp in DU patients after surgical interventions such as gastrectomy or vagotomy. The purpose of this study was to evaluate the influence of gastrectomy or truncal vagotomy with pyloroplasty on the prevalence of Hp in 51 DU patients just before and 6-8 months after these procedures. Using C14-urea breath test (UTB), rapid CLO-test and histology of the biopsy samples of gastric mucosa obtained during gastroscopy, the Hp was detected in all DU subjects submitted to operation. Following distal gastric resection (antrectomy) with Billroth II anastomosis (N = 32) due to an ulcer resistance to conservative therapy, peptic ulceration was not observed during 6-8 months in any of the examined subjects and the Hp was only rarely observed (only in 3 out of 32 operated patients). Histologically, in antral biopsies taken prior to surgery, all DU patients presented chronic active gastritis. After the surgery, the absence of Hp was confirmed also by histology. Histological evaluation of gastrectomy stump biopsies revealed typical chronic gastritis with concomitant foveolar hyperplasia and focal gland dilation. Following selective vagotomy and pyloroplasty (N = 19), the scarring of duodenal bulb (without active ulcer) was seen in 4 out of 19 operated patients but the Hp was detected in all (100%) cases. Gastric biopsies prior and after vagotomy revealed chronic active gastritis associated with Hp infection. Basal plasma gastrin was reduced after gastrectomy by about 30% and basal and maximal pentagastrin-induced acid secretion was decreased by about 60% and 70%, respectively. Vagotomy did not reduce activity of the mucosal inflammation and the incidence of Hp. Basal plasma gastrin level was increased by about 60%, while basal and pentagastrin induced acid secretion was decreased by 25% and 40

  6. When Eastern Surgeons Meet Western Patients: A Pilot Study of Gastrectomy with Lymphadenectomy in Caucasian Patients at a Single Korean Institute.

    PubMed

    Nakagawa, Masatoshi; Choi, Yoon Young; An, Ji Yeong; Seo, Sang Hyuk; Shin, Hyun Beak; Bang, Hui Jae; Li, Shuangxi; Kim, Hyung Il; Cheong, Jae Ho; Hyung, Woo Jin; Noh, Sung Hoon

    2016-09-01

    East Asian surgeons generally report lower morbidity and mortality rates for gastrectomy with D2 lymphadenectomy than do surgeons in Western countries; however, the disparity remains unexplained. The aim of this article was to determine the feasibility and safety regarding cases in which East Asian surgeons perform such procedures in Caucasian patients (CPs). Twelve CPs underwent gastrectomy with lymphadenectomy for gastric cancer at Yonsei University Severance Hospital, Seoul, Korea between June 2011 and April 2014. Procedures performed included total gastrectomy (7 of 12, 58%), distal gastrectomy (4 of 12, 33%), and completion total gastrectomy (1 of 12, 8%). Nine patients (75%) underwent D2 lymphadenectomy, and D1+ lymphadenectomy was performed in three others (25%). In four patients (33%), combined resections were carried out. The median values of surgical parameters were as follows: operative time, 266.5 min (range, 120-586 min); estimated blood loss, 90 mL (range, 37-350 mL); retrieved lymph node count, 37.5 (range, 22-63); and postoperative hospital stay, 13.7 days (range, 5-63 days). No mortality was encountered, although two patients (17%) experienced complications (both Clavien-Dindo classification grade IIIa anastomotic leakages), which were successfully managed by conservative treatment. In the hands of East Asian surgeons, mortality and short-term morbidity appears to be acceptably low in CPs subjected to gastrectomy with lymphadenectomy for gastric cancer. PMID:27401666

  7. [Treatment of bone disease caused by gastrectomy].

    PubMed

    Iwamoto, Jun

    2015-11-01

    Gastrectomy is undergone mainly in patients with gastric cancer. Bone diseases(osteoporosis and osteomalacia)caused by gastractomy are associated with weight loss, calcium and vitamin D inadequancy, and malnutrition. Most patients after gastrectomy have multile risk factors of bone diseases and subsequently are at a higher risk for fractures. In particular, sex hormone deficiency and aging enhance the risk for fractures. The management of bone diseases caused by gastraectomy include adequet intake of calcium, vitamin D and protein, sunlight exposure, and regular weight-bearing exercise, as well as non-smoking and avoiding excess alcohol drinking. The patients at a high risk for fractures shoud be treated with bisphosphonates.

  8. Laparoscopic gastrectomy for gastric cancer in China: an overview.

    PubMed

    Lan, Huanrong; Zhu, Naibiao; Lan, Yuefu; Jin, Ketao; Teng, Lisong

    2015-01-01

    Since its introduction in China in 2000, laparoscopic gastrectomy has shown classical advantages of minimally invasive surgery over open counterpart. Like all the pioneers of the technique, Chinese gastrointestinal surgeons claim that laparoscopic gastrectomy led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to open gastrectomy while offering the same functional and oncological results. There has been booming interest in laparoscopic gastrectomy since 2006 in China. The last decade has witnessed national growth in the application of laparoscopic gastrectomy and yielded a significant amount of scientific data to support its clinical merits and advantages. However, few prospective randomized controlled trials have investigated the benefits of laparoscopic gastrectomy in China. In this article, we make an overview of the current data and state of the art of laparoscopic gastrectomy for gastric cancer in China. PMID:25911902

  9. Readmission Following Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Maselli, Amy; Lindborg, Ryan; Kabata, Krystyna; Tortolani, Anthony; Gorecki, Piotr

    2016-01-01

    Background and Objectives: Prior studies have established a 1.7–4.33% readmission rate for laparoscopic sleeve gastrectomy (LSG), a rate that falls within the reported range for other bariatric procedures. The current report describes the incidence of 30-day readmission after primary LSG procedures performed at a single bariatric center of excellence (COE) and examines factors that may be associated with readmission. Methods: Data on 343 consecutive LSG operations performed from February 2010 to May 2014 by a single surgeon (PG) were analyzed. Patients readmitted within 30 d were compared to the remaining patients by using Student's t test for continuous variables and the χ2 test for categorical variables. Results: All LSGs were completed laparoscopically with no conversions to open procedures. There were no reoperations, leaks, perioperative hemorrhages, or mortalities. Twelve patients (3.5%) were readmitted; 1 was readmitted twice. There were no identified risk factors for readmission, including patient demographics, comorbidities, and perioperative factors. Notably, 7 (7%) readmissions occurred in the initial 100 patients and 5 (2%) in the remaining 243 patients (P = .04). Clinical pathways were modified after the initial 100 patients; routine contrast esophagograms were no longer performed, and a 1-day routine postoperative stay was adopted. Operative time also decreased from 94.2 ± 23.8 to 78.2 ± 20.0 min (P < .001). Conclusions: Readmission rates after LSG remain in a range similar to those described for other laparoscopic bariatric procedures. Larger prospective studies are needed to identify patterns of complications and readmissions in patients undergoing LSG that may differ from other bariatric procedures. PMID:27667914

  10. Effect of Previous Gastrectomy on the Performance of Postoperative Colonoscopy

    PubMed Central

    Kim, Sunghwan; Choi, Jeongmin; Kim, Tae Han; Suh, Yun-Suhk; Im, Jong Pil; Lee, Hyuk-Joon; Kim, Sang Gyun; Jeong, Seung-Yong; Kim, Joo Sung; Yang, Han-Kwang

    2016-01-01

    Purpose The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. Materials and Methods Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. Results A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. Conclusions History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time. PMID:27752394

  11. Gastrobronchial fistula following laparoscopic sleeve gastrectomy

    PubMed Central

    Abraham, Albin; Virdi, Ravi Paul Singh; Rajan, Dhyan; Singh, Jaspreet; Mustacchia, Paul; Iqbal, Javed; Rizvon, Kaleem

    2012-01-01

    Acquired fistulas between the tracheobronchial tree and the gastrointestinal tract are rare but serious complications of laparoscopic sleeve gastrectomies with significant morbidity and mortality. With the rising popularity and widespread acceptance of bariatric surgery techniques, the occurrence of gastrobronchial fistulas is being increasingly recognised. We present the case of a 26-year-old woman who underwent laparoscopic sleeve gastrectomy for morbid obesity and presented later with a history of chronic productive cough. Upper gastrointestinal series showed the presence of a communicating fistula between the stomach and the lung, with extravasation of contrast into the lung. The aim of this paper is to highlight the importance of considering the diagnosis of a gastrobronchial fistula in cases of persistent respiratory infections in the postoperative period following bariatric surgery and to review its incidence, clinical manifestations and treatment. PMID:22977059

  12. Gastroesophageal Reflux Disease and Sleeve Gastrectomy.

    PubMed

    Melissas, John; Braghetto, Italo; Molina, Juan Carlos; Silecchia, Gianfranco; Iossa, Angelo; Iannelli, Antonio; Foletto, Mirto

    2015-12-01

    Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy. PMID:26428250

  13. Gastroesophageal Reflux Disease and Sleeve Gastrectomy.

    PubMed

    Melissas, John; Braghetto, Italo; Molina, Juan Carlos; Silecchia, Gianfranco; Iossa, Angelo; Iannelli, Antonio; Foletto, Mirto

    2015-12-01

    Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.

  14. Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients?

    PubMed Central

    Huang, Lei; Xu, A-Man; Li, Tuan-Jie; Han, Wen-Xiu; Xu, Jing

    2014-01-01

    AIM: To investigate the necessity and correctness of acid suppression pre- and post-gastrectomy among gastric carcinoma (GC) patients. METHODS: From June 2011 to April 2013, 99 patients who were diagnosed with GC or adenocarcinoma of the gastroesophageal junction (type II or III) and needed surgical management were enrolled. They all underwent gastrectomy by the same operators [35 undergoing total gastrectomy (TG) plus Roux-en-Y reconstruction, 34 distal gastrectomy (DG) plus Billroth I reconstruction, and 30 proximal gastrectomy (PG) plus gastroesophagostomy]. We collected and analyzed their gastrointestinal juice and tissues from the pre-operational day to the 5th day post-operation, and 6 mo post-surgery. Gastric pH was detected with a precise acidity meter. Gastric juice contents including potassium, sodium and bicarbonate ions, urea nitrogen, direct and indirect bilirubin, and bile acid were detected using Automatic Biochemical Analyzer. Data regarding tumor size, histological type, tumor penetration and tumor-node-metastasis (TNM) stage were obtained from the pathological records. Reflux symptoms pre- and 6 mo post-gastrectomy were evaluated by reflux disease questionnaire (RDQ) and gastroesophageal reflux disease questionnaire (GERD-Q). SPSS 16.0 was applied to analyze the data. RESULTS: Before surgery, gastric pH was higher than the threshold of hypoacidity (4.25 ± 1.45 vs 3.5, P = 0.000), and significantly affected by age, tumor size and differentiation grade, and potassium and bicarbonate ions; advanced malignancies were accompanied with higher pH compared with early ones (4.49 ± 1.31 vs 3.66 ± 1.61, P = 0.008). After operation, gastric pH in all groups was of weak-acidity and significantly higher than that pre-gastrectomy; on days 3-5, comparisons of gastric pH were similar between the 3 groups. Six months later, gastric pH was comparable to that on days 3-5; older patients were accompanied with higher total bilirubin level, indicating more serious

  15. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review.

    PubMed

    Mahawar, Kamal K; Carr, William R J; Jennings, Neil; Balupuri, Shlok; Small, Peter K

    2015-01-01

    Sleeve gastrectomy can exacerbate gastro-oesophageal reflux disease in some patients and cause de novo reflux in others. Some surgeons believe Roux-en-Y gastric bypass is the best bariatric surgical procedure for obese patients with hiatus hernia. Others believe that even patients with hiatus hernia can also be safely offered sleeve gastrectomy if combined with a simultaneous hiatus hernia repair. Still, others will offer these patients sleeve gastrectomy without any attempt to diagnose or repair hiatus hernia repair. The effectiveness of concurrent hiatal hernia repair in reducing the incidence of postoperative reflux after sleeve gastrectomy is unclear. This review systematically investigates the results and techniques of simultaneous sleeve gastrectomy and hiatus hernia repair for the treatment of obesity in accordance with PRISMA guidelines. PMID:25348434

  16. Curation of Frozen Samples

    NASA Technical Reports Server (NTRS)

    Fletcher, L. A.; Allen, C. C.; Bastien, R.

    2008-01-01

    NASA's Johnson Space Center (JSC) and the Astromaterials Curator are charged by NPD 7100.10D with the curation of all of NASA s extraterrestrial samples, including those from future missions. This responsibility includes the development of new sample handling and preparation techniques; therefore, the Astromaterials Curator must begin developing procedures to preserve, prepare and ship samples at sub-freezing temperatures in order to enable future sample return missions. Such missions might include the return of future frozen samples from permanently-shadowed lunar craters, the nuclei of comets, the surface of Mars, etc. We are demonstrating the ability to curate samples under cold conditions by designing, installing and testing a cold curation glovebox. This glovebox will allow us to store, document, manipulate and subdivide frozen samples while quantifying and minimizing contamination throughout the curation process.

  17. Low Serum Albumin Level, Male Sex, and Total Gastrectomy Are Risk Factors of Severe Postoperative Complications in Elderly Gastric Cancer Patients

    PubMed Central

    Kang, Sung Chan; Kim, Hyun Il

    2016-01-01

    Purpose It is well known that old age is a risk factor for postoperative complications. Therefore, this study aimed to explore the risk factors for poor postoperative surgical outcomes in elderly gastric cancer patients. Materials and Methods Between January 2006 and December 2015, 247 elderly gastric cancer patients who underwent curative gastrectomy were reviewed. In this study, an elderly patient was defined as a patient aged ≥65 years. All possible variables were used to explore the risk factors for poor early surgical outcomes in elderly gastric cancer patients. Results Based on multivariate analyses of preoperative risk factors, preoperative low serum albumin level (<3.5 g/dl) and male sex showed statistical significance in predicting severe postoperative complications. Additionally, in an analysis of surgery-related risk factors, total gastrectomy was a risk factor for severe postoperative complications. Conclusions Our study findings suggest that low serum albumin level, male sex, and total gastrectomy could be risk factors of severe postoperative complications in elderly gastric cancer patients. Therefore, surgeons should work carefully in cases of elderly gastric cancer patients with low preoperative serum albumin level and male sex. We believe that efforts should be made to avoid total gastrectomy in elderly gastric cancer patients. PMID:27104026

  18. Robot-assisted gastrectomy for cancer.

    PubMed

    Buchs, N C; Bucher, P; Pugin, F; Morel, P

    2011-03-01

    Minimally invasive approach for gastric cancer has gained increasing acceptance. Introduction of the da Vinci robotic system has allowed overcoming the technical limitations of standard laparoscopy. To date, several studies have been published reporting the feasibility of robot-assisted gastrectomy (RAG). The aim of this study is to extensively review all the published literature concerning RAG and to assess its value. Since 2003, this systematic review of the literature shows that 10 original studies reporting 199 RAG for cancer have been published worldwide. The authors analyzed operative time, blood loss, conversion rate, lymph nodes retrieval, complications, mortality, length of hospital stay and follow-up through a systematic review. Mean age was 63 years (range: 25-96). Mean operative times were 265 minutes and 334 minutes for total and subtotal gastrectomy respectively. Mean blood loss reported was 113 mL (range: 12-1400). Conversion rate was 2.5%. Average lymph nodes retrieval was 32 (range: 11-83). Twenty-nine complications were reported (14.6%). Mortality rate was 1.5%. Mean length of stay was 10 days (range: 3-175).This review demonstrates that RAG for cancer is not only feasible but also seems to be safe, with low mortality and acceptable morbidity. However, due to the lack of long-term follow-up and the limited number of published studies, it is relatively too early to draw definitive conclusions and/or to recommend the use of RAG for oncologic gastrectomy. Randomized controlled trials with long-term follow up are needed before this promising approach can eventually be generalized.

  19. [Effectiveness of chemoradiotherapy for a patient with local recurrence of advanced gastric cancer followed by curable gastrectomy].

    PubMed

    Natsume, Soichiro; Iwasaki, Yoshiaki; Yajima, Kazuhito; Yuu, Ken; Oohinata, Ryouki; Ishiyama, Satoshi; Takahashi, Keiichi; Maeda, Yoshiharu

    2014-11-01

    We report here the effectiveness of chemoradiotherapy for a patient with local recurrence followed by curable gastrectomy. A 57-year-old man presented with a history of total gastrectomy with distal pancreatectomy and splenectomy, D2 lymphadenectomy, and Roux-en-Y reconstruction for advanced gastric cancer arising from the cardia. Esophageal intramural metastasis and lymph node metastasis around the right recurrent nerve were detected by chest-abdominal computed tomography and gastrointestinal endoscopy 27 months after the initial gastrectomy. Stable disease was achieved following 7 courses of chemotherapy using S-1 plus CDDP. Concurrent chemoradiotherapy including administration of S-1 and radiation of total 50 Gy (2 Gy/25 Fr) was selected for local tumor control. The patient was not able to eat solid food because of esophageal stenosis from regrowth of intramural metastasis of the esophagus 60 months after the chemotherapy. A WallFlex™ Duodenal Stent was placed to improve the dysphagia 67 months after chemotherapy. The patient died from recurrence of gastric cancer 69 months after completion of the initial chemotherapy and 2 months after the stent insertion.

  20. Curating the Shelves

    ERIC Educational Resources Information Center

    Schiano, Deborah

    2013-01-01

    Curation: to gather, organize, and present resources in a way that meets information needs and interests, makes sense for virtual as well as physical resources. A Northern New Jersey middle school library made the decision to curate its physical resources according to the needs of its users, and, in so doing, created a shelving system that is,…

  1. Gastric microbiota and predicted gene functions are altered after subtotal gastrectomy in patients with gastric cancer

    PubMed Central

    Tseng, Ching-Hung; Lin, Jaw-Town; Ho, Hsiu J.; Lai, Zi-Lun; Wang, Chang-Bi; Tang, Sen-Lin; Wu, Chun-Ying

    2016-01-01

    Subtotal gastrectomy (i.e., partial removal of the stomach), a surgical treatment for early-stage distal gastric cancer, is usually accompanied by highly selective vagotomy and Billroth II reconstruction, leading to dramatic changes in the gastric environment. Based on accumulating evidence of a strong link between human gut microbiota and host health, a 2-year follow-up study was conducted to characterize the effects of subtotal gastrectomy. Gastric microbiota and predicted gene functions inferred from 16S rRNA gene sequencing were analyzed before and after surgery. The results demonstrated that gastric microbiota is significantly more diverse after surgery. Ralstonia and Helicobacter were the top two genera of discriminant abundance in the cancerous stomach before surgery, while Streptococcus and Prevotella were the two most abundant genera after tumor excision. Furthermore, N-nitrosation genes were prevalent before surgery, whereas bile salt hydrolase, NO and N2O reductase were prevalent afterward. To our knowledge, this is the first report to document changes in gastric microbiota before and after surgical treatment of stomach cancer. PMID:26860194

  2. Function-preserving gastrectomy for gastric cancer in Japan.

    PubMed

    Nomura, Eiji; Okajima, Kunio

    2016-07-14

    Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy

  3. Function-preserving gastrectomy for gastric cancer in Japan

    PubMed Central

    Nomura, Eiji; Okajima, Kunio

    2016-01-01

    Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy

  4. Should an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery Be Preserved during Laparoscopic Gastrectomy for Early Gastric Cancer Treatment?

    PubMed Central

    Kim, Jieun; Kim, Su Mi; Seo, Jeong Eun; Ha, Man Ho; An, Ji Yeong; Choi, Min Gew; Lee, Jun Ho; Bae, Jae Moon; Kim, Sung; Jeong, Woo Kyoung

    2016-01-01

    Purpose During laparoscopic gastrectomy, an aberrant left hepatic artery (ALHA) arising from the left gastric artery (LGA) is occasionally encountered. The aim of this study was to define when an ALHA should be preserved during laparoscopic gastrectomy. Materials and Methods From August 2009 to December 2014, 1,340 patients with early gastric cancer underwent laparoscopic distal gastrectomy. One hundred fifty patients presented with an ALHA; of the ALHA was ligated in 116 patients and preserved in 34 patients. Patient characteristics, postoperative outcomes and perioperative liver function tests were reviewed retrospectively. Correlations between the diameter of the LGA measured on preoperative abdominal computed tomography and postoperative liver enzyme levels were analyzed. Results Pearson's correlation analysis showed a positive correlation between the diameter of the LGA and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respectively). Linear regression analysis estimated the diameter of the LGA to be 5.1 mm and 4.9 mm when AST and ALT levels were twice the normal limit on postoperative day 1. Conclusions We suggest preserving the ALHA arising from a large LGA, having diameter greater than 5 mm, during laparoscopic gastrectomy to prevent immediate postoperative hepatic dysfunction. PMID:27433391

  5. The Impact of Confluence Types of the Right Gastroepiploic Vein on No. 6 Lymphadenectomy During Laparoscopic Radical Gastrectomy.

    PubMed

    Cao, Long-Long; Huang, Chang-Ming; Lu, Jun; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Chen, Qi-Yue; Lin, Mi; Tu, Ru-Hong

    2015-08-01

    This study investigated anatomical variations in the confluence types of the right gastroepiploic vein (RGEV) to improve knowledge regarding no. 6 lymphadenectomy for laparoscopic gastrectomy.The RGEV drainage patterns of 144 patients who were diagnosed with gastric cancer and underwent laparoscopic distal gastrectomy at our department from July 2010 to June 2011 were prospectively collected and retrospectively analyzed, and we compared the impact of different drainage patterns on no. 6 lymphadenectomy.The RGEV confluence types were classified into 6 categories in this study. Types I, II, and III, which were observed in 53 (36.8%), 27 (18.8%), and 21 (14.6%) cases, respectively, were the most frequently found during gastrectomy. All 3 of these types included a gastropancreatic trunk and were defined as the gastropancreatic group (GP group). In addition, 15 cases (10.4%) were categorized as type IV, 19 (13.2%) were categorized as type V, and 9 (6.3%) were categorized as type VI. These 3 types, which could form a gastrocolic trunk, were defined as the gastrocolic group (GC group). No significant differences were found with respect to the clinicopathological characteristics, postoperative morbidity, perioperative mortality, and 3-year overall survival rates after surgery between the 2 groups (all P > 0.05). However, the mean no. 6 lymph node (No. 6 LN) dissection time, the mean blood loss due to No. 6 LN dissection and the rate of infrapyloric vascular injury were significantly increased in the GC group compared with the GP group (all P < 0.05).The RGEV exhibits 6 types of drainage patterns, and the division points of this vein during laparoscopic gastrectomy depend on the different drainage patterns. For types IV, V, and VI, the surgeon should carefully vascularize and divide the RGEV above its confluences during surgery.

  6. Distal splenorenal shunt

    MedlinePlus

    ... shunt procedure; Renal - splenic venous shunt; Warren shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal ... hepatitis Blood clots Certain congenital disorders Primary biliary cirrhosis When blood cannot flow normally through the portal ...

  7. Distal Convoluted Tubule

    PubMed Central

    Ellison, David H.

    2014-01-01

    The distal convoluted tubule is the nephron segment that lies immediately downstream of the macula densa. Although short in length, the distal convoluted tubule plays a critical role in sodium, potassium, and divalent cation homeostasis. Recent genetic and physiologic studies have greatly expanded our understanding of how the distal convoluted tubule regulates these processes at the molecular level. This article provides an update on the distal convoluted tubule, highlighting concepts and pathophysiology relevant to clinical practice. PMID:24855283

  8. Gastrectomy in siblings with Christmas disease (hemophilia B).

    PubMed

    Mizumoto, R; Kawarada, Y; Ogura, Y

    1980-12-01

    Gastrointestinal hemorrhage is regarded as one of the commonest clinical manifestations of classic hemophilia and Christmas disease. Although major surgery is usually avoided in such cases, recently we had 2 cases of Christmas disease in siblings who had undergone a successful gastrectomy and concomitant administration of a concentrated preparation of factor IX. In addition, findings in 7 other Japanese patients with hemophilia who underwent gastrectomy are discussed.

  9. [J-pouch after total gastrectomy].

    PubMed

    Prete, F; Montemurro, S; Rucci, A; Rinaldi, S; Liguori, P

    1992-04-01

    The Authors report their initial experience with the construction of a J-pouch as restorative surgery following total gastrectomy (TG) for malignant neoplasms. In the last 10 months of the 1990 upon 52 interventions for gastric cancer 31 TG were performed, and in 13 cases a J-pouch on the proximal end of the jejunal segment was constructed. No mortality or specific morbidity was registered using the totally stapled technique. Within one month 3/4 of the patients had normal meals as far as quantity and quality; also the foamy regurgitation seemed to be minimal. The ease of the reconstructive technique and the short term results obtained encourage the use of such approach.

  10. Laparoscopic sleeve gastrectomy for morbid obesity

    PubMed Central

    Iannelli, Antonio; Dainese, Raffaella; Piche, Thierry; Facchiano, Enrico; Gugenheim, Jean

    2008-01-01

    The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity. Bariatric surgery proved effective in providing weight loss of large magnitude, correction of comorbidities and excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage. The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very “trendy” among laparoscopic surgeons involved in bariatric surgery. As LSG proved to be effective in achieving considerable weight loss in the short-term, it has been proposed by some as a sole bariatric procedure. This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity. PMID:18240338

  11. Laparoscopic sleeve gastrectomy and gastroesophageal reflux.

    PubMed

    Stenard, Fabien; Iannelli, Antonio

    2015-09-28

    Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.

  12. Intraoperative assessment of tissue oxygen saturation of the remnant stomach by near-infrared spectroscopy in two cases of pancreatectomy following gastrectomy

    PubMed Central

    Akabane, Shintaro; Ohira, Masahiro; Ishiyama, Kohei; Kobayashi, Tsuyoshi; Ide, Kentaro; Tahara, Hiroyuki; Kuroda, Shintaro; Tanimine, Naoki; Shimizu, Seiichi; Tanabe, Kazuaki; Ohdan, Hideki

    2016-01-01

    Introduction Objective and quantitative intraoperative methods of bowel viability assessment could decrease the risk of postoperative ischemic complications in gastrointestinal surgery. Because the remnant stomach and the pancreas share an arterial blood supply, it is often unclear whether the remnant stomach can be safely preserved when performing pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) post gastrectomy. We herein report two cases in which the remnant stomach was safely preserved using near-infrared spectroscopy to assess the regional saturation of oxygen (rSO2) in the remnant stomach during operation. Presentation of case The first patient, a 68-year-old man, was diagnosed with cancer of the pancreatic head and underwent PD a year after proximal gastrectomy for gastric cancer. The remnant stomach was safely preserved by evaluation of the rSO2 before and after reconstruction of the arteries. The second patient, an 82-year-old woman with a history of distal gastrectomy for gastric cancer 40 years previously, was diagnosed with a main duct intraductal papillary mucinous neoplasm of the pancreatic body, requiring DP. As in the previous case, we could safely preserve the remnant stomach through assessing the intraoperative rSO2 of the remnant stomach. Discussion Through comparing changes in the rSO2 during surgery, near-infrared spectroscopy provides objective and quantitative assessments of intestinal viability to predict ischemic complications. Conclusion This method may be a viable option to evaluate the blood supply to the alimentary tract. PMID:27061481

  13. Prognostic Factors for Node-Negative Advanced Gastric Cancer after Curative Gastrectomy

    PubMed Central

    Lee, Eun Woo; Koo, Ho-Seok

    2016-01-01

    Purpose Lymph node (LN) metastasis is the best prognostic indicator in non-distant metastatic advanced gastric cancer. This study aimed to assess the prognostic value of various clinicopathologic factors in node-negative advanced gastric cancer. Materials and Methods We retrospectively analyzed the clinical records of 254 patients with primary node-negative stage T2~4 gastric cancer. These patients were selected from a pool of 1,890 patients who underwent radical resection at Memorial Jin-Pok Kim Korea Gastric Cancer Center, Inje University Seoul Paik Hospital between 1998 and 2008. Results Of the 254 patients, 128 patients (50.4%), 88 patients (34.6%), 37 patients (14.6%), and 1 patient (0.4%) had T2, T3, T4a, and T4b tumors, respectively. In a univariate analysis, operation type, T-stage, venous invasion, tumor size, and less than 15 LNs significantly correlated with tumor recurrence and cumulative overall survival. In a multivariate logistic regression analysis, tumor size, venous invasion, and less than 15 LNs significantly and independently correlated with recurrence. In a multivariate Cox proportional hazards analysis, tumor size (hazard ratio [HR]: 2.926; 95% confidence interval [CI]: 1.173~7.300; P=0.021), venous invasion (HR: 3.985; 95% CI: 1.401~11.338; P=0.010), and less than 15 LNs (HR: 0.092; 95% CI: 0.029~0.290; P<0.001) significantly correlated with overall survival. Conclusions Node-negative gastric cancers recurred in 8.3% of the patients in our study. Tumor size, venous invasion, and less than 15 LNs reliably predicted recurrence as well as survival. Aggressive postoperative treatments and timely follow-ups should be considered in cases with these characteristics. PMID:27752393

  14. Distal Myopathies: Case Studies.

    PubMed

    Shaibani, Aziz

    2016-08-01

    About 15% of myopathies present with distal weakness. Lack of sensory deficit, and preservation of sensory responses and deep tendon reflexes, favors a myopathic cause for distal weakness. Electromyogram confirms this diagnosis. Profuse spontaneous discharges are common in inflammatory, metabolic, and myofibrillar myopathy (MFM). If the clinical picture indicates a specific disease such as facioscapulohumeral muscular dystrophy (FSHD), genetic testing provides the quickest diagnosis. Otherwise, muscle biopsy can distinguish specific features. The common causes of myopathic distal weakness are FSHD, myotonic dystrophy, and inclusion body myositis. Other causes include MFM, distal muscular dystrophies, metabolic myopathies, and congenital myopathies. PMID:27445241

  15. Current status of robotic gastrectomy for gastric cancer.

    PubMed

    Obama, Kazutaka; Sakai, Yoshiharu

    2016-05-01

    Although over 3000 da Vinci Surgical System (DVSS) devices have been installed worldwide, robotic surgery for gastric cancer has not yet become widely spread and is only available in several advanced institutions. This is because, at least in part, the advantages of robotic surgery for gastric cancer remain unclear. The safety and feasibility of robotic gastrectomy have been demonstrated in several retrospective studies. However, no sound evidence has been reported to support the superiority of a robotic approach for gastric cancer treatment. In addition, the long-term clinical outcomes following robotic gastrectomy have yet to be clarified. Nevertheless, a robotic approach can potentially overcome the disadvantages of conventional laparoscopic surgery if the advantageous functions of this technique are optimized, such as the use of wristed instruments, tremor filtering and high-resolution 3-D images. The potential advantages of robotic gastrectomy have been discussed in several retrospective studies, including the ability to achieve sufficient lymphadenectomy in the area of the splenic hilum, reductions in local complication rates and a shorter learning curve for the robotic approach compared to conventional laparoscopic gastrectomy. In this review, we present the current status and discuss issues regarding robotic gastrectomy for gastric cancer.

  16. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    PubMed Central

    Zikry, Amir Abu; DeSousa, Kalindi; Alanezi, Khaled H

    2011-01-01

    Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG) in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO2 and SaO2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication. PMID:21772696

  17. Laparoscopic Proximal Gastrectomy With Gastric Tube Reconstruction

    PubMed Central

    Shiraishi, Norio; Toujigamori, Manabu; Shiroshita, Hidefumi; Etoh, Tsuyoshi; Inomata, Masafumi

    2016-01-01

    Background and Objectives: There is no standardized method of reconstruction in laparoscopic proximal gastrectomy (LPG). We present a novel technique of reconstruction with a long, narrow gastric tube in LPG for early gastric cancer (EGC). Methods: During the laparoscopic procedure, the upper part of the stomach is fully mobilized with perigastric and suprapancreatic lymphadenectomy, and then the abdominal esophagus is transected. After a minilaparotomy is created, the entire stomach is pulled outside. A long, narrow gastric tube (20 cm long, 3 cm wide) is created with a linear stapler. The proximal part of the gastric tube is formed into a cobra head shape for esophagogastric tube anastomosis, which is then performed with a 45-mm linear stapler under laparoscopic view. The end of the esophagus is fixed on the gastric tube to prevent postoperative esophageal reflux. Results: Thirteen patients with early proximal gastric cancer underwent the procedure. The mean operative time was 283 min, and median blood loss was 63 ml. There were no conversions to open surgery, and no intraoperative complications. Conclusion: This new technique of reconstruction after LPG is simple and feasible. The procedure has the potential of becoming a standard reconstruction technique after LPG for proximal EGC. PMID:27547027

  18. Gastric cancer arising from the remnant stomach after distal gastrectomy: a review.

    PubMed

    Takeno, Shinsuke; Hashimoto, Tatsuya; Maki, Kenji; Shibata, Ryosuke; Shiwaku, Hironari; Yamana, Ippei; Yamashita, Risako; Yamashita, Yuichi

    2014-10-14

    Gastric stump carcinoma was initially reported by Balfore in 1922, and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology, carcinogenesis, Helicobacter pylori (H. pylori) infection, Epstein-Barr virus infection, clinicopathologic characteristics and endoscopic treatment. In particular, it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition, endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast, many issues concerning gastric stump carcinoma remain to be clarified, including molecular biological characteristics and the carcinogenesis of H. pylori infection. We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.

  19. Morbid obesity and sleeve gastrectomy: how does it work?

    PubMed

    Papailiou, Joanna; Albanopoulos, Konstantinos; Toutouzas, Konstantinos G; Tsigris, Christos; Nikiteas, Nikolaos; Zografos, George

    2010-10-01

    Laparoscopic sleeve gastrectomy is known to be a safe and effective procedure for treating morbid obesity and is performed with increasing frequency both in Europe and the USA. Despite its broad use, many questions about the remaining gastric tube diameter, its long-term efficacy, its effects on gastric emptying, and the hormones involved still remain to be answered. In order to use such a relatively new surgical procedure wisely, it is essential for every surgeon and physician to understand how sleeve gastrectomy acts in obesity and what its potential benefits on the patients' metabolism are. This review focuses on the most important pathophysiologic questions referred to sleeve gastrectomy on the literature so far, in an attempt to evaluate the different issues still pending on the subject.

  20. Function-preserving gastrectomy for early gastric cancer.

    PubMed

    Hiki, Naoki; Nunobe, Souya; Kubota, Takeshi; Jiang, Xiaohua

    2013-08-01

    The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures. Applications of function-preserving gastric cancer surgery may therefore also be increasing because of its low incidence of lymph node metastasis, excellent survival rates, and the possibility of less-invasive procedures such as laparoscopic gastrectomy being used in combination. Pylorus-preserving gastrectomy (PPG) with radical lymph node dissection is one such function-preserving procedure that has been applied for EGC, with the indications, limitations, and survival benefits of PPG already reported in several retrospective studies. Laparoscopy-assisted proximal gastrectomy has also been applied for EGC of the upper third of the stomach, although this procedure can be associated with the 2 major problems of reflux esophagitis and carcinoma arising in the gastric stump. In the patient with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved very small stomach may provide a better quality of life for the patients and fewer postoperative complications. Finally, the laparoscopy endoscopy cooperative surgery procedure combines endoscopic submucosal dissection with laparoscopic gastric wall resection, which prevents excessive resection and deformation of the stomach after surgery and was recently applied for EGC cases without possibility of lymph node metastasis. Function-preserving laparoscopic gastrectomy is recommended for the treatment of EGC if the indication followed by accurate diagnosis is strictly confirmed. Preservation of remnant stomach sometimes causes severe postoperative dysfunctions such as delayed gastric retention in PPG, esophageal reflux in PG, and gastric stump carcinoma in the remnant stomach. Moreover, these techniques present technical difficulties to the surgeon. Although many retrospective studies showed the functional benefit or oncological safety of function-preserving gastrectomy

  1. Superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy.

    PubMed

    Pineda, Lucas; Sarhan, Mohammad; Ahmed, Leaque

    2013-08-01

    Laparoscopic procedures for morbid obesity are becoming standard of care which, in experienced hands, has a very low mortality and morbidity. Superior mesenteric vein thrombosis has been reported in the literature after different bariatric and nonbariatric laparoscopic procedures. Laparoscopic sleeve gastrectomy is a relatively new procedure in the treatment of morbid obesity; its complications being well-known including staple line leak, bleeding, and stricture among others. We present a case of superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy successfully managed conservatively with therapeutic anticoagulation, and propose a different hypothesis for the development of such a complication.

  2. [LAPAROSCOPIC "SLEEVE" GASTRECTOMY POST HEART TRANSPLANTION].

    PubMed

    Mahler, Ilanit; Ben Gal, Tuvia; Kashtan, Hanoch; Keidar, Andrei

    2016-03-01

    Morbid obesity affects the function of the transplanted heart either directly, by damaging many elements that affect cardiac function or indirectly, by the initial appearance or worsening of co-morbidities that affect the heart. Bariatric surgery is the most effective treatment for a significant and sustained decrease in weight and it leads to the disappearance of co-morbidities such as diabetes, hypertension and dyslipidemia in high rates. These diseases can damage the blood vessels of the graft and impair its function. We report a case study of a 47-year-old morbidly obese male (BMI 36 kg/m2] who underwent heart transplantation three years previously, developed gradual weight gain and symptoms of aggravating heart failure. Coronary artery disease in the implanted heart was diagnosed. Clinically, he started suffering from shortness of breath and chest pain during minimal effort. In addition, he also suffered from high blood pressure and kidney failure. Laparoscopic sleeve gastrectomy was successfully performed and he was discharged four days later. On follow-up the patient has lost 35 kg. His present weight is 74 kg (BMI 25.7). All symptoms of heart failure improved and oral medications for hypertension and heart failure were withdrawn. Our conclusion is that it is justified to consider bariatric surgery in heart transplant recipients suffering from morbid obesity, as long as the long-term benefit outweighs the surgical risk. The decision to perform bariatric surgery should be made by a multidisciplinary team and the operation should take place at a center with extensive experience in bariatric surgery. PMID:27305748

  3. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV

    PubMed Central

    PINTO, José Máximo Costa; de LIMA, Marianna Gomes Cavalcanti Leite; de ALMEIDA, Ana Luiza Melo Cavalcanti; SOUSA, Marcelo Gonçalves

    2016-01-01

    ABSTRACT Introduction: It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. Objective: To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Methods: Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. Conclusion: It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. PMID:27683793

  4. Distal biceps brachii.

    PubMed

    Brigido, Monica Kalume; De Maeseneer, Michel; Morag, Yoav

    2013-02-01

    There has been a renewed interest in the recent literature with regard to the normal anatomy of the distal biceps tendon. Cadaveric studies have demonstrated that a large percentage of individuals have two independent muscle bellies, the short and the long head, with two distinct separate tendons attaching at the radial tuberosity. To avoid diagnostic errors that may have an impact on patient management in case of tendon injury, it is important to keep this anatomical variant in mind. Ultrasonography has been shown to be a useful imaging modality in the evaluation of disorders of the distal biceps brachii muscle and tendon. In this article, we review the relevant anatomy of the distal biceps brachii, the ultrasound technique with alternative approaches for optimum visualization of the distal tendon, and the most common pathologies in this region.

  5. Transphyseal Distal Humerus Fracture.

    PubMed

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  6. Distal humeral epiphyseal separation.

    PubMed

    Moucha, Calin S; Mason, Dan E

    2003-10-01

    Distal humeral epiphyseal separation is an uncommon injury that is often misdiagnosed upon initial presentation. To make a timely, correct diagnosis, the treating physician must have a thorough understanding of basic anatomical relationships and an awareness of the existence of this injury. This is a case of a child who sustained a separation of the distal humeral epiphysis, as well as multiple other bony injuries, secondary to child abuse.

  7. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure?

    PubMed Central

    Benaiges, David; Más-Lorenzo, Antonio; Goday, Albert; Ramon, José M; Chillarón, Juan J; Pedro-Botet, Juan; Roux, Juana A Flores-Le

    2015-01-01

    Sleeve gastrectomy (SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications. PMID:26557004

  8. Anaemia after partial gastrectomy: a neglected curable condition.

    PubMed

    Tovey, F I; Clark, C G

    1980-05-01

    Anaemia is a well recognised complication of partial gastrectomy, the incidence increasing with the postoperative interval. Many surveys show a similar incidence of untreated anaemia, which implies that the need for regular follow-up is recognised but not put into practice. Much information is available on the aetiology of postgastrectomy anaemia, and a single course of therapy is known to be effective. Since the difficulty semms to lie in early detection, prophylaxis may be a solution. Our study of a group of patients treated by gastrectomy attending a follow-up clinic during the past ten years has provided information on the frequency of anaemia and the outcome of different treatments. PMID:6103303

  9. Curative cancer chemotherapy.

    PubMed

    Frei, E

    1985-12-01

    Cancer chemotherapy provides variably effective treatment for the majority of forms of human cancer and curative treatment for some 12 categories of cancer. Curative treatment is defined as the proportion of patients who survive beyond the time after which the risk of treatment failure approaches zero, i.e., the disease-free survival plateau. This progress has resulted from a closely integrated scientific effort, including drug development, pharmacology, preclinical modeling, experimental design with respect to clinical trials, quantitative criteria for response, and a series of clinical trials (initially in children with acute lymphocytic leukemia) in which the importance of complete remission, of dose and schedule, of sequencing chemotherapeutic agents, of pharmacological sanctuaries, and particularly of combination chemotherapy was studied. The principles derived from these studies, particularly those relating to combination chemotherapy, resulted in curative treatment for disseminated Hodgkin's disease, non-Hodgkin's lymphoma, pediatric solid tumors, testicular cancer, and limited small cell lung cancer. Many patients with certain stages of solid tumors, such as breast cancer and osteogenic sarcoma, are at high risk of having disseminated microscopic disease. Experimental studies indicate that treatment which is only partially effective against macroscopic disease is much more effective against microscopic tumors. Therefore chemotherapy is administered immediately following control of the primary tumor in patients at high risk of having disseminated microscopic disease, a treatment known as adjuvant chemotherapy. This program has been highly successful in increasing the cure rate in patients with pediatric solid tumors and in prolonging disease-free survival in patients with premenopausal breast cancer. Given dissemination of the technology, it is estimated that 15,000-30,000 patients per year are potentially curable in the United States. Curability of cancer

  10. Absorption of biliary cobalamin in baboons following total gastrectomy

    SciTech Connect

    Green, R.; Jacobsen, D.W.; Van Tonder, S.V.; Kew, M.C.; Metz, J.

    1982-11-01

    Absorption of radiolabeled cobalamin in baboons was assessed by whole body counting. Retention of biliary cobalamin and an aqueous solution of cyanocobalamin was measured in normal baboons and in baboons after total gastrectomy by using /sup 57/Co-labeled biliary cobalamin and /sup 58/C0-cyanocobalamin, with and without baboon gastric juice containing intrinsic factor. Radiolabeled biliary cobalamin was obtained by intravenous injection of /sup 57/Co-cyanocobalamin in baboons and collection of bile through a cannula placed in the common bile duct. Cobalamin absorption was not completely abolished by gastrectomy and biliary cobalamin was better retained than cyanocobalamin; intrinsic factor enhanced absorption of both forms. After gastrectomy there was steady depletion of liver and serum cobalamin levels, which ceased after a new equilibrium was reached between a progressively diminishing cobalamin loss and the impaired but significant residual level of absorption. These studies in the nonhuman primate provide further information concerning the enterohepatic circulation of cobalamin and suggest that the form of cobalamin in bile may be more readily absorbed than is cyanocobalamin or that bile itself may have an enhancing effect on cobalamin absorption. The data also suggest that physiologically significant amounts of cobalamin may be absorbed in the absence of a gastric source of intrinsic factor.

  11. Is love curative?

    PubMed

    Glucksman, Myron L

    2010-01-01

    This article explores the phenomenon of love in the therapeutic relationship and its role as a curative factor. Since Freud's (1915) description of transference love, a major goal of treatment is to understand its developmental antecedents. Most analysts agree that transference love is no different than ordinary love, except that it is overdetermined and requires the patient to view it as simultaneously real and illusory without reciprocity from the analyst. Nontransferential, realistic elements of the therapeutic relationship also play an important role in treatment. An important outgrowth of the therapeutic process is the development of a new object relationship between analyst and patient. This special or transformative friendship is a new object relationship characterized by genuine feelings of mutual respect, trust, caring, and even love. It facilitates the patient's capacity to form and maintain other loving relationships. Two case presentations are illustrative.

  12. Risk factors for pulmonary complications following laparoscopic gastrectomy

    PubMed Central

    Ntutumu, Redondo; Liu, Hao; Zhen, Li; Hu, Yan-Feng; Mou, Ting-Yu; Lin, Tian; I, Balde A.; Yu, Jiang; Li, Guo-Xin

    2016-01-01

    Abstract The risk factors associated with postoperative pulmonary complications (PPCs) following laparoscopic gastrectomy have not been well studied. We sought to identify the risk factors for PPCs following gastric cancer surgery. A retrospective analysis was performed on all gastric cancer patients in a prospective database who underwent a laparoscopic gastrectomy from 2004 to 2014. The potential risk factors for PPCs were evaluated. PPCs occurred in 6.8% (83/1205) of patients and included pneumonia in 56 (67.5%) patients, pleural effusion in 26 (31.3%) patients, and pulmonary embolism in 1 (1.2%) patient. The multivariate analysis identified the following significant risk factors for PPCs: advanced age (odds ratio [OR] = 1.043, 95% confidence interval [CI] = 1.021%, 1.066%), chronic obstructive pulmonary disease (COPD) (OR = 17.788, 95% CI = 2.618%, 120.838%), total gastrectomy (OR = 2.781, 95% CI = 1.726%, 4.480%), time to first diet (OR = 1.175, 95% CI = 1.060%, 1.302%), and postoperative hospital stay (OR = 1.015, 95% CI = 1.002%, 1.028%). The risk factors for pneumonia included advanced age (OR = 1.036, 95% CI = 1.010%, 1.063%), total gastrectomy (OR = 3.420, 95% CI = 1.960%, 5.969%), and time to first diet (OR = 1.207, 95% CI = 1.703%, 1.358%). Only pancreatectomy was a risk factor for pleural effusion (OR = 9.082, 95% CI = 2.412%, 34.206%). The frequency of PPCs in patients with gastric cancer who underwent laparoscopic surgery was relatively high. Patients with cardiac and pulmonary comorbidities and those who undergo total gastrectomy and combined resection should be considered at high risk. PMID:27512884

  13. Long-term survival outcomes of laparoscopic versus open gastrectomy for gastric cancer: a systematic review and meta-analysis.

    PubMed

    Chen, Xin-Zu; Wen, Lei; Rui, Yuan-Yi; Liu, Chao-Xu; Zhao, Qing-Chuan; Zhou, Zong-Guang; Hu, Jian-Kun

    2015-01-01

    Many meta-analyses have confirmed the technical feasibility and favorable short-term surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer patients, but the long-term survival outcome of LG remains controversial compared with open gastrectomy (OG). This study aimed to compare the 5-year overall survival (OS), recurrence, and gastric cancer-related death of LG with OG among gastric cancer patients. PubMed was searched to February 2014. The resectable gastric cancer patients who underwent curative LG or OG were eligible. The studies that compared 5-year OS, recurrence, or gastric cancer-related death in the LG and OG groups were included. A meta-analysis, meta-regression, sensitivity analysis, subgroup analysis, and stage-specific analysis were performed to estimate the survival outcome between the two groups and identify the potential confounders. Quality assessment was based on a tailored comparability scoring system. Twenty-three studies with 7336 patients were included. The score of comparability between two groups and the extent of lymphadenectomy were two independent confounders. Based on the well-balanced studies, the 5-year OS (OR = 1.07, 95% CI 0.90-1.28, P = 0.45), recurrence (OR = 0.83, 95% CI 0.68-1.02, P = 0.08), and gastric cancer-related death (OR = 0.86, 95% CI 0.65-1.13, P = 0.28) rates were comparable in LG and OG. Several subsets such as the publication year, study region, sample size, gastrectomy pattern, extent of lymphadenectomy, number of nodes harvested, and proportion of T1-2 or N0-1 did not influence the estimates, if they were well balanced. Particularly, the stage-specific estimates obtained comparable results between the two groups. Randomized controlled trials comparing LG with OG remain sparse to assess their long-term survival outcomes. The major contributions of this systematic review compared with other meta-analyses are a comprehensive collection of available long-term survival outcomes within

  14. [Life-saving total gastrectomy in abdominal sepsis after bariatric surgery of gastric sleeve].

    PubMed

    Barboza, E; Barboza, A; Calmet, F; Montes, M; Ronceros, V; Málaga, G; Gotuzzo, E; Sattui, A; Portugal, J; Mattos, L; Bocanegra, J; Vásquez, F; Contardo, M; Arias Stella, J

    2007-01-01

    Three obese patients underwent sleeve gastrectomy. They developed gastric dehiscence with generalized peritonitis, sepsis and shock, being operated as total gastrectomy of the remanent stomach with Roux in Y esophago-jejunostomy reconstruction as a last chance of life saving procedure. PMID:17934544

  15. How much does curation cost?

    PubMed Central

    2016-01-01

    NIH administrators have recently expressed concerns about the cost of curation for biological databases. However, they did not articulate the exact costs of curation. Here we calculate the cost of biocuration of articles for the EcoCyc database as $219 per article over a 5-year period. That cost is 6–15% of the cost of open-access publication fees for publishing biomedical articles, and we estimate that cost is 0.088% of the cost of the overall research project that generated the experimental results. Thus, curation costs are small in an absolute sense, and represent a miniscule fraction of the cost of the research. PMID:27504008

  16. How much does curation cost?

    PubMed

    Karp, Peter D

    2016-01-01

    NIH administrators have recently expressed concerns about the cost of curation for biological databases. However, they did not articulate the exact costs of curation. Here we calculate the cost of biocuration of articles for the EcoCyc database as $219 per article over a 5-year period. That cost is 6-15% of the cost of open-access publication fees for publishing biomedical articles, and we estimate that cost is 0.088% of the cost of the overall research project that generated the experimental results. Thus, curation costs are small in an absolute sense, and represent a miniscule fraction of the cost of the research.

  17. JSC Stardust Curation Team

    NASA Technical Reports Server (NTRS)

    Zolensky, Michael E.

    2000-01-01

    STARDUST, a NASA Discovery-class mission, is the first to return samples from a comet. Grains from comet Wild 2's coma-the gas and dust envelope that surrounds the nucleus-will be collected as well as interstellar dust. The mission which launched on February 7, 1999 will encounter the comet on January 10, 2004. As the spacecraft passes through the coma, a tray of silica aerogel will be exposed, and coma grains will impact there and become captured. Following the collection, the aerogel tray is closed for return to Earth in 2006. A dust impact mass spectrometer on board the STARDUST spacecraft will be used to gather spectra. of dust during the entire mission, including the coma passage. This instrument will be the best chance to obtain data on volatile grains, which will not be well-collected in the aerogel. The dust impact mass spectrometer will also be used to study the composition of interstellar grains. In the past 5 years, analysis of data from dust detectors aboard the Ulysses and Galileo spacecraft have revealed that there is a stream of interstellar dust flowing through our solar system. These grains will be captured during the cruise phase of the STARDUST mission, as the spacecraft travels toward the comet. The sample return capsule will parachute to Earth in February 2006, and will land in western Utah. Once on y the ground, the sample return capsule will be placed into a dry nitrogen environment and flown to the curation lab at JSC.

  18. Single-Port Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction for Early Gastric Cancer: Report of a Case

    PubMed Central

    Lee, Chang Min; Park, Da Won; Jung, Do Hyun; Jang, You Jin; Kim, Jong-Han; Park, Sungsoo

    2016-01-01

    In Korea, proximal gastrectomy has recently attracted attention as a better choice of function-preserving surgery for proximal early gastric cancer than total gastrectomy. Of the various strategies to overcome reflux symptoms from remnant stomach, double tract reconstruction not only reduces the incidence of anastomosis-related complications, but is also sufficiently reproducible as a laparoscopic procedure. Catching up with the recent rise of single-port laparoscopic surgeries, we performed a pure single-port laparoscopic proximal gastrectomy with DTR. This procedure was designed by merging the function-preserving concept of proximal gastrectomy with single-port laparoscopic total gastrectomy. PMID:27752399

  19. Factors Related to Morbidity in Elderly Gastric Cancer Patients Undergoing Gastrectomies

    PubMed Central

    Shin, Ha Song; Suh, Byoung Jo

    2014-01-01

    Purpose The prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients. Materials and Methods For this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups (<70 years vs. ≥70 years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality. Results Comorbidities were more prevalent in the elderly group (≥70 years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group. Conclusions Pulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer. PMID:25328762

  20. Benefits of xiphoidectomy in total gastrectomy: Technical note

    PubMed Central

    Mihmanlı, Mehmet; Köksal, Hakan Mustafa; Demir, Uygar; Işıl, Rıza Gürhan

    2016-01-01

    Objective: The esophago-gastric junction may be challenging during total gastrectomy due to gastric cancer. This situation may compromise the security of both the dissection and anastomosis. The purpose of this study was to investigate the usefulness of xiphoidectomy to overcome this issue. Material and Methods: The files of patients who underwent total gastrectomy + D2 lymph node dissection due to proximal gastric cancer or cardia cancer between April 2002–December 2013 were retrospectively evaluated. We assessed the outcome in patients with xiphoidectomy in addition to the midline incision in terms of xiphoidectomy technique, xiphoidectomy time, and operative and postoperative complications. Results: Thirty cases were identified to undergo xiphoidectomy. Nineteen patients were male and 11 were female, with a mean age of 51 (21–80) years. The time required for xiphoidectomy was 7–15 minutes (mean 8.7 minutes). The mean additional time required for the closure of the incision in cases with xiphoidectomy was 2 minutes. There was minimal arterial bleeding from the diaphragmatic surface in one patient, which was controlled by electrocautery. Only two patients developed wound infection. Conclusion: Performing xiphoidectomy is quite easy, after a certain learning phase. The operative time was 7–15 minutes longer due to excision of xiphoid and closure of the related defect. Minor hemorrhage was a problem during surgery. There were no early or late post-operative complications. We suggest that the procedure is beneficial in selected cases with requirement of a wider operative field or better exposure of the esophago-gastric junction during total gastrectomy for gastric cancer, and recommend removal of the xiphoid bone PMID:26985158

  1. Lithium Toxicity Following Vertical Sleeve Gastrectomy: A Case Report

    PubMed Central

    Alam, Abdulkader; Raouf, Sherief; Recio, Fernando O.

    2016-01-01

    We are presenting the first documented case of lithium toxicity after vertical sleeve gastrectomy surgery in an 18 year-old female with psychiatric history of bipolar disorder who was treated with lithium. This case illustrates the need for closer monitoring of lithium levels following bariatric surgery. Both psychiatrists and surgeons should be aware of the potential risk of lithium toxicity following bariatric surgery, as well as the need to judiciously monitor lithium level and possibly adjust the dose of some medications. PMID:27489390

  2. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    PubMed

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  3. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

    PubMed Central

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-01-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  4. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    PubMed

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  5. Wernicke’s encephalopathy after sleeve gastrectomy: Literature review

    PubMed Central

    Pardo-Aranda, Fernando; Perez-Romero, Noelia; Osorio, Javier; Rodriguez-Santiago, Joaquín; Muñoz, Emilio; Puértolas, Noelia; Veloso, Enrique

    2016-01-01

    Objective To describe a case of Wernicke’s encephalopathy after laparoscopic sleeve gastrectomy. Setting Emergency Department and gastrointestinal surgery department. Case report A 20-year-old man class III obesity (BMI 50.17 kg/m2) underwent laparoscopic sleeve gastrectomy with uneventful recovery. Five weeks after surgery he was admitted in the Emergency Department because of persistent vomiting and dysphagia to solids. Esophagogastroduodenal transit and upper gastrointestinal endoscopy were requested but no relevant findings were shown. Laboratory analyses showed vitamin B1 12.2 ng/mL and 48 h following admission the patient experienced generalized weakness, sialorrhea and restrictions of actions such as reading a book. Neurological evaluation found confusion, motor ataxia, diplopy and nystagmus. A brain magnetic resonance was normal. According to low level of vitamin B1 and symptoms found in the patient a presumed diagnosis of Wernicke encephalopathy was made and parenteral thiamine 100 mg/day was started. The patient was discharged asymptomatic with oral intake of vitamin B1 600 mg per day. Conclusion Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors. PMID:26826934

  6. Robotic Gastrectomy: The Current State of the Art

    PubMed Central

    Marano, Alessandra

    2012-01-01

    Since the first laparoscopic gastrectomy for cancer was reported in 1994, minimally invasive surgery is enjoying its wide acceptance. Numerous procedures of this approach have developed, and many patients have benefited from its effectiveness, which has been recently demonstrated for early gastric cancer. However, since laparoscopic surgery is not exempt from some limitations, the robotic surgery system was introduced as a solution by the late 1990's. Many experienced surgeons have embraced this new emerging method that provides undoubted technical and minimally invasive advantages. To date, several studies have concentrated to this new system, and have compared it with open and laparoscopic approach. Most of them have reported satisfactory results concerning the post-operative short-term outcomes, but almost all believe that the role of robotic gastrectomy is still out of focus, especially because long-term outcomes that can prove robotic oncologic equivalency are lacking, and operative costs and time are higher in comparison to the open and laparoscopic ones. This article is a review about the current status of robotic surgery for the treatment of gastric cancer, especially, focusing on the technical aspects, comparisons to other approaches and future prospects. PMID:22792518

  7. [Post-gastrectomy reconstruction versus enteral alimentation--a one year follow-up study].

    PubMed

    Kostov, D; Balabanova, G; Vasilev, B; Plachkov, I; Ignatov, G

    2000-01-01

    This is a report on various post-gastrectomy reconstructive procedures, proceeding from personal experience had with 14 patients undergoing gastrectomy for carcinoma of the stomach and five patients with operations of esophagus and stomach for various pathological conditions. An assessment is done of the reconstructive methods used on the ground of objective indicators. All patients are subjected to enteral alimentation through nutritive jejunostomy. In the pre- and postoperatived periods, the trophic state of patients is evaluated on basis of biochemical, anthropometric and immunologic study data. Postoperatively, in those with small-intestinal reservoir a lower degree negative symptomatology is established, along with life style improvement. Post-gastrectomy patients presenting I-II (UICC) stage of the oncological disease are indicated for small-intestinal reservoir formation. In the overall therapeutic approach to post-gastrectomy patients adequate clinical therapeutic feeding proves absolutely indispensable.

  8. Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer

    PubMed Central

    Sumer, Fatih; Karagul, Servet

    2016-01-01

    Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer. PMID:27104027

  9. Teacher Training in Curative Education.

    ERIC Educational Resources Information Center

    Juul, Kristen D.; Maier, Manfred

    1992-01-01

    This article considers the application of the philosophical and educational principles of Rudolf Steiner, called "anthroposophy," to the training of teachers and curative educators in the Waldorf schools. Special emphasis is on the Camphill movement which focuses on therapeutic schools and communities for children with special needs. (DB)

  10. Cognitive Curations of Collaborative Curricula

    ERIC Educational Resources Information Center

    Ackerman, Amy S.

    2015-01-01

    Assuming the role of learning curators, 22 graduate students (in-service teachers) addressed authentic problems (challenges) within their respective classrooms by selecting digital tools as part of implementation of interdisciplinary lesson plans. Students focused on formative assessment tools as a means to gather evidence to make improvements in…

  11. Curation of OSIRIS-REx Asteroid Samples

    NASA Astrophysics Data System (ADS)

    Righter, K.; Nakamura-Messnger, K.; Lauretta, D. S.; Osiris-Rex Curation Working Group

    2013-09-01

    An overview of the mission curation plan will be given, including the main elements of contamination control, sample recovery, sample cleanroom construction, and curation support once the sample is returned to Earth.

  12. Assisted curation: does text mining really help?

    PubMed

    Alex, Beatrice; Grover, Claire; Haddow, Barry; Kabadjov, Mijail; Klein, Ewan; Matthews, Michael; Roebuck, Stuart; Tobin, Richard; Wang, Xinglong

    2008-01-01

    Although text mining shows considerable promise as a tool for supporting the curation of biomedical text, there is little concrete evidence as to its effectiveness. We report on three experiments measuring the extent to which curation can be speeded up with assistance from Natural Language Processing (NLP), together with subjective feedback from curators on the usability of a curation tool that integrates NLP hypotheses for protein-protein interactions (PPIs). In our curation scenario, we found that a maximum speed-up of 1/3 in curation time can be expected if NLP output is perfectly accurate. The preference of one curator for consistent NLP output and output with high recall needs to be confirmed in a larger study with several curators.

  13. Ataxic gait following total gastrectomy for gastric cancer

    PubMed Central

    Hwang, Chang Ho; Park, Dong Jin; Kim, Gyu Yeol

    2016-01-01

    A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal. This was followed by weekly intramuscular injections of vitamin B12 for another 2 wk and oral administration of vitamin B12 three times per day. After comprehensive rehabilitation for 4 wk, she showed sufficient improvements in strength and ataxic gait, enabling her to return to her normal daily activities. PMID:27729749

  14. Incidental gastric glomus tumor after laparoscopic sleeve gastrectomy

    PubMed Central

    Oruç, Mehmet Tahir; Aslaner, Arif; Çekiç, Sema; Sakar, Alkan; Yardimci, Erdem Can

    2016-01-01

    Gastric glomus tumors (GGTs) are unusual benign, subepithelial, mesenchymal neoplasms of modified smooth muscle cells representing a neoplastic counterpart of glomus bodies. A 38-year-old woman was admitted to our clinic presenting morbid obesity. Routine preoperative evaluations, such as laboratory analysis, abdominal ultrasonography, and upper gastrointestinal endoscopy, were performed. She underwent a classical laparoscopic sleeve gastrectomy (LSG). The postoperative course was uneventful and she was discharged for outpatient control. Her histopathology report revealed a GGT 0.8 cm in diameter. No further treatment was done and she had lost 28 kg at the postoperative sixth month. Here, we present the case of GGT, which was diagnosed incidentally after LSG. PMID:27284541

  15. Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis

    PubMed Central

    Parisi, Amilcare; Ricci, Francesco; Trastulli, Stefano; Cirocchi, Roberto; Gemini, Alessandro; Grassi, Veronica; Corsi, Alessia; Renzi, Claudio; De Santis, Francesco; Petrina, Adolfo; Pironi, Daniele; D’Andrea, Vito; Santoro, Alberto; Desiderio, Jacopo

    2015-01-01

    Abstract Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis. Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run. A new reconstructive approach, not yet described in literature, was recently adopted at our Center. Robotic total gastrectomy with D2 lymphadenectomy and a so-called “double-loop” reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases. Preoperative, intraoperative, and postoperative data were collected and a technical note was documented. All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred. Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery. The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes. PMID:26656323

  16. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy

    PubMed Central

    Zavadilová, Vladislava; Holéczy, Pavol; Švagera, Zdeněk; Švorc, Pavol; Foltys, Aleš; Zonča, Pavel

    2014-01-01

    Introduction Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits. Aim To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy. Material and methods The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ±4.9 kg/m2. Pre-operative examination included baseline measurements of body composition. Dietary habits and intake frequency were monitored by a questionnaire method. Follow-up examinations were carried out in a scope identical to the pre-operative examination, 6 and 12 months after surgery, respectively. Results The average patient weight loss 12 months after surgery was 31.7 kg. Excess weight loss was 55.2 ±20.6%. Patients reported reduced appetite (p < 0.001), increasingly regular food intake (p < 0.001), intake of more meal portions per day (p = 0.003) and a decrease in consuming the largest portions during the afternoon and evening (p = 0.030). Plasma levels of fasting glucose, leptin and ghrelin significantly decreased (p = 0.006; p = 0.0.043); in contrast, the level of adiponectin significantly increased (p < 0.001). Conclusions Sleeve gastrectomy and follow-up nutritional therapy resulted in a significant body weight reduction within 1 year after surgery. An improvement of certain dietary habits in patients was registered. At 12 months after surgery, there were no statistically significant differences in decreases in ghrelin and leptin concentrations between patients without changed appetite and those reporting decreased appetite. PMID:25561993

  17. Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients

    PubMed Central

    Rodriguez, John; El-Hayek, Kevin; Brethauer, Stacy; Schauer, Philip; Zelisko, Andrea; Chand, Bipan; O'Rourke, Colin; Kroh, Matthew

    2015-01-01

    Background and Objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m2. Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required

  18. Distal convoluted tubule.

    PubMed

    McCormick, James A; Ellison, David H

    2015-01-01

    The distal convoluted tubule (DCT) is a short nephron segment, interposed between the macula densa and collecting duct. Even though it is short, it plays a key role in regulating extracellular fluid volume and electrolyte homeostasis. DCT cells are rich in mitochondria, and possess the highest density of Na+/K+-ATPase along the nephron, where it is expressed on the highly amplified basolateral membranes. DCT cells are largely water impermeable, and reabsorb sodium and chloride across the apical membrane via electroneurtral pathways. Prominent among this is the thiazide-sensitive sodium chloride cotransporter, target of widely used diuretic drugs. These cells also play a key role in magnesium reabsorption, which occurs predominantly, via a transient receptor potential channel (TRPM6). Human genetic diseases in which DCT function is perturbed have provided critical insights into the physiological role of the DCT, and how transport is regulated. These include Familial Hyperkalemic Hypertension, the salt-wasting diseases Gitelman syndrome and EAST syndrome, and hereditary hypomagnesemias. The DCT is also established as an important target for the hormones angiotensin II and aldosterone; it also appears to respond to sympathetic-nerve stimulation and changes in plasma potassium. Here, we discuss what is currently known about DCT physiology. Early studies that determined transport rates of ions by the DCT are described, as are the channels and transporters expressed along the DCT with the advent of molecular cloning. Regulation of expression and activity of these channels and transporters is also described; particular emphasis is placed on the contribution of genetic forms of DCT dysregulation to our understanding.

  19. Genetics Home Reference: distal arthrogryposis type 1

    MedlinePlus

    ... Conditions distal arthrogryposis type 1 distal arthrogryposis type 1 Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description Distal arthrogryposis type 1 is a disorder characterized by joint deformities (contractures) ...

  20. Gastrectomy is Associated with an Increased Risk of Pyogenic Liver Abscess: A 13-Year Nationwide Cohort Study

    PubMed Central

    Tsai, Ming-Shian; Lin, Cheng-Li; Jeng, Long-Bin

    2016-01-01

    Whether patients who have undergone gastrectomy are at a high risk of developing pyogenic liver abscess (PLA) remains debatable. From the inpatient claims records of Taiwan’s National Health Insurance Research Database, we identified 33 834 patients with a history of 2000–2010 and135 336 controls without a history of gastrectomy. The 2cohorts were matched by age, sex, and admission year and followed-up until the end of 2011 for estimating the risk of PLA. Overall, the incidence of PLA was 3.5-fold higher in the gastrectomy cohort than in the control cohort (21.6 vs 5.76 per 10 000 person-y). The adjusted hazard ratio (aHR) for the gastrectomy cohort obtained using the multivariate Cox proportional hazards regression model was 3.08 (95% confidence interval [CI] = 2.60–3.64). An elevated post gastrectomy PLA risk was observed in both men and women. Age-specific data revealed that the aHR for the gastrectomy cohort, compared with the control cohort, was the highest in patients younger than 50 years (aHR = 5.16, 95% CI = 2.96–9.01). An addition analysis showed that the gastrectomy cohort exhibited an elevated PLA risk regardless of whether the patients underwent total or partial gastrectomy. Patients with a history of gastrectomy exhibit a high risk of PLA. PMID:27671754

  1. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer

    PubMed Central

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-01-01

    Abstract Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79

  2. How to explant a diseased liver for living donor liver transplantation after previous gastrectomy with severe adhesion (with video).

    PubMed

    Eguchi, Susumu; Soyama, Akihiko; Takatsuki, Mitsuhisa; Hidaka, Masaaki; Adachi, Tomohiko; Kitasato, Amane; Baimakhanov, Zhassulan; Kuroki, Tamotsu

    2014-08-01

    We performed living donor liver transplantation (LDLT) in a patient who had undergone distal gastrectomy for gastric ulcer disease with Billroth I reconstruction 30 years before the LDLT. The adhesion was very severe between remnant stomach and hepatic hilum as well as left liver lobe with shortening of hepatoduodenal structures. After dissection of the infrahepatic inferior vena cava, the Spiegel lobe was identified from the dorsal side. The Spiegel lobe was then penetrated with a right angle dissector so that a plastic tape could be placed around the whole adhesion, including important structures in the hepatoduodenal ligament. Next, the right hepatic vein was transected with a vascular stapler using Pringle's maneuver using the plastic tape to fasten the entire adhesional structure. Subsequently, the trunk of the middle and left hepatic vein was transected after clamping. The remaining short hepatic veins in the left side were divided completely from the cranial to the caudal direction to dissect Spiegel's lobe. Finally, the hepatoduodenal ligament was identified from the attached remnant stomach and the duodenum and a vascular clamp was placed on the entire hepatoduaodenal ligament. Finally, the diseased liver was explanted for graft implantation. Thus, retrograde explantation of the liver was effective in decreasing the risk of damaging vital elements in the hepatoduodenal ligament, the remnant stomach, and the duodenum.

  3. Clean and Cold Sample Curation

    NASA Technical Reports Server (NTRS)

    Allen, C. C.; Agee, C. B.; Beer, R.; Cooper, B. L.

    2000-01-01

    Curation of Mars samples includes both samples that are returned to Earth, and samples that are collected, examined, and archived on Mars. Both kinds of curation operations will require careful planning to ensure that the samples are not contaminated by the instruments that are used to collect and contain them. In both cases, sample examination and subdivision must take place in an environment that is organically, inorganically, and biologically clean. Some samples will need to be prepared for analysis under ultra-clean or cryogenic conditions. Inorganic and biological cleanliness are achievable separately by cleanroom and biosafety lab techniques. Organic cleanliness to the <50 ng/sq cm level requires material control and sorbent removal - techniques being applied in our Class 10 cleanrooms and sample processing gloveboxes.

  4. Gallbladder sludge and stone formation in relation to contractile function after gastrectomy. A prospective study.

    PubMed Central

    Inoue, K; Fuchigami, A; Higashide, S; Sumi, S; Kogire, M; Suzuki, T; Tobe, T

    1992-01-01

    In a prospective trial to determine whether gastric surgery induces gallbladder sludge and stone formation, 48 patients with gastric cancer were ultrasonographically examined with simultaneous observation on changes in gallbladder contractile function before and serially for 5 years after gastrectomy. Gallbladder sludge formation was induced with a high frequency of 42% 1 month after gastrectomy, with corresponding significant lowering of gallbladder contractile function. Most of gallbladder sludges, however, disappeared within 12 months in relation to the gradual recovery of gallbladder contractile function. Conversely, gallstone developed in nine patients (18.8%), mostly more than 6 months after gastrectomy. Interestingly, gallstone formation was induced in seven patients who were sludge negative. An evolvement of gallbladder sludge into stone was observed in only two patients, who were, however, treated with intravenous hyperalimentation. This study first provides evidence for the relationship between gastrectomy and a considerably high frequency of incidence of gallbladder sludge and stone in relation to changes in gallbladder kinetics after gastrectomy. Images FIG. 1. FIG. 3. FIG. 4. PMID:1731646

  5. Post-gastrectomy Syndrome Successfully Treated With Kampo Medicine: A Case Report.

    PubMed

    Ohgishi, Miwako; Horiba, Yuko; Watanabe, Kenji

    2016-01-01

    Cancer-related gastrectomy can cause post-gastrectomy syndrome, which includes weight loss, dumping syndrome, and reflux esophagitis and negatively affects the quality of life. Comprehensive and individualized patient management is required; however, there is a limit to Western medicine's ability to treat these symptoms. Kampo, a traditional Japanese medicine, adapts treatments to each individual's symptoms and constitution. We treated a 68-year-old male patient with post-gastrectomy syndrome using senpukukataishasekito, a Kampo medicine. He was diagnosed with Stage II-A gastric cancer at age 66 years and underwent a laparoscopic, pylorus-preserving gastrectomy followed by chemotherapy for 13 months. He visited our clinic for chemotherapy-related fatigue, postsurgical weight loss, and limb numbness. He was prescribed both hachimijiogan and hochuekkito. At the second visit, he complained of stomach discomfort, so we prescribed senpukukataishasekito. As his stomach function improved, his body weight increased and his fatigue decreased. We suggest that senpukukataishasekito may be an effective treatment for post-gastrectomy syndrome. PMID:26937322

  6. Preexisting Diabetes and Risks of Morbidity and Mortality After Gastrectomy for Gastric Cancer

    PubMed Central

    Tsai, Ming-Shian; Wang, Yu-Chiao; Kao, Yin-Hsien; Jeng, Long-Bin; Kao, Chia-Hung

    2015-01-01

    Abstract The purpose of this study was to determine the risk of surgical mortality and morbidity in patients with diabetes mellitus (DM) undergoing a gastrectomy for gastric cancer (GC). Using the Taiwan National Health Insurance Research Database, we identified 6284 patients who underwent gastrectomy for GC from 1999 to 2010. In addition, we created a non-DM control cohort consisting of 6268 patients who received gastrectomy during the same period. Compared with the non-DM cohort, the DM cohort exhibited a higher prevalence of preoperative coexisting medical conditions, namely hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease, chronic pulmonary disease, stroke, and cirrhosis. The odds ratio (OR) of 30-day postoperative mortality after gastrectomy in the DM cohort was 1.04 (95% confidence interval 0.78–1.40) after we adjusted for covariates. The DM cohort did not exhibit a significantly higher risk of 30-day postoperative morbidities. Further analysis revealed that only patients with a history of a DM-related coma exhibited a higher risk of 30-day postoperative mortality (adjusted OR 2.46, 95% confidence interval 1.10 − 5.54). Moreover, the risk of 90-day postoperative mortality was significantly higher in patients with DM-related eye involvement, coma, peripheral circulatory disease, and renal manifestations, in comparison with the non-DM cohort. The risk of 90-day mortality after gastrectomy for GC is higher in patients with DM-related manifestations than those without DM. PMID:26376386

  7. Post-gastrectomy Syndrome Successfully Treated With Kampo Medicine: A Case Report.

    PubMed

    Ohgishi, Miwako; Horiba, Yuko; Watanabe, Kenji

    2016-01-01

    Cancer-related gastrectomy can cause post-gastrectomy syndrome, which includes weight loss, dumping syndrome, and reflux esophagitis and negatively affects the quality of life. Comprehensive and individualized patient management is required; however, there is a limit to Western medicine's ability to treat these symptoms. Kampo, a traditional Japanese medicine, adapts treatments to each individual's symptoms and constitution. We treated a 68-year-old male patient with post-gastrectomy syndrome using senpukukataishasekito, a Kampo medicine. He was diagnosed with Stage II-A gastric cancer at age 66 years and underwent a laparoscopic, pylorus-preserving gastrectomy followed by chemotherapy for 13 months. He visited our clinic for chemotherapy-related fatigue, postsurgical weight loss, and limb numbness. He was prescribed both hachimijiogan and hochuekkito. At the second visit, he complained of stomach discomfort, so we prescribed senpukukataishasekito. As his stomach function improved, his body weight increased and his fatigue decreased. We suggest that senpukukataishasekito may be an effective treatment for post-gastrectomy syndrome.

  8. Laparoscopic total gastrectomy for Ménétrier's disease.

    PubMed

    Sanchez, Caroline; Brody, Fred; Pucci, Edward; Bashir, Showkat

    2007-02-01

    Most patients with Ménétrier's disease are treated nonoperatively with nutritional support, antacids, and pain medications. Surgical intervention is rarely required. We report the case of a 41-year-old male with HIV and hepatitis B who presented with weight loss, abdominal pain, nausea, and vomiting. A computed tomography scan of the abdomen showed diffuse gastric thickening without lymphadenopathy and an upper endoscopy revealed chronic gastritis and enlarged gastric folds without evidence of Helicobacter pylori. Multiple endoscopic biopsies showed chronic inflammation without malignancy. A laparoscopic assisted full thickness biopsy revealed foveolar hyperplasia consistent with Ménétrier's disease. Postoperatively, the patient's symptoms continued to worsen and were complicated by lower gastrointestinal bleeding secondary to gastric erosions. The patient did not experience any hematemesis, only melena. A laparoscopic total gastrectomy with a Roux-en-Y esophagojejunostomy was performed. The patient was discharged home on postoperative day 7 tolerating a postgastrectomy diet. His hematocrit stabilized and he remained asymptomatic at 16-month follow-up. Ménétrier's disease is a rare gastrointestinal entity that can be treated safely with minimally invasive skills. We report this case in detail and discuss Ménétrier's disease.

  9. Pancreaticoduodenectomy following total gastrectomy: a case report and literature review.

    PubMed

    Yokoyama, Satoshi; Sekioka, Akinori; Ueno, Kohei; Higashide, Yasuhiro; Okishio, Yuko; Kawaguchi, Nao; Hagihara, Takeshi; Yamada, Harumi; Kamimura, Ryo; Kuwahara, Michio; Ichimiya, Masato; Utsunomiya, Hirofumi; Uyama, Shiro; Kato, Hiroaki

    2014-03-14

    We present a case of afferent loop syndrome (ALS) occurring after pancreaticoduodenectomy (PD) in a patient who had previously undergone total gastrectomy (TG), and review the English-language literature concerning reconstruction procedures following PD in patients who had undergone TG. The patient was a 69-year-old man who had undergone TG reconstruction by a Roux-en-Y method at age 58 years. The patient underwent PD for pancreas head adenocarcinoma. A jejunal limb previously made at the prior TG was used for pancreaticojejunostomy and hepaticojejunostomy. Despite normal patency of the hepaticojejunostomy, he suffered from repeated postoperative cholangitis which was brought on by ALS due to shortness of the jejunal limb (15 cm in length). We therefore performed receliotomy in which the hepaticojejunostomy was disconnected and reconstructed using a new Y limb 40-cm in length constructed in a double Roux-en-Y fashion. The refractory cholangitis resolved immediately after the receliotomy and did not recur. Review of the literature revealed the lack of any current consensus for a standard procedure for reconstruction following PD in patients who had previously undergone TG. This issue warrants further attention, particularly given the expected future increase in the number of PDs in patients with a history of gastric cancer. PMID:24627609

  10. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    PubMed

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  11. [Distal humerus fractures in children].

    PubMed

    Schneidmueller, D; Boettger, M; Laurer, H; Gutsfeld, P; Bühren, V

    2013-11-01

    Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.

  12. Curation of Osiris-REx Asteroid Samples

    NASA Technical Reports Server (NTRS)

    Righter, K.; Nakamura-Messenger, K.; Lauretta, D. S.

    2013-01-01

    The New Frontiers mission, OSIRIS-REx, will encounter carbonaceous asteroid 101955 Bennu (1999 RQ36; [1]) in 2018, collect a sample and return it to Earth and deliver it to NASA-JSC for curation in 2023. The mission curation plan is being developed and an overview will be given, including the main elements of contamination control, sample recovery, cleanroom construction, and curation support once the sample is returned to Earth.

  13. Robot-Assisted Sleeve Gastrectomy in Morbidly Obese Versus Super Obese Patients

    PubMed Central

    Bhatia, Parveen; Singh, Rahul; Gonzalez-Heredia, Raquel; Kalhan, Sudhir; Khetan, Mukund; John, Suviraj

    2014-01-01

    Background and Objectives: This study evaluates our technique for robot-assisted sleeve gastrectomy for morbidly obese and super obese patients and our outcomes. Methods: A retrospective analysis of patients who underwent robot-assisted sleeve gastrectomy at a single center was performed. The procedure was performed with the da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, California). The staple line was imbricated with No. 2-0 polydioxanone in all cases. The super obese (body mass index ≥50 kg/m2) subset of patients was compared with the morbidly obese group in terms of demographic characteristics, comorbidities, operative times, perioperative complications, and excess body weight loss. Results: A total of 35 patients (15 female and 20 male patients) with a mean body mass index of 48.17 ± 11.7 kg/m2 underwent robot-assisted sleeve gastrectomy. Of these patients, 11 were super obese and 24 were morbidly obese. The mean operative time was 116.3 ± 24.7 minutes, and the mean docking time was 8.9 ± 5.4 minutes. Mean blood loss was 19.36 ± 4.62 mL, and there were no complications, conversions, or perioperative deaths. When compared with the morbidly obese patients, the super obese patients showed no significant difference in operative time, blood loss, and length of hospital stay. There was a steep decline in operating room times after 10 cases of robot-assisted sleeve gastrectomy. Conclusion: This study shows the feasibility and safety of robot-assisted sleeve gastrectomy. Robotic assistance might help overcome the operative difficulties encountered in super obese patients. It shows a rapid reduction in operative times with the growing experience of the entire operative team. Robot-assisted sleeve gastrectomy can be a good procedure by which to introduce robotics in a bariatric surgery center before going on to perform Roux-en-Y gastric bypass and revision procedures. PMID:25392663

  14. Short-term changes in bone and mineral metabolism following gastrectomy in gastric cancer patients.

    PubMed

    Baek, Ki Hyun; Jeon, Hae Myung; Lee, Seong Su; Lim, Dong Jun; Oh, Ki Won; Lee, Won Young; Rhee, Eun Jung; Han, Je Ho; Cha, Bong Yun; Lee, Kwang Woo; Son, Ho Young; Kang, Sung Koo; Kang, Moo Il

    2008-01-01

    Changes in bone and mineral metabolism that occur after gastrectomy have long been recognized. Gastrectomy has been identified as a risk factor for decreased bone mass and the increased fracture incidence. Previous investigations concerning postgastrectomy bone disease have been observational studies. No prospective studies have been reported that quantify the amount of bone loss after gastrectomy within the same patients. This study investigated 46 patients undergoing gastrectomy for gastric adenocarcinoma and analyzed 36 patients (58.1+/-10.8 years, 24 men and 12 women) who had dual energy X-ray absorptiometry (DXA) performed before and 1 year after gastrectomy. Systemic adjuvant chemotherapy was administered to 14 patients. Blood was sampled from all patients to determine serum calcium, phosphorous, and bone turnover marker levels before gastrectomy and at 1, 3, 6 and 12 months after surgery and for serum parathyroid hormone (PTH) and 25-hydroxyvitamin D levels before and 12 months after surgery. The mean bone loss in the lumbar spine, total hip, femoral neck, and trochanter, which was calculated as the percentage change from the baseline to the level measured at 12 months, was 5.7% (P<0.01), 5.4% (P<0.01), 6.6% (P<0.01) and 8.7% (P<0.01), respectively. Bone loss was generally greater in the group receiving chemotherapy. The serum calcium and phosphorous levels were not changed significantly and remained within the normal range throughout the observation period. After gastrectomy, the level of ICTP increased and reached a peak at 1 and 3 months, and progressively declined to baseline by 12 months. The osteocalcin levels were not coupled to an increase before 6 months. The level of 25-hydroxyvitamin D at 12 months postgastrectomy was not significantly changed compared to the baseline, however, the PTH levels increased by a mean of 63.6% at 12 months compared to the baseline (P<0.01). Significant correlations were found between the percent change in the BMD at the

  15. Data Curation Is for Everyone! The Case for Master's and Baccalaureate Institutional Engagement with Data Curation

    ERIC Educational Resources Information Center

    Shorish, Yasmeen

    2012-01-01

    This article describes the fundamental challenges to data curation, how these challenges may be compounded for smaller institutions, and how data management is an essential and manageable component of data curation. Data curation is often discussed within the confines of large research universities. As a result, master's and baccalaureate…

  16. Outcome Analysis of Early Laparoscopic Sleeve Gastrectomy Experience

    PubMed Central

    Antanavicius, Gintaras; Bonanni, Fernando

    2013-01-01

    Background and Objectives: Laparoscopic vertical sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch in the superobese population. In the past few years, however, LSG has been performed as a definitive procedure because of its promising early and midterm results. In this study we describe our initial experience and outcomes with LSG as a potential independent bariatric operation. Methods: A prospectively maintained database including all patients between 2008 and 2011 was reviewed. Results: A total of 100 initial consecutive patients (69 women and 31 men) were included, with a mean age of 50 years (range, 19–79 years) and body mass index of 49 kg/m2 (range, 36.6–70.3 kg/m2). The mean operative time was 106 minutes (range, 58–212 minutes) with a 2% conversion rate. Thirty-day perioperative complications included port-site hemorrhage (1.0%) and the inability to tolerate oral intake resulting in dehydration (3%). The reoperation rate was 2%, and the mean length of stay was 3.1 days (range, 2–12 days). In one patient with a prolonged hospital stay, an acute cholecystitis developed, and prosthetic heart valve complications developed in another patient. The mean excess body weight loss was 18%, 31.7%, 45%, 52%, 58.4%, and 64% at 1, 3, 6, 9, 12, and 18 months postoperatively, respectively. No deaths occurred in this series. Conclusions: Satisfactory outcomes and low complication rates were observed after LSG. Our findings suggest that LSG is safe and effective to serve as a definitive bariatric procedure. PMID:24398203

  17. The impact of sleeve gastrectomy on hypertension: a systematic review.

    PubMed

    Sarkhosh, Kourosh; Birch, Daniel W; Shi, Xinzhe; Gill, Richdeep S; Karmali, Shahzeer

    2012-05-01

    Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure associated with an acceptable weight loss and a relatively low morbidity. There is existing evidence suggesting bariatric surgery resolves or improves hypertension. The purpose of this study is to systematically review the effect of LSG on hypertension. An electronic search method was primarily used for identification of the studies. We performed a comprehensive search of all electronic databases (MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, BIOSIS, Previews, TRIP, Web of Science, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database) using broad search terms. All human studies from August 2000 to September 2011 were included. After an initial screening, a total of 326 studies were identified. After assessment of these studies based on our exclusion criteria, 222 studies were considered for the abstract review. A total of 33 studies were identified after a careful screening, involving a total of 3,997 patients. The mean pre-operative body mass index (BMI) was 49.1 ± 7.5 kg/m(2) (range 37-68). The average follow-up time was 16.9 ± 9.8 months (range 12-48). The mean post-operative BMI was 36 ± 7.0 kg/m(2) (range 25.6-54). LSG resulted in resolution of hypertension in 58% of patients. On average, 75% of patients experienced resolution or improvement of their hypertension. Based on our systematic review, LSG has a significant effect on hypertension, inducing resolution or improvement in the majority of cases. Therefore, LSG remains a viable surgical option in obese patients with hypertension.

  18. Preoperative endoscopy may reduce the need for revisional surgery for gastro-oesophageal reflux disease following laparoscopic sleeve gastrectomy.

    PubMed

    Madhok, B M; Carr, W R J; McCormack, C; Boyle, M; Jennings, N; Schroeder, N; Balupuri, S; Small, P K

    2016-08-01

    Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux-en-Y gastric bypass is the preferred operation in morbidly obese patients with gastro-oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro-oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro-oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux-en-Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery (p = 0.001). Baseline demographics were comparable between the groups, and average follow-up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro-oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery. PMID:27400631

  19. Genetics Home Reference: Laing distal myopathy

    MedlinePlus

    ... for This Page GeneReview: Laing Distal Myopathy Laing NG, Laing BA, Meredith C, Wilton SD, Robbins P, ... T, Bridges LR, Fabian V, Rozemuller A, Laing NG. Laing early onset distal myopathy: slow myosin defect ...

  20. [Technique and immediate results of the Moreno Gonzalez-Carboni reconstruction after total gastrectomy].

    PubMed

    Carboni, M; Catarci, M; Proposito, D; Saputelli, A; Zaraca, F; Gossetti, F; Flati, G; Guadagni, S; Tuscano, D; Negro, P

    1992-04-01

    Reconstruction following total gastrectomy for gastric cancer is still matter of debate. The Roux-en-Y esophagojejunostomy and the interposed loop esophago-jejunoduodenostomy are the techniques commonly employed. The Authors describe their modification of Henley's jejunal interposition and report early results achieved in a series of 60 consecutive patients.

  1. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  2. Short- and medium-term outcomes of laparoscopic sleeve gastrectomy: a single center experience*

    PubMed Central

    GIGANTE, G.; MARTINES, G.; FRANCO, I.; CAPUANO, P.; MEMEO, V.

    2014-01-01

    There are different surgical techniques adopted to treat morbid obesity. The objective of this study is to report surgical results after 20 laparoscopic sleeve gastrectomy (LSG) cases treated for morbid obesity during a 2-year follow-up and verify the effectiveness of LSG in term of Excess Weight Loss (EWL) as compared to laparoscopic adjustable gastric banding (LAGB). PMID:25174297

  3. Laparoscopic Total Gastrectomy in Elderly Patients (≥70 Years) with Gastric Carcinoma: A Retrospective Study

    PubMed Central

    Jung, Hong Sung; Park, Young Kyu; Ryu, Seong Yeob

    2015-01-01

    Purpose To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. Materials and Methods Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (≥70 years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups. Results The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (≥70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. Conclusions Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy. PMID:26468415

  4. Distal clavicle fractures in children☆

    PubMed Central

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  5. Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer.

    PubMed

    Ahn, Sang-Hoon; Son, Sang-Yong; Jung, Do Hyun; Park, Young Suk; Shin, Dong Joon; Park, Do Joong; Kim, Hyung-Ho

    2015-06-01

    Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

  6. Distal esophageal spasm: an update.

    PubMed

    Achem, Sami R; Gerson, Lauren B

    2013-09-01

    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latency<4.5 s) in a context of normal EGJ relaxation. The etiology of DES remains insufficiently understood, but evidence links nitric oxide (NO) deficiency as a culprit resulting in a disordered neural inhibition. GERD frequently coexists in DES, and its role in the pathogenesis of symptoms needs further evaluation. There is some evidence from small series that DES can progress to achalasia. Treatment remains challenging due in part to lack of randomized placebo-controlled trials. Current treatment agents include nitrates (both short and long acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality. PMID:23892829

  7. Chondroblastoma of the distal phalanx.

    PubMed

    Gregory, James R; Lehman, Thomas P; White, Jeremy R; Fung, Kar-Ming

    2014-05-01

    Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand-dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors' knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance.

  8. Chondroblastoma of the distal phalanx.

    PubMed

    Gregory, James R; Lehman, Thomas P; White, Jeremy R; Fung, Kar-Ming

    2014-05-01

    Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand-dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors' knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance. PMID:24810830

  9. Laparoscopic gastric bypass vs sleeve gastrectomy in obese Korean patients

    PubMed Central

    Park, Ji Yeon; Kim, Yong Jin

    2015-01-01

    AIM: To compare the mid-term outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese Korean patients. METHODS: All consecutive patients who underwent either LSG or LRYGB with primary to treat morbid obesity between January 2011 and December 2012 were retrospectively reviewed. Patients with a body mass index (BMI) ≥ 30 kg/m2 with inadequately controlled obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, hypertension, or obesity-related arthropathy) or BMI ≥ 35 kg/m2 were considered for bariatric surgery according to the International Federation for the Surgery of Obesity-Asia Pacific Chapter Consensus statements in 2011. The decision regarding the procedure type was made on an individual basis following extensive discussion with the patient about the specific risks associated with each procedure. All operative procedures were performed laparoscopically by a single surgeon experienced in upper gastrointestinal surgeries. Baseline demographics, perioperative surgical outcomes, and postoperative anthropometric data from a prospectively established database were thoroughly reviewed and compared between the two surgical approaches. RESULTS: One hundred four patients underwent LSG, and 236 underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than that of the LRYGB group (38.6 kg/m2 vs 37.2 kg/m2, P = 0.024). Patients with diabetes were more prevalent in the LRYGB group (18.3% vs 35.6%, P = 0.001). Operating time and hospital stay were significantly shorter in the LSG group compared with the LRYGB group (100 min vs 130 min, P < 0.001; 1 d vs 2 d, P = 0.003), but the incidence of perioperative complications was similar between the groups (P = 0.351). The mean percentage of excess weight loss (%EWL) was 71.2% for LRYGB, while it was 63.5% for LSG, at mean follow-up periods of 18.0 and 21.0 mo, respectively (P = 0.073). The %EWL at 1, 3, 6, 12, 18, 24, and 36 mo was equivalent

  10. Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer

    PubMed Central

    Kim, Hee Sung; Kim, Sun Oak; Kim, Byung Sik

    2015-01-01

    AIM: To evaluate the implementation of a clinical pathway and identify clinical factors affecting the clinical pathway for laparoscopic gastrectomy. METHODS: A standardized clinical pathway for gastric cancer (GC) patients was developed in 2001 by the GC surgery team at the Asan Medical Center. We reviewed the collected data of 4800 consecutive patients treated using the clinical pathway following laparoscopic gastrectomy with lymph node dissection for GC involving intracorporeal and extracorporeal anastomosis. The patients were treated between August 2004 and October 2013 in a single institution. To evaluate the rate of completion and risk factors affecting dropout from the clinical pathway, we used a multivariate logistic regression analysis. RESULTS: The overall completion rate of the clinical pathway for laparoscopic gastrectomy was 84.1% (n = 4038). In the comparison between groups of intracorporeal anastomosis and extracorporeal anastomosis patients, the completion rates were 83.88% (n = 1740) and 84.36% (n = 2071), respectively, showing no statistically significant difference. The main reasons for dropping out were postoperative complications (n = 463, 9.7%) and the need for patient observation (n = 299, 6.2%). Among the discharged patients treated using the clinical pathway, the number of patients who were readmitted within 30 d due to postoperative complications was 54 (1.1%). In a multivariate analysis, the intraoperative events (OR = 2.558) were the most predictable risk factors for dropping out of the clinical pathway. Additionally, being male (OR = 1.459), advanced age (OR = 1.727), total gastrectomy (OR = 2.444), combined operation (OR = 1.731), and ASA score (OR = 1.889) were significant risk factors affecting the dropout rate from the clinical pathway. CONCLUSION: Laparoscopic gastrectomy appears to be a good indication for the application of a clinical pathway. For successful application, patients with risk factors should be managed carefully. PMID

  11. SIMPLIFIED TECHNIQUE FOR RECONSTRUCTION OF THE DIGESTIVE TRACT AFTER TOTAL AND SUBTOTAL GASTRECTOMY FOR GASTRIC CANCER

    PubMed Central

    ZILBERSTEIN, Bruno; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; YAGI, Osmar Kenji; RIBEIRO-JR, Ulysses; COIMBRA, Brian Guilherme Monteiro Marta; CECCONELLO, Ivan

    2014-01-01

    Background Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. Aim To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. Methods In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. Results The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. Conclusion The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method. PMID:25004292

  12. Metabolic Effects of Sleeve Gastrectomy in a Female Rat Model of Diet-Induced Obesity

    PubMed Central

    Brinckerhoff, Tatiana Z.; Bondada, Sandhya; Lewis, Catherine E.; French, Sam; DeUgarte, Daniel A.

    2011-01-01

    Background While females disproportionately undergo bariatric surgery, rodent models investigating mechanisms of bariatric surgery have been limited to males. Female rodent models can also potentially allow us to understand the effects of surgical intervention on future generations of offspring. Sleeve gastrectomy is an attractive weight loss procedure for reproductive-age female patients as it avoids the malabsorption associated with intestinal bypass. Objectives We sought to evaluate the impact of sleeve gastrectomy on young female rats with diet-induced obesity. Settings David Geffen School of Medicine at UCLA Methods Sprague Dawley female rats were fed a 60% high-fat diet. At 12 weeks of age, animals underwent either sleeve gastrectomy or sham surgery. Animals were sacrificed four weeks after surgery. A chemistry panel was performed, and serum adipokines and gut hormones were assayed. Homeostasis model assessment score (HOMA) was calculated. Liver histology was graded for steatosis. Two-sample t-test was used to compare groups. Results Sleeve gastrectomy was associated with significant weight loss (5±6% vs. −4±6%; p<0.001), lower leptin levels (1.3±1.2 vs. 3.5±2.3 ng/ml; p<0.01), and higher adiponectin levels (0.43 ± 0.19 vs. 0.17 ± 0.14 ng/ml; p<0.004) when compared to sham animals. There were no significant differences in fasting ghrelin. Furthermore, we did not observe evidence of insulin resistance or steatohepatitis after 11 weeks of high-fat diet. Despite these limitations, further gender-specific studies are warranted given that the majority of bariatric surgeries are performed in females. Conclusion Sleeve gastrectomy appears to result in weight loss and improvements in adiponectin and leptin via mechanisms independent of ghrelin in a female model of diet-induced obesity. PMID:22093377

  13. Total gastrectomy may result in reduced drug effectiveness due to an increase in the expression of the drug-metabolizing enzyme Cytochrome P450, in the liver.

    PubMed

    Ishii, Makoto; Toda, Takahiro; Ikarashi, Nobutomo; Kusunoki, Yoshiki; Kon, Risako; Ochiai, Wataru; Machida, Yoshiaki; Sugiyama, Kiyoshi

    2014-01-23

    In patients with gastrectomy, it is possible that drug effectiveness is reduced compared to healthy subjects due to the increased of the drug-metabolizing enzyme, Cytochrome P450 (CYP). The purpose of this study is to verify this possibility. Gastrectomy model mice were prepared to evaluate the expression level of various CYPs in the liver from 2 to 24 weeks post-operation. No significant differences were observed in the protein expression levels of CYP3A, CYP1A, CYP2C, and CYP2D between the sham operation group and the gastrectomy group up to 4 weeks after the gastrectomy. On the other hand, significant increases in the protein expression levels of any CYPs were observed in the gastrectomy group compared to the sham operation group from 12 weeks after the gastrectomy onward. These increases in expression levels were maintained until 24 weeks after the gastrectomy. The examination of metabolic activity in the liver in the gastrectomy group using triazolam revealed that the metabolic activity at 12 weeks after the gastrectomy was significantly increased in the gastrectomy group. The administration of the anticancer drug imatinib, which is a substrate of CYP3A, to mice at 12weeks after gastrectomy resulted in an increase in the metabolic rate, suggesting a possible decrease in drug effectiveness. It has been revealed that drug effectiveness may be reduced after gastrectomy because the expression levels of various CYPs in the liver were increased over a prolonged period. The results of this study can serve as valuable fundamental knowledge for drug therapy in patients with gastrectomy.

  14. Reflections on curative health care in Nicaragua.

    PubMed Central

    Slater, R G

    1989-01-01

    Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. PMID:2705603

  15. Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer.

    PubMed

    Irino, Tomoyuki; Hiki, Naoki; Nunobe, Souya; Ohashi, Manabu; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

    2014-08-01

    The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with early GSC were enrolled and 24 patients (36.4 %) underwent subtotal gastrectomy (SG group). Clinicopathological characteristics were analyzed along with those of the other 42 patients (63.6 %) who underwent total gastrectomy (TG group). There were no significant differences between the two groups in the number of lymph nodes harvested (p = 0.880). Lymph node involvement was detected in 2 patients (8.3 %) in SG group and 5 patients (11.9 %) in TG group (p = 1.000). The previous disease (benign or malignant) and surgery (Billroth I or II) did not affect the rate of nodal involvement. The 5-year overall survival rate of SG group (94.7 %) was acceptable. Subtotal gastrectomy of the gastric remnant could be a feasible treatment option for patients with early gastric stump cancer when indicated.

  16. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men.

    PubMed

    Tatara, Marcin R; Krupski, Witold; Szpetnar, Maria; Dąbrowski, Andrzej; Bury, Paweł; Szabelska, Anna; Charuta, Anna; Boguszewska-Czubara, Anna; Maciejewski, Ryszard; Wallner, Grzegorz

    2015-12-01

    The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P < 0.05). Plasma concentration of adipic acid was significantly higher by 101.6% one year after total gastrectomy procedure in the patients when compared to the baseline value (P = 0.01). Plasma concentration of silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid

  17. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men

    PubMed Central

    Krupski, Witold; Szpetnar, Maria; Dąbrowski, Andrzej; Bury, Paweł; Szabelska, Anna; Charuta, Anna; Boguszewska-Czubara, Anna; Maciejewski, Ryszard; Wallner, Grzegorz

    2015-01-01

    The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P < 0.05). Plasma concentration of adipic acid was significantly higher by 101.6% one year after total gastrectomy procedure in the patients when compared to the baseline value (P = 0.01). Plasma concentration of silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid

  18. Curating NASA's Past, Present, and Future Extraterrestrial Sample Collections

    NASA Technical Reports Server (NTRS)

    McCubbin, F. M.; Allton, J. H.; Evans, C. A.; Fries, M. D.; Nakamura-Messenger, K.; Righter, K.; Zeigler, R. A.; Zolensky, M.; Stansbery, E. K.

    2016-01-01

    The Astromaterials Acquisition and Curation Office (henceforth referred to herein as NASA Curation Office) at NASA Johnson Space Center (JSC) is responsible for curating all of NASA's extraterrestrial samples. Under the governing document, NASA Policy Directive (NPD) 7100.10E "Curation of Extraterrestrial Materials", JSC is charged with "...curation of all extra-terrestrial material under NASA control, including future NASA missions." The Directive goes on to define Curation as including "...documentation, preservation, preparation, and distribution of samples for research, education, and public outreach." Here we describe some of the past, present, and future activities of the NASA Curation Office.

  19. Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

    SciTech Connect

    Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A. Sugimura, Kazuro

    2006-12-15

    A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy.

  20. [Recent advances of anastomosis techniques of esophagojejunostomy after laparoscopic totally gastrectomy in gastric tumor].

    PubMed

    Li, Xi; Ke, Chongwei

    2015-05-01

    The esophageal jejunum anastomosis of the digestive tract reconstruction techniques in laparoscopic total gastrectomy includes two categories: circular stapler anastomosis techniques and linear stapler anastomosis techniques. Circular stapler anastomosis techniques include manual anastomosis method, purse string instrument method, Hiki improved special anvil anastomosis technique, the transorally inserted anvil(OrVil(TM)) and reverse puncture device technique. Linear stapler anastomosis techniques include side to side anastomosis technique and Overlap side to side anastomosis technique. Esophageal jejunum anastomosis technique has a wide selection of different technologies with different strengths and the corresponding limitations. This article will introduce research progress of laparoscopic total gastrectomy esophagus jejunum anastomosis from both sides of the development of anastomosis technology and the selection of anastomosis technology.

  1. [A Case of Laparoscopic Gastrectomy in a Patient with Refractory Vasospastic Angina].

    PubMed

    Tanaka, Ryota; Hirakawa, Toshiki; Kametani, Naoki; Kato, Yukihiro; Komoto, Masahiro; Yamagata, Shigehito; Nakazawa, Kazunori; Kanehara, Isao; Ako, Eiji; Yamada, Nobuya; Nishimura, Shigehiko; Taenaka, Naoyuki

    2015-11-01

    We report a case of laparoscopic gastrectomy in a patient with refractory vasospastic angina. An 83-year-old man received 2 types of oral coronary vasodilators but complained of chest pain about twice a week thereafter. He was diagnosed with refractory vasospastic angina. Upper gastrointestinal endoscopy was performed for tarry stools and revealed a type 2 tumor in the anglar posterior wall. CT revealed no lymph node swelling or metastasis. Laparoscopic gastrectomy was performed, and intravenous administration of coronary vasodilators was started before the operation. During the operation, coronary spasm could be prevented while being careful not to induce circulation change, bleeding, or traction of the peritoneum. Many cases of coronary spasm-related angina in the absence of a history of angina have been reported during non-cardiac operations. In such cases, careful coronary spasm is necessary.

  2. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Derici, Serhan; Atila, Koray; Bora, Seymen; Yener, Serkan

    2016-01-01

    Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 80–90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device. PMID:27274724

  3. Three-decade metabolic outcome of neonatal gastrectomy and early Roux-en-Y.

    PubMed

    Stefater, M A; Xanthakos, S A; Johannigman, J; Inge, T H

    2014-02-01

    Little information is available about long-term outcomes of major gastric surgery when performed very early in life and adverse consequences in growing children might be expected. In this case, gastrectomy with Roux-en-Y esophagojejunostomy was performed in early childhood. Despite stomach loss, growth velocity paralleled the third percentile for age during development. Maintained on a daily multivitamin and monthly B12 injections, no overt nutritional deficiencies were detected in adulthood. However, dual energy X-ray absorptiometry scan at age 31 revealed that the patient had abnormally low bone mineral density. This case study demonstrates that even after gastrectomy and reconstruction early in life, linear growth can be achieved. However, bone density can be adversely affected, even in the face of normal serum calcium and vitamin D levels.

  4. Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction.

    PubMed

    Murata, S; Yamazaki, M; Kosugi, C; Hirano, A; Yoshimura, Y; Shiragami, R; Suzuki, M; Shuto, K; Koda, K

    2014-01-01

    Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.

  5. Ability of Serum C-Reactive Protein Concentrations to Predict Complications After Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study.

    PubMed

    Zhang, Kecheng; Xi, Hongqing; Wu, Xiaosong; Cui, Jianxin; Bian, Shibo; Ma, Liangang; Li, Jiyang; Wang, Ning; Wei, Bo; Chen, Lin

    2016-05-01

    Inflammatory markers, including C-reactive protein (CRP) and white blood cell (WBC), are widely available in clinical practice. However, their predictive roles for infectious complications following laparoscopy-assisted gastrectomy (LAG) have not been investigated. Our aim was to investigate the diagnostic accuracy of CRP concentrations and WBC counts for early detection of infectious complications following LAG and to construct a nomogram for clinical decision-making.The clinical data of consecutive patients who underwent LAG with curative intent between December 2013 and March 2015 were prospectively collected. Postoperative complications were recorded according to the Clavien-Dindo classification. The diagnostic value of CRP concentrations and WBC counts was evaluated by area under the curve of receiver-operating characteristic curves. Optimal cutoff values were determined by Youden index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for complications, after which a nomogram was constructed.Twenty-nine of 278 patients (10.4%) who successfully underwent LAG developed major complications (grade ≥III). CRP concentration on postoperative day 3 (POD 3) and WBC count on POD 7 had the highest diagnostic accuracy for major complications with an area under the curve value of 0.86 (95% confidence interval [CI], 0.79-0.92] and 0.68 (95% CI, 0.56-0.79) respectively. An optimal cutoff value of 172.0 mg/L was identified for CRP, yielding a sensitivity of 0.79 (95% CI, 0.60-0.92) and specificity 0.74 (95% CI, 0.68-0.80). Multivariate analysis identified POD3 CRP concentrations ≥172.0 mg/L, Eastern Cooperative Oncology Group Performance Status ≥1, presence of preoperative comorbidity, and operation time ≥240 min as risk factors for major complications after LAG.The optimal cut-off value of CRP on POD3 to predict complications following LAG was 172.0 mg/L and a CRP-based nomogram may contribute to early

  6. Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: Effect of intestinal pacing

    SciTech Connect

    Karlstrom, L.; Kelly, K.A. )

    1989-11-01

    The aims of this study were to determine whether ectopic pacemakers are present after meals in the Roux limbs of dogs after vagotomy and Roux gastrectomy, whether these pacemakers slow gastric emptying of liquids or solids, and whether abolishing the pacemakers with electric pacing might speed any slow emptying that occurs. In six dogs that underwent vagotomy and Roux gastrectomy and in four dogs that underwent vagotomy and Billroth gastrectomy (controls), myoelectric activity of the Roux limb or duodenum was measured during gastric emptying of a 500 kcal mixed meal of 99mTc-labeled cooked egg and 111In-labeled milk. Roux dogs were tested with and without pacing of the Roux limb. Roux dogs showed ectopic pacemaker in the Roux limb that drove the pacesetter potentials of the limb in a reverse, or orad, direction during 57% of the postprandial recordings. Billroth dogs had no ectopic pacemakers (p less than 0.05). Liquids emptied more slowly in Roux dogs (half-life (t1/2) = 121 +/- 15 minutes) than in Billroth dogs (t1/2 = 43 +/- 9 minutes; p less than 0.05), but solids emptied similarly in both groups of dogs (t1/2 approximately 8 hours). Pacing the Roux limb abolished the ectopic pacemakers, restored the slow emptying of liquids to the more rapid rate found in the Billroth dogs (t1/2: paced Roux, 72 +/- 15 minutes; Billroth, 43 +/- 9 minutes; p greater than 0.05) and did not change emptying of solids. The conclusion was that ectopic pacemakers present in the Roux limb after vagotomy and Roux gastrectomy drove the limb in a reverse direction and slowed emptying of liquids after the operation. The defect was corrected by pacing the Roux limb in a forward direction.

  7. MEDIUM-TERM FOLLOW-UP RESULTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY

    PubMed Central

    RAMOS, Almino Cardoso; BASTOS, Eduardo Lemos de Souza; RAMOS, Manoela Galvão; BERTIN, Nestor Tadashi Suguitani; GALVÃO, Thales Delmondes; de LUCENA, Raphael Torres Figueiredo; CAMPOS, Josemberg Marins

    2015-01-01

    Background : The indications for sleeve gastrectomy in the surgical treatment of morbid obesity have increased worldwide. Despite this, several aspects related to results at medium and long term remain in constant research. Aim : To present the experience of sleeve gastrectomy in a center of excellence in bariatric surgery by analyzing clinical outcomes, complications and follow-up in the medium term. Methods : The study included 120 morbidly obese patients who underwent sleeve gastrectomy and who were followed for at least 24 months. Aspects related to surgical technique, surgical complications and clinical outcome were analyzed. Results : Seventy-five patients were women (62.5%) and the average age was 36 years. The body mass index preoperatively ranged from 35.5 to 58 kg/m2(average of 40.2 kg/m2). The length of stay ranged from 1 to 4 days (mean 2.1 days). Comorbidities observed were hypertension (19%), type 2 diabetes mellitus (6.6%), dyslipidemia (7.5%), sleep apnea (16.6%), reflux esophagitis (10%) and orthopedic diseases (7.5%). The mean body mass index and total weight loss percentage with 3, 12, 18 and 24 months were 32.2 kg/m2-19,9%; 29.5 kg/m2-26,5%; 28.2 kg/m2-30,3% and 26.9 kg/m2-32,7%, respectively. Remission of diabetes and dyslipidemia occurred in all patients. In relation to hypertension, there was improvement or remission in 86%. There were only two complications (bronchial pneumonia and dehydration), with good response to clinical treatment. There was no evidence digestive fistula and mortality was zero. Eleven patients (9.1%) had regained weighing more than 5 kg. Conclusion : The sleeve gastrectomy is surgical technique that has proven safe and effective in the surgical treatment of obesity and control of their comorbidities in postoperative follow-up for two years. PMID:26537277

  8. Laparoscopic Conversion of a Sleeve Gastrectomy to the Roux-en-Y Gastric Bypass.

    PubMed

    Amor, Imed Ben; Debs, Tarek; Martini, Francesco; Elias, Bachir; Kassir, Radwan; Gugenheim, Jean

    2015-08-01

    After the failure of sleeve gastrectomy (SG), three options are available as a second intervention: the conversion into a biliopancreatic diversion with duodenal switch, the Roux-en-Y gastric bypass (RYGBP), and more recently, a re-SG consisting in the refashioning of a dilated gastric tube. We describe two different approaches for the conversion. The conversion to RYGBP remains a technically challenging operation but feasible and effective, and it should be reserved to specialized centers.

  9. Peripheral nerve blocks for distal extremity surgery.

    PubMed

    Offierski, Chris

    2013-10-01

    Peripheral nerve block is well suited for distal extremity surgery. Blocking the nerves at the distal extremity is easily done. It does not require ultrasound or stimulators to identify the nerve. Blocking nerves in the distal extremity is safe with low risk of toxicity. The effect of the nerve block is limited to the distribution of the nerve. The distal nerves in the lower extremity are sensory branches of the sciatic nerve. This provides a sensory block only. This has the advantage of allowing the patient to actively contract tendons in the foot and ambulate more quickly after surgery. PMID:24093651

  10. Primary Squamous Cell Carcinoma of the Remnant Stomach after Subtotal Gastrectomy

    PubMed Central

    Kim, Min Sung; Kim, Dong Hee; Park, Seulkee; You, Ji Young; Han, Joon Kil; Kim, Seong Hwan; Lee, Ho Jung

    2016-01-01

    Primary squamous cell carcinoma (SCC) of the stomach is a very rare disease. However, the pathogenesis, clinical characteristics, and prognosis of gastric SCC are controversial and remain to be elucidated. Herein, we report a case of primary gastric SCC of the remnant stomach after subtotal gastrectomy. A 65-year-old man was admitted to our hospital due to epigastric discomfort and dizziness. He had undergone subtotal gastrectomy 40 years previously for gastric ulcer perforation. Endoscopy revealed a normal esophagus and a large mass in the remnant stomach. Abdominal computed tomography revealed enhanced wall thickening of the anastomotic site and suspected metachronous gastric cancer. Endoscopic biopsy revealed SCC. Total gastrectomy was performed with Roux-en-Y esophagojejunostomy. A 10-cm tumor was located at the remnant stomach just proximal to the previous area of anastomosis. Pathologic examination showed well-differentiated SCC extended into the subserosa without lymph node involvement (T3N0M0). The patient received adjuvant systemic chemotherapy with 6 cycles of 5-FU and cisplatin regimen, and he is still alive at the 54-month follow-up. According to the treatment principles of gastric cancer, early detection and radical surgical resection can improve the prognosis. PMID:27433399

  11. [Salvage gastrectomy and radiotherapy for R-CHOP-refractory gastric malignant lymphoma].

    PubMed

    Shibata, Shigeru; Akasaka, Harue; Wakiya, Taiichi; Yamanaka, Yuji; Narita, Junichi; Sutou, Takemichi; Iino, Chikara

    2014-11-01

    A man in his seventies presented with a stomach abnormality that was revealed upon physical examination.Following workup, he was diagnosed with gastric diffuse large B-cell lymphoma (DLBCL)StageII1 (Lugano staging system for gastrointestinal lymphoma) with low risk as defined by the International Prognostic Index criteria.The entire stomach showed an intense, abnormal FDG uptake by FDG-PET evaluation.He was treated with rituximab plus CHOP (R-CHOP).The patient's body weight decreased by 12 kg during the treatment period.Post -treatment evaluation by gastroscopy and FDG-PET following 5 courses of R-CHOP therapy revealed a residual lesion in the stomach.Total gastrectomy was performed for R-CHOP refractory gastric DLBCL.The pathological diagnosis was DLBCL, and the pathological therapeutic effect was Grade 1a.Lymphoma cells were detected at the duodenal margin of the resected specimen, and an FDG-PET scan showed abnormal FDG uptake in the duodenal stump necessitating salvage chemotherapy (DeVIC therapy)and radiotherapy.The patient's body weight increased by 5 kg after gastrectomy and there were no signs of relapse for 14 months after the operation.Salvage therapy including gastrectomy may be effective for chemotherapy-resistant gastric DLBCL. PMID:25731535

  12. Distal metatarsal synostosis: a case report.

    PubMed

    Aspros, Dimitrios; Ananda-Rajan, Ethan; Jnr, Zdenak Klezl; Rajan, Rohan

    2014-09-01

    We report a rare case of distal metatarsal synostosis of the 4th and 5th metatarsals in an 11 year old male. He was referred with forefoot pain. Clinical examination and radiographs have confirmed an osseous connection of the distal 4th and 5th metatarsal. This was treated surgically with bony bridge excision and the patient is now asymptomatic.

  13. Astromaterials Acquisition and Curation Office (KT) Overview

    NASA Technical Reports Server (NTRS)

    Allen, Carlton

    2014-01-01

    The Astromaterials Acquisition and Curation Office has the unique responsibility to curate NASA's extraterrestrial samples - from past and forthcoming missions - into the indefinite future. Currently, curation includes documentation, preservation, physical security, preparation, and distribution of samples from the Moon, asteroids, comets, the solar wind, and the planet Mars. Each of these sample sets has a unique history and comes from a unique environment. The curation laboratories and procedures developed over 40 years have proven both necessary and sufficient to serve the evolving needs of a worldwide research community. A new generation of sample return missions to destinations across the solar system is being planned and proposed. The curators are developing the tools and techniques to meet the challenges of these new samples. Extraterrestrial samples pose unique curation requirements. These samples were formed and exist under conditions strikingly different from those on the Earth's surface. Terrestrial contamination would destroy much of the scientific significance of extraterrestrial materials. To preserve the research value of these precious samples, contamination must be minimized, understood, and documented. In addition, the samples must be preserved - as far as possible - from physical and chemical alteration. The elaborate curation facilities at JSC were designed and constructed, and have been operated for many years, to keep sample contamination and alteration to a minimum. Currently, JSC curates seven collections of extraterrestrial samples: (a)) Lunar rocks and soils collected by the Apollo astronauts, (b) Meteorites collected on dedicated expeditions to Antarctica, (c) Cosmic dust collected by high-altitude NASA aircraft,t (d) Solar wind atoms collected by the Genesis spacecraft, (e) Comet particles collected by the Stardust spacecraft, (f) Interstellar dust particles collected by the Stardust spacecraft, and (g) Asteroid soil particles collected

  14. Distal symphalangism: a report of two families.

    PubMed

    Poush, J R

    1991-01-01

    This study describes distal symphalangism in 36 individuals in two families, one of which is the largest pedigree of this rare defect yet documented. Distal symphalangism is ankylosis or rigidity of the distal interphalangeal joints of the hands and/or feet. The findings of this report substantiate the mutation as an autosomal dominant phenotype. Several manifestations of distal symphalangism were observed, including the lack of cutaneous creases over affected joints, brachydactyly, fourth-finger hypophalangism, absent nails, and rudimentary nails. Variability ranged from just toes affected, to a single finger affected, to all fingers and all lesser toes affected. The most common expression of the mutant gene was rigid index fingers. Craniosynostosis, premature closure of the sutures of the skull, was encountered twice in the larger of the two families. It is a possible pleiotropic effect of distal symphalangism. PMID:2061594

  15. Distal symphalangism: a report of two families.

    PubMed

    Poush, J R

    1991-01-01

    This study describes distal symphalangism in 36 individuals in two families, one of which is the largest pedigree of this rare defect yet documented. Distal symphalangism is ankylosis or rigidity of the distal interphalangeal joints of the hands and/or feet. The findings of this report substantiate the mutation as an autosomal dominant phenotype. Several manifestations of distal symphalangism were observed, including the lack of cutaneous creases over affected joints, brachydactyly, fourth-finger hypophalangism, absent nails, and rudimentary nails. Variability ranged from just toes affected, to a single finger affected, to all fingers and all lesser toes affected. The most common expression of the mutant gene was rigid index fingers. Craniosynostosis, premature closure of the sutures of the skull, was encountered twice in the larger of the two families. It is a possible pleiotropic effect of distal symphalangism.

  16. Robotic distal pancreatectomy: a valid option?

    PubMed

    Jung, M K; Buchs, N C; Azagury, D E; Hagen, M E; Morel, P

    2013-10-01

    Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach.

  17. Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

    PubMed Central

    Huh, Yeon-Ju; Oh, Seung-Young; Lee, Kyung-Goo; Yang, Jun-Young; Ahn, Hye-Seong; Suh, Yun-Suhk; Kong, Seong-Ho; Lee, Kuhn-Uk; Yang, Han-Kwang

    2015-01-01

    Purpose This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG. PMID:26468417

  18. A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition

    PubMed Central

    Iwasaki, Yoshiaki; Yuu, Ken; Oohinata, Ryouki; Amaki, Misato; Kohira, Yoshinori; Natsume, Souichiro; Ishiyama, Satoshi; Takahashi, Keiichi

    2016-01-01

    A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SM)N0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer's early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach. PMID:27034881

  19. AMC: amyoplasia and distal arthrogryposis.

    PubMed

    Kimber, Eva

    2015-12-01

    Arthrogryposis multiplex congenita (AMC) is a heterogeneous condition defined as multiple congenital joint contractures in two or more body areas. The common pathogenesis is impaired fetal movements. Amyoplasia, the most frequent form, is a sporadically occurring condition with hypoplastic muscles and joint contractures. Distal arthrogryposis (DA) syndromes are often hereditary, and joint involvement is predominantly in the hands and feet. In a Swedish study, 131 patients with arthrogryposis were investigated. The most frequent diagnoses were amyoplasia and DA. In amyoplasia, muscle strength was found to be more important than joint range of motion (ROM) for motor function. In DA, muscle weakness was present in 44 % of investigated patients. The clinical findings were found to be highly variable between families and also within families with DA. Fetal myopathy due to sarcomeric protein dysfunction can cause DA. An early multidisciplinary team evaluation of the child with arthrogryposis for specific diagnosis and planning of treatment is recommended. Attention should be directed at the development of muscle strength with early stimulation of active movements. Immobilization should be minimized.

  20. The Curative Fantasy and Psychic Recovery

    PubMed Central

    ORNSTEIN, ANNA

    1992-01-01

    The discovery of selfobject transferences and the interpretation of symptomatic behavior from within the patient’s perspective have altered the conduct of psychoanalytic psychotherapy in fundamental ways. A review of the treatment process from a self psychological perspective serves as a background for pointing to the significance of curative fantasies in the process of recovery. PMID:22700052

  1. Curating and Nudging in Virtual CLIL Environments

    ERIC Educational Resources Information Center

    Nielsen, Helle Lykke

    2014-01-01

    Foreign language teachers can benefit substantially from the notions of curation and nudging when scaffolding CLIL activities on the internet. This article shows how these principles can be integrated into CLILstore, a free multimedia-rich learning tool with seamless access to online dictionaries, and presents feedback from first and second year…

  2. Curating Media Learning: Towards a Porous Expertise

    ERIC Educational Resources Information Center

    McDougall, Julian; Potter, John

    2015-01-01

    This article combines research results from a range of projects with two consistent themes. Firstly, we explore the potential for curation to offer a productive metaphor for the convergence of digital media learning across and between home/lifeworld and formal educational/system-world spaces--or between the public and private spheres. Secondly, we…

  3. Canto: an online tool for community literature curation

    PubMed Central

    Rutherford, Kim M.; Harris, Midori A.; Lock, Antonia; Oliver, Stephen G.; Wood, Valerie

    2014-01-01

    Motivation: Detailed curation of published molecular data is essential for any model organism database. Community curation enables researchers to contribute data from their papers directly to databases, supplementing the activity of professional curators and improving coverage of a growing body of literature. We have developed Canto, a web-based tool that provides an intuitive curation interface for both curators and researchers, to support community curation in the fission yeast database, PomBase. Canto supports curation using OBO ontologies, and can be easily configured for use with any species. Availability: Canto code and documentation are available under an Open Source license from http://curation.pombase.org/. Canto is a component of the Generic Model Organism Database (GMOD) project (http://www.gmod.org/). Contact: helpdesk@pombase.org PMID:24574118

  4. Distal phalanges of Eosimias and Hoanghonius.

    PubMed

    Gebo, Daniel L; Beard, K Christopher; Ni, Xijun; Dagosto, Marian

    2015-09-01

    Seven primate distal phalanges have been identified from two middle Eocene fossil localities (Locality 1 and Nanbaotou) in the Yuanqu Basin, China, providing the first evidence of distal phalangeal morphology in Asian Eocene adapiform and eosimiid primates. The bones are best allocated to the basal anthropoid Eosimias centennicus and to hoanghoniine adapiforms. All distal phalangeal specimens display a morphology consistent with nail-bearing fingers and toes. The hallucal distal phalanx of the basal anthropoid Eosimias is more similar to that of primitive tarsiiforms than to crown group anthropoids. The adapiform distal phalanges from Locality 1 are allocated to Hoanghonius stehlini while those from Nanbaotou are tentatively assigned to an indeterminate hoanghoniine because dental remains of adapiforms have yet to be identified from this site. The distal phalangeal anatomy of hoanghoniines differs slightly from that documented for adapines and notharctines. One distal phalanx from Locality 1 shows a second pedal digit "grooming claw" morphology as noted for notharctines by Maiolino et al. (2012) and cercamoniines by Von Koenigswald et al. (2012).

  5. Clinical evaluation of double-channel gastroscope for endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

    PubMed Central

    Wang, Sheng; Liu, Wen; Wang, Guoxin; Liu, Xiang; Ge, Nan; Guo, Jintao

    2016-01-01

    Aim To evaluate the use of a double-channel gastroscope in patients with Billroth II gastrectomy to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. Material and methods From January 2008 to December 2013, 18 patients with Billroth II gastrectomy were enrolled in this study. Endoscopic retrograde cholangiopancreatography was performed using a straight forward gastroscope with double working channel (4.2-mm diameter, 2.8-mm diameter). Results The success rate of selective cannulation and accomplishment of planned procedures was 15 out of 18 patients (83.3%), and no serious complications were encountered. Conclusions The double-channel gastroscope appears to be useful in performing endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy. PMID:27713777

  6. Scaling drug indication curation through crowdsourcing.

    PubMed

    Khare, Ritu; Burger, John D; Aberdeen, John S; Tresner-Kirsch, David W; Corrales, Theodore J; Hirchman, Lynette; Lu, Zhiyong

    2015-01-01

    Motivated by the high cost of human curation of biological databases, there is an increasing interest in using computational approaches to assist human curators and accelerate the manual curation process. Towards the goal of cataloging drug indications from FDA drug labels, we recently developed LabeledIn, a human-curated drug indication resource for 250 clinical drugs. Its development required over 40 h of human effort across 20 weeks, despite using well-defined annotation guidelines. In this study, we aim to investigate the feasibility of scaling drug indication annotation through a crowdsourcing technique where an unknown network of workers can be recruited through the technical environment of Amazon Mechanical Turk (MTurk). To translate the expert-curation task of cataloging indications into human intelligence tasks (HITs) suitable for the average workers on MTurk, we first simplify the complex task such that each HIT only involves a worker making a binary judgment of whether a highlighted disease, in context of a given drug label, is an indication. In addition, this study is novel in the crowdsourcing interface design where the annotation guidelines are encoded into user options. For evaluation, we assess the ability of our proposed method to achieve high-quality annotations in a time-efficient and cost-effective manner. We posted over 3000 HITs drawn from 706 drug labels on MTurk. Within 8 h of posting, we collected 18 775 judgments from 74 workers, and achieved an aggregated accuracy of 96% on 450 control HITs (where gold-standard answers are known), at a cost of $1.75 per drug label. On the basis of these results, we conclude that our crowdsourcing approach not only results in significant cost and time saving, but also leads to accuracy comparable to that of domain experts. PMID:25797061

  7. Scaling drug indication curation through crowdsourcing

    PubMed Central

    Khare, Ritu; Burger, John D.; Aberdeen, John S.; Tresner-Kirsch, David W.; Corrales, Theodore J.; Hirchman, Lynette; Lu, Zhiyong

    2015-01-01

    Motivated by the high cost of human curation of biological databases, there is an increasing interest in using computational approaches to assist human curators and accelerate the manual curation process. Towards the goal of cataloging drug indications from FDA drug labels, we recently developed LabeledIn, a human-curated drug indication resource for 250 clinical drugs. Its development required over 40 h of human effort across 20 weeks, despite using well-defined annotation guidelines. In this study, we aim to investigate the feasibility of scaling drug indication annotation through a crowdsourcing technique where an unknown network of workers can be recruited through the technical environment of Amazon Mechanical Turk (MTurk). To translate the expert-curation task of cataloging indications into human intelligence tasks (HITs) suitable for the average workers on MTurk, we first simplify the complex task such that each HIT only involves a worker making a binary judgment of whether a highlighted disease, in context of a given drug label, is an indication. In addition, this study is novel in the crowdsourcing interface design where the annotation guidelines are encoded into user options. For evaluation, we assess the ability of our proposed method to achieve high-quality annotations in a time-efficient and cost-effective manner. We posted over 3000 HITs drawn from 706 drug labels on MTurk. Within 8 h of posting, we collected 18 775 judgments from 74 workers, and achieved an aggregated accuracy of 96% on 450 control HITs (where gold-standard answers are known), at a cost of $1.75 per drug label. On the basis of these results, we conclude that our crowdsourcing approach not only results in significant cost and time saving, but also leads to accuracy comparable to that of domain experts. Database URL: ftp://ftp.ncbi.nlm.nih.gov/pub/lu/LabeledIn/Crowdsourcing/. PMID:25797061

  8. How Workflow Documentation Facilitates Curation Planning

    NASA Astrophysics Data System (ADS)

    Wickett, K.; Thomer, A. K.; Baker, K. S.; DiLauro, T.; Asangba, A. E.

    2013-12-01

    The description of the specific processes and artifacts that led to the creation of a data product provide a detailed picture of data provenance in the form of a workflow. The Site-Based Data Curation project, hosted by the Center for Informatics Research in Science and Scholarship at the University of Illinois, has been investigating how workflows can be used in developing curation processes and policies that move curation "upstream" in the research process. The team has documented an individual workflow for geobiology data collected during a single field trip to Yellowstone National Park. This specific workflow suggests a generalized three-part process for field data collection that comprises three distinct elements: a Planning Stage, a Fieldwork Stage, and a Processing and Analysis Stage. Beyond supplying an account of data provenance, the workflow has allowed the team to identify 1) points of intervention for curation processes and 2) data products that are likely candidates for sharing or deposit. Although these objects may be viewed by individual researchers as 'intermediate' data products, discussions with geobiology researchers have suggested that with appropriate packaging and description they may serve as valuable observational data for other researchers. Curation interventions may include the introduction of regularized data formats during the planning process, data description procedures, the identification and use of established controlled vocabularies, and data quality and validation procedures. We propose a poster that shows the individual workflow and our generalization into a three-stage process. We plan to discuss with attendees how well the three-stage view applies to other types of field-based research, likely points of intervention, and what kinds of interventions are appropriate and feasible in the example workflow.

  9. Nonbridging external fixation of distal radius fractures.

    PubMed

    Eichenbaum, Matthew D; Shin, Eon K

    2010-08-01

    Surgical management of distal radius fractures continues to evolve because of their high incidence in an increasingly active elderly population. Traditional radiocarpal external fixation relies on ligamentotaxis for fracture reduction but has several drawbacks. Nonbridging external fixation has evolved to provide early wrist mobility in the setting of anatomic fracture reduction. Several studies of the nonbridging technique have demonstrated satisfactory results in isolated nonbridging external fixation series and in comparison with traditional spanning external fixation. Nonbridging external fixation for surgical treatment of distal radius fractures can be technically demanding and requires at least 1 cm of intact volar cortex in the distal fracture fragment for successful implementation.

  10. Distal Peripheral Polyneuropathy in a Great Dane

    PubMed Central

    Henricks, Paul M.; Steiss, Jan; Petterson, Joanne D.

    1987-01-01

    A spayed female five year old Great Dane dog was diagnosed as having a chronic, progressive, symmetrical distal polyneuropathy and concurrent hypothyroidism. Axonal degeneration and segmental demyelination were evident in teased nerve fiber preparations. Clinical signs included hindlimb weakness and muscle atrophy of the head and distal limbs. Diagnosis was based on clinical, electrophysiological, and nerve and muscle biopsy findings. Thyroxine supplementation for one month was of no benefit. The etiology of the polyneuropathy was not established but several causes were considered. The extent of demyelination in our case was of greater magnitude than described in a previous report of a similar idiopathic distal symmetrical polyneuropathy in a Great Dane. PMID:17422753

  11. Surgical skills for laparoscopic resection of the bursa omentalis and lymph node scavenging with radical gastrectomy

    PubMed Central

    ZOU, LIAO-NAN; HE, YAO-BIN; LI, HONG-MING; DIAO, DE-CHANG; MO, DE-LONG; WANG, WEI; WAN, JIN

    2015-01-01

    The aim of the present study was to inquire into the feasibility, surgical skills required and short-term effect of a laparoscopic resection of the bursa omentalis and lymph node scavenging with radical gastrectomy. In this study, the clinical data of 18 patients who received a laparoscopic resection of the bursa omentalis with radical gastrectomy in the Department of Gastrointestinal Surgery, Guangdong Province Hospital of Traditional Chinese Medicine (Guangzhou, Guangdong, China) during the period between January 2012 and January 2014. A retrospective analysis was performed and the surgical duration, bursa omentalis resection time, amount of bleeding during the surgery, post-operative complications associated with the surgery, length of hospital stay, number of lymph nodes scavenged and short-term follow-up results were assessed. The results indicated that all of these 18 patients successfully received a resection of the bursa omentalis and no one required conversion to open surgery. The mean surgical duration was 289.3±30.3 min, the bursa omentalis resection time was 46.1±18.6 min and the amount of bleeding was recorded as 35.5±6.5 ml in these patients. No patients suffered from post-operative complications, such as pancreatic fistulae, anastomotic fistulae, intestinal obstructions or succumbing to the surgery, and no patients succumbed within a 6-month follow-up period. In conclusion, for advanced gastric carcinoma, laparoscopic resection of the bursa omentalis and lymph node scavenging with radical gastrectomy is feasible. In addition to meeting the requirement that the operator should be skilled and experienced in open bursa omentalis resection, and have well-knit basic skills in using a laparoscope, attention must also be paid to the construction of the surgical team. PMID:26170983

  12. Nomogram Estimating the Probability of Intraabdominal Abscesses after Gastrectomy in Patients with Gastric Cancer

    PubMed Central

    Eom, Bang Wool; Joo, Jungnam; Park, Boram; Yoon, Hong Man; Ryu, Keun Won; Kim, Soo Jin

    2015-01-01

    Purpose Intraabdominal abscess is one of the most common reasons for re-hospitalization after gastrectomy. This study aimed to develop a model for estimating the probability of intraabdominal abscesses that can be used during the postoperative period. Materials and Methods We retrospectively reviewed the clinicopathological data of 1,564 patients who underwent gastrectomy for gastric cancer between 2010 and 2012. Twenty-six related markers were analyzed, and multivariate logistic regression analysis was used to develop the probability estimation model for intraabdominal abscess. Internal validation using a bootstrap approach was employed to correct for bias, and the model was then validated using an independent dataset comprising of patients who underwent gastrectomy between January 2008 and March 2010. Discrimination and calibration abilities were checked in both datasets. Results The incidence of intraabdominal abscess in the development set was 7.80% (122/1,564). The surgical approach, operating time, pathologic N classification, body temperature, white blood cell count, C-reactive protein level, glucose level, and change in the hemoglobin level were significant predictors of intraabdominal abscess in the multivariate analysis. The probability estimation model that was developed on the basis of these results showed good discrimination and calibration abilities (concordance index=0.828, Hosmer-Lemeshow chi-statistic P=0.274). Finally, we combined both datasets to produce a nomogram that estimates the probability of intraabdominal abscess. Conclusions This nomogram can be useful for identifying patients at a high risk of intraabdominal abscess. Patients at a high risk may benefit from further evaluation or treatment before discharge. PMID:26816657

  13. Villous adenoma of the distal appendix.

    PubMed

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  14. Potential Mechanisms Mediating Sustained Weight Loss Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

    PubMed

    Makaronidis, Janine M; Batterham, Rachel L

    2016-09-01

    Bariatric surgery is the only effective treatment for severe obesity. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most commonly performed procedures, lead to sustained weight loss, improvements in obesity-related comorbidities and reduced mortality. In humans, the main driver for weight loss following RYGB and SG is reduced energy intake. Reduced appetite, changes in subjective taste and food preference, and altered neural response to food cues are thought to drive altered eating behavior. The biological mediators underlying these changes remain incompletely understood but changes in gut-derived signals, as a consequence of altered nutrient and/or biliary flow, are key candidates.

  15. Potential Mechanisms Mediating Sustained Weight Loss Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

    PubMed

    Makaronidis, Janine M; Batterham, Rachel L

    2016-09-01

    Bariatric surgery is the only effective treatment for severe obesity. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most commonly performed procedures, lead to sustained weight loss, improvements in obesity-related comorbidities and reduced mortality. In humans, the main driver for weight loss following RYGB and SG is reduced energy intake. Reduced appetite, changes in subjective taste and food preference, and altered neural response to food cues are thought to drive altered eating behavior. The biological mediators underlying these changes remain incompletely understood but changes in gut-derived signals, as a consequence of altered nutrient and/or biliary flow, are key candidates. PMID:27519129

  16. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report.

    PubMed

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-03-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition.

  17. The blood volume and plasma protein levels before and after gastrectomy 1

    PubMed Central

    Swan, Alexander; Allen, Geoffrey T.; Tanner, Norman C.

    1962-01-01

    This paper is a survey of a series of 185 plasma volume estimations carried out on 75 gastric surgical patients before and after operation at St. James's Hospital in 1958-59. In the majority of cases serum proteins were also measured. The purpose of this work was to study the effects of gastric operations, and especially of partial gastrectomy, on patients' blood volume, the oxygen-carrying capacity of the blood as measured by the total circulating red cell volume, and serum protein content. PMID:13918772

  18. An emerging role: the nurse content curator.

    PubMed

    Brooks, Beth A

    2015-01-01

    A new phenomenon, the inverted or "flipped" classroom, assumes that students are no longer acquiring knowledge exclusively through textbooks or lectures. Instead, they are seeking out the vast amount of free information available to them online (the very essence of open source) to supplement learning gleaned in textbooks and lectures. With so much open-source content available to nursing faculty, it benefits the faculty to use readily available, technologically advanced content. The nurse content curator supports nursing faculty in its use of such content. Even more importantly, the highly paid, time-strapped faculty is not spending an inordinate amount of effort surfing for and evaluating content. The nurse content curator does that work, while the faculty uses its time more effectively to help students vet the truth, make meaning of the content, and learn to problem-solve. Brooks.

  19. Data Curation Education in Research Centers (DCERC)

    NASA Astrophysics Data System (ADS)

    Marlino, M. R.; Mayernik, M. S.; Kelly, K.; Allard, S.; Tenopir, C.; Palmer, C.; Varvel, V. E., Jr.

    2012-12-01

    Digital data both enable and constrain scientific research. Scientists are enabled by digital data to develop new research methods, utilize new data sources, and investigate new topics, but they also face new data collection, management, and preservation burdens. The current data workforce consists primarily of scientists who receive little formal training in data management and data managers who are typically educated through on-the-job training. The Data Curation Education in Research Centers (DCERC) program is investigating a new model for educating data professionals to contribute to scientific research. DCERC is a collaboration between the University of Illinois at Urbana-Champaign Graduate School of Library and Information Science, the University of Tennessee School of Information Sciences, and the National Center for Atmospheric Research. The program is organized around a foundations course in data curation and provides field experiences in research and data centers for both master's and doctoral students. This presentation will outline the aims and the structure of the DCERC program and discuss results and lessons learned from the first set of summer internships in 2012. Four masters students participated and worked with both data mentors and science mentors, gaining first hand experiences in the issues, methods, and challenges of scientific data curation. They engaged in a diverse set of topics, including climate model metadata, observational data management workflows, and data cleaning, documentation, and ingest processes within a data archive. The students learned current data management practices and challenges while developing expertise and conducting research. They also made important contributions to NCAR data and science teams by evaluating data management workflows and processes, preparing data sets to be archived, and developing recommendations for particular data management activities. The master's student interns will return in summer of 2013

  20. A Reflection on a Data Curation Journey

    PubMed Central

    van Zyl, Christa

    2015-01-01

    This commentary is a reflection on experience of data preservation and sharing (i.e., data curation) practices developed in a South African research organization. The lessons learned from this journey have echoes in the findings and recommendations emerging from the present study in Low and Middle-Income Countries (LMIC) and may usefully contribute to more general reflection on the management of change in data practice. PMID:26297756

  1. Curation accuracy of model organism databases.

    PubMed

    Keseler, Ingrid M; Skrzypek, Marek; Weerasinghe, Deepika; Chen, Albert Y; Fulcher, Carol; Li, Gene-Wei; Lemmer, Kimberly C; Mladinich, Katherine M; Chow, Edmond D; Sherlock, Gavin; Karp, Peter D

    2014-01-01

    Manual extraction of information from the biomedical literature-or biocuration-is the central methodology used to construct many biological databases. For example, the UniProt protein database, the EcoCyc Escherichia coli database and the Candida Genome Database (CGD) are all based on biocuration. Biological databases are used extensively by life science researchers, as online encyclopedias, as aids in the interpretation of new experimental data and as golden standards for the development of new bioinformatics algorithms. Although manual curation has been assumed to be highly accurate, we are aware of only one previous study of biocuration accuracy. We assessed the accuracy of EcoCyc and CGD by manually selecting curated assertions within randomly chosen EcoCyc and CGD gene pages and by then validating that the data found in the referenced publications supported those assertions. A database assertion is considered to be in error if that assertion could not be found in the publication cited for that assertion. We identified 10 errors in the 633 facts that we validated across the two databases, for an overall error rate of 1.58%, and individual error rates of 1.82% for CGD and 1.40% for EcoCyc. These data suggest that manual curation of the experimental literature by Ph.D-level scientists is highly accurate. Database URL: http://ecocyc.org/, http://www.candidagenome.org//

  2. VERTICAL GASTRECTOMY AND GASTRIC BYPASS IN ROUX-EN-Y INDUCE POSTOPERATIVE GASTROESOPHAGEAL REFLUX DISEASE?

    PubMed Central

    NASSIF, Paulo Afonso Nunes; MALAFAIA, Osvaldo; RIBAS-FILHO, Jurandir Marcondes; CZECZKO, Nicolau Gregori; GARCIA, Rodrigo Ferreira; ARIEDE, Bruno Luiz

    2014-01-01

    Background The association between obesity and gastroesophageal reflux disease has a high incidence and may be present in half of obese patients with surgical indication. Bariatric operations can also induce reflux alone - differently from BMI factors - and its mechanisms are dependent on the type of procedure performed. Objective To perform a literature review comparing the two procedures currently most used for surgical treatment of obesity and analyze their relationship with the advent of pre-existing reflux disease or its appearance only in postoperative period. Method The literature was reviewed in virtual database Medline/PubMed, SciELO, Lilacs, Embase and Cochrane crossing the following MeSH descriptors: gastric bypass AND / OR anastomosis, Roux-en-Y AND / OR gastroesophageal reflux AND / OR gastroenterostomy AND / OR gastrectomy AND / OR obesity AND / OR bariatric surgery AND / OR postoperative period. A total of 135 relevant references were considered but only 30 were used in this article. Also was added the experience of the authors of this article in handling these techniques on this field. Conclusion The structural changes caused by surgical technique in vertical gastrectomy shows greater commitment of antireflux mechanisms predisposing the induction of GERD postoperatively compared to the surgical technique performed in the gastrointestinal Bypass Roux-en-Y. PMID:25409970

  3. Blood count and C-reactive protein evolution in gastric cancer patients with total gastrectomy surgery

    PubMed Central

    CSENDES J., Attila; MUÑOZ Ch., Andrea; BURGOS L., Ana María

    2014-01-01

    Background The complete blood count (CBC) and C-reactive protein (CRP) are useful inflammatory parameters for ruling out acute postoperative inflammatory complications. Aim To determine their changes in gastric cancer patients submitted to total gastrectomy. Methods This is a prospective study, with 36 patients with gastric cancer who were submitted to elective total gastrectomy. On the first, third and fifth postoperative day (POD), blood count and CRP changes were assessed. Patients with postoperative complications were excluded. Results Twenty-one (58%) were men and 15 (42%) women. The mean age was 65 years. The leukocytes peaked on the 1st POD with a mean of 13,826 u/mm³, and decreased to 8,266 u/mm³ by the 5th POD. The bacilliforms peaked on the 1st POD with a maximum value of 1.48%. CRP reached its maximum level on the 3rd POD with a mean of 144.64 mg/l±44.84. Preoperative hematocrit (HCT) was 35% and 33.67% by the 5th POD. Hemoglobin, showed similar values. Conclusions Leukocytes increased during the 1st POD but reached normal values by the 5th POD. CRP peaked on the 3rd POD but did not reach normal values by the 5th POD. PMID:25626929

  4. Archaic and modern human distal humeral morphology.

    PubMed

    Yokley, Todd R; Churchill, Steven E

    2006-12-01

    The morphology of the proximal ulna has been shown to effectively differentiate archaic or premodern humans (such as Homo heidelbergensis and H. neanderthalensis) from modern humans (H. sapiens). Accordingly, the morphology of adjacent, articulating elements should be able to distinguish these two broad groups as well. Here we test the taxonomic utility of another portion of the elbow, the distal humerus, as a discriminator of archaic and modern humans. Principal components analysis was employed on a suite of log-raw and log-shape distal humeral measures to examine differences between Neandertal and modern human distal humeri. In addition, the morphological affinities of Broken Hill (Kabwe) E.898, an archaic human distal humeral fragment from the middle Pleistocene of Zambia, and five Pliocene and early Pleistocene australopith humeri were assessed. The morphometric analyses effectively differentiated the Neandertals from the other groups, while the Broken Hill humerus appears morphologically similar to modern human distal humeri. Thus, an archaic/modern human dichotomy-as previously reported for proximal ulnar morphology-is not supported with respect to distal humeral morphology. Relative to australopiths and modern humans, Neandertal humeri are characterized by large olecranon fossae and small distodorsal medial and lateral pillars. The seeming disparity in morphological affinities of proximal ulnae (in which all archaic human groups appear distinct from modern humans) and distal humeri (in which Neandertals appear distinct from modern humans, but other archaic humans do not) is probably indicative of a highly variable, possibly transitional population of which our knowledge is hampered by sample-size limitations imposed by the scarcity of middle-to-late Pleistocene premodern human fossils outside of Europe.

  5. Management of distal humeral coronal shear fractures

    PubMed Central

    Yari, Shahram S; Bowers, Nathan L; Craig, Miguel A; Reichel, Lee M

    2015-01-01

    Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. PMID:25984515

  6. Esophagojejunostomy after laparoscopic total gastrectomy by OrVilTM or hemi-double stapling technique

    PubMed Central

    Wang, Hao; Hao, Qun; Wang, Meng; Feng, Min; Wang, Feng; Kang, Xin; Guan, Wen-Xian

    2015-01-01

    AIM: To investigate the feasibility, advantages and disadvantages of two types of anvil insertion techniques for esophagojejunostomy after laparoscopic total gastrectomy. METHODS: This was an open-label prospective cohort study. Laparoscopy-assisted radical total gastrectomy with D2 lymph node dissection was performed in 84 patients with primary non-metastatic gastric cancer confirmed by pre-operative histological examination. Overweight patients were excluded, as well as patients with peritoneal dissemination and invasion of adjacent organs. After total gastrectomy, all patients were randomized into two groups. Patients in Group I underwent esophagojejunostomy using a transorally-inserted anvil (OrVilTM), while patients in Group II underwent esophagojejunostomy using the hemi-double stapling technique (HDST). Both types of esophagojejunostomy were performed under laparoscopy. Patients’ baseline characteristics, preoperative characteristics, perioperative characteristics, short-term postoperative outcomes and operation cost were compared between the two groups. The primary endpoint was evaluation of the surgical outcome (operating time, time of digestive tract reconstruction and time of anvil insertion) and the medical cost of each operation (operation cost and total cost of hospitalization). The secondary endpoints were time to solid diet, post-surgical hospitalization time, time to defecation, time to ambulation and intra-operative blood loss. In addition, complications were assessed and compared. RESULTS: Laparoscopic total gastrectomy and esophagojejunostomy were successfully performed in all 84 patients, without conversion to laparotomy. There were no significant differences in the operative time and time for total gastrectomy between the two groups (287.8 ± 38.4 min vs 271.8 ± 46.1 min, P = 0.09, and 147.7 ± 31.6 min vs 159.8 ± 33.8 min, P = 0.09, respectively). The time for digestive tract reconstruction and for anvil insertion were significantly

  7. Distal protection for treatment of complete cervical internal carotid occlusion.

    PubMed

    Hungerford, John P; Chaudry, Imran; Turner, Raymond; Turk, Aquilla S

    2012-01-01

    Distal protection devices (DPD) have been advocated for carotid artery stenting to reduce the risk of distal embolization. These devices were designed for deployment in the straight cervical segment of the internal carotid artery. We present a case of total cervical carotid occlusion recanalized with the aid of a distal protection device deployed 'distally' in the intracranial internal carotid artery.

  8. Demographic features, BMPR2 status and outcomes in distal chronic thromboembolic pulmonary hypertension

    PubMed Central

    Suntharalingam, Jay; Machado, Rajiv D; Sharples, Linda D; Toshner, Mark R; Sheares, Karen K; Hughes, Rodney J; Jenkins, David P; Trembath, Richard C; Morrell, Nicholas W; Pepke‐Zaba, Joanna

    2007-01-01

    Background Although pulmonary endarterectomy (PEA) is potentially curative in chronic thromboembolic pulmonary hypertension (CTEPH), some patients have distally distributed disease that is not amenable to surgery. The aetiology and characteristics of this patient group are currently not well understood. Objectives This study compares the baseline demographic features and outcomes in subjects with distal CTEPH, those with proximal CTEPH and those with idiopathic pulmonary arterial hypertension (IPAH) to determine whether these conditions represent separate entities or whether they exist along the same spectrum of disease. Methods The medical history, clinical characteristics, bone morphogenetic protein receptor type II (BMPR2) mutation status and outcomes of 96 subjects with IPAH, 35 with distal CTEPH and 68 with proximal CTEPH referred to a single specialist centre between 1994 and 2005 were reviewed. Results There were significant differences between the distal CTEPH, proximal CTEPH and IPAH groups in age (55.9 years vs 54.8 years vs 46.2 years, p<0.001), proportion who were male (43% vs 69% vs 29%, p<0.001), previous deep vein thrombosis (28.6% vs 30.9% vs 3.1%, p<0.001), positive BMPR2 status (0% vs 0% vs 15%, p = 0.018), mean pulmonary artery pressure (47.3 mm Hg vs 45.4 mm Hg vs 54.8 mm Hg, p<0.001) and total pulmonary resistance (12.9 WU vs 12.4 WU vs 18.1 WU, p<0.001). Patients with distal CTEPH and those with IPAH were managed similarly and had comparable survival characteristics (1 year survival 77% vs 86%; 3 year survival 53% vs 60%; p = 0.68). Conclusions Patients with distal CTEPH share certain demographic features with patients with proximal CTEPH that not only indicate a common aetiology but also help to differentiate them from patients with IPAH. Despite more favourable haemodynamic parameters in those with distal CTEPH, patients in this group had a poor long‐term outcome which was similar to that of patients

  9. Sextant of Sapphires for Molar Distalization

    PubMed Central

    Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy

    2016-01-01

    Introduction Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. Aim To identify features seen in molar distalization cases. Materials and Methods The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. Results The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. Conclusion The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton’s discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan. PMID:27656572

  10. Failure of distal biceps repair by gapping

    PubMed Central

    Copas, David; Watts, Adam C

    2016-01-01

    Background We describe the clinical, radiological and surgical findings of failed distal biceps repair by gapping and report the functional outcomes following revision repair. Methods A retrospective review of five consecutive patients was conducted. Patients presented with radial-sided forearm pain after their distal biceps fixation. All patients had less than 5 cm of retraction of the biceps muscle belly, a palpable tendon although the manoeuvre was painful with weakness on resisted supination. Flexed abducted supinated magnetic resonance imaging (FABS MRI) showed a gap between the distal end of the tendon and the footprint on the radial tuberosity. Results Mean FEA score at presentation was 44/100 (35 to 49). Mean time to re-operation was 18 months (range 4 months to 36 months). At revision, the distal end of the tendon was retracted and not making contact with the bone. All cases were revised to an in-bone endobutton repair. Mean postoperative Functional Elbow Assessment (FEA) scores undertaken at a mean of 14 months (range 5 months to 22 months) after revision improved to 95/100 (90 to 100). Conclusions Patients presenting with persistent radial sided forearm pain and weakness on provocative testing after distal biceps repair with a seemingly intact repair should be investigated with FABS MRI to look for evidence of failure of repair by gapping. Revision repair with an anatomic in-bone technique can lead to good results. PMID:27583018

  11. Is Duodenal Invasion a Relevant Prognosticator in Patients Undergoing Adjuvant Chemoradiotherapy for Distal Common Bile Duct Cancer?

    SciTech Connect

    Kim, Kyubo; Chie, Eui Kyu; Jang, Jin-Young; Kim, Sun Whe

    2010-07-15

    Purpose: To analyze the outcome of adjuvant chemoradiotherapy for patients with distal common bile duct (CBD) cancer who underwent curative surgery, and to identify the prognostic factors for these patients. Methods and Materials: Between January 1991 and December 2002, 38 patients with adenocarcinoma of the distal CBD underwent curative resection followed by adjuvant chemoradiotherapy. There were 27 men and 11 women, and the median age was 60 years (range, 34-73). Adjuvant radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40 Gy at 2 Gy/fraction with a 2-week planned rest. Intravenous 5-fluorouracil (500mg/m{sup 2}/day) was given on day 1 to day 3 of each split course. The median follow-up period was 39 months. Results: The 5-year overall survival rate of all patients was 49.1%. On univariate analysis, only histologic differentiation (p = 0.0005) was associated with overall survival. Tumor size ({<=}2cm vs. >2cm) had a marginally significant impact on the treatment outcome (p = 0.0624). However, there was no difference in overall survival rates between T3 and T4 tumors (p = 0.6189), for which the main determinants were pancreatic and duodenal invasion, respectively. On multivariate analysis, histologic differentiation (p = 0.0092) and tumor size (p = 0.0046) were independent risk factors for overall survival. Conclusions: Long-term survival can be expected in patients with distal CBD cancer undergoing curative surgery and adjuvant chemoradiotherapy. Histologic differentiation and tumor size were significant prognostic factors predicting overall survival, whereas duodenal invasion was not. This finding suggests the need for further refinement in tumor staging.

  12. The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass

    PubMed Central

    Arndtz, Katherine; Steed, Helen; Hodson, James; Manjunath, Srikantaiah

    2016-01-01

    Background This study aimed to assess the endoscopic burden of bariatric surgical procedures at our trust. This is an enhanced parallel study to “The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass” published in Frontline Gastroenterology in 2013 incorporating the data for sleeve gastrectomy and comparison with Roux-en-Y gastric bypass (RYGB). Methods This is a retrospective study that included 211 patients undergoing sleeve gastrectomy over a 34-month period. We utilized previously collected data for the RYGB patient cohort which included 553 patients over a 29-month period. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications related to their surgery. Results 16.6% of the sleeve gastrectomy patients required post-operative endoscopy, of whom 11.4% underwent therapeutic procedures. This compares to 20.4% of the RYGB cohort of whom 50.4% needed therapeutic procedures (P<0.001). 1.9% of sleeve gastrectomy patients encountered a post-operative staple line leak and collectively required 29 endoscopic procedures. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated an equivalent cost of €159,898 in endoscopy tariffs, or €177 per RYGB and €373 per sleeve gastrectomy performed. Conclusions Bariatric surgery can have significant implications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account. PMID:26752949

  13. Research Problems in Data Curation: Outcomes from the Data Curation Education in Research Centers Program

    NASA Astrophysics Data System (ADS)

    Palmer, C. L.; Mayernik, M. S.; Weber, N.; Baker, K. S.; Kelly, K.; Marlino, M. R.; Thompson, C. A.

    2013-12-01

    The need for data curation is being recognized in numerous institutional settings as national research funding agencies extend data archiving mandates to cover more types of research grants. Data curation, however, is not only a practical challenge. It presents many conceptual and theoretical challenges that must be investigated to design appropriate technical systems, social practices and institutions, policies, and services. This presentation reports on outcomes from an investigation of research problems in data curation conducted as part of the Data Curation Education in Research Centers (DCERC) program. DCERC is developing a new model for educating data professionals to contribute to scientific research. The program is organized around foundational courses and field experiences in research and data centers for both master's and doctoral students. The initiative is led by the Graduate School of Library and Information Science at the University of Illinois at Urbana-Champaign, in collaboration with the School of Information Sciences at the University of Tennessee, and library and data professionals at the National Center for Atmospheric Research (NCAR). At the doctoral level DCERC is educating future faculty and researchers in data curation and establishing a research agenda to advance the field. The doctoral seminar, Research Problems in Data Curation, was developed and taught in 2012 by the DCERC principal investigator and two doctoral fellows at the University of Illinois. It was designed to define the problem space of data curation, examine relevant concepts and theories related to both technical and social perspectives, and articulate research questions that are either unexplored or under theorized in the current literature. There was a particular emphasis on the Earth and environmental sciences, with guest speakers brought in from NCAR, National Snow and Ice Data Center (NSIDC), and Rensselaer Polytechnic Institute. Through the assignments, students

  14. Fabrication and Evaluation of a Noncompliant Molar Distalizing Appliance: Bonded Molar Distalizer

    PubMed Central

    Sodagar, A.; Ahmad Akhoundi, M. S.; Rafighii, A.; Arab, S.

    2011-01-01

    Objective Attempts to treat class II malocclusions without extraction in non-compliant patients have led to utilization of intraoral molar distalizing appliances. The purpose of this study was to investigate dental and skeletal effects of Bonded Molar Distalizer (BMD) which is a simple molar distalizing appliance. Materials and Methods Sixteen patients (12 girls, four boys) with bilateral half-cusp class II molar relationship, erupted permanent second molars and normal or vertical growth pattern were selected for bilateral distalization of maxillary molars via BMD. The screws were activated every other day, alternately. Lateral cephalograms and study models were obtained before treatment and after 11 weeks activation of the appliance. Results Significant amounts of molar distalization, molar distal tipping and anchorage loss were observed. The mean maxillary first molar distal movement was 1.22±0.936 mm with a distal tipping of 2.97±3.74 degrees in 11 weeks. The rate of distal movement was 0.48 mm per month. Reciprocal mesial movement of the first premolars was 2.26±1.12 mm with a mesial tipping of 4.25±3.12 degrees. Maxillary incisors moved 3.55±1.46 mm and tipped 9.87±5.03 degrees mesially. Lower anterior face height (LAFH) decreased 1.28±1.36 mm. Conclusion BMD is appropriate for distalizing maxillary molars, especially in patients with critical LAFH, although significant amounts of anchorage loss occur using this appliance. PMID:22457837

  15. Treatment Options for Distal Femur Fractures.

    PubMed

    von Keudell, Arvind; Shoji, Kristin; Nasr, Michael; Lucas, Robert; Dolan, Robert; Weaver, Michael J

    2016-08-01

    Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement. PMID:27441931

  16. Distal Humerus Fractures: Open Reduction Internal Fixation.

    PubMed

    Mighell, Mark A; Stephens, Brent; Stone, Geoffrey P; Cottrell, Benjamin J

    2015-11-01

    Distal humerus fractures are challenging injuries for the upper extremity surgeon. However, recent techniques in open reduction internal fixation have been powerful tools in getting positive outcomes. To get such results, the surgeon must be aware of how to properly use these techniques in their respective practices. The method of fixation depends on the fracture, taking the degree of comminution and the restoration of the columns and articular surface into account. This article helps surgeons understand the concepts behind open reduction internal fixation of the distal humerus and makes them aware of pitfalls that may lead to negative results.

  17. Exposure of the forearm and distal radius.

    PubMed

    Klausmeyer, Melissa A; Mudgal, Chaitanya

    2014-11-01

    Approaches to the forearm use internervous planes to allow adequate bone exposure and prevent muscle denervation. The Henry approach utilizes the plane between muscles supplied by the median and radial nerves. The Thompson approach utilizes the plane between muscles supplied by the radial and posterior interosseous nerves. The distal radius may be approached volarly. The extended flexor carpi radialis approach is useful for intraarticular fractures, subacute fractures, and malunions. The distal radius can be approached dorsally by releasing the third dorsal compartment and continuing the dissection subperiosteally. Choice of approach depends on the injury pattern and the need for exposure. PMID:25440071

  18. Prophylactic and curative foodstuffs from topinambour

    NASA Astrophysics Data System (ADS)

    Bobrovnik, Leonid D.; Gulyi, Ivan S.; Remeslo, Natalia V.; Yefimov, Andrey S.; Melnik, Ivan M.; Vysotskiy, Vadim G.

    1999-01-01

    Topinambour belongs to medicinal pants with unique useful chemical composition which is characterized by a wide range of biological-active substances. This composition stipulates high nutrient value of topinambour. On this basis the researchers of the Ukrainian Sate University of Food Technologies elaborated some technologies of prophylactic- curative food-stuffs. These products promote the strengthening of immune system, therefore they are very useful for all people, particularly for those who live on the region contaminated by radionuclides. The results of medical-biological and clinical investigations have been discussed in this paper.

  19. Effect of sleeve gastrectomy on postprandial lipoprotein metabolism in morbidly obese patients

    PubMed Central

    2013-01-01

    Background Obesity is associated with abnormal fasting and postprandial lipids, which may link obesity with atherosclerosis. We explored fasting and postprandial lipids in morbidly obese patients treated with sleeve gastrectomy and in control subjects. Methods After fasting for 12 h 15 morbidly obese patients (BMI 51.4±6.5 kg/m2, 43.7±12.6 years) received a standardized oral fat load before and 3 months after bariatric surgery (sleeve gastrectomy). Controls (n=9, BMI 23.1±1.4 kg/m2) were studied once. Plasma was obtained fasting and then postprandially every 2 h for 8 h. Triglycerides (TG), chylomicron-TG (CM-TG), VLDL/chylomicron-remnant (VLDL/CR)-TG, cholesterol, LDL-cholesterol, VLDL/CR-cholesterol and HDL-cholesterol were isolated by ultracentrifugation at each time point. Postprandial values were expressed as area under the curve (AUC) and incremental area under the curve (iAUC). In addition, fasting glucose and insulin values and HOMA-IR-Index was measured (n=14). Results Compared to controls morbidly obese patients had elevated TG and slightly altered postprandial lipids. Following surgery (weight loss 23.4 kg±6.2 kg; p<0.001) fasting TG (−19.1%; p=0.04), VLDL/CR-TG (−20.0%; p=0.05) decreased significantly, while fasting cholesterol, VLDL-, HDL- and LDL-cholesterol did not change. AUC and iAUC decreased significantly for VLDL/CR-TG (−20.4%, p=0.04 and −38.5%, p=0.04, respectively). Neither fasting nor postprandial changes correlated with the change in weight. In patients with preoperatively elevated TG (>150 mg/dl) a similar pattern was observed. Fasting insulin and HOMA were reduced significantly (−51.9%; p=0.004 and −47.9%; p=0.011). Conclusions Three months after sleeve gastrectomy fasting and postprandial lipoprotein metabolism and glucose metabolism is improved in morbidly obese patients. The potential mechanisms may relate to decreased caloric intake but also to hormonal changes. PMID:23725203

  20. Comparison of Maxillary Molar Distalization with an Implant-Supported Distal Jet and a Traditional Tooth-Supported Distal Jet Appliance

    PubMed Central

    Cozzani, Mauro; Pasini, Marco; Zallio, Francesco; Ritucci, Robert; Mutinelli, Sabrina; Mazzotta, Laura; Giuca, Maria Rita; Piras, Vincenzo

    2014-01-01

    Aim. To investigate and compare the efficiency of two appliances for molar distalization: the bone-anchored distal screw (DS) and the traditional tooth-supported distal jet (DJ) for molar distalization and anchorage loss. Methods. Tests (18 subjects) were treated with a DS and controls (18 subjects) were treated with a DJ. Lateral cephalograms were obtained before and at the end of molar distalization and were analysed. Shapiro Wilk test, unpaired t-test, and Wilcoxon rank-sum test were applied according to values distribution. The α level was fixed at 0.05. Results. Maxillary first molars were successfully distalized into a Class I relationship in all patients. The mean molar distalization and treatment time were similar in both groups. The DS group exhibited a spontaneous distalization (2.1 ± 0.9 mm) of the first premolar with control of anchorage loss, distal tipping, extrusion, and skeletal changes. Conclusions. The DS is an adequate compliance-free distalizing appliance that can be used safely for the correction of Class II malocclusions. In comparison to the traditional DJ, the DS enables not only a good rate of molar distalization, but also a spontaneous distalization of the first premolars. PMID:25018770

  1. Improving the Acquisition and Management of Sample Curation Data

    NASA Technical Reports Server (NTRS)

    Todd, Nancy S.; Evans, Cindy A.; Labasse, Dan

    2011-01-01

    This paper discusses the current sample documentation processes used during and after a mission, examines the challenges and special considerations needed for designing effective sample curation data systems, and looks at the results of a simulated sample result mission and the lessons learned from this simulation. In addition, it introduces a new data architecture for an integrated sample Curation data system being implemented at the NASA Astromaterials Acquisition and Curation department and discusses how it improves on existing data management systems.

  2. Comparative evaluation of molar distalization therapy using pendulum and distal screw appliances

    PubMed Central

    Cafagna, Alessandra; Fontana, Mattia; Cozzani, Mauro

    2015-01-01

    Objective To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. Methods Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 ± 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 ± 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. Results PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2° vs. 9.0°, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0°) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1°) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. Conclusions PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA. PMID:26258063

  3. A New Distal Radioulnar Joint Prosthesis

    PubMed Central

    Schuurman, Arnold H.

    2013-01-01

    Pain and instability of the distal radioulnar joint (DRUJ) are common sequelae following a fracture of the distal radius. Many soft tissue procedures have been described, not all of which are successful. Ulnar head replacement prostheses are available but do not always provide stability. We designed a two-part, easy to implant, distal radioulnar prosthesis and implanted it in 19 patients. The first prototype was inserted in 2002 and is still in place. During the study, the design was changed twice, resulting in three groups with four patients in group A, five in group B, and ten in group C. Unfortunately all five prostheses in group B had to be removed because of loosening, while only two prostheses in group C had to be removed, for nonprosthetic reasons. For the 12 patients who retained their prosthesis, forearm function increased while grip strength increased significantly. Pain scores decreased and the Disabilities of the Arm, Shoulder, and Hand (DASH) score improved but remained high. We conclude that the prosthesis offers a new treatment option for ulnar instability following distal ulnar resection. PMID:24436843

  4. The Use of Serum Uric Acid Concentration as an Indicator of Laparoscopic Sleeve Gastrectomy Success

    PubMed Central

    Menenakos, Evangelos; Doulami, Georgia; Tzanetakou, Irene P.; Natoudi, Maria; Kokoroskos, Nikolaos; Almpanopoulos, Konstantinos; Leandros, Emmanouil; Zografos, George; Theodorou, Dimitrios

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) effectively reduces weight by restricting gastric capacity and altering gut hormones levels. We designed a prospective study to investigate the correlation of serum uric acid (SUA) concentration and weight loss. SUA and body mass index (BMI) were measured preoperatively and on first postoperative month and year in patients who underwent LSG in our department of bariatric surgery. Data on 55 patients were analyzed. Preoperative SUA concentration had a significant positive correlation with percentage of total weight loss (TWL) on first postoperative month (P = 0.001) and year (P = 0.002). SUA concentration on first postoperative month had a positive correlation with percentage of TWL on first postoperative year (P = 0.004). SUA concentration could be used as a predictor of LSG's success and could help in early detection of patients with rapid loss of weight, in order to prevent complications. PMID:25594659

  5. Novel method for esophagojejunal anastomosis after laparoscopic total gastrectomy: Semi-end-to-end anastomosis

    PubMed Central

    Zhao, Yong-Liang; Su, Chong-Yu; Li, Teng-Fei; Qian, Feng; Luo, Hua-Xing; Yu, Pei-Wu

    2014-01-01

    AIM: To test a new safe and simple technique for circular-stapled esophagojejunostomy in laparoscopic total gastrectomy (LATG). METHODS: We selected 26 patients with gastric cancer who underwent LATG and Roux-en-Y gastrointestinal reconstruction with semi-end-to-end esophagojejunal anastomosis. RESULTS: LATG with semi-end-to-end esophagojejunal anastomosis was successfully performed in all 26 patients. The average operation time was 257 ± 36 min, with an average anastomosis time of 51 ± 17 min and an average intraoperative blood loss of 88 ± 46 mL. The average postoperative hospital stay was 8 ± 3 d. There were no complications and no mortality in this series. CONCLUSION: The application of semi-end-to-end esophagojejunal anastomosis after LATG is a safe and feasible procedure, which can be easily performed and has a short operation time in terms of anastomosis. PMID:25309086

  6. Mechanistic Comparison between Gastric Bypass vs. Duodenal Switch with Sleeve Gastrectomy in Rat Models

    PubMed Central

    Kodama, Yosuke; Johannessen, Helene; Furnes, Marianne W.; Zhao, Chun-Mei; Johnsen, Gjermund; Mårvik, Ronald; Kulseng, Bård; Chen, Duan

    2013-01-01

    Background Both gastric bypass (GB) and duodenal switch with sleeve gastrectomy (DS) have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. Methods Animals were subjected to GB, DS or laparotomy (controls), and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. Results Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. Conclusion GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models. PMID:24039816

  7. FXR is a molecular target for the effects of vertical sleeve gastrectomy

    PubMed Central

    Ryan, Karen K.; Tremaroli, Valentina; Clemmensen, Christoffer; Kovatcheva-Datchary, Petia; Myronovych, Andriy; Karns, Rebekah; Wilson-Pérez, Hilary E.; Sandoval, Darleen A.; Kohli, Rohit; Bäckhed, Fredrik; Seeley, Randy J.

    2014-01-01

    SUMMARY Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are currently the most effective therapy for the treatment of obesity, and are associated with substantial improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms contributing to these benefits remain largely undetermined, despite offering tremendous potential to reveal new targets for therapeutic intervention. The present study demonstrates that the therapeutic value of VSG does not result from mechanical restriction imposed by a smaller stomach. Rather, we report that VSG is associated with increased circulating bile acids, and associated changes to gut microbial communities. Moreover, in the absence of nuclear bile acid receptor FXR, the ability of VSG to reduce body weight and improve glucose tolerance is substantially reduced. These results point to bile acids and FXR signaling as an important molecular underpinning for the beneficial effects of this weight-loss surgery. PMID:24670636

  8. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity

    PubMed Central

    Shabbir, Asim; Dargan, Dallan

    2015-01-01

    Abstract The rapid reversal of diabetes, hypertension, hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome. Sleeve gastrectomy, which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch, has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure. Superior excess weight loss, a low complication rate, and excellent food tolerance, combined with a short hospital stay, have made this the procedure of choice for patients and surgeons across the globe. High volume centres nurture the ongoing development of experienced and specialized teams, pathways and regimens. Optimum surgical outcomes allow minimization of metabolic syndrome, reducing cardiovascular and cerebrovascular risk. PMID:25859262

  9. Short-term pilot study of the effect of sleeve gastrectomy on food preference.

    PubMed

    Ammon, Brandon S; Bellanger, Drake E; Geiselman, Paula J; Primeaux, Stefany D; Yu, Ying; Greenway, Frank L

    2015-06-01

    The effect of vertical sleeve gastrectomy (VSG) on food preference has not been examined in humans, but VSG decreases preference for fat and calorically dense foods in rodents. A validated Food Preference Questionnaire (FPQ) assessed food preference changes before and 6 weeks after VSG in humans. The FPQ was completed before and 43 ± 19 days (Mean ± SD) after VSG. Fifteen subjects (14 females) completed the study. Hedonic ratings decreased for foods high in fat and sugar (p = 0.002) and high in fat and complex carbohydrate (p = 0.007). Fat preference (p = 0.048) decreased, VSG reduced preference for calorically dense foods high in fat, sugar, and complex carbohydrate, and these changes may contribute to the weight loss with VSG.

  10. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy.

    PubMed

    Liu, Shirley Yuk-Wah; Wong, Simon Kin-Hung; Ng, Enders Kwok-Wai

    2015-01-01

    The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing.

  11. [A case of partial hepatectomy and gastrectomy for hepatocellular carcinoma with direct invasion to the stomach].

    PubMed

    Yoshida, Yuta; Murakami, Masahiro; Shimizu, Junzo; Kawada, Masahiro; Yasuyama, Akinobu; Yoshikawa, Yukihiro; Watase, Chikashi; Nishigaki, Takahiko; Kim, Ho Min; Hitora, Toshiki; Oda, Naofumi; Hirota, Masaki; Yoshikawa, Masato; Morishima, Hirotaka; Ikenaga, Masakazu; Mikata, Shoki; Matsunami, Nobuteru; Hasegawa, Junichi

    2014-11-01

    An 81-year-old man treated with chronic hepatitis C virus (HCV)-related hepatitis and hepatocellular carcinoma (HCC) was diagnosed in 2010 with HCC recurrence (subclass S2) on computed tomography (CT). He refused surgery and was followed up without treatment. In 2012, he was admitted to our hospital because of hematemesis. Gastrointestinal endoscopy revealed a large tumor in the upper gastric corpus, and pathological examination of the tumor revealed HCC; hence, we diagnosed the patient with direct HCC invasion to the stomach. Although active bleeding from the tumor was controlled, he experienced repeated episodes of hematemesis, and the tumor increased in size. Therefore, partial hepatectomy and gastrectomy were performed. It was confirmed that the tumor invaded the stomach wall. Although surgery was effective for gastrointestinal bleeding caused by HCC invasion, the patient died 12 months after surgery because of multiple liver metastases and exacerbated liver failure.

  12. Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review

    PubMed Central

    Aurello, Paolo; Sirimarco, Dario; Magistri, Paolo; Petrucciani, Niccolò; Berardi, Giammauro; Amato, Silvia; Gasparrini, Marcello; D’Angelo, Francesco; Nigri, Giuseppe; Ramacciato, Giovanni

    2015-01-01

    AIM: To identify the most effective treatment of duodenal stump fistula (DSF) after gastrectomy for gastric cancer. METHODS: A systematic review of the literature was performed. PubMed, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and UpToDate databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients’ characteristics, type of treatment, short and long-term outcomes were extracted and analyzed. RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach (3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodeno-jejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy (32 cases) and percutaneous biliary diversion (13 cases). The median healing time in this group was 43 d. CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail. PMID:26140005

  13. Metabolic and histopathological effects of sleeve gastrectomy and gastric plication: an experimental rodent model

    PubMed Central

    Gulcicek, Osman Bilgin; Ozdogan, Kamil; Solmaz, Ali; Yigitbas, Hakan; Altınay, Serdar; Gunes, Aysegul; Celik, Duygu Sultan; Yavuz, Erkan; Celik, Atilla; Celebi, Fatih

    2016-01-01

    Introduction Obesity has recently become a major health problem, and researchers have been directed to work toward the development of surgical techniques, with new mediators playing an important role in nutrition. Gastric plication (GP) and sleeve gastrectomy (SG) have become popular recently. These are widely used techniques in bariatric surgery. Objectives In this study, we aimed to compare the efficiency of SG and GP techniques on rats. Methods Wistar-Hannover rats (n=18) were divided into three equal groups, namely SG, GP, and control. Blood samples were taken before the operation and on the 30th day after the operation. The weights of all rats were recorded both on first day and the 30th day after the operation. Serum gastrin, ghrelin, and leptin levels were also measured on the same days. For histopathological examination, gastrectomy was performed after the animals were sacrificed. Results Average weight loss was 10% for the SG group and 6.5% for the GP group. One month after the operations, the decrease in the ghrelin and leptin levels of GP and SG groups was significant compared with the levels of the control group. Gastrin levels of the SG group increased significantly compared with those of the control group. Histopathological examination revealed that there was significant decrease in the ghrelin and leptin levels of the GP and SG groups compared with those of the control group. Foveolar hyperplasia (FH), cystic glandular dilatation, and fibrosis were significantly higher in the GP and SG groups compared with the control group. Conclusion Although GP is not as effective as SG in terms of weight loss, it provides the same effectiveness in decreasing ghrelin and leptin levels. Histopathological findings revealed that FH, fibrosis, and the cystic glandular dilatation development rates were similar. PMID:27087477

  14. Sleeve gastrectomy does not cause hypertrophy and reprogramming of intestinal glucose metabolism in rats

    PubMed Central

    Mumphrey, Michael B.; Hao, Zheng; Townsend, R. Leigh; Patterson, Laurel M.; Berthoud, Hans-Rudolf

    2015-01-01

    BACKGROUND & AIMS Clinical studies have shown similar rapid improvements in body mass and glycemic control after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). Evidence suggests that adaptive intestinal tissue growth and reprogramming of intestinal glucose disposal plays a key role in the beneficial effects on glucose homeostasis after RYGB, but it is not known whether such adaptive changes also occur after sleeve gastrectomy. METHODS High-fat diet-induced obese rats were subjected to either VSG or RYGB and intestinal growth and functional adaptations were assessed by using morphometric, immunohistochemical and immuno-blot techniques, 3 months after surgery or sham surgery. RESULTS The cross-sectional areas of the Roux and common limbs are significantly increased after RYGB compared with sham surgery (Roux limb: 17.1 ± 4.0 vs. 5.5 ± 0.1 mm2; common limb: 11.7 ± 0.6 vs. 5.1 ± 0.5 mm2; p < 0.01), but the cross-sectional area of the corresponding jejunum is not different from controls after VSG. Similarly, mucosal thickness and the number of GLP-1 cells are not increased after VSG. Protein expression of hexokinase II is increased four-fold (p <0.01) in the Roux limb after RYGB, but not in the jejunum after VSG. CONCLUSIONS Adaptive hypertrophy and reprogramming of glucose metabolism in the small intestine are not necessary for VSG to improve body composition and glycemic control. The similar beneficial effects of VSG and RYGB on glucose homeostasis might be mediated by different mechanisms. PMID:25566744

  15. Curating NASA's Past, Present, and Future Astromaterial Sample Collections

    NASA Technical Reports Server (NTRS)

    Zeigler, R. A.; Allton, J. H.; Evans, C. A.; Fries, M. D.; McCubbin, F. M.; Nakamura-Messenger, K.; Righter, K.; Zolensky, M.; Stansbery, E. K.

    2016-01-01

    The Astromaterials Acquisition and Curation Office at NASA Johnson Space Center (hereafter JSC curation) is responsible for curating all of NASA's extraterrestrial samples. JSC presently curates 9 different astromaterials collections in seven different clean-room suites: (1) Apollo Samples (ISO (International Standards Organization) class 6 + 7); (2) Antarctic Meteorites (ISO 6 + 7); (3) Cosmic Dust Particles (ISO 5); (4) Microparticle Impact Collection (ISO 7; formerly called Space-Exposed Hardware); (5) Genesis Solar Wind Atoms (ISO 4); (6) Stardust Comet Particles (ISO 5); (7) Stardust Interstellar Particles (ISO 5); (8) Hayabusa Asteroid Particles (ISO 5); (9) OSIRIS-REx Spacecraft Coupons and Witness Plates (ISO 7). Additional cleanrooms are currently being planned to house samples from two new collections, Hayabusa 2 (2021) and OSIRIS-REx (2023). In addition to the labs that house the samples, we maintain a wide variety of infra-structure facilities required to support the clean rooms: HEPA-filtered air-handling systems, ultrapure dry gaseous nitrogen systems, an ultrapure water system, and cleaning facilities to provide clean tools and equipment for the labs. We also have sample preparation facilities for making thin sections, microtome sections, and even focused ion-beam sections. We routinely monitor the cleanliness of our clean rooms and infrastructure systems, including measurements of inorganic or organic contamination, weekly airborne particle counts, compositional and isotopic monitoring of liquid N2 deliveries, and daily UPW system monitoring. In addition to the physical maintenance of the samples, we track within our databases the current and ever changing characteristics (weight, location, etc.) of more than 250,000 individually numbered samples across our various collections, as well as more than 100,000 images, and countless "analog" records that record the sample processing records of each individual sample. JSC Curation is co-located with JSC

  16. The Role of Preoperative TIPSS to Facilitate Curative Gastric Surgery

    SciTech Connect

    Norton, S.A.; Vickers, J.; Callaway, M.P. Alderson, D.

    2003-08-15

    The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

  17. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer: A retrospective study in a single minimally invasive surgery center.

    PubMed

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-06-01

    Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57

  18. Genetics Home Reference: distal hereditary motor neuropathy, type II

    MedlinePlus

    ... hereditary motor neuropathy, type II distal hereditary motor neuropathy, type II Enable Javascript to view the expand/ ... Open All Close All Description Distal hereditary motor neuropathy, type II is a progressive disorder that affects ...

  19. Genetics Home Reference: distal hereditary motor neuropathy, type V

    MedlinePlus

    ... hereditary motor neuropathy, type V distal hereditary motor neuropathy, type V Enable Javascript to view the expand/ ... Open All Close All Description Distal hereditary motor neuropathy, type V is a progressive disorder that affects ...

  20. Sample Curation at a Lunar Outpost

    NASA Technical Reports Server (NTRS)

    Allen, Carlton C.; Lofgren, Gary E.; Treiman, A. H.; Lindstrom, Marilyn L.

    2007-01-01

    The six Apollo surface missions returned 2,196 individual rock and soil samples, with a total mass of 381.6 kg. Samples were collected based on visual examination by the astronauts and consultation with geologists in the science back room in Houston. The samples were photographed during collection, packaged in uniquely-identified containers, and transported to the Lunar Module. All samples collected on the Moon were returned to Earth. NASA's upcoming return to the Moon will be different. Astronauts will have extended stays at an out-post and will collect more samples than they will return. They will need curation and analysis facilities on the Moon in order to carefully select samples for return to Earth.

  1. Endoscopic Papillary Large Balloon Dilation for the Retrieval of Bile Duct Stones After Prior Billroth II Gastrectomy

    PubMed Central

    Kim, Tae-Nyeun

    2014-01-01

    Background/Aims: Endoscopic retrieval of large common bile duct (CBD) stones is often difficult in patients who have undergone Billroth II gastrectomy, as anatomic alterations may present technical barriers to successful cannulation and increase procedure-related complications. Endoscopic papillary large balloon dilation (EPLBD) can be an alternative technique for the removal of difficult stones. Accordingly, the aim of this study was to evaluate the safety and effectiveness of EPLBD for CBD stone extraction in patients with Billroth II gastrectomy. Materials and Methods: From July 2006 to November 2011, 30 patients who underwent EPLBD with limited endoscopic sphincterotomy (EPLBD + ES) or EPLBD alone for the treatment of large CBD stones (≥10 mm) after Billroth II gastrectomy were retrospectively reviewed. A large balloon dilator (12-18 mm) was used to dilate the ampullary orifice. Results: Selective cannulation was successful in 25 patients (83.3%) with a standard catheter. Of the 30 subjects, EPLBD + ES was performed in 19 and EPLBD alone in 11. The mean bile duct diameter was 17.7 ± 4.3 mm (range, 11-31 mm), and mean size of balloon dilation was 14.5 ± 2.6 mm (range, 12-18 mm). Stone removal was successfully completed in 29 patients (96.7%). Successful stone retrieval during the first session was achieved in 27 patients (90.0%). Two cases (6.7%) of mild pancreatitis responded to conservative treatment, and no perforation or mortality was encountered. Conclusions: EPLBD with or without needle knife (NK) sphincterotomy seems to be a safe and feasible modality for CBD stone retrieval in patients with prior Billroth II gastrectomy. PMID:24705151

  2. Extracorporeal shockwave lithotripsy of distal ureteral calculi.

    PubMed

    Miller, K; Bubeck, J R; Hautmann, R

    1986-01-01

    To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.

  3. [Fracture endoprosthesis of distal humerus fractures].

    PubMed

    Müller, L P; Wegmann, K; Burkhart, K J

    2013-08-01

    The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

  4. Fracture of distal end clavicle: A review

    PubMed Central

    Sambandam, Balaji; Gupta, Rajat; Kumar, Santosh; Maini, Lalit

    2014-01-01

    Management of fracture distal end clavicle has always puzzled the orthopaedic surgeons. Now-a-days with a relatively active lifestyle, patients want better results both cosmetically and functionally. Despite so much literature available for the management of this common fracture, there is no consensus regarding the gold standard treatment for this fracture. In this article, we reviewed the literature on various techniques of management for this fracture, both conservative as well as surgical, and their merits and demerits. PMID:25983473

  5. Fractures of Distal Radius: An Overview

    PubMed Central

    Meena, Sanjay; Sharma, Pankaj; Sambharia, Abhishek Kumar; Dawar, Ashok

    2014-01-01

    Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. PMID:25657938

  6. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    SciTech Connect

    Kelogrigoris, M. Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-06-15

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26-52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  7. Distal Embolic Protection for Renal Arterial Interventions

    SciTech Connect

    Dubel, Gregory J. Murphy, Timothy P.

    2008-01-15

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

  8. Distal nerve entrapment following nerve repair.

    PubMed

    Schoeller, T; Otto, A; Wechselberger, G; Pommer, B; Papp, C

    1998-04-01

    Failure of nerve repair or poor functional outcome after reconstruction can be influenced by various causes. Besides improper microsurgical technique, fascicular malalignment and unphysiologic tension, we found in our clinical series that a subclinical nerve compression distal to the repair site can seriously impair regeneration. We concluded that the injured nerve, whether from trauma or microsurgical intervention, could be more susceptible to distal entrapment in the regenerative stage because of its disturbed microcirculation, swelling and the increase of regenerating axons followed by increased nerve volume. In two cases we found the regenerating nerve entrapped at pre-existing anatomical sites of narrowing resulting in impaired functional recovery. In both cases the surgical therapy was decompression of the distal entrapped nerve and this was followed by continued regeneration. Thorough clinical and electrophysiologic follow-up is necessary to detect such adverse compression effects and to distinguish between the various causes of failed regeneration. Under certain circumstances primary preventive decompression may be beneficial if performed at the time of nerve coaptation.

  9. Mirrored visual feedback limits distal effect anticipation.

    PubMed

    Sutter, Christine; Ladwig, Stefan

    2012-04-01

    Modern tools in technological environments are often characterized by a spatial separation of hand actions (operating a remote control) and their intended action effects (displayed movements of an unmanned vehicle, a robot, or an avatar on a screen). Often non-corresponding proximal and distal movement effects put high demands on the human information processing system. The present study aimed to investigate how modern technological environments influence processes of planning and controlling actions. Participants performed ipsi- or contralateral movements in response to colored stimuli, while the stimulus location had to be ignored. They did not see the stimuli and hands directly, but received visual feedback (with retained or reversed spatial relations) on a projection screen in front of them. Visual feedback retaining spatial relations led to the usual Simon effect. However, visual feedback reversing spatial relations inverted the Simon effect in ipsilateral responses, and eliminated it in contralateral responses (Exp. 1). Impairing the proximal movement-effect loop so that proprioceptive/tactile information from the moving hand was no longer a reliable source for planning and controlling actions attenuated compatibility effects (Exp. 2). Moreover, distal action effects predominated action control even for opposing body-related effects. It seemed that action control of transformed movements depended on the reliability of proprioceptive/tactile and visual information. When the amount of feature overlap between proprioception and vision was low and proprioceptive (visual) information was no longer reliable, then distal (proximal) action effects stepped forward and became crucial in controlling transformed actions.

  10. Surgical treatment of tumors of the distal rectum with sphincter preservation.

    PubMed Central

    Heimann, T M; Oh, C; Steinhagen, R M; Greenstein, A J; Perez, C; Aufses, A H

    1992-01-01

    One hundred one patients with villous adenoma or invasive carcinoma of the distal rectum treated with local excision or coloanal anastomosis were studied. Twenty-three (45%) of the 51 patients with villous adenomas had transanal excision, another 23 (45%) had a posterior proctotomy, and five (10%) had a coloanal anastomosis. Only two patients with a villous adenoma developed a recurrence requiring repeat local excision. Fifteen (30%) of the 50 patients with invasive cancer were treated by transanal excision. All had tumors confined to the submucosa or superficial muscularis. Eighteen (85%) of 21 patients having posterior proctotomy also had tumors with similar depth of invasion. Six (43%) of the 14 patients having coloanal anastomosis had Dukes' B tumors, six (43%) were Dukes' C, and another two (14%) underwent palliative resection. The overall actuarial 5-year survival was 77%. Only four patients treated by transanal excision or posterior proctotomy died of metastatic disease. In the coloanal group, two of 12 patients undergoing curative resection died of recurrent cancer, and another has a pelvic recurrence. Villous adenomas of the distal rectum and selected carcinomas may be treated with local excision and coloanal anastomosis with preservation of sphincter function with good results. PMID:1417192

  11. [Resection of the remnant pancreas for recurrent pancreatic cancer after distal pancreatectomy-a case report].

    PubMed

    Kinoshita, Shoichi; Sho, Masayuki; Akahori, Takahiro; Nomi, Takeo; Yamato, Ichiro; Hokutoh, Daisuke; Yasuda, Satoshi; Nakajima, Yoshiyuki

    2012-11-01

    The standard treatment for metastatic pancreatic cancer is chemotherapy. The effect of surgical resection for localized recurrence in the remnant pancreas after pancreatectomy for pancreatic cancer is unknown, but is reported to have a moderately good outcome in a few reports. We herein report a case of curative resection for recurrence in the remnant pancreas, 24 months after distal pancreatectomy for pancreatic cancer. A 71-year-old man was diagnosed with pancreas tail cancer. Neoadjuvant treatment with chemoradiotherapy[ weekly full-dose gemcitabine(GEM) and radiation therapy 50 Gy/25 Fr] was followed by distal pancreatectomy. Postoperative adjuvant therapy with hepatic arterial infusion of 5-FU and systemic GEM therapy was completed. Twenty-four months after surgery, follow-up computed tomography scan results showed a lesion of 15-mm diameter in the remnant pancreas. Resection of the remnant pancreas was performed. The pathological findings showed moderately differentiated adenocarcinoma, morphologically similar to the primary pancreatic cancer. Six months following surgery, there are no signs of recurrence at present.

  12. Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy

    PubMed Central

    Zheng, Xing; Feng, Xu; Cai, Xiu-Jun

    2016-01-01

    AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration (CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine (group CWI). Group 2 patients received 0.5 mg/mL morphine intravenously by a patient-controlled analgesia pump (PCIA) (group PCIA). Group 3 patients received epidural analgesia (EA) with 0.12% ropivacaine and 20 µg/mL morphine with an infusion at 6-8 mL/h for 48 h (group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia (2 mg bolus of morphine, intravenous) was given when the visual analogue scale (VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing, mean length of hospitalization after surgery, and the patient’s satisfaction were also recorded. RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption (P < 0.001), less postoperative nausea and vomiting (1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation (16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function (2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI (8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA (7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA

  13. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.

    PubMed

    Lai, Eric C H; Tang, Chung Ngai

    2015-09-01

    Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

  14. Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report

    PubMed Central

    2014-01-01

    Introduction To reduce incidence and severity of postsurgical pain and minimize the effect of its clinical and economic correlates, multimodal therapy for surgical patients is recommended. In this report, we discuss the use of liposome bupivacaine, a novel multivesicular formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia, as part of a multimodal analgesic regimen in a patient with a history of chronic pain scheduled to undergo laparoscopic sleeve gastrectomy. To the best of our knowledge, this is the first published report of liposome bupivacaine in the setting of laparoscopic sleeve gastrectomy. Case presentation A 35-year-old white woman with morbid obesity was admitted for laparoscopic sleeve gastrectomy to lose weight prior to hip replacement surgery. Because of a complicated medical history that included rheumatoid arthritis, fibromyalgia, diabetes mellitus, hypertension, and chronic pain, for which she was receiving high doses of opioid analgesics, postsurgical pain management was a concern and she was considered a candidate for multimodal analgesia. At initiation of surgery, 50mL of lidocaine and epinephrine was infiltrated around the port sites. At the conclusion, 25mL of normal sterile saline was added to a 20mL vial of liposome bupivacaine (266mg) and injected around the port sites and at the site of liver retraction. Laparoscopic sleeve gastrectomy was successfully completed. Our patient was discharged to the postanesthesia care unit for approximately four hours before discharge to the surgical floor with a pain score of 5 (11-point scale; 0 = no pain, 10 = worst possible pain). Her postoperative course was uneventful; no adverse events were recorded during surgery or during the remainder of her hospital stay. Our patient was discharged on the same opioid regimen used previously for control of her preexisting chronic pain. Conclusions Liposome bupivacaine use in this morbidly obese

  15. Resolution of Acanthosis Nigricans Following Curative Gastric Carcinoma Resection.

    PubMed

    Jagwani, A V; Reynu, R; Affirul, C A; Mustafa, M T; Kosai, N R

    2016-01-01

    We discuss a 48-year old, who presented with upper epigastrium pain associated with early satiety and significant weight loss. Physical examination revealed a thickening and darkening of skins around the skin folds, scalp, back and front of abdomen. A diagnosis of gastro-esophageal junction adenocarcinoma was confirmed by oesophagogastroduodenoscopy (OGDS) and biopsy. The biopsy of the skin lesion revealed a diagnosis of acanthosis nigricans, He underwent a total gastrectomy followed by adjuvant chemo-radiotherapy. Recovery is unremarkable. Interestingly, the skin lesions disappear following our therapy. We believe this may be attributed to the treatment of the malignancy. We highlight the interesting association, pathophysiology and therapy. PMID:27598021

  16. Subtotal Gastrectomy as “Last Resort” Consideration in the Management of Refractory Rumination Syndrome

    PubMed Central

    Cooper, Chad J.; Otoukesh, Salman; Mojtahedzadeh, Mona; Galvis, Juan M.; McCallum, Richard W.

    2014-01-01

    Rumination syndrome is a behavioral disorder resulting in effortless regurgitation of undigested food within minutes of meal intake that is subsequently either re-swallowed or ejected. It is commonly misdiagnosed, patients often undergo extensive testing and multiple therapies, many of which are directed at suspected gastroparesis. A 25-year-old Caucasian female initially presented to our care 1 year ago with a 4-year history of nausea and vomiting occurring in the immediate postprandial period, specifically within 15 minutes from oral intake. She had an extensive history of multiple diagnostic, therapeutic and surgical procedures over the previous 4 years which included cholecystectomy, botulin toxin injection into the pyloric sphincter, pyloroplasty, placement of a gastric stimulator and jejunal feeding tube with no sustained results. On a previous admission we determined the functional status of the stomach by obtaining full thickness gastric biopsies during a diagnostic laparoscopy. This revealed an adequate population number of cells of Cajal and myenteric neurons as well as normal stomach muscle. After 1 year of attempting “breathing relaxation techniques”, while being nutritionally maintained by nocturnal jejunostomy feedings, the patient presented again to our care with refractory nausea and vomiting and unable to work or function. Her weight was 90 lbs. She underwent a subtotal gastrectomy (80%) with Roux-en-Y reconstruction and continuation of jejunostomy feeding. The refractory nausea and vomiting significantly improved over the 4 weeks after discharge and breathing exercises were continued. On subsequent follow-up visits over a 6-month course, the refractory nausea and vomiting had resolved by more than 85% with and improvement in her BMI and quality of life.The recommended treatment of rumination syndrome is focused on breathing exercises and relaxation techniques to “distract” while eating. We believe our case is the first reported where a

  17. Toward a curated CellML model repository.

    PubMed

    Nickerson, David; Stevens, Carey; Halstead, Matt; Hunter, Peter; Nielsen, Poul

    2006-01-01

    With the development of standards for the description of experimental data and mathematical models of physiological processes has come the advent of publicly accessible repositories of such descriptions. To make these repositories acceptable to the community, the descriptions contained therein must be curated to provide an indication of how accurately the standard description represents the actual experimental data or mathematical model. We define here a curation method for CellML encoded models and propose a model repository workflow using such curation within the CellML model repository.

  18. The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon's Experience While Introducing the Robotic Technology in a Bariatric Surgery Department.

    PubMed

    Vilallonga, Ramon; Fort, José Manuel; Gonzalez, Oscar; Caubet, Enric; Boleko, Angeles; Neff, Karl John; Armengol, Manel

    2012-01-01

    Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases.

  19. Complications of Distal Biceps Tendon Repair

    PubMed Central

    Amin, Nirav H.; Volpi, Alex; Lynch, T. Sean; Patel, Ronak M.; Cerynik, Douglas L.; Schickendantz, Mark S.; Jones, Morgan H.

    2016-01-01

    Background: Anatomic reinsertion of the distal biceps is critical for restoring flexion and supination strength. Single- and double-incision surgical techniques have been reported, analyzing complications and outcomes measures. Which technique results in superior clinical outcomes and the lowest associated complications remains unclear. Hypothesis: We hypothesized that rerupture rates would be similar between the 2 techniques, while nerve complications would be higher for the single-incision technique and heterotopic ossification would be more frequent with the double-incision technique. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was conducted using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials databases to identify articles reporting distal biceps ruptures up to August 2013. We included English-language articles on adult patients with a minimum of 3 cases reporting single- and double-incision techniques. Frequencies of each complication as a percentage of total cases were calculated. Fisher exact tests were used to test the association between frequencies for each repair method, with P < .05 considered statistically significant. Odds ratios with 95% CIs were also computed. Results: A total of 87 articles met the inclusion criteria. Lateral antebrachial cutaneous nerve neurapraxia was the most common complication in the single-incision group, occurring in 77 of 785 cases (9.8%). Heterotopic ossification was the most common complication in the double-incision group, occurring in 36 of 498 cases (7.2%). Conclusion: The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. The frequencies of rerupture and nerve complications are both higher for single-incision repairs while the frequency of heterotopic ossification is higher for

  20. Enriching Earthdata by Improving Content Curation

    NASA Astrophysics Data System (ADS)

    Bagwell, R.; Wong, M. M.; Murphy, K. J.

    2014-12-01

    Since the launch of Earthdata in the later part of 2011, there has been an emphasis on improving the user experience and providing more enriched content to the user, ultimately with the focus to bring the "pixels to the people" or to ensure that a user clicks the fewest amount of times to get to the data, tools, or information which they seek. Earthdata was founded to be a single source of information for Earth Observing System Data and Information System (EOSDIS) components and services as a conglomeration between over 15 different websites. With an increased focus on access to Earth science data, the recognition is now on transforming Earthdata from a static website to one that is a dynamic, data-driven site full of enriched content.In the near future, Earthdata will have a number of components that will drive the access to the data, such as Earthdata Search, the Common Metadata Repository (CMR), and a redesign of the Earthdata website. The focus on content curation will be to leverage the use of these components to provide an enriched content environment and a better overall user experience, with an emphasis on Earthdata being "powered by EOSDIS" components and services.

  1. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis

    NASA Astrophysics Data System (ADS)

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song

    2008-09-01

    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  2. The Role of Small Heterodimer Partner (SHP) in NAFLD Improvement after Vertical Sleeve Gastrectomy in Mice

    PubMed Central

    Myronovych, Andriy; Salazar-Gonzales, Rosa-Maria; Ryan, Karen K.; Miles, Lili; Zhang, Wujuan; Jha, Pinky; Wang, Li; Setchell, Kenneth DR; Seeley, Randy J; Kohli, Rohit

    2014-01-01

    Objective Bile acids (BA) are elevated after vertical sleeve gastrectomy (VSG) and farnesoid-X-receptor (FXR) is critical to the success of murine VSG. BA down-regulate hepatic lipogenesis by activating the FXR-small heterodimer partner (SHP) pathway. We tested the role of SHP in fatty liver disease (NAFLD) improvement after VSG. Design and Methods Wild type (WT), SHP liver-transgenic (SHP-Tg) and SHP knockout (SHP-KO) high-fat diet (HFD) fed mice underwent either VSG or Sham surgery. Body weight, BA level & composition, steatosis and BA metabolism gene expression were evaluated. Results Obese WT mice post-VSG lost weight, reduced steatosis, decreased plasma alanine aminotransferase (ALT), had more BA absorptive ileal area, and elevated serum BA. Obese SHP-Tg mice post-VSG also lost weight and had decreased steatosis. SHP-KO mice were however resistant to steatosis despite weight gain on a HFD. Further SHP-KO mice that underwent VSG lost weight but developed hepatic inflammation and had increased ALT. Conclusions VSG produces weight loss independent of SHP status. SHP ablation creates a pro-inflammatory phenotype which is exacerbated after VSG despite weight loss. These inflammatory alterations are possibly related to factors extrinsic to a direct manifestation of NASH. PMID:25376397

  3. Increased Expression of CSF-1 Associates With Poor Prognosis of Patients With Gastric Cancer Undergoing Gastrectomy.

    PubMed

    Liu, Hao; Zhang, Heng; Shen, Zhenbin; Lin, Chao; Wang, Xuefei; Qin, Jing; Qin, Xinyu; Xu, Jiejie; Sun, Yihong

    2016-03-01

    Clinical significance of diametrically polarized tumor-associated macrophages in gastric cancer has been elucidated in our previous study, whereas the role of cytokines that orchestrate tumor-associated macrophages polarization in gastric cancer remains elusive. The study aims to evaluate the prognostic value of colony-stimulating factor-1 expression in patients with gastric cancer. We examined the colony-stimulating factor-1 expression in tumor tissues by immunohistochemical staining in retrospectively enrolled 365 patients with gastric cancer undergoing gastrectomy at Zhongshan Hospital during 2008. Kaplan-Meier analysis and Cox regression models were used to evaluate the prognostic value of colony-stimulating factor-1 expression and its association with clinicopathological factors. A predictive nomogram by integrating colony-stimulating factor-1 expression with the TNM staging system was generated for overall survival evaluation of the patients. High colony-stimulating factor-1 expression predicted an unfavorable outcome in gastric cancer. The colony-stimulating factor-1 expression in tumor tissue could give a further discrimination for the prognosis of gastric cancer patients. Cox multivariate analysis identified the colony-stimulating factor-1 expression as an independent prognostic factor. The generated nomogram performed well in predicting the 3- and 5-year overall survival of gastric cancer patients.T he colony-stimulating factor-1 is a potential independent adverse prognosticator for gastric cancer patients, which could be integrated with the tumor-associated macrophages staging system to improve the predictive accuracy for overall survival, especially in advanced tumors.

  4. Effect of vertical sleeve gastrectomy on food selection and satiation in rats

    PubMed Central

    Wilson-Perez, Hilary E.; McGrath, Sean; Grayson, Bernadette E.; Ryan, Karen K.; D'Alessio, David A.; Woods, Stephen C.; Sandoval, Darleen A.; Seeley, Randy J.

    2012-01-01

    Vertical sleeve gastrectomy (VSG) is a restrictive procedure that reduces food intake to produce weight loss. Here we assess volume and nutrient effects on the ingestive behavior of VSG and sham surgery animals. Rats given access to Ensure or pelleted chow were used to determine if liquid foods would adversely affect weight loss after surgery. Volume effects were studied by altering the caloric density of Ensure, and dietary preferences for fat and carbohydrate (sucrose) were assessed using a two-bottle test. c-Fos was used to measure neuronal activation in the nucleus of the solitary tract and area postrema in response to intragastric infusions of water, sucrose, or Intralipid. The degree of colocalization with catecholaminergic neurons was also assessed. VSG rats did not show the expected preference for a liquid diet over chow and lacked dietary preferences for fat seen in shams. Preferences for carbohydrate/sucrose solutions were unaffected by surgery. Meal size was reduced by VSG; however, VSG rats were able to alter their volume of intake to compensate for changes in caloric density, and intragastric infusions of water produced similar levels of neuronal activation among VSG, sham, and pair-fed rats. In comparison, nutrient-induced c-Fos activation was substantially increased by VSG. Colocalization between c-Fos and catecholaminergic-expressing neurons was similar among rats treated with water, sucrose, or Intralipid. VSG alters nutrient sensing in a manner that lowers the threshold for satiety and reduces fat preference to induce and maintain weight loss. PMID:22932782

  5. Gastric Wall Thickness in Sleeve Gastrectomy Patients: Thickness Variation of the Gastric Wall.

    PubMed

    van Rutte, Pim W J; Naagen, Bertus J; Spek, Marinus; Jakimowicz, Jack J; Nienhuijs, Simon W

    2015-11-01

    The sleeve gastrectomy has been accepted as a primary bariatric procedure. One of the most feared complications is staple line leakage. It is important to use the right staple sizes to minimize the risk of leak. Knowledge of gastric thickness is important. The goal of this study was to measure the thickness of the gastric wall after elimination of the gastric folds in the mucosa. An electronic thickness gauge was developed that measured the anterior and posterior wall of the fresh stomach specimen together at 5 points at a pressure based on the finger pressure necessary to flatten the gastric folds. Thirty-three fresh specimens were measured. The mean compression pressure was 714 grams, and no difference was found between the 5 measure points. There was a significant difference in stomach wall thickness. The gastric antrum was more than 1 mm thicker than the fundus. No difference was found between BMI groups <40 Kg/m2, 40-50 Kg/m2, or >50 Kg/m2. No bleeding occurred, leakage occurred in 1 case. There is a significant difference in thickness of the stomach wall between the gastric fundus and the antrum. A pressure 2.5 times lower than applied in prior studies was necessary to achieve full tissue compression. Choosing thinner staple sizes for the gastric fundus might be the optimal technique for compression. However, there are several additional factors that influence the risk of staple line leaks. PMID:26680415

  6. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment

    PubMed Central

    Valle, Mario; Federici, Orietta; Levi Sandri, Giovanni Battista; Camperchioli, Ida; Lapenta, Rocco; Assisi, Daniela; Garofalo, Alfredo

    2016-01-01

    Background Esophagojejunal anastomosis leakage after total gastrectomy (TG) for esophagogastric junction (EGJ) adenocarcinoma (ADC) constitutes one of the most serious and sometimes life-threatening complications. Management remains controversial and still challenging. Methods A total of 198 patients operated for type I and II EGJ ADC were reviewed. Diagnosis of leakage was based on a combination of clinical and radiological findings. It was classified including objective endoscopic and clinical parameters requiring different type of treatment. Results Anastomotic leakage was diagnosed in 14 patients (7%). Two cases recovered with conservative therapy. Six cases underwent endoscopy with clips placement in 2 and partially covered self-expandable metal stent placement in 4. Other two cases underwent reoperation with reconstruction of anastomosis and primary repair respectively. In the last four cases emergency surgery with total esophagectomy and diversion was required. Mortality occurred only in 3 of these patients and overall treatment was successful in 11 patients (78.5%). Conclusions No consensus has been reached on the best method of esophagojejunal anastomosis leakage management and the rate of failure remains significant. Different options of treatment are available but early detection and multidisciplinary approaches are the keys to obtain successful results irrespective of the employed strategy. PMID:27563440

  7. Lessons learned during Apollo lunar sample quarantine and sample curation

    NASA Astrophysics Data System (ADS)

    Allton, J. H.; Bagby, J. R.; Stabekis, P. D.

    During fast-paced Apollo, three responsibilities often competed: 1) landing a man on the Moon and returning him safely, 2) prevention of back contamination, and 3) sample curation. Coordination of U.S. agency back contamination requirements was done by the Interagency Committee on Back Contamination (ICBC). The most severe constraint to proper implementation of flight requirements was lack of time. Preservation, examination and distribution of samples was overseen by the Lunar Sample Analysis Planning Team (LSAPT) which did not feel the Lunar Receiving Laboratory (LRL) was suitable for sample curation and moved the samples to another facility at the conclusion of Apollo 17. The Apollo experience emphasizes the need for 1) early back contamination and sample curation planning, 2) adequate time to implement requirements and 3) high level management responsibility. Building mutual respect for quarantine and sample curation is highly desirable.

  8. The Practice of American History: A Canadian Curator's Perspective.

    ERIC Educational Resources Information Center

    Hood, Adrienne D.

    1994-01-01

    Presents reactions to a survey of attitudes toward history, historiography, and instruction among contemporary historians. Contends that both museums and universities are undergoing fundamental transformations and that more communication between historians and museum curators is desirable. (CFR)

  9. EURO-CARES Sample Curation Facility: Preliminary Design

    NASA Astrophysics Data System (ADS)

    Hutzler, A.; Ferrière, L.; Bennett, A.; Brucato, J. R.; Debaille, V.; Folco, L.; Longobardo, A.; Meneghin, A.; Palomba, E.; Pottage, T.; Smith, C. L.; Euro-Cares Consortium

    2016-08-01

    EURO-CARES is a multinational project, funded under the European Commission's Horizon2020 research programme to create a roadmap of a European Extra-terrestrial Sample Curation Facility. We present here a preliminary design of the facility.

  10. 58. CURATOR'S OFFICE, SECOND FLOOR, WEST WING, SHOWING A CASTINPLACE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    58. CURATOR'S OFFICE, SECOND FLOOR, WEST WING, SHOWING A CAST-IN-PLACE CONCRETE TABLE. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

  11. Aqueous outflow: Segmental and distal flow

    PubMed Central

    Swaminathan, Swarup S.; Oh, Dong-Jin; Kang, Min Hyung; Rhee, Douglas J.

    2014-01-01

    A prominent risk factor of primary open-angle glaucoma is ocular hypertension, a pathologic state caused by impaired outflow of aqueous humor through the trabecular meshwork within the iridocorneal angle. The juxtacanalicular region of the trabecular meshwork and the inner wall of Schlemm canal have been identified as the main contributors to aqueous outflow resistance, and both extracellular matrix within the trabecular meshwork and trabecular meshwork cell shape have been shown to affect outflow. Overexpression of multiple ECM proteins in perfused cadaveric human eyes has led to increased outflow resistance and elevated IOP. Pharmacologic agents targeting trabecular meshwork cytoskeletal arrangements have been developed after multiple studies demonstrated the importance of cell shape on outflow. Several groups have shown that aqueous outflow occurs only at certain segments of the trabecular meshwork circumferentially, a concept known as segmental flow. This is based on the theory that aqueous outflow is dependent on the presence of discrete pores within the Schlemm canal. Segmental flow has been described in the eyes of multiple species, including primate, bovine, mouse, and human samples. While the trabecular meshwork appears to be the major source of resistance, trabecular meshwork bypass procedures have been unable to achieve the degree of IOP reduction observed with trabeculectomy, reflecting the potential impact of distal flow, or flow through Schlemm canal and collector channels, on outflow. Multiple studies have demonstrated that outflow occurs preferentially near collector channels, suggesting that these distal structures may be more important to aqueous outflow than previously believed. PMID:25088623

  12. Maxillary molar distalization with first class appliance

    PubMed Central

    Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

    2014-01-01

    Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation. PMID:24577171

  13. Distal metatarsal coalition: A rare case report

    PubMed Central

    Vun, Shen Hwa; Drampalos, Efstathios; Shareef, Sajan; Sinha, Satyajit; Bramley, Diane

    2015-01-01

    Introduction Metatarsal coalition is an extremely rare condition. We report the second documented case of 4th and 5th distal metatarsal coalition in the literature. Presentation of case An eight-year-old girl was referred to an orthopaedic clinic with a four-month history of forefoot pain and swelling on the plantar aspect of the right little toe. Radiograph and clinical examination confirmed distal metatarsal coalition between the 4th and 5th metatarsals. Following a period of conservative treatment, excision was eventually performed due to worsening symptoms. Patient re-attended two years later with a recurrence of the coalition confirmed by computed tomography (CT) scan. The case was discussed at a tertiary paediatric orthopaedic insititution. Decision was made to manage patient conservatively with insole and physiotherapy until skeletal maturity. A year later, patient’s symptoms did not worsen, and her foot displayed no evidence of change in the arch and shape. Discussion The timing of ossification of coalition varies from one anatomical site to another. Surgery when performed before ossification is complete runs the risk of recurrence. Conclusion Our case report illustrates the importance of restoring normal weight bearing dynamics and pain relief when managing metatarsal coalition, or synostosis in skeletally immature patients. We recommend persevering with conservative treatment, with operative treatment reserved only as a later option, and ideally, until skeletal maturity is achieved. PMID:25670408

  14. Distal vacuolar myopathy in nephropathic cystinosis.

    PubMed

    Charnas, L R; Luciano, C A; Dalakas, M; Gilliatt, R W; Bernardini, I; Ishak, K; Cwik, V A; Fraker, D; Brushart, T A; Gahl, W A

    1994-02-01

    Nephropathic cystinosis is a lysosomal storage disorder leading to renal failure by age 10 years. Prolonged patient survival following renal transplantation has allowed the development of previously unknown long-term complications. Muscle involvement has been reported in a single posttransplant cystinosis patient, but the range of clinical, electrophysiologic, and histologic features has not been fully described. Thirteen of 54 post-renal-transplant patients that we examined developed weakness and wasting in the small hand muscles, with or without facial weakness and dysphagia. Tendon reflexes were preserved and sensory examinations were normal. Electrophysiologic studies in 11 affected patients showed normal nerve conduction velocities and preserved sensory action potentials. The voluntary motor units in the affected distal muscles had reduced amplitude and brief duration, confirmed with quantitative electromyography in 4 patients. Biopsy of the severely affected abductor digiti minimi or extensor carpi radialis brevis muscles in 2 patients revealed marked fiber size variability, prominent acid phosphatase-positive vacuoles, and absence of fiber type grouping or inflammatory cells. Crystals of cystine were detected in perimysial cells but not within the muscle cell vacuoles. The muscle cystine content of clinically affected muscles was markedly elevated. We conclude that a distal vacuolar myopathy is a common late complication of untreated nephropathic cystinosis. Although the cause is unclear, the general lysosomal defect in this disease may also affect the lysosomes within muscle fibers.

  15. Supporting the curation of biological databases with reusable text mining.

    PubMed

    Miotto, Olivo; Tan, Tin Wee; Brusic, Vladimir

    2005-01-01

    Curators of biological databases transfer knowledge from scientific publications, a laborious and expensive manual process. Machine learning algorithms can reduce the workload of curators by filtering relevant biomedical literature, though their widespread adoption will depend on the availability of intuitive tools that can be configured for a variety of tasks. We propose a new method for supporting curators by means of document categorization, and describe the architecture of a curator-oriented tool implementing this method using techniques that require no computational linguistic or programming expertise. To demonstrate the feasibility of this approach, we prototyped an application of this method to support a real curation task: identifying PubMed abstracts that contain allergen cross-reactivity information. We tested the performance of two different classifier algorithms (CART and ANN), applied to both composite and single-word features, using several feature scoring functions. Both classifiers exceeded our performance targets, the ANN classifier yielding the best results. These results show that the method we propose can deliver the level of performance needed to assist database curation.

  16. Curating NASA's Future Extraterrestrial Sample Collections: How Do We Achieve Maximum Proficiency?

    NASA Technical Reports Server (NTRS)

    McCubbin, Francis; Evans, Cynthia; Zeigler, Ryan; Allton, Judith; Fries, Marc; Righter, Kevin; Zolensky, Michael

    2016-01-01

    The Astromaterials Acquisition and Curation Office (henceforth referred to herein as NASA Curation Office) at NASA Johnson Space Center (JSC) is responsible for curating all of NASA's extraterrestrial samples. Under the governing document, NASA Policy Directive (NPD) 7100.10E "Curation of Extraterrestrial Materials", JSC is charged with "The curation of all extraterrestrial material under NASA control, including future NASA missions." The Directive goes on to define Curation as including "... documentation, preservation, preparation, and distribution of samples for research, education, and public outreach." Here we describe some of the ongoing efforts to ensure that the future activities of the NASA Curation Office are working towards a state of maximum proficiency.

  17. A Curated Database of Rodent Uterotrophic Bioactivity

    PubMed Central

    Kleinstreuer, Nicole C.; Ceger, Patricia C.; Allen, David G.; Strickland, Judy; Chang, Xiaoqing; Hamm, Jonathan T.; Casey, Warren M.

    2015-01-01

    Background: Novel in vitro methods are being developed to identify chemicals that may interfere with estrogen receptor (ER) signaling, but the results are difficult to put into biological context because of reliance on reference chemicals established using results from other in vitro assays and because of the lack of high-quality in vivo reference data. The Organisation for Economic Co-operation and Development (OECD)-validated rodent uterotrophic bioassay is considered the “gold standard” for identifying potential ER agonists. Objectives: We performed a comprehensive literature review to identify and evaluate data from uterotrophic studies and to analyze study variability. Methods: We reviewed 670 articles with results from 2,615 uterotrophic bioassays using 235 unique chemicals. Study descriptors, such as species/strain, route of administration, dosing regimen, lowest effect level, and test outcome, were captured in a database of uterotrophic results. Studies were assessed for adherence to six criteria that were based on uterotrophic regulatory test guidelines. Studies meeting all six criteria (458 bioassays on 118 unique chemicals) were considered guideline-like (GL) and were subsequently analyzed. Results: The immature rat model was used for 76% of the GL studies. Active outcomes were more prevalent across rat models (74% active) than across mouse models (36% active). Of the 70 chemicals with at least two GL studies, 18 (26%) had discordant outcomes and were classified as both active and inactive. Many discordant results were attributable to differences in study design (e.g., injection vs. oral dosing). Conclusions: This uterotrophic database provides a valuable resource for understanding in vivo outcome variability and for evaluating the performance of in vitro assays that measure estrogenic activity. Citation: Kleinstreuer NC, Ceger PC, Allen DG, Strickland J, Chang X, Hamm JT, Casey WM. 2016. A curated database of rodent uterotrophic bioactivity. Environ

  18. Distal Communication by Chimpanzees (Pan troglodytes): Evidence for Common Ground?

    PubMed

    Leavens, David A; Reamer, Lisa A; Mareno, Mary Catherine; Russell, Jamie L; Wilson, Daniel; Schapiro, Steven J; Hopkins, William D

    2015-01-01

    van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, "Do chimpanzees display distal communication?" Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally.

  19. PHILOS humerus plate for a distal tibial fracture.

    PubMed

    Twaij, Haider; Damany, Dev

    2013-01-04

    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required plate was unavailable. A PHILOS humeral plate seemed to fit the contours of the distal tibia. The broad end of the PHILOS, when placed distally, gave options to place locking screws in the medial malleolar fragment. The fracture was stable after fixation. The patient made a full post-operative recovery and follow-up at 4 months was satisfactory. Despite adequate planning, there will be instances where one has to improvise. An understanding of the principles of fracture management can aid in finding solutions. PHILOS humeral plate may be used to stabilize a distal tibial fracture if an appropriate distal tibial locking plate is not available.

  20. Ultrasound-Assisted Distal Radius Fracture Reduction

    PubMed Central

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  1. Ultrasound-Assisted Distal Radius Fracture Reduction.

    PubMed

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter; Atkinson, Paul

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  2. Distal Xq duplication and functional Xq disomy

    PubMed Central

    Sanlaville, Damien; Schluth-Bolard, Caroline; Turleau, Catherine

    2009-01-01

    Distal Xq duplications refer to chromosomal disorders resulting from involvement of the long arm of the X chromosome (Xq). Clinical manifestations widely vary depending on the gender of the patient and on the gene content of the duplicated segment. Prevalence of Xq duplications remains unknown. About 40 cases of Xq28 functional disomy due to cytogenetically visible rearrangements, and about 50 cases of cryptic duplications encompassing the MECP2 gene have been reported. The most frequently reported distal duplications involve the Xq28 segment and yield a recognisable phenotype including distinctive facial features (premature closure of the fontanels or ridged metopic suture, broad face with full cheeks, epicanthal folds, large ears, small and open mouth, ear anomalies, pointed nose, abnormal palate and facial hypotonia), major axial hypotonia, severe developmental delay, severe feeding difficulties, abnormal genitalia and proneness to infections. Xq duplications may be caused either by an intrachromosomal duplication or an unbalanced X/Y or X/autosome translocation. In XY males, structural X disomy always results in functional disomy. In females, failure of X chromosome dosage compensation could result from a variety of mechanisms, including an unfavourable pattern of inactivation, a breakpoint separating an X segment from the X-inactivation centre in cis, or a small ring chromosome. The MECP2 gene in Xq28 is the most important dosage-sensitive gene responsible for the abnormal phenotype in duplications of distal Xq. Diagnosis is based on clinical features and is confirmed by CGH array techniques. Differential diagnoses include Prader-Willi syndrome and Alpha thalassaemia-mental retardation, X linked (ATR-X). The recurrence risk is significant if a structural rearrangement is present in one of the parent, the most frequent situation being that of an intrachromosomal duplication inherited from the mother. Prenatal diagnosis is performed by cytogenetic testing

  3. Glucose Homeostasis and Weight Loss in Morbidly Obese Patients Undergoing Banded Sleeve Gastrectomy: A Prospective Clinical Study

    PubMed Central

    Miguel, Gustavo Peixoto Soares; Azevedo, Joao Luiz Moreira Coutinho; Neto, Carlos Gicovate; Moreira, Cora Lavigne Castelo Branco; Viana, Elaine Cristina; Carvalho, Perseu Seixas

    2009-01-01

    OBJECTIVE To assess glucose homeostasis and weight loss in morbidly obese patients undergoing Silastic® ring sleeve gas-trectomy. METHODS This was a prospective clinical study. Thirty-three female patients with a mean body mass index (BMI) of 42.33 ± 1.50 kg/m2 (range: 40–45 kg/m2), a mean age of 36.7 ± 9.4 years and a mean waist circumference of 118.7 ± 5.98 cm were included in this study. Type 2 diabetes mellitus was observed in 11 patients (33.3%), and glucose intolerance was observed in 4 patients (12.1%). Mean plasma fasting glucose levels were 109.77 ± 44.19 mg/dl (75–320) in the preoperative period. All Silastic® ring sleeve gastrectomy procedures were performed by the same surgical team using the same anesthetic technique. The patients were monitored for at least 12 months after surgery. RESULTS The mean weight of the patients decreased from 107.69 ± 6.57 kg to 70.52 ± 9.36 kg (p < 0.001), the mean BMI decreased to 27.4 ± 2.42 kg/m2 (p < 0.001), and the mean waist circumference decreased to 89.87 cm ± 6.66 (p < 0.001) in the postoperative period. Excess BMI loss was 86.5 ± 14.2%. Fasting glucose levels were reduced to 80.94 ± 6.3 mg/dl (p < 0.001). Remission of diabetes and glucose intolerance was observed in all patients. CONCLUSION Silastic® ring sleeve gastrectomy was effective in promoting weight loss, waist circumference reduction and control of glucose homeostasis in morbidly obese patients. PMID:19936183

  4. Clinical significance of No. 10 and 11 lymph nodes posterior to the splenic vessel in D2 radical total gastrectomy

    PubMed Central

    Wang, Wei; Xiong, Wenjun; Liu, Zhiwei; Luo, Lijie; Zheng, Yansheng; Tan, Ping; Diao, Dechang; Zou, Liaonan; Wan, Jin

    2016-01-01

    Abstract D2 lymphadenectomy is widely performed for advanced proximal gastric cancer, but complete dissection of No. 10 and 11 lymph nodes (LNs) is technically challenging, especially for those posterior to the splenic vessel. This study aimed to investigate the clinical significance of removing No. 10 and 11 LNs posterior to the splenic vessel in radical total gastrectomy. Between January 2013 and February 2015, 53 patients who underwent spleen-preserving D2 radical total gastrectomy were enrolled. While dissecting No. 10 and 11 LNs, we divided them into 2 parts, namely LNs anterosuperior and posterior to the splenic vessel, and the pathological data were reviewed. Sixteen patients underwent laparoscopy and 37 underwent laparotomy. No mortality was recorded. According to the pathological results, the TNM stages of the tumor were IIA in 11 patients (20.8%), IIB in 5 (9.4%), IIIA in 7 (13.2%), IIIB in 10 (18.9%), and IIIC in 20 (18.9%). The mean number of LNs retrieved was 30.3 ± 12.3. The sum of No. 10 and 11 LNs posterior to the splenic vessel was 59 and the mean number was 1.11 ± 1.47. One LN with metastasis was found in the special 59 regional LNs, and the metastasis rate was 1.9% (1/53). Concerning the low metastasis rate (1.9%) and difficult complete dissection of No. 10 and 11 LNs posterior to the splenic vessel, our initial analysis suggests that the rate of No. 10 and 11 LNs posterior to the splenic vessel metastasis was 1.9%, but further studies are needed to reveal its clinical significance in D2 radical total gastrectomy for advanced proximal gastric cancer. PMID:27512888

  5. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    PubMed Central

    Sahoo, Manash Ranjan; Gowda, Manoj S; Kumar, Anil T

    2014-01-01

    OBJECTIVE: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS) in patients undergoing laparoscopic assisted total gastrectomy. MATERIALS AND METHODS: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22) patients received enhanced recovery programme (ERAS) management and rest twenty-five (n = 25) conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. RESULTS: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h) when compared to conventional group (140 ± 28 h). ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h). There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43) g/L vs. (73.07 ± 19.32) g/L, d3 (126.10 ± 18.62) g/L vs. (160.72 ± 26.18) g/L)]. CONCLUSION: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits. PMID:25013329

  6. Improved radiographic visualization of calculus in distal ureter.

    PubMed

    Amar, A D

    1979-10-01

    Roentgenographic visualization of a calculus in the distal ureter is often made difficult by gas or bowel contents in the region of the pelvis. Filling the bladder with sterile water raises the bladder dome and displaces the bowel upward. Any calculus in the lower 4 to 5 cm. of the distal ureter is then clearly demonstrated on roentgenograms taken against the water-filled bladder instead of against the bowel filled with gas and feces. This maneuver also aids in differentiation of a calculus in the distal ureter from a phlebolith in the bladder wall, and has improved visualization of distal ureteral calculus in 50 patients during the last six years. PMID:494477

  7. Distal myopathy with rimmed vacuoles and cerebellar atrophy.

    PubMed

    Merkli, Hajnalka; Pál, Endre; Gáti, István; Czopf, József

    2006-01-01

    Distal myopathies constitute a clinically and pathologically heterogeneous group of genetically determined neuromuscular disorders, where the distal muscles of the upper or lower limbs are affected. The disease of a 41-year-old male patient started with gait disturbances, when he was 25. The progression was slow, but after 16 years he became seriously disabled. Neurological examination showed moderate to severe weakness in distal muscles of all extremities, marked cerebellar sign and steppage gait. Muscle biopsy resulted in myopathic changes with rimmed vacuoles. Brain MRI scan showed cerebellar atrophy. This case demonstrates a rare association of distal myopathy and cerebellar atrophy.

  8. [A case of S-1/CDDP chemotherapy for inoperable advanced gastric cancer which led to gastrectomy with histological complete response].

    PubMed

    Kobayashi, Kenji; Tanizaki, Keiko; Aoki, Taro; Takachi, Kou; Nishioka, Kiyonori; Matsumoto, Takashi; Komori, Takamichi; Chono, Teruhiro; Kato, Aya; Hyuga, Satoshi; Watanabe, Risa; Uemura, Yoshio

    2011-11-01

    As the treatment for inoperable advanced gastric cancer, S-1/CDDP combination therapy (SP chemotherapy) has become a standard treatment. In our hospital, a second course of chemotherapy was performed on an outpatient basis in order to improve a traditional QOL. In this case, it showed remarkable effects in 15 months after starting chemotherapy. Then gastrectomy was performed. Histological findings of the resected specimens confirmed pCR in all tumors. We report on progress of this case and explain about the ingenuity of SP chemotherapy.

  9. Differences in short-term food preferences following vertical sleeve gastrectomy and Roux-en-Y gastric bypass surgery.

    PubMed

    Primeaux, Stefany D; Tzeng, Tony H; Allerton, Timothy D; Chiang, Monica C; Cosentino, Gina; Dubin, Robert L; Varughese, Amy; Moore, Rachel; Geiselman, Paula J; Greenway, Frank L; Uwaifo, Gabriel I

    2015-01-01

    Bariatric surgery is effective in reducing body weight and obesity-related comorbidities. This study examined differences in the short-term effect of Roux en Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on the hedonic rating of food. Predominantly black women with complicated obesity and a BMI>50 g/m(2) completed a validated food preference questionnaire before and 1-3 months following surgery. Analysis of preference scores indicated that the preference for fat decreased with both surgeries. VSG also decreased the preference for sugar. Further studies are needed to evaluate long term effects of surgery on food preferences and to elucidate physiological mechanisms.

  10. Implant arthroplasty for the distal radioulnar joint.

    PubMed

    Scheker, Luis R

    2008-11-01

    The distal radioulnar joint (DRUJ) is a weight-bearing joint; the ulnar head is frequently excised either totally or partially and in some cases is fused because of degenerative, rheumatoid, or posttraumatic arthritis and treated with a "salvage procedure." The result of these procedures is the inability of those patients to lift even minor weight. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength or lifting capacity. We present an alternative to the salvage procedures that allows full range of motions as well as the ability to grip and lift weights encountered in daily living, such as a gallon of milk. The Aptis total DRUJ replacement prosthesis (Aptis Medical, Louisville, KY), a bipolar self-stabilizing DRUJ endoprosthesis, restores the forearm function. The technique of implantation is presented here.

  11. [Distal radius fractures: conservative or surgical treatment?].

    PubMed

    Mark, G; Ryf, C

    1993-07-01

    The "classical" Colles fracture of the distal radius is the most common fracture in the adult. In order to reduce the still rather high rate of permanent disability, this fracture involving a functionally important joint requires accurate reduction. The AO-fracture classification introduced by Müller not only defines the severity of an injury, but also allows for decision-making as to the most adequate treatment. Besides the purely conservative management by closed reduction and plaster cast for the type-A fractures, we have a number of other treatment modalities for the more complex-B and C-type fractures, such as closed reduction and percutaneous K-wire application or the use of the small external fixator as well as open reduction and internal fixation by plates and screws for a few selected indications. PMID:8211844

  12. Effect of posture on 13C-urea breath test in partial gastrectomy patients

    PubMed Central

    Yin, Shu-Ming; Zhang, Fan; Shi, Dong-Mei; Xiang, Ping; Xiao, Li; Huang, Yi-Qin; Zhang, Gan-Sheng; Bao, Zhi-Jun

    2015-01-01

    AIM: To investigate whether posture affects the accuracy of 13C-urea breath test (13C-UBT) for Helicobacter pylori (H. pylori) detection in partial gastrectomy patients. METHODS: We studied 156 consecutive residual stomach patients, including 76 with H. pylori infection (infection group) and 80 without H. pylori infection (control group). H. pylori infection was confirmed if both the rapid urease test and histology were positive during gastroscopy. The two groups were divided into four subgroups according to patients’ posture during the 13C-UBT: subgroup A, sitting position; subgroup B, supine position; subgroup C, right lateral recumbent position; and subgroup D, left lateral recumbent position. Each subject underwent the following modified 13C-UBT: 75 mg of 13C-urea (powder) in 100 mL of citric acid solution was administered, and a mouth wash was performed immediately; breath samples were then collected at baseline and at 5-min intervals up to 30 min while the position was maintained. Seven breath samples were collected for each subject. The cutoff value was 2.0‰. RESULTS: The mean delta over baseline (DOB) values in the subgroups of the infection group were similar at 5 min (P > 0.05) and significantly higher than those in the corresponding control subgroups at all time points (P < 0.01). In the infection group, the mean DOB values in subgroup A were higher than those in other subgroups within 10 min and peaked at the 10-min point (12.4‰ ± 2.4‰). The values in subgroups B and C both reached their peaks at 15 min (B, 13.9‰ ± 1.5‰; C, 12.2‰ ± 1.7‰) and then decreased gradually until the 30-min point. In subgroup D, the value peaked at 20 min (14.7‰ ± 1.7‰). Significant differences were found between the values in subgroups D and B at both 25 min (t = 2.093, P = 0.043) and 30 min (t = 2.141, P = 0.039). At 30 min, the value in subgroup D was also significantly different from those in subgroups A and C (D vs C: t = 6.325, P = 0.000; D vs A: t

  13. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia.

    PubMed

    Stamou, Konstantinos M; Menenakos, Evangelos; Gomatos, Ilias P; Panousopoulos, Sotirios-George D; Smparounis, Spyridon; Leandros, Emmanuel; Zografos, George

    2011-10-01

    Splenic arterial demarcation has been observed during laparoscopic sleeve gastrectomy (LSG). The present study aims to detect its actual incidence during LSG and clarify its clinical significance. This is a prospective observational study of 287 consecutive patients that underwent LSG by the same surgical team over 3 years. In all patients, the gastric fundus was mobilized using a standard technique. Before withdrawal of the pneumoperitoneum, the spleen was exposed and carefully inspected for evidence of arterial demarcation. Patients with a clear demarcation were followed with Doppler ultrasound. Computed tomography scan with oral contrast was performed to rule out septic complications. Median preoperative body mass index was 46 kg/m(2) (range 35.1-78). Median operative time was 58 min (range 42-185), median hospital stay was 3 days (range 3-45), and overall morbidity rate was 8.6%. Intraoperative demarcation of the upper splenic pole was evident in 12 patients (4.1%). Eleven patients had uneventful postoperative course. One patient raised temperature of 38.5°C at the 7th postoperative day and was readmitted for further treatment. Once afebrile, the patient was discharged on the 10th postoperative day and continued on prophylactic low molecular weight heparin (tinzaparin, 7,500 U sc.) for 20 days. Splenic discoloration following LSG is an uncommon complication with minimal clinical significance, which could be related to hematoma, venous congestion, or ischemia. The possibility of a late splenic abscess cannot be ruled out. No risk factors can be identified preoperatively.

  14. Vertical sleeve gastrectomy restores glucose homeostasis in apolipoprotein A-IV KO mice.

    PubMed

    Pressler, Josh W; Haller, April; Sorrell, Joyce; Wang, Fei; Seeley, Randy J; Tso, Patrick; Sandoval, Darleen A

    2015-02-01

    Bariatric surgery is the most successful strategy for treating obesity, yet the mechanisms for this success are not clearly understood. Clinical literature suggests that plasma levels of apolipoprotein A-IV (apoA-IV) rise with Roux-en-Y gastric bypass (RYGB). apoA-IV is secreted from the intestine postprandially and has demonstrated benefits for both glucose and lipid homeostasis. Because of the parallels in the metabolic improvements seen with surgery and the rise in apoA-IV levels, we hypothesized that apoA-IV was necessary for obtaining the metabolic benefits of bariatric surgery. To test this hypothesis, we performed vertical sleeve gastrectomy (VSG), a surgery with clinical efficacy very similar to that for RYGB, in whole-body apoA-IV knockout (KO) mice. We found that VSG reduced body mass and improved both glucose and lipid homeostasis similarly in wild-type mice compared with apoA-IV KO mice. In fact, VSG normalized the impairment in glucose tolerance and caused a significantly greater improvement in hepatic triglyceride storage in the apoA-IV KO mice. Last, independent of surgery, apoA-IV KO mice had a significantly reduced preference for a high-fat diet. Altogether, these data suggest that apoA-IV is not necessary for the metabolic improvements shown with VSG, but also suggest an interesting role for apoA-IV in regulating macronutrient preference and hepatic triglyceride levels. Future studies are necessary to determine whether this is the case for RYGB as well.

  15. Early postoperative changes of HDL subfraction profile and HDL-associated enzymes after laparoscopic sleeve gastrectomy.

    PubMed

    Doğan, Serdar; Aslan, Ibrahim; Eryılmaz, Ramazan; Ensari, Cemal Ozben; Bilecik, Tuna; Aslan, Mutay

    2013-12-01

    This study aimed to determine early postoperative changes of LDL/HDL subfraction profile and HDL-associated enzymes following laparoscopic sleeve gastrectomy (LSG). Thirteen obese patients (mean body mass index (BMI) 52.74 ± 10.97 kg/m(2)) underwent LSG and normal weight control patients (mean BMI 23.56 ± 1.92 kg/m(2)) underwent laparoscopic abdominal surgery. Fasting blood samples were collected prior to surgery, at day 1 after surgery, and after postoperation oral feeding. LDL and HDL subfraction analysis was done by continuous disk polyacrylamide gel electrophoresis. Plasma levels of cholesteryl ester transfer protein (CETP), lecithin-cholesterol acyltransferase (LCAT), and apolipoprotein A-1 (apoA-I) were determined by enzyme-linked immunosorbent assay. Measurement of CETP and LCAT activity was performed via fluorometric analysis. LDL subfraction profile showed no change in both LSG and control group patients. No significant difference was observed in HDL cholesterol, HDL-subfraction distribution, and apoA-I levels in the control group. LSG patients showed a significant increase in HDL-large and a significant decrease in HDL-small fractions at postoperation day 1 compared to preoperation. HDL cholesterol significantly decreased and apoA-I significantly increased in LSG patients after postoperation oral feeding compared to both preoperation and postoperation day 1. Changes in HDL subfraction profile at postoperation day 1 after LSG were accompanied by a significant decrease in CETP protein, LCAT protein, and LCAT activity as compared to preoperation levels. Early changes in HDL subfraction profile and HDL-associated enzymes following LSG suggest that the surgical procedure, irrespective of changes in body weight, affects reverse cholesterol transport. PMID:23760763

  16. Prediction of Prolonged Postoperative Ileus After Radical Gastrectomy for Gastric Cancer

    PubMed Central

    Huang, Dong-Dong; Zhuang, Cheng-Le; Wang, Su-Lin; Pang, Wen-Yang; Lou, Neng; Zhou, Chong-Jun; Chen, Fan-Feng; Shen, Xian; Yu, Zhen

    2015-01-01

    Abstract Currently, there is a paucity of study investigating postoperative ileus in gastric cancer surgery. This prospective study aims to identify the risk factors for prolonged postoperative ileus (PPOI) and to use these risk factors to generate a risk stratification scoring system for the occurrence of PPOI. Patients who underwent radical gastrectomy for gastric cancer were included in this study. A multivariate logistic analysis was applied to identify independent risk factors for PPOI and to generate the scoring system. A receiver operating characteristic curve was generated and the area under the curve was calculated to demonstrate the predictive power of the scoring system. Finally, 296 patients were included and analyzed, of whom 96 (32.4%) developed PPOI. The multivariate analysis showed that age ≥65 years, operative duration ≥4 hours, tumor–node–metastasis (TNM) stage = III, open/converted operative technique, and total postoperative opiates dose (TOD) ≥0.3 mg/kg were independent risk factors for PPOI. Based on these factors, a risk stratification scoring system was generated, classified by low-risk (score 0–2), moderate-risk (score 3–4), and high-risk (score 5–6) groups. The incidence of PPOI increased by 7.5-fold from low-risk to high-risk group. The area under the curve of the scoring system was 0.841 (95% CI, 0.793–0.890), indicating a good predictive capability for the occurrence of PPOI. We have identified independent risk factors for the occurrence of PPOI and used these factors to construct a risk stratification scoring system. PMID:26705206

  17. MGAT2 deficiency and vertical sleeve gastrectomy have independent metabolic effects in the mouse

    PubMed Central

    Mul, Joram D.; Begg, Denovan P.; Haller, April M.; Pressler, Josh W.; Sorrell, Joyce; Woods, Stephen C.; Farese, Robert V.; Seeley, Randy J.

    2014-01-01

    Vertical sleeve gastrectomy (VSG) is currently one of the most effective treatments for obesity. Despite recent developments, the underlying mechanisms that contribute to the metabolic improvements following bariatric surgery remain unresolved. VSG reduces postprandial intestinal triglyceride (TG) production, but whether the effects of VSG on intestinal metabolism are related to metabolic outcomes has yet to be established. The lipid synthesis enzyme acyl CoA:monoacylglycerol acyltransferase-2 (Mogat2; MGAT2) plays a crucial role in the assimilation of dietary fat in the intestine and in regulation of adiposity stores as well. Given the phenotypic similarities between VSG-operated and MGAT2-deficient animals, we reasoned that this enzyme could also have a key role in mediating the metabolic benefits of VSG. However, VSG reduced body weight and fat mass and improved glucose metabolism similarly in whole body MGAT2-deficient (Mogat2−/−) mice and wild-type littermates. Furthermore, along with an increase in energy expenditure, surgically naive Mogat2−/− mice had altered macronutrient preference, shifting preference away from fat and toward carbohydrates, and increased locomotor activity. Collectively, these data suggest that the beneficial effects of VSG on body weight and glucose metabolism are independent of MGAT2 activity and rather that they are separate from the effects of MGAT2 deficiency. Because MGAT2 inhibitors are proposed as a pharmacotherapeutic option for obesity, our data suggest that, in addition to increasing energy expenditure, shifting macronutrient preference away from fat could be another important mechanism by which these compounds could contribute to weight loss. PMID:25315695

  18. Curating and Preserving the Big Canopy Database System: an Active Curation Approach using SEAD

    NASA Astrophysics Data System (ADS)

    Myers, J.; Cushing, J. B.; Lynn, P.; Weiner, N.; Ovchinnikova, A.; Nadkarni, N.; McIntosh, A.

    2015-12-01

    Modern research is increasingly dependent upon highly heterogeneous data and on the associated cyberinfrastructure developed to organize, analyze, and visualize that data. However, due to the complexity and custom nature of such combined data-software systems, it can be very challenging to curate and preserve them for the long term at reasonable cost and in a way that retains their scientific value. In this presentation, we describe how this challenge was met in preserving the Big Canopy Database (CanopyDB) system using an agile approach and leveraging the Sustainable Environment - Actionable Data (SEAD) DataNet project's hosted data services. The CanopyDB system was developed over more than a decade at Evergreen State College to address the needs of forest canopy researchers. It is an early yet sophisticated exemplar of the type of system that has become common in biological research and science in general, including multiple relational databases for different experiments, a custom database generation tool used to create them, an image repository, and desktop and web tools to access, analyze, and visualize this data. SEAD provides secure project spaces with a semantic content abstraction (typed content with arbitrary RDF metadata statements and relationships to other content), combined with a standards-based curation and publication pipeline resulting in packaged research objects with Digital Object Identifiers. Using SEAD, our cross-project team was able to incrementally ingest CanopyDB components (images, datasets, software source code, documentation, executables, and virtualized services) and to iteratively define and extend the metadata and relationships needed to document them. We believe that both the process, and the richness of the resultant standards-based (OAI-ORE) preservation object, hold lessons for the development of best-practice solutions for preserving scientific data in association with the tools and services needed to derive value from it.

  19. A MOD(ern) perspective on literature curation.

    PubMed

    Hirschman, Jodi; Berardini, Tanya Z; Drabkin, Harold J; Howe, Doug

    2010-05-01

    Curation of biological data is a multi-faceted task whose goal is to create a structured, comprehensive, integrated, and accurate resource of current biological knowledge. These structured data facilitate the work of the scientific community by providing knowledge about genes or genomes and by generating validated connections between the data that yield new information and stimulate new research approaches. For the model organism databases (MODs), an important source of data is research publications. Every published paper containing experimental information about a particular model organism is a candidate for curation. All such papers are examined carefully by curators for relevant information. Here, four curators from different MODs describe the literature curation process and highlight approaches taken by the four MODs to address: (1) the decision process by which papers are selected, and (2) the identification and prioritization of the data contained in the paper. We will highlight some of the challenges that MOD biocurators face, and point to ways in which researchers and publishers can support the work of biocurators and the value of such support.

  20. Young Children's Sibling Relationship Quality: Distal and Proximal Correlates

    ERIC Educational Resources Information Center

    Kretschmer, Tina; Pike, Alison

    2009-01-01

    Background: Relationships within families are interdependent and related to distal environmental factors. Low socioeconomic status (SES) and high household chaos (distal factors) have been linked to less positive marital and parent-child relationships, but have not yet been examined with regard to young children's sibling relationships. The…

  1. Insulin Resistance, Microbiota, and Fat Distribution Changes by a New Model of Vertical Sleeve Gastrectomy in Obese Rats.

    PubMed

    Basso, Nicola; Soricelli, Emanuele; Castagneto-Gissey, Lidia; Casella, Giovanni; Albanese, Davide; Fava, Francesca; Donati, Claudio; Tuohy, Kieran; Angelini, Giulia; La Neve, Federica; Severino, Anna; Kamvissi-Lorenz, Virginia; Birkenfeld, Andrea L; Bornstein, Stefan; Manco, Melania; Mingrone, Geltrude

    2016-10-01

    Metabolic surgery improves insulin resistance and type 2 diabetes possibly because of weight loss. We performed a novel sleeve gastrectomy in rats that resects ∼80% of the glandular portion, leaving the forestomach almost intact (glandular gastrectomy [GG]) and compared subsequent metabolic remodeling with a sham operation. GG did not affect body weight, at least after 10 weeks; improved hepatic and peripheral insulin sensitivity likely through increased Akt, glycogen synthase kinase 3, and AMPK phosphorylation; and reduced ectopic fat deposition and hepatic glycogen overaccumulation. Body adipose tissue was redistributed, with reduction of intraabdominal fat. We found a reduction of circulating ghrelin levels, increased GLP-1 plasma concentration, and remodeling of gut microbiome diversity characterized by a lower relative abundance of Ruminococcus and a higher relative abundance of Lactobacillus and Collinsella These data suggest that at least in rat, the glandular stomach plays a central role in the improvement of insulin resistance, even if obesity persists. GG provides a new model of the metabolically healthy obese phenotype. PMID:27431457

  2. [Brain Abscess due to Infection with Dematiaceous Fungi Cladophialophora bantiana Associated with Hypogammaglobulinemia Following Gastrectomy: A Case Report].

    PubMed

    Shimogawa, Takafumi; Sayama, Tetsuro; Haga, Sei; Akiyama, Tomoaki; Makihara, Kosuke; Morioka, Takato

    2016-01-01

    Dematiaceous fungi have melanin-like pigment in the cell wall and usually cause a variety of dermal infections in humans. Infections of the central nervous system(cerebral phaeohyphomycosis)are rare but serious, since they commonly occur in immunocompromized patients. A 76-year-old man was admitted with mild motor aphasia and underwent total excision of a mass in the left frontal lobe. With the postoperative diagnosis of brain abscess due to infection with dematiaceous fungi (C. bantiana) associated with hypogammaglobulinemia following gastrectomy, intravenous antifungal drugs including amphotericin B and fluconazole were administered. Regrowth of the abscess with intraventricular rupture was noted at about the 88th day after the initial surgery, and the patient underwent neuroendoscopic aspiration of the pus and placement of a ventricular drain. Following intraventricular administration of miconazole through ventricular drainage or an Ommaya reservoir, neuroradiological findings improved, but general and neurological conditions worsened. Further treatment was discontinued and the patient died 9 months after onset. The poor outcome in this patient is attributed to 1)intractability of dematiaceous fungi, 2)development of ventriculitis and the need for intraventricular administration of antifungal drugs, and 3)untreatable hypogammaglobulinemia following gastrectomy. PMID:26771098

  3. Different effect of antiulcer agents on rat cysteamine-induced duodenal ulcer after sialoadenectomy, but not gastrectomy.

    PubMed

    Bedekovic, Vlado; Mise, Stjepan; Anic, Tomislav; Staresinic, Mario; Gjurasin, Miroslav; Kopljar, Mario; Kalogjera, Livije; Drvis, Petar; Boban Blagaic, Alenka; Batelja, Lovorka; Seiwerth, Sven; Sikiric, Predrag

    2003-09-01

    The focus was on salivary glands in cysteamine-induced duodenal ulcer and the different effects of antiulcer agents on cysteamine-induced duodenal ulcer in sialoadenectomized but not gastrectomized rats. We tested antiulcer agents on cysteamine-induced duodenal ulcer in rats (agents/kg i.p.) simultaneously with cysteamine 400 mg/kg s.c., rat killed 24 h thereafter subjected to no surgery (normal), to gastrectomy (24 h before) or sialoadenectomy, acute (24 h before) or chronic (21 days before). (i) Ulcerogenesis: cysteamine-induced duodenal ulcer had the same severity and incidence in normal, gastrectomized or acutely or chronically sialoadenectomized rats. (ii) Antiulcer effect under normal conditions or following gastrectomy: in normal or gastrectomized rats all agents tested, gastric pentadecapeptide BPC 157 [currently in clinical trials for inflammatory bowel disease (PL-10, PLD-116, PL-14736, Pliva) (10.0 microg or 10.0 ng), ranitidine (10 mg), atropine (10 mg), omeprazole (10 mg)] inhibited cysteamine-induced duodenal ulcers, acting through gastric acid-independent mechanisms. Following sialoadenectomy, acute or chronic: ranitidine, omeprazole and atropine were completely ineffective, while pentadecapeptide BPC 157 could protect. Thus, we found that contrary to stomach, salivary glands are implicated in cytoprotective agent activity (standard agents were ineffective after sialoadenectomy). Also, gastric pentadecapeptide BPC 157 was consistently associated with a cytoprotective effect, suggesting a beneficial activity distinctive from that of H2-receptor blockers, proton-pump inhibitors and anticholinergics; but probably replacing missing salivary glands factors. PMID:14512101

  4. Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer

    PubMed Central

    Ali, Bandar Idrees; Park, Cho Hyun

    2016-01-01

    Purpose We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer. Materials and Methods A total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed. Results Duodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively. Conclusions Non-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention. PMID:27104024

  5. Insulin Resistance, Microbiota, and Fat Distribution Changes by a New Model of Vertical Sleeve Gastrectomy in Obese Rats.

    PubMed

    Basso, Nicola; Soricelli, Emanuele; Castagneto-Gissey, Lidia; Casella, Giovanni; Albanese, Davide; Fava, Francesca; Donati, Claudio; Tuohy, Kieran; Angelini, Giulia; La Neve, Federica; Severino, Anna; Kamvissi-Lorenz, Virginia; Birkenfeld, Andrea L; Bornstein, Stefan; Manco, Melania; Mingrone, Geltrude

    2016-10-01

    Metabolic surgery improves insulin resistance and type 2 diabetes possibly because of weight loss. We performed a novel sleeve gastrectomy in rats that resects ∼80% of the glandular portion, leaving the forestomach almost intact (glandular gastrectomy [GG]) and compared subsequent metabolic remodeling with a sham operation. GG did not affect body weight, at least after 10 weeks; improved hepatic and peripheral insulin sensitivity likely through increased Akt, glycogen synthase kinase 3, and AMPK phosphorylation; and reduced ectopic fat deposition and hepatic glycogen overaccumulation. Body adipose tissue was redistributed, with reduction of intraabdominal fat. We found a reduction of circulating ghrelin levels, increased GLP-1 plasma concentration, and remodeling of gut microbiome diversity characterized by a lower relative abundance of Ruminococcus and a higher relative abundance of Lactobacillus and Collinsella These data suggest that at least in rat, the glandular stomach plays a central role in the improvement of insulin resistance, even if obesity persists. GG provides a new model of the metabolically healthy obese phenotype.

  6. Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture.

    PubMed

    Lee, Sang Ki; Kim, Kap Jung; Cha, Yong Han; Choy, Won Sik

    2016-09-01

    Treatments for acute distal radioulnar joint (DRUJ) instability with distal radius fracture vary from conservative to operative treatment, although it seems to be no consensus regarding which treatment is optimal. This prospective randomized study was designed to compare the clinical outcomes for operative and conservative treatment of acute DRUJ instability with distal radius fracture, according to the presence or absence and type of ulnar styloid process fracture and the degree of its displacement. Between July 2008 and February 2013, we enrolled 157 patients who exhibited an unstable DRUJ during intraoperative manual stress testing (via the ballottement test) after fixation of the distal radius. Patients were classified according to the type of the ulnar styloid process fracture, using preoperative wrist radiography, and each group was divided into subgroups, according to their treatment method. We then compared the clinical outcomes between the conservative and operative treatments, using their range of motion; Disabilities of the Arm, Shoulder, and Hand score; modified Mayo wrist score; and grip strength. At 3 months after surgery, among patients without ulnar styloid process fracture, the flexion-extension range was 79 ± 15° after supination sugar-tong splinting (group A-1), 91 ± 14° after DRUJ transfixation (group A-2), and 89 ± 10° after arthroscopic triangular fibrocartilage complex repair (group A-3); the operative treatments provided greater joint motion ranges than conservative treatment. The groups with ulnar styloid process fractures at the tip (group B) or base (group C) also exhibited better clinical outcomes after the operative treatments, compared with after the conservative treatment. However, at the final follow-up, groups A-1, A-2, and A-3 exhibited similar flexion-extension ranges (122 ± 25°, 119° ± 18°, and 120° ± 16°, respectively) and modified Mayo wrist scores (87 ± 7, 89 ± 8, and 85 ± 9). Thus, the conservative and

  7. Building an efficient curation workflow for the Arabidopsis literature corpus.

    PubMed

    Li, Donghui; Berardini, Tanya Z; Muller, Robert J; Huala, Eva

    2012-01-01

    TAIR (The Arabidopsis Information Resource) is the model organism database (MOD) for Arabidopsis thaliana, a model plant with a literature corpus of about 39 000 articles in PubMed, with over 4300 new articles added in 2011. We have developed a literature curation workflow incorporating both automated and manual elements to cope with this flood of new research articles. The current workflow can be divided into two phases: article selection and curation. Structured controlled vocabularies, such as the Gene Ontology and Plant Ontology are used to capture free text information in the literature as succinct ontology-based annotations suitable for the application of computational analysis methods. We also describe our curation platform and the use of text mining tools in our workflow. Database URL: www.arabidopsis.org PMID:23221298

  8. Osteoarticular Allograft Reconstruction for an Angiosarcoma of the Distal Radius.

    PubMed

    Mavrogenis, Andreas F; Galanopoulos, John; Vottis, Christos; Megaloikonomos, Panayiotis D; Palmerini, Emanuela; Kokkalis, Zinon T

    2016-01-01

    Angiosarcoma of bone is a rare high-grade malignant vascular tumor accounting for <1% of malignant bone tumors. Tumor location in the distal radius is very rare. Complete surgical resection with limb salvage surgery or amputation is essential for the outcome of the patient. However, the literature is vague regarding the best surgical approach for resection of the distal radius and the optimal reconstruction option after a bone tumor resection. Several reconstruction techniques have been described, varying from arthrodesis to arthroplasties. In this article, we present a report of a patient with angiosarcoma of the distal radius treated with complete resection and reconstruction with a distal radius osteoarticular allograft. We discuss the advantages and the limitations of this surgical technique for the distal radius. PMID:27649764

  9. Giant serpentine aneurysm of the distal anterior cerebral artery.

    PubMed

    Senbokuya, Nobuo; Kanemaru, Kazuya; Kinouchi, Hiroyuki; Horikoshi, Toru

    2012-11-01

    We report a case of a 38-year-old man with a giant serpentine aneurysm arising from the distal anterior cerebral artery. This aneurysm grew from a fusiform aneurysm to a huge aneurysm within 5 months before manifesting as a mass lesion. The aneurysm was largely filled with thrombus, and 4 distal branches arose from the aneurysm dome. Selective balloon test occlusion of the distal anterior cerebral artery using an intravascular technique was performed to confirm the tolerance of the brain tissue. The balloon test occlusion elicited adequate leptomeningeal collateral circulation and no neurologic symptoms; thus, the aneurysm was treated with trapping and resection. The patient had no ischemic complications after the surgery and returned to his job 1 month later. No ischemia developed in the 2 years after surgery. Selective balloon test occlusion of the distal cerebral artery using an intravascular technique can be a very useful tool in planning the therapeutic strategy for a complicated distal cerebral aneurysm.

  10. A 3-Dimensional Anatomic Study of the Distal Biceps Tendon

    PubMed Central

    Walton, Christine; Li, Zhi; Pennings, Amanda; Agur, Anne; Elmaraghy, Amr

    2015-01-01

    Background Complete rupture of the distal biceps tendon from its osseous attachment is most often treated with operative intervention. Knowledge of the overall tendon morphology as well as the orientation of the collagenous fibers throughout the musculotendinous junction are key to intraoperative decision making and surgical technique in both the acute and chronic setting. Unfortunately, there is little information available in the literature. Purpose To comprehensively describe the morphology of the distal biceps tendon. Study Design Descriptive laboratory study. Methods The distal biceps terminal musculature, musculotendinous junction, and tendon were digitized in 10 cadaveric specimens and data reconstructed using 3-dimensional modeling. Results The average length, width, and thickness of the external distal biceps tendon were found to be 63.0, 6.0, and 3.0 mm, respectively. A unique expansion of the tendon fibers within the distal muscle was characterized, creating a thick collagenous network along the central component between the long and short heads. Conclusion This study documents the morphologic parameters of the native distal biceps tendon. Reconstruction may be necessary, especially in chronic distal biceps tendon ruptures, if the remaining tendon morphology is significantly compromised compared with the native distal biceps tendon. Knowledge of normal anatomical distal biceps tendon parameters may also guide the selection of a substitute graft with similar morphological characteristics. Clinical Relevance A thorough description of distal biceps tendon morphology is important to guide intraoperative decision making between primary repair and reconstruction and to better select the most appropriate graft. The detailed description of the tendinous expansion into the muscle may provide insight into better graft-weaving and suture-grasping techniques to maximize proximal graft incorporation. PMID:26665092

  11. Linking Geobiology Fieldwork and Data Curation Through Workflow Documentation

    NASA Astrophysics Data System (ADS)

    Thomer, A.; Baker, K. S.; Jett, J. G.; Gordon, S.; Palmer, C. L.

    2014-12-01

    Describing the specific processes and artifacts that lead to the creation of data products provides a detailed picture of data provenance in the form of a high-level workflow. The resulting diagram identifies:1. "points of intervention" at which curation processes can be moved upstream, and 2. data products that may be important for sharing and preservation. The Site-Based Data Curation project, an Institute of Museum and Library Services-funded project hosted by the Center for Informatics Research in Science and Scholarship at the University of Illinois, previously inferred a geobiologist's planning, field and laboratory workflows through close study of the data products produced during a single field trip to Yellowstone National Park (Wickett et al, 2013). We have since built on this work by documenting post hoc curation processes, and integrating them with the existing workflow. By holistically considering both data collection and curation, we are able to identify concrete steps that scientists can take to begin curating data in the field. This field-to-repository workflow represents a first step toward a more comprehensive and nuanced model of the research data lifecycle. Using our initial three-phase workflow, we identify key data products to prioritize for curation, and the points at which data curation best practices integrate with research processes with minimal interruption. We then document the processes that make key data products sharable and ready for preservation. We append the resulting curatorial phases to the field data collection workflow: Data Staging, Data Standardizing and Data Packaging. These refinements demonstrate:1) the interdependence of research and curatorial phases;2) the links between specific research products, research phases and curatorial processes; 3) the interdependence of laboratory-specific standards and community-wide best practices. We propose a poster that shows the six-phase workflow described above. We plan to discuss

  12. Organic Contamination Baseline Study on NASA JSC Astromaterial Curation Gloveboxes

    NASA Technical Reports Server (NTRS)

    Calaway, Michael J.; Allton, J. H.; Allen, C. C.; Burkett, P. J.

    2013-01-01

    Future planned sample return missions to carbon-rich asteroids and Mars in the next two decades will require strict handling and curation protocols as well as new procedures for reducing organic contamination. After the Apollo program, astromaterial collections have mainly been concerned with inorganic contamination [1-4]. However, future isolation containment systems for astromaterials, possibly nitrogen enriched gloveboxes, must be able to reduce organic and inorganic cross-contamination. In 2012, a baseline study was orchestrated to establish the current state of organic cleanliness in gloveboxes used by NASA JSC astromaterials curation labs that could be used as a benchmark for future mission designs.

  13. Protein Interaction Data Curation - The International Molecular Exchange Consortium (IMEx)

    PubMed Central

    Orchard, Sandra; Kerrien, Samuel; Abbani, Sara; Aranda, Bruno; Bhate, Jignesh; Bidwell, Shelby; Bridge, Alan; Briganti, Leonardo; Brinkman, Fiona S. L.; Cesareni, Gianni; Chatr-aryamontri, Andrew; Chautard, Emilie; Chen, Carol; Dumousseau, Marine; Goll, Johannes; Hancock, Robert E. W.; Hannick, Linda I.; Jurisica, Igor; Khadake, Jyoti; Lynn, David J.; Mahadevan, Usha; Perfetto, Livia; Raghunath, Arathi; Ricard-Blum, Sylvie; Roechert, Bernd; Salwinski, Lukasz; Stümpflen, Volker; Tyers, Mike; Uetz, Peter; Xenarios, Ioannis; Hermjakob, Henning

    2013-01-01

    The IMEx consortium is an international collaboration between major public interaction data providers to share curation effort and make a non-redundant set of protein interactions available in a single search interface on a common website (www.imexconsortium.org). Common curation rules have been developed and a central registry is used to manage the selection of articles to enter into the dataset. The advantages of such a service to the user, quality control measures adopted and data distribution practices are discussed. PMID:22453911

  14. Effect of coffee on distal colon function.

    PubMed Central

    Brown, S R; Cann, P A; Read, N W

    1990-01-01

    Ninety nine healthy young volunteers (58 men, 34 women, aged 17-27 years) answered a questionnaire concerning their bowel habit with particular reference to the effects of beverages. Twenty nine per cent (63% women) claimed that coffee induced a desire to defecate. The rectosigmoid motor responses to black, unsweetened coffee were then investigated by multiport manometry in 14 healthy-subjects (12 men, two women, eight of whom claimed coffee caused a desire to defecate (responders). Results revealed an increase in motility index within four minutes after ingestion of both regular and decaffeinated coffee (p less than 0.05) in the eight responders, but not in the six non-responders. The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes. There was no increase in the motility index in any subject after a drink of hot water. These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people. PMID:2338272

  15. Distal Stressors and Depression among Homeless Men.

    PubMed

    Coohey, Carol; Easton, Scott D

    2016-05-01

    Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Guided by Ensel and Lin's life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childhood, contributed to men's depression above and beyond current (or proximal) stressors, such as substance abuse and health problems, and social resources. The sample consisted of 309 homeless men who had entered a federally funded emergency shelter. Using the Burns Depression Checklist, the authors found that one out of three men met the threshold for moderate to severe depression during the past week. The logistic regression showed that past exposure to parent problems was related to depression after accounting for current stressors and social resources (number of close adult relationships and whether their emotional support needs were met). Past victimization was not related to depression. To address men's depression, workers should concurrently provide services that meet men's basic needs (for example, housing) and address their relationship needs, including their need for emotional support. PMID:27263201

  16. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy.

    PubMed

    Dogan, Berna; Dogan, Ugur; Erol, Muhammet Kazim; Habibi, Mani; Bulbuller, Nurullah

    2016-01-01

    Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40) who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT), total macular volume (TMV), and retinal ganglion cell layer (RGCL) were measured by spectral-domain optical coherence tomography (SD-OCT). Subfoveal choroidal thickness (SFCT) was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT). Results. The mean CMT was 237.4 ± 24.5 μm, 239.3 ± 24.1 μm, and 240.4 ± 24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean TMV was 9.88 ± 0.52 mm(3), 9.96 ± 0.56 mm(3), and 9.99 ± 0.56 mm(3) preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean RGCL was 81.2 ± 6.5 μm, 82.7 ± 6.6 μm, and 82.9 ± 6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean SFCT was 309.8 ± 71.8 μm, 331.0 ± 81.4 μm, and 352.7 ± 81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p = 0.34), disc area (p = 0.64), vertical cup/disc ratio (p = 0.39), cup volume (p = 0.08), or retinal nerve fiber layer (p = 0.90). Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery. PMID:27413543

  17. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Dogan, Ugur; Habibi, Mani; Bulbuller, Nurullah

    2016-01-01

    Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40) who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT), total macular volume (TMV), and retinal ganglion cell layer (RGCL) were measured by spectral-domain optical coherence tomography (SD-OCT). Subfoveal choroidal thickness (SFCT) was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT). Results. The mean CMT was 237.4 ± 24.5 μm, 239.3 ± 24.1 μm, and 240.4 ± 24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean TMV was 9.88 ± 0.52 mm3, 9.96 ± 0.56 mm3, and 9.99 ± 0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean RGCL was 81.2 ± 6.5 μm, 82.7 ± 6.6 μm, and 82.9 ± 6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean SFCT was 309.8 ± 71.8 μm, 331.0 ± 81.4 μm, and 352.7 ± 81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p = 0.34), disc area (p = 0.64), vertical cup/disc ratio (p = 0.39), cup volume (p = 0.08), or retinal nerve fiber layer (p = 0.90). Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery. PMID:27413543

  18. Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter.

    PubMed

    Cozzens, J W; Chandler, J P

    1997-11-01

    The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation. Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55). It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.

  19. Distal anastomotic intimal hyperplasia: histopathologic character and biogenesis.

    PubMed

    Sottiurai, V S; Yao, J S; Batson, R C; Sue, S L; Jones, R; Nakamura, Y A

    1989-01-01

    Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimal hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in the late graft occlusion. Forth-two canine PTFE iliofemoral grafts (all with end-to-side distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimal hyperplasia occurred exclusively at the heel and the toe of the graft and the floor of the host artery. The distal anastomotic intimal hyperplasia was 80-130 cells thick. Light microscopy and transmission electron microscopy revealed a similar architecture of interlamination of cellular elements and extracellular matrix in the hyperplastic cells. Transmission electron microscopy further defined a gradual cell transformation and orientation from the graft to the lumen. The cells near the graft were characterized by a gradual reduction of rough endoplasmic reticulum with a concomitant acquisition of myofilaments, transforming ovoid mesenchymoid cells to slender myofibroblasts. The orientation of cells in distal anastomotic intimal hyperplasia was embodied by random cell distribution at the periphery to a well-organized interlamination of myofibroblasts and extracellular matrix near the lumen. Distal anastomotic intimal hyperplasia is a biologic entity with active cellular and subcellular events. Its biogenesis appears to be influenced by the hemodynamics of blood flow at the distal anastomosis. PMID:2713229

  20. The distal radioulnar joint. Anatomic and functional considerations.

    PubMed

    Kauer, J M

    1992-02-01

    The distal radioulnar joint is functionally coupled with the proximal radioulnar joint, thus forming a mechanism for the longitudinal rotation of the hand. Distal radioulnar mobility is derived from the geometry of the joint, joint surfaces, and radioulnar connections. There is a structural and functional separation between the distal radioulnar and carpal joints, giving the possibility of pronation and supination in every position of the hand to the forearm. As for the stability of the joints involved, the ulnar articular disk plays an essential role. Being part of both distal radioulnar and carpal joints, the disk has very specific morphologic features that not only are individualized to the function of both joints but also stabilize the joints in their independent movements. Developmental data give the strong impression of an architectural scheme, of which the distal radioulnar joint is only a part. Traumatic lesions at the distal radioulnar joint and disturbances in normal distal radioulnar alignment have to be viewed, therefore, in a wider context. PMID:1735231

  1. Distal Insertions of the Biceps Femoris

    PubMed Central

    Branch, Eric A.; Anz, Adam W.

    2015-01-01

    Background: Avulsion of the biceps femoris from the fibula and proximal tibia is encountered in clinical practice. While the anatomy of the primary posterolateral corner structures has been qualitatively and quantitatively described, a quantitative analysis regarding the insertions of the biceps femoris on the fibula and proximal tibia is lacking. Purpose: To quantitatively assess the insertions of the biceps femoris, fibular collateral ligament (FCL), and anterolateral ligament (ALL) on the fibula and proximal tibia as well as establish relationships among these structures and to pertinent surgical anatomy. Study Design: Descriptive laboratory study. Methods: Dissections were performed on 12 nonpaired, fresh-frozen cadaveric specimens identifying the biceps femoris, FCL, and ALL, and their insertions on the proximal tibia and fibula. The footprint areas, orientations, and distances from relevant osseous landmarks were measured using a 3-dimensional coordinate measurement device. Results: Dissection produced 6 easily identifiable and reproducible anatomic footprints. Tibial footprints included the insertion of the ALL and an insertion of the biceps femoris (TBF). Fibular footprints included the insertion of the FCL, a distal insertion of the biceps femoris (DBF), a medial footprint of the biceps femoris (MBF), and a proximal footprint of the biceps femoris (PBF). The mean area of these footprints (95% CI) was as follows: ALL, 53.0 mm2 (38.4-67.6); TBF, 93.9 mm2 (72.0-115.8); FCL, 86.8 mm2 (72.3-101.2); DBF, 119 mm2 (91.1-146.9); MBF, 46.8 mm2 (29.0-64.5); and PBF, 215 mm2 (192.4-237.5). The mean distance (95% CI) from the Gerdy tubercle to the center of the ALL footprint was 24.3 mm (21.6-27.0) and to the center of the TBF was 22.5 mm (21.0-24.0). The center of the DBF was 8.68 mm (7.0-10.3) from the anterior border of the fibula, the center of the FCL was 14.6 mm (12.5-16.7) from the anterior border of the fibula and 20.7 mm (19.0-22.4) from the tip of the fibular

  2. The learning curve in robotic distal pancreatectomy.

    PubMed

    Napoli, Niccolò; Kauffmann, Emanuele F; Perrone, Vittorio Grazio; Miccoli, Mario; Brozzetti, Stefania; Boggi, Ugo

    2015-09-01

    No data are available on the learning curve in robotic distal pancreatectomy (RADP). The learning curve in RADP was assessed in 55 consecutive patients using the cumulative sum method, based on operative time. Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of surgery. No operation was converted to laparoscopic or open surgery and no patient died. Post-operative complications occurred in 34 patients (61.8%), being of Clavien-Dindo grade I-II in 32 patients (58.1%), including pancreatic fistula in 29 patients (52.7%). No grade C pancreatic fistula occurred. Four patients received blood transfusions (7.2%), three were readmitted (5.4%) and one required repeat surgery (1.8%). Based on the reduction of operative times (421.1 ± 20.5 vs 248.9 ± 9.3 min; p < 0.0001), completion of the learning curve was achieved after ten operations. Operative time of the first 10 operations was associated with a positive slope (0.47 + 1.78* case number; R (2) 0.97; p < 0.0001*), while that of the following 45 procedures showed a negative slope (23.52 - 0.39* case number; R (2) 0.97; p < 0.0001*). After completion of the learning curve, more patients had a malignant histology (0 vs 35.6%; p = 0.002), accounting for both higher lymph node yields (11.1 ± 12.2 vs 20.9 ± 18.5) (p = 0.04) and lower rate of spleen preservation (90 vs 55.6%) (p = 0.04). RADP was safely feasible in selected patients and the learning curve was completed after ten operations. Improvement in clinical outcome was not demonstrated, probably because of the limited occurrence of outcome comparators.

  3. The learning curve in robotic distal pancreatectomy.

    PubMed

    Napoli, Niccolò; Kauffmann, Emanuele F; Perrone, Vittorio Grazio; Miccoli, Mario; Brozzetti, Stefania; Boggi, Ugo

    2015-09-01

    No data are available on the learning curve in robotic distal pancreatectomy (RADP). The learning curve in RADP was assessed in 55 consecutive patients using the cumulative sum method, based on operative time. Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of surgery. No operation was converted to laparoscopic or open surgery and no patient died. Post-operative complications occurred in 34 patients (61.8%), being of Clavien-Dindo grade I-II in 32 patients (58.1%), including pancreatic fistula in 29 patients (52.7%). No grade C pancreatic fistula occurred. Four patients received blood transfusions (7.2%), three were readmitted (5.4%) and one required repeat surgery (1.8%). Based on the reduction of operative times (421.1 ± 20.5 vs 248.9 ± 9.3 min; p < 0.0001), completion of the learning curve was achieved after ten operations. Operative time of the first 10 operations was associated with a positive slope (0.47 + 1.78* case number; R (2) 0.97; p < 0.0001*), while that of the following 45 procedures showed a negative slope (23.52 - 0.39* case number; R (2) 0.97; p < 0.0001*). After completion of the learning curve, more patients had a malignant histology (0 vs 35.6%; p = 0.002), accounting for both higher lymph node yields (11.1 ± 12.2 vs 20.9 ± 18.5) (p = 0.04) and lower rate of spleen preservation (90 vs 55.6%) (p = 0.04). RADP was safely feasible in selected patients and the learning curve was completed after ten operations. Improvement in clinical outcome was not demonstrated, probably because of the limited occurrence of outcome comparators. PMID:25990666

  4. Quantitative shape measurements of distal volcanic ash

    NASA Astrophysics Data System (ADS)

    Riley, Colleen M.; Rose, William I.; Bluth, Gregg J. S.

    2003-10-01

    Large-scale volcanic eruptions produce fine ash (<200 μm) which has a long atmospheric residence time (1 hour or more) and can be transported great distances from the volcanic source, thus, becoming a hazard to aircraft and public health. Ash particles have irregular shapes, so data on particle shape, size, and terminal velocities are needed to understand how the irregular-shaped particles affect transport processes and radiative transfer measurements. In this study, a methodology was developed to characterize particle shapes, sizes, and terminal velocities for three ash samples of different compositions. The shape and size of 2500 particles from (1) distal fallout (˜100 km) of the 14 October 1974 Fuego eruption (basaltic), (2) the secondary maxima (˜250 km) of the 18 August 1992 Spurr eruption (andesitic), and (3) the Miocene Ash Hollow member, Nebraska (rhyolitic) were measured using image analysis techniques. Samples were sorted into 10 to 19 terminal velocity groups (0.6-59.0 cm/s) using an air elutriation device. Grain-size distributions for the samples were measured using laser diffraction. Aspect ratio, feret diameter, and perimeter measurements were found to be the most useful descriptors of how particle shape affects terminal velocity. These measurement values show particle shape differs greatly from a sphere (commonly used in models and algorithms). The diameters of ash particles were 10-120% larger than ideal spheres at the same terminal velocity, indicating that irregular particle shape greatly increases drag. Gas-adsorption derived surface areas are 1 to 2 orders of magnitude higher than calculated surface areas based on measured dimensions and simple geometry, indicating that particle shapes are highly irregular. Correction factors for surface area were derived from the ash sample measurements so that surface areas calculated by assuming spherical particle shapes can be corrected to reflect more realistic values.

  5. Meteorites - The Significance of Collection and Curation and Future Developments

    NASA Astrophysics Data System (ADS)

    Smith, Caroline

    2015-03-01

    Meteorites are some of the most important and valuable rocks available for scientific study. Approximately 43,000 meteorites are known on Earth and are egeologicalf samples of extraterrestrial bodies - meteorites are known to originate from asteroids, the Moon, Mars and possibly comets. With expanding exploration of our Solar System, meteorites provide the eground truthf to compare data collected by robotic missions with results gained from a variety of more accurate and precise techniques using laboratories on Earth. This talk will give an introduction to the history of meteorite science and the importance of meteorite collections to the field of meteoritics, planetary and solar system science. Curation of extraterrestrial samples is a particularly pertinent issue, especially with regards to particularly rare samples such as those from Mars like the recent Tissint meteorite. Future sample return missions to asteroids and Mars also pose siginificant challenges around the curation of these precious materials. Issues surrounding the curation of samples and how curation and curatorial actions can influence scientific studies will also be discussed.

  6. Geospatial Data Curation at the University of Idaho

    ERIC Educational Resources Information Center

    Kenyon, Jeremy; Godfrey, Bruce; Eckwright, Gail Z.

    2012-01-01

    The management and curation of digital geospatial data has become a central concern for many academic libraries. Geospatial data is a complex type of data critical to many different disciplines, and its use has become more expansive in the past decade. The University of Idaho Library maintains a geospatial data repository called the Interactive…

  7. Kids as Curators: Virtual Art at the Seattle Museum.

    ERIC Educational Resources Information Center

    Scanlan, Laura Wolff

    2000-01-01

    Discusses the use of technology at the Seattle Art Museum (Washington). Includes a Web site that enables students in grades six through ten to act as curators and offers integrations of technology in the exhibition "Leonardo Lives: The Codex Leicester and Leonardo da Vinci's Legacy of Art and Science." (CMK)

  8. New Roles for New Times: Digital Curation for Preservation

    ERIC Educational Resources Information Center

    Walters, Tyler; Skinner, Katherine

    2011-01-01

    Digital curation refers to the actions people take to maintain and add value to digital information over its lifecycle, including the processes used when creating digital content. Digital preservation focuses on the "series of managed activities necessary to ensure continued access to digital materials for as long as necessary." In this report,…

  9. An alternative method of osteosynthesis for distal humeral shaft fractures.

    PubMed

    Levy, Jonathan C; Kalandiak, Steven P; Hutson, James J; Zych, Gregory

    2005-01-01

    Treatment of extra-articular distal humerus shaft fractures with plating techniques is often difficult, as traditional centrally located posterior plates often encroach on the olecranon fossa, limiting distal osseous fixation. The use of a modified Synthes Lateral Tibial Head Buttress Plate (Synthes, Paoli, PA) allows for a centrally placed posterior plating of the humeral shaft that angles anatomically along the lateral column to treat far distal humeral shaft fractures. Fifteen patients treated in this manner were followed to radiographic and clinical union. There were no cases of instrumentation failure or loss of reduction.

  10. Two-wave propagation in in vitro swine distal ulna

    NASA Astrophysics Data System (ADS)

    Mano, Isao; Horii, Kaoru; Matsukawa, Mami; Otani, Takahiko

    2015-07-01

    Ultrasonic transmitted waves were obtained in an in vitro swine distal ulna specimen, which mimics a human distal radius, that consists of interconnected cortical bone and cancellous bone. The transmitted waveforms appeared similar to the fast waves, slow waves, and overlapping fast and slow waves measured in the specimen after removing the surface cortical bone (only cancellous bone). In addition, the circumferential waves in the cortical bone and water did not affect the fast and slow waves. This suggests that the fast-and-slow-wave phenomenon can be observed in an in vivo human distal radius.

  11. Hyperammonaemia in a child with distal renal tubular acidosis.

    PubMed

    Seracini, D; Poggi, G M; Pela, I

    2005-11-01

    A 5-month-old girl with distal renal tubular acidosis (RTA) and hyperammonaemia that had lasted for 12 days, despite metabolic acidosis correction, is presented in this report. The patient showed failure to thrive, poor feeding, hypotonia and vomiting crisis in absence of inborn errors of metabolism. Probably, hyperammonaemia was the result of an imbalance between the increased ammonia synthesis, in response to metabolic acidosis, and the impaired ammonia excretion, typical of distal RTA. Our case confirms that hyperammonaemia may be observed in distal RTA, mimicking an inborn error of metabolism, and it underlines that hyperammonaemia may persist several days after metabolic acidosis correction. PMID:16133056

  12. An Asian Perspective on the Management of Distal Radius Fractures

    PubMed Central

    Sebastin, Sandeep J.; Chung, Kevin C.

    2012-01-01

    Synopsis There is little data with regards to the epidemiology, pathology, or management of distal radius fractures from centers in Asia. Asia includes five advanced economies, namely Hong Kong SAR, Japan, Korea, Singapore, and Taiwan and a number of emerging economies prominent among which are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, and compares the management of distal radius fractures in the advanced and emerging Asian economies and how they match up to the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in both the advanced and emerging economies of Asia. PMID:22554658

  13. An Asian perspective on the management of distal radius fractures.

    PubMed

    Sebastin, Sandeep J; Chung, Kevin C

    2012-05-01

    There is limited data regarding the epidemiology, pathology, and management of distal radius fractures from centers in Asia. The advanced economies in Asia include Hong Kong, Japan, Korea, Singapore, and Taiwan, whereas the prominent emerging economies are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, compares the management of distal radius fractures in the advanced and emerging Asian economies and how they compare with the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in Asia.

  14. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    PubMed Central

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P < 0.001), but not for total complications. However, sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P < 0.001) and disease-free survival (HR = 1.620, P < 0.001). Under the adjusted tumor-node-metastasis (TNM) stage, sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover

  15. Egas: a collaborative and interactive document curation platform

    PubMed Central

    Campos, David; Lourenço, Jóni; Matos, Sérgio; Oliveira, José Luís

    2014-01-01

    With the overwhelming amount of biomedical textual information being produced, several manual curation efforts have been set up to extract and store concepts and their relationships into structured resources. As manual annotation is a demanding and expensive task, computerized solutions were developed to perform such tasks automatically. However, high-end information extraction techniques are still not widely used by biomedical research communities, mainly because of the lack of standards and limitations in usability. Interactive annotation tools intend to fill this gap, taking advantage of automatic techniques and existing knowledge bases to assist expert curators in their daily tasks. This article presents Egas, a web-based platform for biomedical text mining and assisted curation with highly usable interfaces for manual and automatic in-line annotation of concepts and relations. A comprehensive set of de facto standard knowledge bases are integrated and indexed to provide straightforward concept normalization features. Real-time collaboration and conversation functionalities allow discussing details of the annotation task as well as providing instant feedback of curator’s interactions. Egas also provides interfaces for on-demand management of the annotation task settings and guidelines, and supports standard formats and literature services to import and export documents. By taking advantage of Egas, we participated in the BioCreative IV interactive annotation task, targeting the assisted identification of protein–protein interactions described in PubMed abstracts related to neuropathological disorders. When evaluated by expert curators, it obtained positive scores in terms of usability, reliability and performance. These results, together with the provided innovative features, place Egas as a state-of-the-art solution for fast and accurate curation of information, facilitating the task of creating and updating knowledge bases and annotated resources

  16. Curative Control of the Peachtree Borer Using Entomopathogenic Nematodes

    PubMed Central

    Shapiro-Ilan, David I.; Cottrell, Ted E.; Mizell, Russell F.; Horton, Dan L.

    2016-01-01

    The peachtree borer, Synanthedon exitiosa (Say 1823), is a major pest of stone fruit trees in North America. Current management relies upon preventative control using broad-spectrum chemical insecticides, primarily chlorpyrifos, applied in the late summer or early fall. However, due to missed applications, poor application timing, or other factors, high levels of S. exitiosa infestation may still occur and persist through the following spring. Curative treatments applied in the spring to established infestations would limit damage to the tree and prevent the next generation of S. exitiosa from emerging within the orchard. However, such curative measures for control of S. exitiosa do not exist. Our objective was to measure the efficacy of the entomopathogenic nematode, Steinernema carpocapsae, as a curative control for existing infestations of S. exitiosa. In peach orchards, spring applications of S. carpocapsae (obtained from a commercial source) were made to infested trees and compared with chlorpyrifos and a water-only control in 2014 and 2015. Additionally, types of spray equipment were compared: nematodes were applied via boom sprayer, handgun, or trunk sprayer. To control for effects of application method or nematode source, in vivo laboratory-grown S. carpocapsae, applied using a watering can, was also included. Treatment effects were assessed 39 d (2014) or 19 d (2015) later by measuring percentage of trees still infested, and also number of surviving S. exitiosa larvae per tree. Results indicated that S. carpocapsae provided significant curative control (e.g., >80% corrected control for the handgun application). In contrast, chlorpyrifos failed to reduce S. exitiosa infestations or number of surviving larvae. In most comparisons, no effect of nematode application method was detected; in one assessment, only the handgun and watering can methods reduced infestation. In conclusion, our study indicates that S. carpocapsae may be used as an effective curative

  17. Distal Triceps Knotless Anatomic Footprint Repair: A New Technique

    PubMed Central

    Paci, James M.; Clark, Jonathan; Rizzi, Angelo

    2014-01-01

    Distal triceps rupture is a rare injury causing significant disability. Several techniques for treating distal triceps ruptures have been described using bone tunnels or suture anchors. More recent techniques have focused on re-creating the anatomic footprint of the distal triceps tendon. However, the increasing numbers of anchors used increase the risk to the articular surface, and all earlier techniques require knot tying and bulky knots beneath the thin posterior elbow soft-tissue envelope. We describe a technique combining the use of bone tunnels and a single suture anchor to create a knotless anatomic footprint repair of the distal triceps. By using this technique, we are able to create a tension-band construct that self-reinforces the anatomic repair and is very low profile while significantly decreasing risk to the articular surface. PMID:25473618

  18. Distal Renal Tubular Acidosis in Infancy: A Bicarbonate Wasting State

    ERIC Educational Resources Information Center

    Rodriguez-Soriano, J.; And Others

    1975-01-01

    Studied were three unrelated infants with distal renal tubular acidosis (a condition characterized by an inability to acidify the urine to minimal pH levels resulting in the loss of bicarbonates). (DB)

  19. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

    PubMed Central

    Vilallonga, Ramon; Fort, José Manuel; Caubet, Enric; Gonzalez, Oscar; Balibrea, José Maria; Ciudin, Andrea; Armengol, Manel

    2015-01-01

    Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed. PMID:26491560

  20. Surgical Models of Roux-en-Y Gastric Bypass Surgery and Sleeve Gastrectomy in Rats and Mice

    PubMed Central

    Bruinsma, Bote G.; Uygun, Korkut; Yarmush, Martin L.; Saeidi, Nima

    2015-01-01

    Bariatric surgery is the only definitive solution currently available for the present obesity pandemic. These operations typically involve reconfiguration of gastrointestinal tract anatomy and impose profound metabolic and physiological benefits, such as substantially reducing body weight and ameliorating type II diabetes. Therefore, animal models of these surgeries offer unique and exciting opportunities to delineate the underlying mechanisms that contribute to the resolution of obesity and diabetes. Here we describe a standardized procedure for mouse and rat models of Roux-en-Y gastric bypass (80–90 minutes operative time) and sleeve gastrectomy (30–45 minutes operative time), which, to a high degree resemble operations in human. We also provide detailed protocols for both pre- and post-operative techniques that ensure a high success rate in the operations. These protocols provide the opportunity to mechanistically investigate the systemic effects of the surgical interventions, such as regulation of body weight, glucose homeostasis, and gut microbiome. PMID:25719268

  1. Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report

    PubMed Central

    Park, Hye-Jin

    2016-01-01

    During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure. PMID:26885310

  2. A distal airway foreign body removed with electromagnetic navigation bronchoscopy.

    PubMed

    Karpman, Craig; Midthun, David E; Mullon, John J

    2014-04-01

    Distal airway foreign bodies can be challenging to remove with a flexible bronchoscope because of angulation or deep impaction. Thoracic surgery may be required if bronchoscopy is not successful. The use of electromagnetic navigation for pulmonary nodule localization and characterization is well established; however, its use to localize and remove distal foreign bodies has not been described. We report the initial case of electromagnetic navigation-assisted foreign body removal.

  3. Comparison of Chevron and Distal Oblique Osteotomy for Bunion Correction.

    PubMed

    Scharer, Brandon M; DeVries, J George

    2016-01-01

    The chevron osteotomy is a standard procedure by which bunions are corrected. One of us routinely performs a distal oblique osteotomy, which, to the best of our knowledge, has not been described for the correction of bunion deformities. The purpose of the present study was to compare the short- and medium-term results of the distal oblique and chevron osteotomies for bunion correction. We performed a retrospective clinical and radiographic comparison of patients who had undergone a distal oblique or chevron osteotomy for the correction of bunion deformity. In addition, a prospective patient satisfaction survey was undertaken. A total of 55 patients were included in the present study and were treated from January 2012 to November 2014. Of the 55 patients, 27 (49.2%) were in the chevron group and 28 (50.8%) in the distal oblique group. Radiographically, no statistically significant difference was found between the 2 groups with respect to postoperative first intermetatarsal angle (p < .0001) and hallux valgus angle (p < .0001), but a greater change was found in the intermetatarsal angle in the distal oblique group (p = .467). Prospective patient satisfaction scores were available for 33 patients (60%), 16 (29%) in the chevron group and 17 (31%) in the distal oblique group. When converting the satisfaction score to a numerical score, the chevron group scored 3.3 ± 1.1 and the distal oblique group scored 3.2 ± 0.8 (p = .812). We found that the distal oblique osteotomy used in the present study is simple and reliable and showed radiographic correction and patient satisfaction equivalent to those in the chevron osteotomy. PMID:26972755

  4. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up.

    PubMed

    Sánchez-Pernaute, Andrés; Herrera, Miguel Angel Rubio; Pérez-Aguirre, María Elia; Talavera, Pablo; Cabrerizo, Lucio; Matía, Pilar; Díez-Valladares, Luis; Barabash, Ana; Martín-Antona, Estaban; García-Botella, Alejandra; Garcia-Almenta, Ester Martín; Torres, Antonio

    2010-12-01

    Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a new operation for morbid obesity based on the biliopancreatic diversion in which a sleeve gastrectomy is followed by an end-to-side duodeno-ileal diversion. The preservation of the pylorus makes possible the reconstruction in one loop, which reduces operating time and needs no mesentery opening. We review the results obtained on the first 50 operated patients with 1 to 3 years follow-up. Eighteen men and 32 women with a mean BMI of 44 kg/m(2) were operated on. Hypertension was present in 50%, sleep apnea in 30%, hypertriglyceridemia in 60% and hypercholesterolemia in 43%.There were 27 type two diabetics, most of them on insulin therapy. There were two gastric staple-line leaks and one long-term subphrenic abscess. Follow-up is complete for 98% of the patients. Excess weight loss reached 94.7% at 1 year, and it was maintained over the second and third year. At 1 year, mild anemia has been detected in 10% of the cases. Albumin concentration was under normal levels in 8% of the patients in the first postoperative year, but all patients recovered to normal levels by the third postoperative year. All diabetic patients have normalized glucose or HbA1c levels after the sixth postoperative month with no need of anti-diabetic therapy. SADI-S is a promising operation which offers excellent weight loss and metabolic results. The elimination of one anastomosis reduces operative time and decreases the possibility of surgically related complications.

  5. Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy: A retrospective case-series study

    PubMed Central

    Kim, Jae Hun; Choi, Chang In; Kim, Dong Il; Kim, Dae Hwan; Jeon, Tae Yong; Kim, Dong Heon; Park, Do Youn

    2015-01-01

    AIM: To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy (LTG). METHODS: Between July 2010 and December 2012, 58 consecutive patients with early gastric cancer underwent LTG were enrolled. We performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all patients. Then patients’ characteristics, perioperative outcome and histopathologic data were analyzed retrospectively. RESULTS: The mean age and body mass index were 59.3 ± 9.7 years and 22.7 ± 2.6 kg/m2. The mean operation, reconstruction and anvil insertion times (from gastric incision to linear stapling) were 251.8 ± 57.0, 43.1 ± 2.8 and 4.2 ± 1.9 min, respectively. Intraoperative blood loss was 204.6 ± 156.3 mL and there was no open conversion. The postoperative complications were in 8 cases (delayed gastric emptying in 4 cases, pulmonary complication in 2 cases, pancreatitis in 1 case, anastomotic stricture in 1 case). Anastomotic stricture occurred after discharge and was recovered by endoscopic intervention. The patients were discharged at a mean of 9.6 ± 2.0 d after surgery. Neither leakage nor bleeding from the esophagojejunostomy occurred postoperatively. The mean proximal margin of specimen was 2.7 ± 2.8 cm CONCLUSION: Roux-en Y esophagojejunostomy using the double stapling technique is simple and rapid, and it may offer a solid, alternative reconstruction method for LTG or proximal gastrectomy. PMID:25780295

  6. Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis: A Novel Approach Adopting the Double-Loop Reconstruction Method.

    PubMed

    Parisi, Amilcare; Ricci, Francesco; Trastulli, Stefano; Cirocchi, Roberto; Gemini, Alessandro; Grassi, Veronica; Corsi, Alessia; Renzi, Claudio; De Santis, Francesco; Petrina, Adolfo; Pironi, Daniele; D'Andrea, Vito; Santoro, Alberto; Desiderio, Jacopo

    2015-12-01

    Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called "double-loop" reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.

  7. Distal Locking Screws for Intramedullary Nailing of Tibial Fractures.

    PubMed

    Agathangelidis, Filon; Petsatodis, Georgios; Kirkos, John; Papadopoulos, Pericles; Karataglis, Dimitrios; Christodoulou, Anastasios

    2016-01-01

    Recently introduced tibial intramedullary nails allow a number of distal screws to be used to reduce the incidence of malalignment and loss of fixation of distal metaphyseal fractures. However, the number of screws and the type of screw configuration to be used remains obscure. This biomechanical study was performed to address this question. Thirty-six Expert tibial nails (Synthes, Oberdorf, Switzerland) were introduced in composite bone models. The models were divided into 4 groups with different distal locking configurations ranging from 2 to 4 screws. A 7-mm gap osteotomy was performed 72 mm from the tibial plafond to simulate a 42-C3 unstable distal tibial fracture. Each group was divided in 3 subgroups and underwent nondestructive biomechanical testing in axial compression, coronal bending, and axial torsion. The passive construct stiffness was measured and statistically analyzed with one-way analysis of variance. Although some differences were noted between the stiffness of each group, these were not statistically significant in compression (P=.105), bending (P=.801), external rotation (P=.246), and internal rotation (P=.370). This in vitro study showed that, when using the Expert tibial nail for unstable distal tibial fractures, the classic configuration of 2 parallel distal screws could provide the necessary stability under partial weight-bearing conditions. PMID:26840700

  8. [Epidemiology and management of isolated distal deep venous thrombosis].

    PubMed

    Galanaud, J-P; Kahn, S R; Khau Van Kien, A; Laroche, J-P; Quéré, I

    2012-12-01

    Isolated distal deep-vein thromboses (DVT) are infra-popliteal DVT without involvement of proximal veins or pulmonary embolism (PE). They can affect deep calf (tibial anterior, tibial posterior, or peroneal) or muscular (gastrocnemius or soleal) veins. They represent half of all lower limbs DVT. Proximal and distal DVTs differ in terms of risk factor profile, proximal DVT being more frequently associated with chronic risk factors and distal DVT with transient ones. Their natural history (rate of spontaneous proximal extension) is debated leading to uncertainties on the need to diagnose and treat them with anticoagulant drugs. In the long term, the risk of venous thromboembolic recurrence is lower than that of proximal DVT and their absolute risk of post-thrombotic syndrome is unknown. French national guidelines suggest treating with anticoagulants for 6 weeks a first episode of isolated distal DVT provoked by a transient risk factor and treating for at least 3 months unprovoked or recurrent or active cancer-related distal DVT. The use of compression stockings use is suggested in case of deep calf vein thrombosis. Ongoing therapeutic trials should provide important data necessary to establish an evidence-based mode of care, especially about the need to treat distal DVT at low risk of extension with anticoagulants.

  9. Dietary 2-oxoglutarate mitigates gastrectomy-evoked structural changes in cartilage of female rats

    PubMed Central

    Tomaszewska, Ewa; Kurlak, Paulina; Pierzynowski, Stefan G

    2015-01-01

    Gastrectomy (Gx) leads to osteopenia/osteoporosis in humans and animals. However, little is known about the influence of Gx on the cartilage in this regard. Recent studies have demonstrated a protective effect of 2-oxoglutaric acid (2-Ox) on bone and cartilage. Hence, the purpose of this study was to investigate whether 2-Ox can mitigate eventual Gx-induced cartilage impairment. Twenty female Sprague-Dawley rats were subjected to Gx and randomly divided into two groups: Gx + 2-Ox and Gx. Another 20 rats were sham-operated (ShO) and randomly divided into two groups: ShO + 2-Ox and ShO. The daily dose of 2-Ox administered to the rats in the drinking water was 0.43 g per 100 g rat. After eight weeks, rats were euthanized and femora and tibiae were collected. Histology and histomorphometry analyses of the articular cartilage and the growth plate were done. Gx resulted in a 32% (±44.5 femur, ±35.8 tibia) decrease in overall thickness of articular cartilage in both bones (femur: ShO 279.1 ± 48.5 vs. Gx 190.2 ± 38.4 µm, tibia: ShO 222.9 ± 50.3 µm vs. Gx 151.3 ± 52.6 µm) (in some zones up to 58 ± 28.0%), and in the growth plate up to 20% (±22.4) (femur: ShO 243.0 ± 34.0 vs. Gx 207.0 ± 33.7 µm, tibia: ShO 220.0 ± 24.6 µm vs. Gx 171.1 ± 16.1 µm). Gx altered the spatial distribution of thick and thin collagen fibers, and chondrocyte shape and size. 2-Ox administration prevented the reduction in both cartilages thickness (Gx + 2-Ox: articular cartilage 265.2 ± 53.8 µm, 235.6 ± 42.7 µm, growth plate 236.7 ± 39.2 µm, 191.3 ± 16.5 µm in femur and tibia, respectively), and abolished the spatial changes in collagen distribution and structure induced by Gx. Gx affects cartilage structure and thickness, however, 2-Ox administration mitigates these effects and showed protective and stimulatory properties. Our observations suggest that dietary 2-Ox can be used to offset

  10. Advanced Curation: Solving Current and Future Sample Return Problems

    NASA Technical Reports Server (NTRS)

    Fries, M.; Calaway, M.; Evans, C.; McCubbin, F.

    2015-01-01

    Advanced Curation is a wide-ranging and comprehensive research and development effort at NASA Johnson Space Center that identifies and remediates sample related issues. For current collections, Advanced Curation investigates new cleaning, verification, and analytical techniques to assess their suitability for improving curation processes. Specific needs are also assessed for future sample return missions. For each need, a written plan is drawn up to achieve the requirement. The plan draws while upon current Curation practices, input from Curators, the analytical expertise of the Astromaterials Research and Exploration Science (ARES) team, and suitable standards maintained by ISO, IEST, NIST and other institutions. Additionally, new technologies are adopted on the bases of need and availability. Implementation plans are tested using customized trial programs with statistically robust courses of measurement, and are iterated if necessary until an implementable protocol is established. Upcoming and potential NASA missions such as OSIRIS-REx, the Asteroid Retrieval Mission (ARM), sample return missions in the New Frontiers program, and Mars sample return (MSR) all feature new difficulties and specialized sample handling requirements. The Mars 2020 mission in particular poses a suite of challenges since the mission will cache martian samples for possible return to Earth. In anticipation of future MSR, the following problems are among those under investigation: What is the most efficient means to achieve the less than 1.0 ng/sq cm total organic carbon (TOC) cleanliness required for all sample handling hardware? How do we maintain and verify cleanliness at this level? The Mars 2020 Organic Contamination Panel (OCP) predicts that organic carbon, if present, will be present at the "one to tens" of ppb level in martian near-surface samples. The same samples will likely contain wt% perchlorate salts, or approximately 1,000,000x as much perchlorate oxidizer as organic carbon

  11. Advances in Astromaterials Curation: Supporting Future Sample Return Missions

    NASA Technical Reports Server (NTRS)

    Evans, C. A.; Zeigler, R. A.; Fries, M. D..; Righter, K.; Allton, J. H.; Zolensky, M. E.; Calaway, M. J.; Bell, M. S.

    2015-01-01

    NASA's Astromaterials, curated at the Johnson Space Center in Houston, are the most extensive, best-documented, and leastcontaminated extraterrestrial samples that are provided to the worldwide research community. These samples include lunar samples from the Apollo missions, meteorites collected over nearly 40 years of expeditions to Antarctica (providing samples of dozens of asteroid bodies, the Moon, and Mars), Genesis solar wind samples, cosmic dust collected by NASA's high altitude airplanes, Comet Wild 2 and interstellar dust samples from the Stardust mission, and asteroid samples from JAXA's Hayabusa mission. A full account of NASA's curation efforts for these collections is provided by Allen, et al [1]. On average, we annually allocate about 1500 individual samples from NASA's astromaterials collections to hundreds of researchers from around the world, including graduate students and post-doctoral scientists; our allocation rate has roughly doubled over the past 10 years. The curation protocols developed for the lunar samples returned from the Apollo missions remain relevant and are adapted to new and future missions. Several lessons from the Apollo missions, including the need for early involvement of curation scientists in mission planning [1], have been applied to all subsequent sample return campaigns. From the 2013 National Academy of Sciences report [2]: "Curation is the critical interface between sample return missions and laboratory research. Proper curation has maintained the scientific integrity and utility of the Apollo, Antarctic meteorite, and cosmic dust collections for decades. Each of these collections continues to yield important new science. In the past decade, new state-of-the-art curatorial facilities for the Genesis and Stardust missions were key to the scientific breakthroughs provided by these missions." The results speak for themselves: research on NASA's astromaterials result in hundreds of papers annually, yield fundamental

  12. Curation and integration of observational metadata in ADS

    NASA Astrophysics Data System (ADS)

    Accomazzi, Alberto

    2015-08-01

    This presentation discusses the current curation of archive bibliographies and their indexing in the NASA Astrophysics Data System (ADS). Integration of these bibliographies provides convenient cross-linking of resources between ADS and the data archives, affording greater visibility to both data products and the literature associated with them. There are practical incentives behind this effort: it has been shown that astronomy articles which provide links to on-line datasets have a citation advantage over similar articles which don’t link to data. Additionally, the availability of paper-based metrics makes it possible for archivists and program managers use them in order to assess the impact of an instrument, facility, funding or observing program.The primary data curated by ADS is bibliographic information provided by publishers or harvested by ADS from conference proceeding sites and repositories. This core bibliographic information is then further enriched by ADS via the generation of citations and usage data, and through the aggregation of external bibliographic information. Important sources of such additional information are the metadata describing observing proposals from the major missions and archives, the curated bibliographies for data centers, and the sets of links between archival observations and published papers.While ADS solicits and welcomes the inclusion of this data from US and foreign data centers, the curation of bibliographies, observing proposals and links to data products is left to the archives which host the data and which have the expertise and resources to properly maintain them. In this regard, the role of ADS is one of resource aggregation through crowdsourced curation, providing a lightweight discovery mechanism through its search capabilities. While limited in scope, this level of aggregation can still be quite useful in supporting the discovery and selection of data products associated with publications. For instance, a user can

  13. Curating and Preparing High-Throughput Screening Data for Quantitative Structure-Activity Relationship Modeling.

    PubMed

    Kim, Marlene T; Wang, Wenyi; Sedykh, Alexander; Zhu, Hao

    2016-01-01

    Publicly available bioassay data often contains errors. Curating massive bioassay data, especially high-throughput screening (HTS) data, for Quantitative Structure-Activity Relationship (QSAR) modeling requires the assistance of automated data curation tools. Using automated data curation tools are beneficial to users, especially ones without prior computer skills, because many platforms have been developed and optimized based on standardized requirements. As a result, the users do not need to extensively configure the curation tool prior to the application procedure. In this chapter, a freely available automatic tool to curate and prepare HTS data for QSAR modeling purposes will be described.

  14. Curating and Preparing High-Throughput Screening Data for Quantitative Structure-Activity Relationship Modeling.

    PubMed

    Kim, Marlene T; Wang, Wenyi; Sedykh, Alexander; Zhu, Hao

    2016-01-01

    Publicly available bioassay data often contains errors. Curating massive bioassay data, especially high-throughput screening (HTS) data, for Quantitative Structure-Activity Relationship (QSAR) modeling requires the assistance of automated data curation tools. Using automated data curation tools are beneficial to users, especially ones without prior computer skills, because many platforms have been developed and optimized based on standardized requirements. As a result, the users do not need to extensively configure the curation tool prior to the application procedure. In this chapter, a freely available automatic tool to curate and prepare HTS data for QSAR modeling purposes will be described. PMID:27518634

  15. Distal antenna and distal antenna related encode nuclear proteins containing pipsqueak motifs involved in antenna development in Drosophila.

    PubMed

    Emerald, B Starling; Curtiss, Jennifer; Mlodzik, Marek; Cohen, Stephen M

    2003-03-01

    Legs and antennae are considered to be homologous appendages. The fundamental patterning mechanisms that organize spatial pattern are conserved, yet appendages with very different morphology develop. A genetic hierarchy for specification of antennal identity has been partly elucidated. We report identification of a novel family of genes with roles in antennal development. The distal antenna (dan) and distal antenna-related (danr) genes encode novel nuclear proteins that are expressed in the presumptive distal antenna, but not in the leg imaginal disc. Ectopic expression of dan or danr causes partial transformation of distal leg structure toward antennal identity. Mutants that remove dan and danr activity cause partial transformation of antenna toward leg identity. Therefore we suggest that dan and danr contribute to differentiation of antenna-specific characteristics. Antenna-specific expression of dan and danr depends on a regulatory hierarchy involving homothorax and Distal-less, as well as cut and spineless. We propose that dan and danr are effector genes that act downstream of these genes to control differentiation of distal antennal structures.

  16. Curation of Microscopic Astromaterials by NASA: "Gathering Dust Since 1981"

    NASA Technical Reports Server (NTRS)

    Frank, D. R.; Bastien, R. K.; Rodriguez, M.; Gonzalez, C.; Zolensky, M. E.

    2013-01-01

    Employing the philosophy that "Small is Beautiful", NASA has been collecting and curating microscopic astromaterials since 1981. These active collections now include interplanetary dust collected in Earth's stratosphere by U-2, ER-2 and WB-57F aircraft (the Cosmic Dust Program - our motto is "Gathering dust since 1981"), comet Wild-2 coma dust (the Stardust Mission), modern interstellar dust (also the Stardust Mission), asteroid Itokawa regolith dust (the Hayabusa Mission - joint curation with JAXA-ISAS), and interplanetary dust impact features on recovered portions of the following spacecraft: Skylab, the Solar Maximum Satellite, the Palapa Satellite, the Long Duration Exposure Facility (LDEF), the MIR Space Station, the International Space Station, and the Hubble Space Telescope (all in the Space Exposed Hardware Laboratory).

  17. Preventive vs. curative medicine: perspectives of the Jewish legal tradition.

    PubMed

    Golding, M P

    1983-08-01

    From the perspectives of Jewish tradition, particularly that of the Halakhah (Jewish law), this paper considers the policy problem of the balance in health care allocations between preventive and curative or crisis medicine. Since the value of human lives has a high degree of supremacy, and the duties to rescue imperiled life and to treat the sick are recognized, it might be argued that a basically curative policy should be favored. On the other hand, the duty of personal health maintenance and safety would appear to argue in favor of a preventive policy. In balancing these considerations, it is suggested that the halakhic tradition can accommodate a preventive policy of health care because the duty to rescue is lessened or negatived by risk to the as-it-were rescuers. It is further suggested that Halakhah permits a non-divertable allocation of tax-generated funds to preventive health care.

  18. Curation and Analysis of Multitargeting Agents for Polypharmacological Modeling

    PubMed Central

    2015-01-01

    In drug discovery and development, the conventional “single drug, single target” concept has been shifted to “single drug, multiple targets” – a concept coined as polypharmacology. For studies in this emerging field, dedicated and high-quality databases of multitargeting ligands would be exceedingly beneficial. To this end, we conducted a comprehensive analysis of the structural and chemical/biological profiles of polypharmacological agents and present a Web-based database (Polypharma). All of these compounds curated herein have been cocrystallized with more than one unique protein with intensive reports of their multitargeting activities. The present study provides more insight of drug multitargeting and is particularly useful for polypharmacology modeling. This specialized curation has been made publically available at http:/imdlab.org/polypharma/ PMID:25133604

  19. Data Preservation and Curation for the Planetary Science Community

    NASA Astrophysics Data System (ADS)

    Hughes, J. S.; Crichton, D. J.; Joyner, R.; Hardman, S.; Rye, E.

    2013-12-01

    The Planetary Data System (PDS) has just released PDS4 Version 1.0, its next generation data standards for the planetary science archive. These data standards are the result of a multi-year effort to develop an information model based on accepted standards for data preservation, data curation, metadata management, and model development. The resulting information model is subsequently used to drive information system development from the generation of data standards documentation to the configuration of federated registries and search engines. This paper will provide an overview of the development of the PDS4 Information Model and focus on the application of the Open Archive Information System (OAIS) Reference Model - ISO 14721:2003, the Metadata Registry (MDR) Standard - ISO/IEC 11179, and the E-Business XML Standard to help ensure the long-term preservation and curation of planetary science data. Copyright 2013 California Institute of Technology Government sponsorship acknowledged

  20. [Preventive and curative value of yoga in cardiometabolic diseases].

    PubMed

    Apor, Péter

    2016-02-28

    Yoga and other body-mind techniques enjoy an increasing popularity in many fields of health maintaining practices, in prevention of some illnesses and in curative medicine in spite of our incomplete knowledge about its applicability and effects. There are large differences among the various yoga-schools and the heterogeneity of indications etc. In this article a bucket of recent information is offered for the inquirers on the potential advantages of yoga (diet, mind-exercises, asanas, pranayamas) for decreasing cardio-metabolic risk factors, stabilizing mental health, and its addictive use in curative medicine. Few adverse side-effects may occur only in the case of misapplication. Its advantages are low costs, availability for broad population, and very few contraindications. Disadvantages include differences in the ability of yoga instructors and in yoga practices.

  1. [Preventive and curative value of yoga in cardiometabolic diseases].

    PubMed

    Apor, Péter

    2016-02-28

    Yoga and other body-mind techniques enjoy an increasing popularity in many fields of health maintaining practices, in prevention of some illnesses and in curative medicine in spite of our incomplete knowledge about its applicability and effects. There are large differences among the various yoga-schools and the heterogeneity of indications etc. In this article a bucket of recent information is offered for the inquirers on the potential advantages of yoga (diet, mind-exercises, asanas, pranayamas) for decreasing cardio-metabolic risk factors, stabilizing mental health, and its addictive use in curative medicine. Few adverse side-effects may occur only in the case of misapplication. Its advantages are low costs, availability for broad population, and very few contraindications. Disadvantages include differences in the ability of yoga instructors and in yoga practices. PMID:26895799

  2. The MetaboLights repository: curation challenges in metabolomics

    PubMed Central

    Salek, Reza M.; Haug, Kenneth; Conesa, Pablo; Hastings, Janna; Williams, Mark; Mahendraker, Tejasvi; Maguire, Eamonn; González-Beltrán, Alejandra N.; Rocca-Serra, Philippe; Sansone, Susanna-Assunta; Steinbeck, Christoph

    2013-01-01

    MetaboLights is the first general-purpose open-access curated repository for metabolomic studies, their raw experimental data and associated metadata, maintained by one of the major open-access data providers in molecular biology. Increases in the number of depositions, number of samples per study and the file size of data submitted to MetaboLights present a challenge for the objective of ensuring high-quality and standardized data in the context of diverse metabolomic workflows and data representations. Here, we describe the MetaboLights curation pipeline, its challenges and its practical application in quality control of complex data depositions. Database URL: http://www.ebi.ac.uk/metabolights PMID:23630246

  3. Medicare Care Choices Model Enables Concurrent Palliative and Curative Care.

    PubMed

    2015-01-01

    On July 20, 2015, the federal Centers for Medicare & Medicaid Services (CMS) announced hospices that have been selected to participate in the Medicare Care Choices Model. Fewer than half of the Medicare beneficiaries use hospice care for which they are eligible. Current Medicare regulations preclude concurrent palliative and curative care. Under the Medicare Choices Model, dually eligible Medicare beneficiaries may elect to receive supportive care services typically provided by hospice while continuing to receive curative services. This report describes how CMS has expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. Medicare-certified hospice programs that will participate in the model are listed.

  4. Spanish health benefits for services of curative care

    PubMed Central

    Planas-Miret, Ivan; Tur-Prats, Ana

    2005-01-01

    This contribution presents entitlements and benefits, decision criteria, and involved actors for services of curative care in Spain. It describes basic benefits included in the category of curative care defined by the central government and any additional benefits that some autonomous communities (ACs) have included to enlarge their own basket. It is concluded that there is no specific and explicit benefit catalogue. As no user charges exist for this category, waiting times serve as the main cost containment tool. There is a need for further legislation, as inequalities may increase across the territory as a matter of fact. Inequalities in access to health care resources between ACs are not due to differences in health baskets but mainly to the availability of technologies. PMID:16267655

  5. Nuts and Bolts - Techniques for Genesis Sample Curation

    NASA Technical Reports Server (NTRS)

    Burkett, Patti J.; Rodriquez, M. C.; Allton, J. H.

    2011-01-01

    The Genesis curation staff at NASA Johnson Space Center provides samples and data for analysis to the scientific community, following allocation approval by the Genesis Oversight Committee, a sub-committee of CAPTEM (Curation Analysis Planning Team for Extraterrestrial Materials). We are often asked by investigators within the scientific community how we choose samples to best fit the requirements of the request. Here we will demonstrate our techniques for characterizing samples and satisfying allocation requests. Even with a systematic approach, every allocation is unique. We are also providing updated status of the cataloging and characterization of solar wind collectors as of January 2011. The collection consists of 3721 inventoried samples consisting of a single fragment, or multiple fragments containerized or pressed between post-it notes, jars or vials of various sizes.

  6. Chemical biology databases: from aggregation, curation to representation.

    PubMed

    Audouze, Karine; Taboureau, Olivier

    2015-07-01

    Systems chemical biology offers a novel way of approaching drug discovery by developing models that consider the global physiological environment of protein targets and their perturbations by drugs. However, the integration of all these data needs curation and standardization with an appropriate representation in order to get relevant interpretations. In this mini review, we present some databases and services, which integrated together with computational tools and data standardization, could assist scientists in decision making during the different drug development process.

  7. Curating Big Data Made Simple: Perspectives from Scientific Communities.

    PubMed

    Sowe, Sulayman K; Zettsu, Koji

    2014-03-01

    The digital universe is exponentially producing an unprecedented volume of data that has brought benefits as well as fundamental challenges for enterprises and scientific communities alike. This trend is inherently exciting for the development and deployment of cloud platforms to support scientific communities curating big data. The excitement stems from the fact that scientists can now access and extract value from the big data corpus, establish relationships between bits and pieces of information from many types of data, and collaborate with a diverse community of researchers from various domains. However, despite these perceived benefits, to date, little attention is focused on the people or communities who are both beneficiaries and, at the same time, producers of big data. The technical challenges posed by big data are as big as understanding the dynamics of communities working with big data, whether scientific or otherwise. Furthermore, the big data era also means that big data platforms for data-intensive research must be designed in such a way that research scientists can easily search and find data for their research, upload and download datasets for onsite/offsite use, perform computations and analysis, share their findings and research experience, and seamlessly collaborate with their colleagues. In this article, we present the architecture and design of a cloud platform that meets some of these requirements, and a big data curation model that describes how a community of earth and environmental scientists is using the platform to curate data. Motivation for developing the platform, lessons learnt in overcoming some challenges associated with supporting scientists to curate big data, and future research directions are also presented.

  8. Online Social Media as a Curation Tool for Teaching.

    PubMed

    Shaw, Ryan J; Sperber, Marc A; Cunningham, Traven

    2016-01-01

    This case study shows how students used online social media to disseminate curated knowledge to the public. This is a "redefined" way of having the students show that they have analyzed the existing knowledge on a topic, synthesized/reorganized it in a meaningful way, and created a new presentation of that knowledge in various ways. This case study demonstrates an effective teaching approach to ensure that students develop competencies in teamwork, collaboration, and informatics.

  9. Online Social Media as a Curation Tool for Teaching.

    PubMed

    Shaw, Ryan J; Sperber, Marc A; Cunningham, Traven

    2016-01-01

    This case study shows how students used online social media to disseminate curated knowledge to the public. This is a "redefined" way of having the students show that they have analyzed the existing knowledge on a topic, synthesized/reorganized it in a meaningful way, and created a new presentation of that knowledge in various ways. This case study demonstrates an effective teaching approach to ensure that students develop competencies in teamwork, collaboration, and informatics. PMID:26001748

  10. Sharing Responsibility for Data Stewardship Between Scientists and Curators

    NASA Astrophysics Data System (ADS)

    Hedstrom, M. L.

    2012-12-01

    Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

  11. Autoxidation of oxymyoglobin with the distal (E7) glutamine.

    PubMed

    Suzuki, T

    1987-08-01

    We reported previously that the distal(E7) histidine is replaced by glutamine in myoglobin from the shark, Galeorhinus japonicus. The amino-acid sequence of myoglobin from another shark, Heterodontus japonicus, has been determined. The myoglobin is composed of 148 residues, is acetylated at the N-terminus, and contains the distal(E7) histidine at position 59. Although the sequence homologies between G. japonicus, H. japonicus, and sperm-whale myoglobins were about 40-55%, their hydropathy profiles were very similar, indicating that they have a similar geometry in their globin folding. The autoxidation rates of the two shark oxymyoglobins were examined in 0.1 M buffer at 25 degrees C over pH range 4.5-11.5. The pH dependence for the autoxidation of H. japonicus myoglobin was very similar to that of sperm-whale myoglobin, although the rate was about 10-times higher over the pH range examined. In both myoglobins, autoxidation was largely accelerated by H+. On the other hand, the pH dependence of G. japonicus myoglobin, which has the distal glutamine in the place of histidine, was quite different from those of sperm-whale and H. japonicus myoglobins. One of the most remarkable features is the fact that the autoxidation rate is not enhanced with an increase in the concentration of H+ in the acidic range of pH, where the autoxidation of sperm-whale and H. japonicus myoglobins is most accelerated. This finding suggests that the distal(E7) histidine participates in the autoxidation reaction as a catalytic residue facilitating the movement of a catalytic proton.

  12. Successful Management of New-Onset Diabetes Mellitus and Obesity With the Use of Laparoscopic Sleeve Gastrectomy After Kidney Transplantation-A Case Report.

    PubMed

    Chen, J-H; Lee, C-H; Chang, C-M; Yin, W-Y

    2016-04-01

    In kidney transplantation, obesity is associated with poorer graft survival and patient survival. Bariatric surgery may provide benefit for these patients, not only by inducing weight loss, but also via reduction of diabetes. We report a case of morbid obesity, poorly controlled new-onset diabetes mellitus, and gout after kidney transplantation that was treated with laparoscopic sleeve gastrectomy 3 years after kidney transplantation. After 1 year of follow-up, 76% excessive body weight loss was attained. No complications were noted. The operation also provided total remission of diabetes and gout as well as good graft survival. Based on our experience, laparoscopic sleeve gastrectomy may be a feasible treatment for obese patients after renal transplantation to help resolve obesity and control new-onset diabetes. However, the timing of operation and the long-term potential for graft and patient survivals with this operation require further study. PMID:27234772

  13. Curation, integration and visualization of bacterial virulence factors in PATRIC

    PubMed Central

    Mao, Chunhong; Abraham, David; Wattam, Alice R.; Wilson, Meredith J.C.; Shukla, Maulik; Yoo, Hyun Seung; Sobral, Bruno W.

    2015-01-01

    Motivation: We’ve developed a highly curated bacterial virulence factor (VF) library in PATRIC (Pathosystems Resource Integration Center, www.patricbrc.org) to support infectious disease research. Although several VF databases are available, there is still a need to incorporate new knowledge found in published experimental evidence and integrate these data with other information known for these specific VF genes, including genomic and other omics data. This integration supports the identification of VFs, comparative studies and hypothesis generation, which facilitates the understanding of virulence and pathogenicity. Results: We have manually curated VFs from six prioritized NIAID (National Institute of Allergy and Infectious Diseases) category A–C bacterial pathogen genera, Mycobacterium, Salmonella, Escherichia, Shigella, Listeria and Bartonella, using published literature. This curated information on virulence has been integrated with data from genomic functional annotations, trancriptomic experiments, protein–protein interactions and disease information already present in PATRIC. Such integration gives researchers access to a broad array of information about these individual genes, and also to a suite of tools to perform comparative genomic and transcriptomics analysis that are available at PATRIC. Availability and implementation: All tools and data are freely available at PATRIC (http://patricbrc.org). Contact: cmao@vbi.vt.edu. Supplementary information: Supplementary data are available at Bioinformatics online. PMID:25273106

  14. Refining literature curated protein interactions using expert opinions.

    PubMed

    Tastan, Oznur; Qi, Yanjun; Carbonell, Jaime G; Klein-Seetharaman, Judith

    2015-01-01

    The availability of high-quality physical interaction datasets is a prerequisite for system-level analysis of interactomes and supervised models to predict protein-protein interactions (PPIs). One source is literature-curated PPI databases in which pairwise associations of proteins published in the scientific literature are deposited. However, PPIs may not be clearly labelled as physical interactions affecting the quality of the entire dataset. In order to obtain a high-quality gold standard dataset for PPIs between human immunodeficiency virus (HIV-1) and its human host, we adopted a crowd-sourcing approach. We collected expert opinions and utilized an expectation-maximization based approach to estimate expert labeling quality. These estimates are used to infer the probability of a reported PPI actually being a direct physical interaction given the set of expert opinions. The effectiveness of our approach is demonstrated through synthetic data experiments and a high quality physical interaction network between HIV and human proteins is obtained. Since many literature-curated databases suffer from similar challenges, the framework described herein could be utilized in refining other databases. The curated data is available at http://www.cs.bilkent.edu.tr/~oznur.tastan/supp/psb2015/.

  15. WormBase 2014: new views of curated biology

    PubMed Central

    Harris, Todd W.; Baran, Joachim; Bieri, Tamberlyn; Cabunoc, Abigail; Chan, Juancarlos; Chen, Wen J.; Davis, Paul; Done, James; Grove, Christian; Howe, Kevin; Kishore, Ranjana; Lee, Raymond; Li, Yuling; Muller, Hans-Michael; Nakamura, Cecilia; Ozersky, Philip; Paulini, Michael; Raciti, Daniela; Schindelman, Gary; Tuli, Mary Ann; Auken, Kimberly Van; Wang, Daniel; Wang, Xiaodong; Williams, Gary; Wong, J. D.; Yook, Karen; Schedl, Tim; Hodgkin, Jonathan; Berriman, Matthew; Kersey, Paul; Spieth, John; Stein, Lincoln; Sternberg, Paul W.

    2014-01-01

    WormBase (http://www.wormbase.org/) is a highly curated resource dedicated to supporting research using the model organism Caenorhabditis elegans. With an electronic history predating the World Wide Web, WormBase contains information ranging from the sequence and phenotype of individual alleles to genome-wide studies generated using next-generation sequencing technologies. In recent years, we have expanded the contents to include data on additional nematodes of agricultural and medical significance, bringing the knowledge of C. elegans to bear on these systems and providing support for underserved research communities. Manual curation of the primary literature remains a central focus of the WormBase project, providing users with reliable, up-to-date and highly cross-linked information. In this update, we describe efforts to organize the original atomized and highly contextualized curated data into integrated syntheses of discrete biological topics. Next, we discuss our experiences coping with the vast increase in available genome sequences made possible through next-generation sequencing platforms. Finally, we describe some of the features and tools of the new WormBase Web site that help users better find and explore data of interest. PMID:24194605

  16. Negative Effects of Total Gastrectomy on Bone Tissue Metabolism and Volumetric Bone Mineral Density (vBMD) of Lumbar Spine in 1-Year Study in Men

    PubMed Central

    Krupski, Witold; Tatara, Marcin R.; Bury, Pawel; Szabelska, Anna; Charuta, Anna; Maciejewski, Ryszard; Wallner, Grzegorz; Dabrowski, Andrzej

    2016-01-01

    Abstract Gastrectomy induces severe osteoporosis in humans but its quantitative scale within trabecular and cortical compartments was not estimated. The aim of the study was to determine changes of volumetric bone mineral density (vBMD) in lumbar vertebrae (L1–L4) and biochemical bone metabolism markers in serum of patients 1 year after total gastrectomy. The control group consisted of patients (N = 8) subjected to abdominal surgery due to cardiospasmus. Total gastrectomy was performed in the experimental group (N = 6). Volumetric bone mineral density of trabecular and cortical bone of lumbar spine was measured before (baseline) and 1 year after the gastric surgery using the quantitative computed tomography method. Serum concentrations of insulin, insulin-like growth factor-1, tyroxine, interleukin-6, C-terminal telopeptides of type II collagen and bone formation, and resorption markers were determined at baseline and 1 year later, using ELISA, EIA, and IEMA methods. Total gastrectomy induced significant decrease of vBMD values, up to 16.8% and 10.0%, within the trabecular and cortical bone compartments of lumbar spine (P < 0.05). These negative changes of vBMD were associated with significantly increased serum concentration of bone resorption markers such as deoxypyridinoline, pyridinoline, and C-terminal telopeptides of type I collagen, by 13.5%, 32.2%, and 121.5%, respectively (P < 0.05). Neither vBMD nor biochemical bone turnover markers and hormone concentrations were influenced in the control patients. Dramatic bone loss during the first year in gastrectomized patients has proven dynamic osteoporosis progress indicating an importance of treatment interventions in these patients with emphasis on inhibition of intensive bone resorption processes. PMID:26886633

  17. Whole bone geometry and bone quality in distal forearm fracture.

    PubMed

    Parkinson, Ian H; Fazzalari, Nicola L

    2008-09-01

    Fracture of the distal radius is a sentinel for future increased risk of other "osteoporotic" fractures, in which the peak age for incidence of distal radius fracture is 5 to 10 years before that for spine and hip fractures. Mean bone mineral density (BMD) of the distal radius was lower in patients with osteoporosis compared with age- and sex-matched normal subjects. However, it has been shown that to predict the strength of the distal radius at the site where fractures occur requires more than measurement of bone mineral content (BMC) or BMD. Only moderate correlations have been found between forearm sites, which may be a result of differences in bone composition between sites. Different forearm sites may be used interchangeably for diagnostic purposes, but the prognostic value is not known. Using the distal radius as a screening tool for identifying individuals at risk of "osteoporotic" fracture shows that forearm site selection and accuracy of measurement can be important confounders in group studies.Improving resolution of computed tomography (CT) scanners has enabled quantitation of cortical bone density and cortical thickness. These measurements have enabled the mechanism of bone loss in the distal radius to be elucidated and show that, after menopause, bone loss is primarily through thinning of the cortex. CT imaging allows the precise localization of bone changes in individuals and should be of value in the assessment of the severity of osteoporosis. It also shows that this technology has the potential to determine the efficacy of therapeutic interventions. A concerted effort has been made to elucidate the interrelationships between the amount of bone and the geometry and that clinical imaging of BMC and/or cross-sectional area in the radius would provide improved prediction of an individual's risk of fracture.The technological tools are available, in the clinic, to accurately measure the 3-dimensional (3D) geometry of the distal radius and the amount of

  18. Opening Data in the Long Tail for Community Discovery, Curation and Action Using Active and Social Curation

    NASA Astrophysics Data System (ADS)

    Hedstrom, M. L.; Kumar, P.; Myers, J.; Plale, B. A.

    2012-12-01

    In data science, the most common sequence of steps for data curation are to 1) curate data, 2) enable data discovery, and 3) provide for data reuse. The Sustainable Environments - Actionable Data (SEAD) project, funded through NSF's DataNet program, is creating an environment for sustainability scientists to discover data first, reuse data next, and curate data though an on-going process that we call Active and Social Curation. For active curation we are developing tools and services that support data discovery, data management, and data enhancement for the community while the data is still being used actively for research. We are creating an Active Content Repository, using drop box, semantic web technologies, and a Flickr-like interface for researchers to "drop" data into a repository where it will be replicated and minimally discoverable. For social curation, we are deploying a social networking tool, VIVO, which will allow researchers to discover data-publications-people (e.g. expertise) through a route that can start at any of those entry points. The other dimension of social curation is developing mechanisms to open data for community input, for example, using ranking and commenting mechanisms for data sets and a community-sourcing capability to add tags, clean up and validate data sets. SEAD's strategies and services are aimed at the sustainability science community, which faces numerous challenges including discovery of useful data, cleaning noisy observational data, synthesizing data of different types, defining appropriate models, managing and preserving their research data, and conveying holistic results to colleagues, students, decision makers, and the public. Sustainability researchers make significant use of centrally managed data from satellites and national sensor networks, national scientific and statistical agencies, and data archives. At the same time, locally collected data and custom derived data products that combine observations and

  19. An intrinsic timer specifies distal structures of the vertebrate limb

    PubMed Central

    Saiz-Lopez, Patricia; Chinnaiya, Kavitha; Campa, Victor M.; Delgado, Irene; Ros, Maria A.; Towers, Matthew

    2015-01-01

    How the positional values along the proximo-distal axis (stylopod-zeugopod-autopod) of the limb are specified is intensely debated. Early work suggested that cells intrinsically change their proximo-distal positional values by measuring time. Recently, however, it is suggested that instructive extrinsic signals from the trunk and apical ectodermal ridge specify the stylopod and zeugopod/autopod, respectively. Here, we show that the zeugopod and autopod are specified by an intrinsic timing mechanism. By grafting green fluorescent protein-expressing cells from early to late chick wing buds, we demonstrate that distal mesenchyme cells intrinsically time Hoxa13 expression, cell cycle parameters and the duration of the overlying apical ectodermal ridge. In addition, we reveal that cell affinities intrinsically change in the distal mesenchyme, which we suggest results in a gradient of positional values along the proximo-distal axis. We propose a complete model in which a switch from extrinsic signalling to intrinsic timing patterns the vertebrate limb. PMID:26381580

  20. Distal Radius Radiographic Indices and Perilunate Fracture Dislocation

    PubMed Central

    Bagherifard, Abolfazl; Jafari, Davod; Keihan Shokouh, Hassan; Motavallian, Ebrahim; Najd Mazhar, Farid

    2016-01-01

    Background Distal radius radiographic indices may play a role as risk factors in pathogenesis of Kienbock’s disease, scaphoid fracture and nonunion. Perilunate fracture dislocations are devastating wrist injuries, and their relationship and distal radius indices have not been addressed in the literature. Objectives The aim of this study was to evaluate the possible role of distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt as risk factors in the perilunate fracture dislocation injury of the wrist. Patients and Methods We studied distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt in 43 patients with perilunate fracture dislocations and compared them with 44 wrists in the control group. Results The mean values of the radial height, radial inclination, ulnar variance and volar tilt were 12.74 (5 - 18), 24.20 (7 - 35), -0.73 (-5 - 4) and 12.28 (2 - 20) in the patient group. These values were 12.68 (9 - 22), 23.22 (17 - 30), -0.11 (-4 - 3) and 11.05 (-3 - 20), respectively in the control group. There was no statistically significant difference between the two groups. Conclusions This study did not show that distal radius anatomical indices including the radial height, radial inclination, ulnar variance and volar tilt influence perilunate fracture dislocation as risk factors.

  1. Implant Size Availability Affects Reproduction of Distal Femoral Anatomy.

    PubMed

    Morris, William Z; Gebhart, Jeremy J; Goldberg, Victor M; Wera, Glenn D

    2016-07-01

    A total knee arthroplasty system offers more distal femoral implant anterior-posterior (AP) sizes than its predecessor. The purpose of this study is to investigate the impact of increased size availability on an implant system's ability to reproduce the AP dimension of the native distal femur. We measured 200 cadaveric femora with the AP-sizing guides of Zimmer (Warsaw, IN) NexGen (8 sizes) and Zimmer Persona (12 sizes) total knee arthroplasty systems. We defined "size deviation" as the difference in the AP dimension between the anatomic size of the native femur and the closest implant size. We defined satisfactory reproduction of distal femoral dimensions as < 1 mm difference between the implant and native femur size. The NexGen system was associated with a mean 0.46 mm greater implant size deviation than Persona (p < 0.001). When using a 1 mm size deviation as a cutoff for satisfactory replication of the native distal femoral anatomy, 85/200 specimens (42.5%) were a poor fit by NexGen, but a satisfactory fit by Persona. Only 1/200 specimens (0.5%) was a poor fit by Persona, but a satisfactory fit by NexGen (p < 0.001). The novel knee system with 12 versus 8 sizes reproduces the AP dimension of the native distal femur more closely than its predecessor. Further study is needed to determine the clinical impact of these differences.

  2. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization

    PubMed Central

    2016-01-01

    The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth. PMID:27528796

  3. Ejecta emplacement: from distal to proximal

    NASA Astrophysics Data System (ADS)

    Artemieva, N.

    2008-09-01

    Introduction Most part of impact ejecta is deposited ballistically at some distance from a crater, defined by ejection velocity V and ejection angle α: d=v2sinα/g. In case of giant impacts, planetary curvature should be taken into account [1]. Combined with ejecta scaling [2], these relations allow to define ejecta thickness as a function of distance. Ejecta from large craters are deposited at velocity high enough to mobilize substrate material and to thicken ejecta deposits [3]. Ballistic approximation is valid for airless bodies (if impact vaporization is not vast) or for proximal ejecta of large impact craters, where ejecta mass per unit area is substantially greater than the mass of involved vapor/atmosphere (M-ratio). Deposition of distal ejecta, in which ejecta mass is negligible compared to the atmosphere, may be also treated in a simplified manner, i.e. as 1) passive motion of ejected particles within an impact plume and 2) later, as sedimentation of particles in undisturbed atmosphere (equilibrium between gravity and drag). In all intermediate M-ratio values, impact ejecta move like a surge, i.e. dilute suspension current in which particles are carried in turbulent flows under the influence of gravity. Surges are well-known for near-surface explosive tests, described in detail for volcanic explosions (Plinian column collapse, phreato-magmatic eruption, lateral blast), and found in ejecta from the Chicxulub [4] and the Ries [5]. Important aspects of surge transport include its ability to deposit ejecta over a larger area than that typical of continuous ballistic ejecta and to create multiple ejecta layers. Numerical model Two-phase hydrodynamics. Surges should be modeled in the frame of two-phase hydrodynamics, i.e. interaction between solid/molten particles and atmospheric gas/impact vapor should be taken into account. There are two techniques of solving equations for dust particle motion in a gas flow. The first one describes solid/molten particles as a

  4. The Hayabusa Curation Facility at Johnson Space Center

    NASA Technical Reports Server (NTRS)

    Zolensky, M.; Bastien, R.; McCann, B.; Frank, D.; Gonzalez, C.; Rodriguez, M.

    2013-01-01

    The Japan Aerospace Exploration Agency (JAXA) Hayabusa spacecraft made contact with the asteroid 25143 Itokawa and collected regolith dust from Muses Sea region of smooth terrain [1]. The spacecraft returned to Earth with more than 10,000 grains ranging in size from just over 300 µm to less than 10 µm [2, 3]. These grains represent the only collection of material returned from an asteroid by a spacecraft. As part of the joint agreement between JAXA and NASA for the mission, 10% of the Hayabusa grains are being transferred to NASA for parallel curation and allocation. In order to properly receive process and curate these samples, a new curation facility was established at Johnson Space Center (JSC). Since the Hayabusa samples within the JAXA curation facility have been stored free from exposure to terrestrial atmosphere and contamination [4], one of the goals of the new NASA curation facility was to continue this treatment. An existing lab space at JSC was transformed into a 120 sq.ft. ISO class 4 (equivalent to the original class 10 standard) clean room. Hayabusa samples are stored, observed, processed, and packaged for allocation inside a stainless steel glove box under dry N2. Construction of the clean laboratory was completed in 2012. Currently, 25 Itokawa particles are lodged in NASA's Hayabusa Lab. Special care has been taken during lab construction to remove or contain materials that may contribute contaminant particles in the same size range as the Hayabusa grains. Several witness plates of various materials are installed around the clean lab and within the glove box to permit characterization of local contaminants at regular intervals by SEM and mass spectrometry, and particle counts of the lab environment are frequently acquired. Of particular interest is anodized aluminum, which contains copious sub-mm grains of a multitude of different materials embedded in its upper surface. Unfortunately the use of anodized aluminum was necessary in the construction

  5. A justification for semantic training in data curation frameworks development

    NASA Astrophysics Data System (ADS)

    Ma, X.; Branch, B. D.; Wegner, K.

    2013-12-01

    In the complex data curation activities involving proper data access, data use optimization and data rescue, opportunities exist where underlying skills in semantics may play a crucial role in data curation professionals ranging from data scientists, to informaticists, to librarians. Here, We provide a conceptualization of semantics use in the education data curation framework (EDCF) [1] under development by Purdue University and endorsed by the GLOBE program [2] for further development and application. Our work shows that a comprehensive data science training includes both spatial and non-spatial data, where both categories are promoted by standard efforts of organizations such as the Open Geospatial Consortium (OGC) and the World Wide Web Consortium (W3C), as well as organizations such as the Federation of Earth Science Information Partners (ESIP) that share knowledge and propagate best practices in applications. Outside the context of EDCF, semantics training may be same critical to such data scientists, informaticists or librarians in other types of data curation activity. Past works by the authors have suggested that such data science should augment an ontological literacy where data science may become sustainable as a discipline. As more datasets are being published as open data [3] and made linked to each other, i.e., in the Resource Description Framework (RDF) format, or at least their metadata are being published in such a way, vocabularies and ontologies of various domains are being created and used in the data management, such as the AGROVOC [4] for agriculture and the GCMD keywords [5] and CLEAN vocabulary [6] for climate sciences. The new generation of data scientist should be aware of those technologies and receive training where appropriate to incorporate those technologies into their reforming daily works. References [1] Branch, B.D., Fosmire, M., 2012. The role of interdisciplinary GIS and data curation librarians in enhancing authentic scientific

  6. Septic arthritis of the distal interphalangeal joint in 12 horses.

    PubMed

    Honnas, C M; Welch, R D; Ford, T S; Vacek, J R; Watkins, J P

    1992-01-01

    The medical records of 12 horses with septic arthritis of a distal interphalangeal joint were reviewed to determine clinical features and response to treatment. Sepsis was caused by trauma or an injection that resulted in an open or contaminated distal interphalangeal joint. All horses were severely lame. Treatment included broad-spectrum parenterally administered antimicrobial drugs (ten horses), percutaneous through-and-through joint lavage (eight horses), indwelling drains (three horses), immobilization of the limb in a cast (three horses), intraarticular injection of sodium hyaluronate (one horse), intraarticular injection of antimicrobial drugs (five horses), curettage of the distal phalanx (one horse), and cancellous bone grafting to promote fusion (one horse). Five horses were euthanatized. Ankylosis of the affected joint developed in five horses, four of which are pasture sound. Two horses treated medically are sound although one underwent subsequent palmar digital neurectomy for treatment of navicular syndrome.

  7. Molar distalization with the assistance of Temporary Anchorage Devices.

    PubMed

    Palencar, Adrian J

    2015-01-01

    This article describes efficient techniques for distalization of maxillary and mandibular molars with the assistance of Temporary Anchorage Devices (TADs). There are numerous occasions where the distalization of molars is required in lieu of the odontectomy of bicuspids. In the past, extra-oral force has been used, (i.e. Cervical or Combination Head Gear, or intra-oral force, i.e. Posterior Sagittal Appliance, Modified Greenfield Appliance, Williams DMJ 20001, CD Distalizer, Magill Sagittal, Pendulum Appliance, etc.). All the intra-oral appliances have a common denominator the orthodontic clinician has to deal with, the undesirable expression of the Third Law of Newton. The utilization of TADs allows us to circumvent this shortcoming, establishing an absolute anchorage, and thus completely negate the expression of the Third Law of Newton. PMID:25881377

  8. Reverse wedge osteotomy of the distal radius in Madelung's deformity.

    PubMed

    Mallard, F; Jeudy, J; Rabarin, F; Raimbeau, G; Fouque, P-A; Cesari, B; Bizot, P; Saint-Cast, Y

    2013-06-01

    Madelung's deformity results from a growth defect in the palmar and ulnar region of the distal radius. It presents as an excessively inclined radial joint surface, inducing "spontaneous progressive palmar subluxation of the wrist". The principle of reverse wedge osteotomy (RWO) consists in the reorientation of the radial joint surface by taking a circumferential bone wedge, the base of which is harvested from the excess of the radial and dorsal cortical bone of the distal radius, then turning it over and putting back this reverse wedge into the osteotomy so as to obtain closure on the excess and opening on the deficient cortical bone. RWO corrects the palmar subluxation of the carpus and improves distal radio-ulnar alignment. All five bilaterally operated patients were satisfied, esthetically and functionally. Its corrective power gives RWO a place apart among the surgical techniques currently available in Madelung's deformity.

  9. Dislocation of the distal phalanx epiphysis in toddlers.

    PubMed

    Waters, P M; Benson, L S

    1993-07-01

    Two cases of physeal fracture dislocation of the distal phalanx are reviewed. Each injury occurred in a toddler, was originally undiagnosed, and appeared years later as a dorsal mass in a fore-shortened digit with decreased distal interphalangeal joint motion. In each case x-ray films revealed a dislocated epiphysis, accounting for the enlarging dorsal prominence and the phalangeal growth disturbance. These cases demonstrate that dislocation of the distal phalanx epiphysis can occur with a crush injury and may be difficult to detect before development of the ossification center. Careful physical examination and a high index of suspicion will increase the likelihood of early diagnosis. Early open reduction may prevent the late complications of deformity and stiffness. PMID:8349960

  10. Mitochondrial dysfunction in distal axons contribute to HIV sensory neuropathy

    PubMed Central

    Lehmann, Helmar C.; Chen, Weiran; Borzan, Jasenka; Mankowski, Joseph; Höke, Ahmet

    2010-01-01

    Objective Accumulation of mitochondrial DNA (mtDNA) damage has been associated with aging and abnormal oxidative metabolism. We hypothesized that in human immunodeficiency virus associated sensory neuropathy (HIV-SN), damaged mtDNA accumulates in distal nerve segments and that a spatial pattern of mitochondrial dysfunction contribute to the distal degeneration of sensory nerve fibers. Methods We measured levels of common deletion mutations in mtDNA and expression levels of mitochondrial respiratory chain complexes of matched proximal and distal nerve specimens from patients with and without HIV-SN. In mitochondria isolated from peripheral nerves of simian immunodeficiency virus (SIV) infected macaques, a model of HIV-SN, we measured mitochondrial function and generation of reactive oxygen species. Results We identified increased levels of mtDNA common deletion mutation in post-mortem sural nerves of patients with HIV-SN as compared to uninfected patients or HIV patients without sensory neuropathy. Furthermore, we found that common deletion mutation in mtDNA was more prevalent in distal sural nerves compared to dorsal root ganglia. In a primate model of HIV-SN, freshly isolated mitochondria from sural nerves of macaques infected with a neurovirulent strain of SIV showed impaired mitochondrial function compared to mitochondria from proximal nerve segments. Interpretation Our findings suggest that mtDNA damage accumulates in distal mitochondria of long axons, especially in patients with HIV-SN, and that this may lead to reduced mitochondrial function in distal nerves relative to proximal segments. Although our findings are based on HIV-SN, if confirmed in other neuropathies, these observations could explain the length-dependent nature of most axonal peripheral neuropathies. PMID:21280080

  11. Reverse telescoping in distal skarns at Campiglia Marittima (Italy)

    NASA Astrophysics Data System (ADS)

    Vezzoni, Simone; Dini, Andrea; Rocchi, Sergio

    2014-05-01

    Skarn deposits commonly results from the metasomatic alteration of a rock, usually carbonate-rich, by infiltration of hydrothermal fluids. Most carbonate-hosted skarn deposits show a direct spatial relationship with magmatic intrusions and an intimate relationship with porphyry copper deposits. Their primary mineralogical and geochemical features indicate metasomatism by high-temperature magmatic fluids. Conversely, many distal Pb-Zn-Ag skarns pose an important challenge because there is no apparent association with magmatic intrusions and external, meteoric and/or basinal fluids should become increasingly dominant with increasing distance from the igneous source. Nevertheless recent investigation of distal skarn deposits indicates that ore-forming fluids match the composition of proximal magmatic fluids in granitoid-related mineral deposits. Besides that metal producer (Pb, Zn, Ag, Cu, Fe, W, Sn), skarn deposits can be key to understanding fluid dynamics at the periphery of magmatic-hydrothermal systems, unraveling pathways to hidden ore deposits (e.g porphyry copper). In this scenario, research on distal skarns opens new perspectives for deep mineral exploration and/or modeling of intrusion centered geothermal systems, because they should represent the outer limit of the hydrothermal system dominated by magmatic aqueous fluids. Here we present exceptional evidences from a distal Pb-Zn-Ag skarn deposit in Campiglia Marittima, Italy, where the magma, after having released the metasomatic fluids, fled up chasing its own fluid stream and invading large pockets of the newly formed skarn bodies at shallower level. Detailed underground mapping and petrologic data indicate that, after the formation of a typical distal Pb-Zn-Ag skarn, the intrusion of the parent magma produced prograde reactions in the skarn silicates, mobilization of the Pb-Zn-Ag sulfides and precipitation of a new Cu-Fe sulfide assemblage. This is a very unusual case of reverse telescoping during which

  12. Distal protection devices during percutaneous coronary and carotid interventions.

    PubMed

    Fasseas, Panayotis; Orford, James L; Denktas, Ali E; Berger, Peter B

    2001-01-01

    Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWiretrade mark is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilitate entrapment of particles and safe removal. The Parodi Anti-Emboli Systemtrade mark is an example of a catheter occlusion device that establishes protection by reversing blood flow in the target vessel.

  13. Galeazzi fracture with volar dislocation of the distal radioulnar joint.

    PubMed

    Kim, Suezie; Ward, James P; Rettig, Michael E

    2012-11-01

    Galeazzi fracture dislocations are fractures of the distal one-third of the radial diaphysis with traumatic disruption of the distal radioulnar joint (DRUJ). This injury results in subluxation or dislocation of the ulnar head. We present a case of a Galeazzi fracture with a volar dislocation of the DRUJ. Open reduction of the DRUJ with Kirschner wire fixation in pronation was necessary to reduce the joint and maintain anatomic alignment. Repair of the triangular fibrocartilage complex was also necessary to maintain stability of the DRUJ.

  14. Future treatment and research directions in distal radius fracture.

    PubMed

    Jupiter, Jesse

    2012-05-01

    Whether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury.

  15. Modified distal shoe appliance--fabrication and clinical performance.

    PubMed

    Gujjar, Kumar Raghav; Indushekar, K R; Amith, H V; Sharma, Shefali Li

    2012-01-01

    When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

  16. Reducing Organic Contamination in NASA JSC Astromaterial Curation Facility

    NASA Technical Reports Server (NTRS)

    Calaway, M. J.; Allen, C. C.; Allton, J. H.

    2013-01-01

    Future robotic and human spaceflight missions to the Moon, Mars, asteroids and comets will require handling and storing astromaterial samples with minimal inorganic and organic contamination to preserve the scientific integrity of each sample. Much was learned from the rigorous attempts to minimize and monitor organic contamination during Apollo, but it was not adequate for current analytical requirements; thus [1]. OSIRIS-REx, Hayabusa-2, and future Mars sample return will require better protocols for reducing organic contamination. Future isolation con-tainment systems for astromaterials, possibly nitrogen enriched gloveboxes, must be able to reduce organic and inorganic cross-contamination. In 2012, a baseline study established the current state of organic cleanliness in gloveboxes used by NASA JSC astromaterials curation labs that could be used as a benchmark for future mission designs [2, 3]. After standard ultra-pure water (UPW) cleaning, the majority of organic contaminates found were hydrocarbons, plasticizers, silicones, and solvents. Hydro-carbons loads (> C7) ranged from 1.9 to 11.8 ng/cm2 for TD-GC-MS wafer exposure analyses and 5.0 to 19.5 ng/L for TD-GC-MS adsorbent tube exposure. Plasticizers included < 0.6 ng/cm2 of DBP, DEP, TXIB, and DIBP. Silicones included < 0.5 ng/cm2 of cyclo(Me2SiO)x (x = 6, 8, 9, 10) and siloxane. Solvents included < 1.0 ng/cm2 of 2-cyclohexen-1-one, 3,5,5-trimethyl- (Isopho-rone), N-formylpiperidine, and 2-(2-butoxyethoxy) ethanol. In addition, DBF, rubber/polymer additive was found at < 0.2 ng/cm2 and caprolactam, nylon-6 at < 0.6 ng/cm2. Reducing Organics: The Apollo program was the last sam-ple return mission to place high-level organic requirements and biological containment protocols on a curation facility. The high vacuum complex F-201 glovebox in the Lunar Receiving Labora-tory used ethyl alcohol (190 proof), 3:1 benzene/methanol (nano grade solution), and heat sterilization at 130degC for 48 hours to reduce organic

  17. Use of Semantic Technology to Create Curated Data Albums

    NASA Technical Reports Server (NTRS)

    Ramachandran, Rahul; Kulkarni, Ajinkya; Li, Xiang; Sainju, Roshan; Bakare, Rohan; Basyal, Sabin; Fox, Peter (Editor); Norack, Tom (Editor)

    2014-01-01

    One of the continuing challenges in any Earth science investigation is the discovery and access of useful science content from the increasingly large volumes of Earth science data and related information available online. Current Earth science data systems are designed with the assumption that researchers access data primarily by instrument or geophysical parameter. Those who know exactly the data sets they need can obtain the specific files using these systems. However, in cases where researchers are interested in studying an event of research interest, they must manually assemble a variety of relevant data sets by searching the different distributed data systems. Consequently, there is a need to design and build specialized search and discovery tools in Earth science that can filter through large volumes of distributed online data and information and only aggregate the relevant resources needed to support climatology and case studies. This paper presents a specialized search and discovery tool that automatically creates curated Data Albums. The tool was designed to enable key elements of the search process such as dynamic interaction and sense-making. The tool supports dynamic interaction via different modes of interactivity and visual presentation of information. The compilation of information and data into a Data Album is analogous to a shoebox within the sense-making framework. This tool automates most of the tedious information/data gathering tasks for researchers. Data curation by the tool is achieved via an ontology-based, relevancy ranking algorithm that filters out non-relevant information and data. The curation enables better search results as compared to the simple keyword searches provided by existing data systems in Earth science.

  18. Use of Semantic Technology to Create Curated Data Albums

    NASA Technical Reports Server (NTRS)

    Ramachandran, Rahul; Kulkarni, Ajinkya; Li, Xiang; Sainju, Roshan; Bakare, Rohan; Basyal, Sabin

    2014-01-01

    One of the continuing challenges in any Earth science investigation is the discovery and access of useful science content from the increasingly large volumes of Earth science data and related information available online. Current Earth science data systems are designed with the assumption that researchers access data primarily by instrument or geophysical parameter. Those who know exactly the data sets they need can obtain the specific files using these systems. However, in cases where researchers are interested in studying an event of research interest, they must manually assemble a variety of relevant data sets by searching the different distributed data systems. Consequently, there is a need to design and build specialized search and discover tools in Earth science that can filter through large volumes of distributed online data and information and only aggregate the relevant resources needed to support climatology and case studies. This paper presents a specialized search and discovery tool that automatically creates curated Data Albums. The tool was designed to enable key elements of the search process such as dynamic interaction and sense-making. The tool supports dynamic interaction via different modes of interactivity and visual presentation of information. The compilation of information and data into a Data Album is analogous to a shoebox within the sense-making framework. This tool automates most of the tedious information/data gathering tasks for researchers. Data curation by the tool is achieved via an ontology-based, relevancy ranking algorithm that filters out nonrelevant information and data. The curation enables better search results as compared to the simple keyword searches provided by existing data systems in Earth science.

  19. Curatable Named-Entity Recognition Using Semantic Relations.

    PubMed

    Hsu, Yi-Yu; Kao, Hung-Yu

    2015-01-01

    Named-entity recognition (NER) plays an important role in the development of biomedical databases. However, the existing NER tools produce multifarious named-entities which may result in both curatable and non-curatable markers. To facilitate biocuration with a straightforward approach, classifying curatable named-entities is helpful with regard to accelerating the biocuration workflow. Co-occurrence Interaction Nexus with Named-entity Recognition (CoINNER) is a web-based tool that allows users to identify genes, chemicals, diseases, and action term mentions in the Comparative Toxicogenomic Database (CTD). To further discover interactions, CoINNER uses multiple advanced algorithms to recognize the mentions in the BioCreative IV CTD Track. CoINNER is developed based on a prototype system that annotated gene, chemical, and disease mentions in PubMed abstracts at BioCreative 2012 Track I (literature triage). We extended our previous system in developing CoINNER. The pre-tagging results of CoINNER were developed based on the state-of-the-art named entity recognition tools in BioCreative III. Next, a method based on conditional random fields (CRFs) is proposed to predict chemical and disease mentions in the articles. Finally, action term mentions were collected by latent Dirichlet allocation (LDA). At the BioCreative IV CTD Track, the best F-measures reached for gene/protein, chemical/drug and disease NER were 54 percent while CoINNER achieved a 61.5 percent F-measure. System URL: http://ikmbio.csie.ncku.edu.tw/coinner/ introduction.htm. PMID:26357317

  20. Advanced Curation of Current and Future Extraterrestrial Samples

    NASA Technical Reports Server (NTRS)

    Allen, Carlton C.

    2013-01-01

    Curation of extraterrestrial samples is the critical interface between sample return missions and the international research community. Curation includes documentation, preservation, preparation, and distribution of samples. The current collections of extraterrestrial samples include: Lunar rocks / soils collected by the Apollo astronauts Meteorites, including samples of asteroids, the Moon, and Mars "Cosmic dust" (asteroid and comet particles) collected by high-altitude aircraft Solar wind atoms collected by the Genesis spacecraft Comet particles collected by the Stardust spacecraft Interstellar dust collected by the Stardust spacecraft Asteroid particles collected by the Hayabusa spacecraft These samples were formed in environments strikingly different from that on Earth. Terrestrial contamination can destroy much of the scientific significance of many extraterrestrial materials. In order to preserve the research value of these precious samples, contamination must be minimized, understood, and documented. In addition the samples must be preserved - as far as possible - from physical and chemical alteration. In 2011 NASA selected the OSIRIS-REx mission, designed to return samples from the primitive asteroid 1999 RQ36 (Bennu). JAXA will sample C-class asteroid 1999 JU3 with the Hayabusa-2 mission. ESA is considering the near-Earth asteroid sample return mission Marco Polo-R. The Decadal Survey listed the first lander in a Mars sample return campaign as its highest priority flagship-class mission, with sample return from the South Pole-Aitken basin and the surface of a comet among additional top priorities. The latest NASA budget proposal includes a mission to capture a 5-10 m asteroid and return it to the vicinity of the Moon as a target for future sampling. Samples, tools, containers, and contamination witness materials from any of these missions carry unique requirements for acquisition and curation. Some of these requirements represent significant advances over

  1. Curating NASA's Astromaterials Collections: Past, Present, and Future

    NASA Technical Reports Server (NTRS)

    Zeigler, Ryan

    2015-01-01

    Planning for the curation of samples from future sample return missions must begin during the initial planning stages of a mission. Waiting until the samples have been returned to Earth, or even when you begin to physically build the spacecraft is too late. A lack of proper planning could lead to irreversible contamination of the samples, which in turn would compromise the scientific integrity of the mission. For example, even though the Apollo missions first returned samples in 1969, planning for the curation facility began in the early 1960s, and construction of the Lunar Receiving Laboratory was completed in 1967. In addition to designing the receiving facility and laboratory that the samples will be characterized and stored in, there are many aspects of contamination that must be addressed during the planning and building of the spacecraft: planetary protection (both outbound and inbound); cataloging, documenting, and preserving the materials used to build spacecraft (also known as coupons); near real-time monitoring of the environment in which the spacecraft is being built using witness plates for critical aspects of contamination (known as contamination control); and long term monitoring and preservation of the environment in which the spacecraft is being built for most aspects of potential contamination through the use of witness plates (known as contamination knowledge). The OSIRIS REx asteroid sample return mission, currently being built, is dealing with all of these aspects of contamination in order to ensure they return the best preserved sample possible. Coupons and witness plates from OSIRIS REx are currently being studied and stored (for future studies) at the Johnson Space Center. Similarly, planning for the clean room facility at Johnson Space Center to house the OSIRIS-REx samples is well advanced, and construction of the facility should begin in early 2017 (despite a nominal 2023 return date for OSIRIS-REx samples). Similar development is being

  2. Curated eutherian third party data gene data sets.

    PubMed

    Premzl, Marko

    2016-03-01

    The free available eutherian genomic sequence data sets advanced scientific field of genomics. Of note, future revisions of gene data sets were expected, due to incompleteness of public eutherian genomic sequence assemblies and potential genomic sequence errors. The eutherian comparative genomic analysis protocol was proposed as guidance in protection against potential genomic sequence errors in public eutherian genomic sequences. The protocol was applicable in updates of 7 major eutherian gene data sets, including 812 complete coding sequences deposited in European Nucleotide Archive as curated third party data gene data sets.

  3. Curated eutherian third party data gene data sets

    PubMed Central

    Premzl, Marko

    2015-01-01

    The free available eutherian genomic sequence data sets advanced scientific field of genomics. Of note, future revisions of gene data sets were expected, due to incompleteness of public eutherian genomic sequence assemblies and potential genomic sequence errors. The eutherian comparative genomic analysis protocol was proposed as guidance in protection against potential genomic sequence errors in public eutherian genomic sequences. The protocol was applicable in updates of 7 major eutherian gene data sets, including 812 complete coding sequences deposited in European Nucleotide Archive as curated third party data gene data sets. PMID:26862561

  4. Treatment of distal humerus fractures in adults: a historical perspective.

    PubMed

    Kozánek, Michal; Bartoníček, Jan; Chase, Samantha M; Jupiter, Jesse B

    2014-12-01

    Nonsurgical treatment was the mainstay of management of distal humerus fractures for centuries and nonunions and malunions were common. The 19th century featured the recognition of distinct injury patterns. With advances in radiology, anesthesia, antisepsis, and hardware technology, surgical treatment is now generally preferred, yet loss of elbow joint mobility can still be a vexing problem.

  5. Proximal versus Distal Validity Coefficients for Teacher Observational Instruments

    ERIC Educational Resources Information Center

    Marzano, Robert J.

    2014-01-01

    This study examined the use of measures of student learning computed using end-of-year assessments (distal measures) versus measures of student learning associated with a single lesson (proximal measures) as criterion scores for the validity of observations of teachers' pedagogical skills. The validity coefficients computed using distal…

  6. Sural Versus Perforator Flaps for Distal Medial Leg Wounds.

    PubMed

    Schannen, Andrew P; Truchan, Lisa; Goshima, Kaoru; Bentley, Roger; DeSilva, Gregory L

    2015-12-01

    Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. PMID:26652325

  7. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    PubMed

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery.

  8. Genetics Home Reference: CAV3-related distal myopathy

    MedlinePlus

    ... gene causes a peculiar form of distal myopathy. Neurology. 2002 Jan 22;58(2):323-5. Erratum in: Neurology 2002 Mar 12;58(5):839. Itoyoma Y [ ... 3 cause four distinct autosomal dominant muscle diseases. Neurology. 2004 Feb 24;62(4):538-43. Review. ...

  9. Ultrasound-Guided Reduction of Distal Radius Fractures

    PubMed Central

    Sabzghabaei, Anita; Shojaee, Majid; Arhami Dolatabadi, Ali; Manouchehrifar, Mohammad; Asadi, Mahdi

    2016-01-01

    Introduction: Distal radius fractures are a common traumatic injury, particularly in the elderly population. In the present study we examined the effectiveness of ultrasound guidance in the reduction of distal radius fractures in adult patients presenting to emergency department (ED). Methods: In this prospective case control study, eligible patients were adults older than 18 years who presented to the ED with distal radius fractures. 130 consecutive patient consisted of two group of Sixty-Five patients were prospectively enrolled for around 1 years. The first group underwent ultrasound-guided reduction and the second (control group) underwent blind reduction. All procedures were performed by two trained emergency residents under supervision of senior emergency physicians. Results: Baseline characteristics between two groups were similar. The rate of repeat reduction was reduced in the ultrasound group (9.2% vs 24.6%; P = .019). The post reduction radiographic indices were similar between the two groups, although the ultrasound group had improved volar tilt (mean, 7.6° vs 3.7°; P = .000). The operative rate was reduced in the ultrasound groups (10.8% vs 27.7%; P = .014). Conclusion: Ultrasound guidance is effective and recommended for routine use in the reduction of distal radius fractures. PMID:27299141

  10. Autosomal dominant distal myopathy: Linkage to chromosome 14

    SciTech Connect

    Laing, N.G.; Laing, B.A.; Wilton, S.D.; Dorosz, S.; Mastaglia, F.L.; Kakulas, B.A.; Robbins, P.; Meredith, C.; Honeyman, K.; Kozman, H.

    1995-02-01

    We have studied a family segregating a form of autosomal dominant distal myopathy (MIM 160500) and containing nine living affected individuals. The myopathy in this family is closest in clinical phenotype to that first described by Gowers in 1902. A search for linkage was conducted using microsatellite, VNTR, and RFLP markers. In total, 92 markers on all 22 autosomes were run. Positive linkage was obtained with 14 of 15 markers tested on chromosome 14, with little indication of linkage elsewhere in the genome. Maximum two-point LOD scores of 2.60 at recombination fraction .00 were obtained for the markers MYH7 and D14S64 - the family structure precludes a two-point LOD score {ge} 3. Recombinations with D14S72 and D14S49 indicate that this distal myopathy locus, MPD1, should lie between these markers. A multipoint analysis assuming 100% penetrance and using the markers D14S72, D14S50, MYH7, D14S64, D14S54, and D14S49 gave a LOD score of exactly 3 at MYH7. Analysis at a penetrance of 80% gave a LOD score of 2.8 at this marker. This probable localization of a gene for distal myopathy, MPD1, on chromosome 14 should allow other investigators studying distal myopathy families to test this region for linkage in other types of the disease, to confirm linkage or to demonstrate the likely genetic heterogeneity. 24 refs., 3 figs., 1 tab.

  11. Management of distal humeral fractures in the elderly.

    PubMed

    Strauss, Eric J; Alaia, Michael; Egol, Kenneth A

    2007-09-01

    Although relatively uncommon, fractures of the distal humerus in the elderly patient population are significant injuries of which optimal management is a subject of debate in orthopaedic literature. The combination of complex anatomy, poor bone quality and extensive comminution often seen with these fractures makes successful treatment difficult. Currently, most surgeons support surgical fixation of distal humeral fractures with the belief that restoration of the patient's native elbow joint provides the best opportunity for a good functional outcome. Others have proposed the use of total elbow arthroplasty as a primary treatment method for geriatric distal humeral fractures based on the difficulties associated with ORIF and the relatively low demands of this patient population. To date, there have been no prospective randomised trials comparing these two treatment alternatives, and a comparison of available outcome data shows good functional outcome for both forms of fracture management. With the aging of the population and an associated increase in the incidence of distal humeral fractures, the debate over the optimal treatment regime will undoubtedly continue. PMID:17723787

  12. Prediction of distal residue participation in enzyme catalysis.

    PubMed

    Brodkin, Heather R; DeLateur, Nicholas A; Somarowthu, Srinivas; Mills, Caitlyn L; Novak, Walter R; Beuning, Penny J; Ringe, Dagmar; Ondrechen, Mary Jo

    2015-05-01

    A scoring method for the prediction of catalytically important residues in enzyme structures is presented and used to examine the participation of distal residues in enzyme catalysis. Scores are based on the Partial Order Optimum Likelihood (POOL) machine learning method, using computed electrostatic properties, surface geometric features, and information obtained from the phylogenetic tree as input features. Predictions of distal residue participation in catalysis are compared with experimental kinetics data from the literature on variants of the featured enzymes; some additional kinetics measurements are reported for variants of Pseudomonas putida nitrile hydratase (ppNH) and for Escherichia coli alkaline phosphatase (AP). The multilayer active sites of P. putida nitrile hydratase and of human phosphoglucose isomerase are predicted by the POOL log ZP scores, as is the single-layer active site of P. putida ketosteroid isomerase. The log ZP score cutoff utilized here results in over-prediction of distal residue involvement in E. coli alkaline phosphatase. While fewer experimental data points are available for P. putida mandelate racemase and for human carbonic anhydrase II, the POOL log ZP scores properly predict the previously reported participation of distal residues.

  13. Non-reducible palmar dislocation of the distal radioulnar joint

    PubMed Central

    Zannou, Rupestre S.; Rezzouk, Joel; Ruijs, Aleid C.J.

    2015-01-01

    Abstract A rare case of an isolated traumatic palmar dislocation of the distal radioulnar joint is presented. Clinically, there is a loss of pronation and supination. The dislocation was treated using an open reduction, reinsertion of the capsule-ligamentous complex and temporary stabilization using K-wires. PMID:26158121

  14. Exposures of the wrist and distal radioulnar joint.

    PubMed

    Bickel, Kyle D

    2014-11-01

    This article reviews the superficial, skeletal, and ligamentous anatomy of the wrist. Standard and alternative exposures of the wrist joint and the distal radioulnar joint are discussed, emphasizing the importance of avoiding nerve injury. Standard exposure of the wrist joint is used in the treatment of carpal ligament injuries, fractures, and dislocations. Case presentations illustrate these techniques.

  15. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    PubMed

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery. PMID:27135145

  16. Haptic Distal Spatial Perception Mediated by Strings: Haptic "Looming"

    ERIC Educational Resources Information Center

    Cabe, Patrick A.

    2011-01-01

    Five experiments tested a haptic analog of optical looming, demonstrating string-mediated haptic distal spatial perception. Horizontally collinear hooks supported a weighted string held taut by a blindfolded participant's finger midway between the hooks. At the finger, the angle between string segments increased as the finger approached…

  17. The distal shoe space maintainer chairside fabrication and clinical performance.

    PubMed

    Brill, Warren A

    2002-01-01

    The chairside-fabricated distal shoe appliance, with a stainless steel crown as the retainer, is an efficacious and cost-effective appliance for guiding the unerupted permanent first molar into position after premature loss or extraction of the second primary molar. The fabrication technique is illustrated in this case report and data is presented on the success rate of the appliance.

  18. [Distalization of the upper second molar: clinical case].

    PubMed

    Castaldo, A; Blasi, S; Vettese, P

    1991-01-01

    The Authors showed a clinical case in which has been put on a distalizing system together with a palatal bar between the first upper molars, a sectional placed between the first and the second molar and a 100 g precalibrated Sentalloy coil. PMID:1784297

  19. Distal Prosodic Context Affects Word Segmentation and Lexical Processing

    ERIC Educational Resources Information Center

    Dilley, Laura C.; McAuley, J. Devin

    2008-01-01

    Three experiments investigated the role of distal (i.e., nonlocal) prosody in word segmentation and lexical processing. In Experiment 1, prosodic characteristics of the initial five syllables of eight-syllable sequences were manipulated; the final portions of these sequences were lexically ambiguous (e.g., "note bookworm", "notebook worm"). Distal…

  20. Metabolic, Behavioral and Reproductive Effects of Vertical Sleeve Gastrectomy in an Obese Rat Model of Polycystic Ovary Syndrome

    PubMed Central

    Ressler, Ilana B.; Grayson, Bernadette E.; Seeley, Randy J.

    2014-01-01

    Introduction Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. Its clinical expression is diverse, including metabolic, behavioral and reproductive effects, with many affected by obesity and decreased quality of life. Women with PCOS who have undergone surgically-induced weight loss have reported tremendous benefit, not only with weight loss, but also improvement of hyperandrogenism and menstrual cyclicity. Methods In a rat model of PCOS achieved via chronic administration of dihydrotestosterone (DHT) exposure, we investigated the ability of bariatric surgery, specifically vertical sleeve gastrectomy (VSG), to ameliorate the metabolic, behavioral and reproductive abnormalities invoked by this PCOS model. Results We found that DHT-treatment combined with exposure to a high-fat diet resulted in increased body weight and body fat, impaired fasting glucose, hirsutism, anxiety and irregular cycles. VSG resulted in reduced food intake, body weight and adiposity with improved fasting glucose and triglycerides. VSG induced lower basal corticosterone levels and attenuated stress responsivity. Once the DHT levels decreased to normal, regular estrous cyclicity was also restored. Conclusion VSG, therefore, improved PCOS manifestations in a comprehensive manner and may represent a potential therapeutic approach for specific aspects of PCOS. PMID:24408363

  1. Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: Results from a large population-based sample

    PubMed Central

    Lu, Jun; Wei, Zhen-Quan; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi

    2015-01-01

    AIM: To report the incidence and potential risk factors of small-volume chylous ascites (SVCA) following laparoscopic radical gastrectomy (LAG). METHODS: A total of 1366 consecutive gastric cancer patients who underwent LAG from January 2008 to June 2011 were enrolled in this study. We analyzed the patients based on the presence or absence of SVCA. RESULTS: SVCA was detected in 57 (4.17%) patients, as determined by the small-volume drainage (range, 30-100 mL/24 h) of triglyceride-rich fluid. Both univariate and multivariate analyses revealed that the total number of resected lymph nodes (LNs), No. 8 or No. 9 LN metastasis and N stage were independent risk factors for SVCA following LAG (P < 0.05). Regarding hospital stay, there was a significant difference between the groups with and without SVCA (P < 0.001). The 3-year disease-free and overall survival rates of the patients with SVCA were 47.4% and 56.1%, respectively, which were similar to those of the patients without SVCA (P > 0.05). CONCLUSION: SVCA following LAG developed significantly more frequently in the patients with ≥ 32 harvested LNs, ≥ 3 metastatic LNs, or No. 8 or No. 9 LN metastasis. SVCA, which was successfully treated with conservative management, was associated with a prolonged hospital stay but was not associated with the prognosis. PMID:25741151

  2. Vertical sleeve gastrectomy reduces hepatic steatosis while increasing serum bile acids in a weight-loss-independent manner

    PubMed Central

    Myronovych, Andriy; Kirby, Michelle; Ryan, Karen K.; Zhang, Wujuan; Jha, Pinky; Setchell, Kenneth DR; Dexheimer, Phillip J; Aronow, Bruce; Seeley, Randy J; Kohli, Rohit

    2013-01-01

    Objective Our objective was to investigate the role of bile acids in hepatic steatosis reduction after vertical sleeve gastrectomy (VSG). Design and Methods High fat diet (HFD) induced obese C57Bl/6 mice were randomized to: VSG, Sham operation (Sham), Sham operation with pair feeding to VSG (Sham-PF), or non-surgical controls (Naïve). All mice were on HFD until sacrifice. Mice were observed post-surgery and data for body weight, body composition, metabolic parameters, serum bile acid level and composition were collected. Further hepatic gene expression by RNAseq and RT-PCR analysis was assessed. Results VSG and Sham-PF mice lost equal weight post-surgery while VSG mice had the lowest hepatic triglyceride content at sacrifice. The VSG mice had elevated serum bile acid levels that positively correlated with maximal weight loss. Serum bile composition in the VSG group had increased cholic and tauroursodeoxycholic acid. These bile acid composition changes in VSG mice explained observed downregulation of hepatic lipogenic and bile acid synthetic genes. Conclusion VSG in obese mice results in greater hepatic steatosis reduction than seen with caloric restriction alone. VSG surgery increases serum bile acids that correlate with weight lost post-surgery and changes serum bile composition that could explain suppression of hepatic genes responsible for lipogenesis. PMID:23804416

  3. Percutaneous transhepatic duodenostomy for a gastrectomy case with CT guidance and real-time visualization by an ultrasound and endoscopy.

    PubMed

    Moriwaki, Yoshihiro; Otani, Jun; Sawada, Yoshiyuki; Okuda, Junzo; Niwano, Toshiyuki; Ntta, Tachiko; Ohshima, Chiaki

    2015-09-01

    After gastrectomy, the remnant stomach, a small stomach behind the lateral segment of the liver, is thought to be a relative contraindication to receiving a percutaneous endoscopy-guided gastrostomy (PEG). We successfully performed a percutaneous duodenostomy in a case with remnant stomach. We used a transhepatic pull method with computed tomography (CT) guidance and real-time visualization by using ultrasound (US) and an endoscopy. The procedure was as follows: 1. Full stretching of the remnant stomach; 2. Insertion of a fine injection needle into the duodenal lumen through the lateral segment of the liver without an intrahepatic vascular and biliary injury using real-time visualization through US; 3. Confirmation of the location of the fine needle using abdominal CT, which showed the fine needle penetrating through the lateral segment and the duodenal lumen; 4. Insertion of the thick needle of the PEG kit just laterally of the fine needle; 5. Confirmation of the location of the thick needle using a repeated CT; 6. Endoscopic confirmation of the location of the two needles; 7. Changing the direction of the thick needle using guidance with endoscopy, inserting the thick needle into the duodenal lumen, and removing the fine needle; 8. Insertion of the guide wire through the thick needle; and 9. Placement of the PEG tube using the pull method. Using a real-time US scan, we detected the puncture of the anterior wall of the duodenum or stomach and avoided intrahepatic major vascular and biliary injuries.

  4. Prevalence of Hypoglycemic Symptoms after Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy and Associated Risk Factors

    PubMed Central

    Lee, Clare J.; Clark, Jeanne M.; Schweitzer, Michael; Magnuson, Thomas; Steele, Kimberley; Koerner, Olivia; Brown, Todd T.

    2015-01-01

    Objective To determine the prevalence of and risk factors for postprandial hypoglycemic symptoms among bariatric surgery patients. Design and Methods A questionnaire including the Edinburgh hypoglycemia scale was mailed to patients who underwent either Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG) at a single center. Based on the questionnaire, we categorized the patients as having high or low suspicion for post-surgical, postprandial hypoglycemic symptoms. Results Of the 1119 patients with valid addresses, 40.2% (N=450) responded. Among the respondents, 34.2% had a high suspicion for symptoms of post-bariatric surgery hypoglycemia. In multivariate analyses, in addition to female sex (p=0.001), RYGB (p=0.004), longer time since surgery (p=0.013), lack of diabetes (p=0.040), the high suspicion group was more likely to report preoperative symptoms of hypoglycemia (p<0.001), compared to the low suspicion group. Similar results were observed when the high suspicion group was restricted to those requiring assistance from others, syncope, seizure with severe symptoms or medically confirmed hypoglycemia (N=52). Conclusion One third of RYGB or VSG reported postprandial symptoms concerning for post-surgical hypoglycemia, which was related to the presence of pre-operative hypoglycemic symptoms. Pre-operative screening for hypoglycemic symptoms may identify a group of patients at increased risk of post-bariatric surgery hypoglycemia. PMID:25866150

  5. Is Gastrectomy-Induced High Turnover of Bone with Hyperosteoidosis and Increase of Mineralization a Typical Osteomalacia?

    PubMed Central

    Ueyama, Takashi; Yamamoto, Yuta; Ueda, Kazuki; Yajima, Aiji; Maeda, Yoshimasa; Yamashita, Yasunobu; Ito, Takao; Tsuruo, Yoshihiro; Ichinose, Masao

    2013-01-01

    Gastrectomy (GX) is thought to result in osteomalacia due to deficiencies in Vitamin D and Ca. Using a GX rat model, we showed that GX induced high turnover of bone with hyperosteoidosis, prominent increase of mineralization and increased mRNA expression of both osteoclast-derived tartrate-resistant acid phosphatase 5b and osteocalcin. The increased 1, 25(OH)2D3 level and unchanged PTH and calcitonin levels suggested that conventional bone and Ca metabolic pathways were not involved or changed in compensation. Thus, GX-induced bone pathology was different from a typical osteomalacia. Gene expression profiles through microarray analysis and data mining using Ingenuity Pathway Analysis indicated that 612 genes were up-regulated and 1,097 genes were down-regulated in the GX bone. These genes were related functionally to connective tissue development, skeletal and muscular system development and function, Ca signaling and the role of osteoblasts, osteoclasts and chondrocytes. Network analysis indicated 9 genes (Aldehyde dehydrogenase 1 family, member A1; Aquaporin 9; Interleukin 1 receptor accessory protein; Very low density lipoprotein receptor; Periostin, osteoblast specific factor; Aggrecan; Gremlin 1; Angiopoietin-like 4; Wingless-type MMTV integration site family, member 10B) were hubs connected with tissue development and immunological diseases. These results suggest that chronic systemic inflammation might underlie the GX-induced pathological changes in bone. PMID:23776526

  6. Determinants of Secondary Hyperparathyroidism in Bariatric Patients after Roux-en-Y Gastric Bypass or Sleeve Gastrectomy: A Pilot Study

    PubMed Central

    Alexandrou, Andreas; Tsoka, Evangelia; Armeni, Eleni; Rizos, Demetrios; Diamantis, Theodoros; Augoulea, Areti; Panoulis, Constantinos; Liakakos, Theodoros; Lambrinoudaki, Irene

    2015-01-01

    Objective. Nutritional deficiencies are common after bariatric surgery. We aimed to assess the prevalence and possible predictors of secondary hyperparathyroidism (SHPT) in bariatric patients. Methods. A total of 95 patients who had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were assessed after a median of 3 years after surgery. Anthropometric/demographic and weight-loss parameters were compared according to the presence of SHPT, independently for men/premenopausal women and postmenopausal women. Results. SHPT was highly prevalent (men/premenopausal women, 52.1%; postmenopausal women, 31.9%). Among men/premenopausal women, multivariate analysis indicated that SHPT was predicted by (a) 25-hydroxyvitamin D levels (Exp(B) = 0.869, P-value = 0.037), independently of age, sex, smoking; (b) calcium (Exp(B) = 0.159, P-value = 0.033) and smoking, independently of age and sex; (c) magnesium (Exp(B) = 0.026, P-value = 0.046) and smoking, independently of age and sex. Among postmenopausal women, SHPT was predicted by menopausal age independently of age, smoking, and levels of 25-hydroxyvitamin D or calcium. The development of SHPT was not associated with the type of surgery. Conclusions. RYGB and SG exhibited similar effects regarding the regulation of the hypothalamus-pituitary-parathyroid axis after surgery. Vitamin D status and menopausal age appear to determine SHPT on the long term. SHPT should be sought and vigorously treated with calcium and vitamin D supplementation. PMID:25949239

  7. A rare cause of bleeding after laparoscopic sleeve gastrectomy : pseudo-aneurysm of the gastro-omental artery.

    PubMed

    Mege, D; Louis, G; Berthet, B

    2013-01-01

    A serious complication of laparoscopic sleeve gastrectomy (LSG) is bleeding that is primarily located along the staples lines. Bleeding may be due to several causes, including hematomas, trocar sites, or visceral pseudo-aneurysms. We reported here a case of bleeding related to a pseudo-aneurysm of the gastro-omental artery. An LSG was performed on a 43-year-old woman (BMI = 46 kg/m2) without apparent surgical complications. Fifteen days later, she was admitted to the emergency department for hematemesis and symptoms of hemorrhagic shock. Abdominal computed tomography angiography revealed blood in the stomach, without a digestive leak, and active bleeding from a pseudo-aneurysm of the gastro-omental artery. An arterial embolisation was performed with the sandwich technique and angiographic guide wires and the placement of several detachable coils. The patient was discharged two days later. We demonstrated for the first time that post-LSG bleeding may involve a pseudo-aneurysm of the gastro-omental artery.

  8. RiceWiki: a wiki-based database for community curation of rice genes.

    PubMed

    Zhang, Zhang; Sang, Jian; Ma, Lina; Wu, Gang; Wu, Hao; Huang, Dawei; Zou, Dong; Liu, Siqi; Li, Ang; Hao, Lili; Tian, Ming; Xu, Chao; Wang, Xumin; Wu, Jiayan; Xiao, Jingfa; Dai, Lin; Chen, Ling-Ling; Hu, Songnian; Yu, Jun

    2014-01-01

    Rice is the most important staple food for a large part of the world's human population and also a key model organism for biological studies of crops as well as other related plants. Here we present RiceWiki (http://ricewiki.big.ac.cn), a wiki-based, publicly editable and open-content platform for community curation of rice genes. Most existing related biological databases are based on expert curation; with the exponentially exploding volume of rice knowledge and other relevant data, however, expert curation becomes increasingly laborious and time-consuming to keep knowledge up-to-date, accurate and comprehensive, struggling with the flood of data and requiring a large number of people getting involved in rice knowledge curation. Unlike extant relevant databases, RiceWiki features harnessing collective intelligence in community curation of rice genes, quantifying users' contributions in each curated gene and providing explicit authorship for each contributor in any given gene, with the aim to exploit the full potential of the scientific community for rice knowledge curation. Based on community curation, RiceWiki bears the potential to make it possible to build a rice encyclopedia by and for the scientific community that harnesses community intelligence for collaborative knowledge curation, covers all aspects of biological knowledge and keeps evolving with novel knowledge. PMID:24136999

  9. Curating NASA's future extraterrestrial sample collections: How do we achieve maximum proficiency?

    NASA Astrophysics Data System (ADS)

    McCubbin, Francis; Evans, Cynthia; Allton, Judith; Fries, Marc; Righter, Kevin; Zolensky, Michael; Zeigler, Ryan

    2016-07-01

    Introduction: The Astromaterials Acquisition and Curation Office (henceforth referred to herein as NASA Curation Office) at NASA Johnson Space Center (JSC) is responsible for curating all of NASA's extraterrestrial samples. Under the governing document, NASA Policy Directive (NPD) 7100.10E "Curation of Extraterrestrial Materials", JSC is charged with "The curation of all extraterrestrial material under NASA control, including future NASA missions." The Directive goes on to define Curation as including "…documentation, preservation, preparation, and distribution of samples for research, education, and public outreach." Here we describe some of the ongoing efforts to ensure that the future activities of the NASA Curation Office are working to-wards a state of maximum proficiency. Founding Principle: Curatorial activities began at JSC (Manned Spacecraft Center before 1973) as soon as design and construction planning for the Lunar Receiving Laboratory (LRL) began in 1964 [1], not with the return of the Apollo samples in 1969, nor with the completion of the LRL in 1967. This practice has since proven that curation begins as soon as a sample return mission is conceived, and this founding principle continues to return dividends today [e.g., 2]. The Next Decade: Part of the curation process is planning for the future, and we refer to these planning efforts as "advanced curation" [3]. Advanced Curation is tasked with developing procedures, technology, and data sets necessary for curating new types of collections as envisioned by NASA exploration goals. We are (and have been) planning for future curation, including cold curation, extended curation of ices and volatiles, curation of samples with special chemical considerations such as perchlorate-rich samples, curation of organically- and biologically-sensitive samples, and the use of minimally invasive analytical techniques (e.g., micro-CT, [4]) to characterize samples. These efforts will be useful for Mars Sample Return

  10. Distal Radius Isoelastic Resurfacing Prosthesis: A Preliminary Report

    PubMed Central

    Ichihara, Satoshi; Díaz, Juan José Hidalgo; Peterson, Brett; Facca, Sybille; Bodin, Frédéric; Liverneaux, Philippe

    2015-01-01

    Background Here we present a preliminary case series of unicompartmental isoelastic resurfacing prosthesis of the distal radius to treat comminuted articular fractures of osteoporotic elderly patients. Materials and Methods Our study included 12 patients, mean age 76 years, who presented with comminuted osteoporotic distal radius fracture. Because of the severity of injury and poor bone quality; osteosynthesis was not deemed to be a good option. Description of Technique The surgery was performed through a dorsal approach. The subchondral bone of the entire distal radial articular was excised and a unicompartmental prosthesis was applied. Results At an average follow-up of 32 months, the pain was 2.8/10, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) 37.4/100, grip strength in neutral 49.9%, in supination 59.0%, and in pronation 56.2% of the contralateral normal side. The wrist ranges of motion in flexion and extension were 56.1% and 79.3%, in supination and pronation 87.7% and 91.0% of the contralateral normal side. Two patients experienced a complex regional pain syndrome (CRPS) type II; these resolved spontaneously. One patient experienced distal radioulnar joint (DRUJ) stiffness, which improved after an ulna head resection. Finally, one patient required revision surgery after a secondary traumatic fracture. Radiographically; the average volar tilt was 9.8°; the average of radial inclination was 11.6°. Conclusion The concept of a unicompartmental isoelastic resurfacing prosthesis offers a promising option for the treatment of comminuted, osteoporotic distal radius articular fractures of elderly patients. Level of Evidence IV PMID:26261738

  11. Distal Oblique Bundle Reinforcement for Treatment of DRUJ Instability

    PubMed Central

    Brink, Peter R. G.; Hannemann, Pascal F. W.

    2015-01-01

    Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ) is diagnosed clinically, based on the patient's complaints and the finding of abnormal laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or treated and there are no signs of osteoarthritis, stabilization of the DRUJ may offer relief. To this end, several different techniques have been investigated over the past 90 years. Materials and Methods In this article we outline the procedure for a new technique using a tendon graft to reinforce the distal edge of the interosseous membrane. Description of Technique A percutaneous technique is used to harvest the palmaris longus tendon and to create a tunnel, just proximal to the sigmoid notch, through the ulna and radius in an oblique direction. By overdrilling the radial cortex, the knotted tendon can be pulled through the radius and ulna and the knot blocked at the second radial cortex, creating a strong connection between the radius and ulna at the site of the distal oblique bundle (DOB). The tendon is fixed in the ulna with a small interference screw in full supination, preventing subluxation of the ulna out of the sigmoid notch during rotation. Results Fourteen patients were treated with this novel technique between 2011 and October 2013. The QuickDASH score at 25 months postoperatively (range 16–38 months) showed an improvement of 32 points. Similarly, an improvement of 33 points (67–34 months) was found on the PRWHE. Only one recurrence of chronic, dynamic bidirectional instability in the DRUJ was observed. Conclusion This simple percutaneous tenodesis technique between radius and ulna at the position of the distal edge of the interosseous membrane shows promise in terms of both restoring stability and relieving complaints related to chronic subluxation in the DRUJ. PMID:26261750

  12. On Curating Multimodal Sensory Data for Health and Wellness Platforms.

    PubMed

    Amin, Muhammad Bilal; Banos, Oresti; Khan, Wajahat Ali; Muhammad Bilal, Hafiz Syed; Gong, Jinhyuk; Bui, Dinh-Mao; Cho, Soung Ho; Hussain, Shujaat; Ali, Taqdir; Akhtar, Usman; Chung, Tae Choong; Lee, Sungyoung

    2016-01-01

    In recent years, the focus of healthcare and wellness technologies has shown a significant shift towards personal vital signs devices. The technology has evolved from smartphone-based wellness applications to fitness bands and smartwatches. The novelty of these devices is the accumulation of activity data as their users go about their daily life routine. However, these implementations are device specific and lack the ability to incorporate multimodal data sources. Data accumulated in their usage does not offer rich contextual information that is adequate for providing a holistic view of a user's lifelog. As a result, making decisions and generating recommendations based on this data are single dimensional. In this paper, we present our Data Curation Framework (DCF) which is device independent and accumulates a user's sensory data from multimodal data sources in real time. DCF curates the context of this accumulated data over the user's lifelog. DCF provides rule-based anomaly detection over this context-rich lifelog in real time. To provide computation and persistence over the large volume of sensory data, DCF utilizes the distributed and ubiquitous environment of the cloud platform. DCF has been evaluated for its performance, correctness, ability to detect complex anomalies, and management support for a large volume of sensory data. PMID:27355955

  13. On Curating Multimodal Sensory Data for Health and Wellness Platforms

    PubMed Central

    Amin, Muhammad Bilal; Banos, Oresti; Khan, Wajahat Ali; Muhammad Bilal, Hafiz Syed; Gong, Jinhyuk; Bui, Dinh-Mao; Cho, Soung Ho; Hussain, Shujaat; Ali, Taqdir; Akhtar, Usman; Chung, Tae Choong; Lee, Sungyoung

    2016-01-01

    In recent years, the focus of healthcare and wellness technologies has shown a significant shift towards personal vital signs devices. The technology has evolved from smartphone-based wellness applications to fitness bands and smartwatches. The novelty of these devices is the accumulation of activity data as their users go about their daily life routine. However, these implementations are device specific and lack the ability to incorporate multimodal data sources. Data accumulated in their usage does not offer rich contextual information that is adequate for providing a holistic view of a user’s lifelog. As a result, making decisions and generating recommendations based on this data are single dimensional. In this paper, we present our Data Curation Framework (DCF) which is device independent and accumulates a user’s sensory data from multimodal data sources in real time. DCF curates the context of this accumulated data over the user’s lifelog. DCF provides rule-based anomaly detection over this context-rich lifelog in real time. To provide computation and persistence over the large volume of sensory data, DCF utilizes the distributed and ubiquitous environment of the cloud platform. DCF has been evaluated for its performance, correctness, ability to detect complex anomalies, and management support for a large volume of sensory data. PMID:27355955

  14. PDS4 - Some Principles for Agile Data Curation

    NASA Astrophysics Data System (ADS)

    Hughes, J. S.; Crichton, D. J.; Hardman, S. H.; Joyner, R.; Algermissen, S.; Padams, J.

    2015-12-01

    PDS4, a research data management and curation system for NASA's Planetary Science Archive, was developed using principles that promote the characteristics of agile development. The result is an efficient system that produces better research data products while using less resources (time, effort, and money) and maximizes their usefulness for current and future scientists. The key principle is architectural. The PDS4 information architecture is developed and maintained independent of the infrastructure's process, application and technology architectures. The information architecture is based on an ontology-based information model developed to leverage best practices from standard reference models for digital archives, digital object registries, and metadata registries and capture domain knowledge from a panel of planetary science domain experts. The information model provides a sharable, stable, and formal set of information requirements for the system and is the primary source for information to configure most system components, including the product registry, search engine, validation and display tools, and production pipelines. Multi-level governance is also allowed for the effective management of the informational elements at the common, discipline, and project level. This presentation will describe the development principles, components, and uses of the information model and how an information model-driven architecture exhibits characteristics of agile curation including early delivery, evolutionary development, adaptive planning, continuous improvement, and rapid and flexible response to change.

  15. On Curating Multimodal Sensory Data for Health and Wellness Platforms.

    PubMed

    Amin, Muhammad Bilal; Banos, Oresti; Khan, Wajahat Ali; Muhammad Bilal, Hafiz Syed; Gong, Jinhyuk; Bui, Dinh-Mao; Cho, Soung Ho; Hussain, Shujaat; Ali, Taqdir; Akhtar, Usman; Chung, Tae Choong; Lee, Sungyoung

    2016-06-27

    In recent years, the focus of healthcare and wellness technologies has shown a significant shift towards personal vital signs devices. The technology has evolved from smartphone-based wellness applications to fitness bands and smartwatches. The novelty of these devices is the accumulation of activity data as their users go about their daily life routine. However, these implementations are device specific and lack the ability to incorporate multimodal data sources. Data accumulated in their usage does not offer rich contextual information that is adequate for providing a holistic view of a user's lifelog. As a result, making decisions and generating recommendations based on this data are single dimensional. In this paper, we present our Data Curation Framework (DCF) which is device independent and accumulates a user's sensory data from multimodal data sources in real time. DCF curates the context of this accumulated data over the user's lifelog. DCF provides rule-based anomaly detection over this context-rich lifelog in real time. To provide computation and persistence over the large volume of sensory data, DCF utilizes the distributed and ubiquitous environment of the cloud platform. DCF has been evaluated for its performance, correctness, ability to detect complex anomalies, and management support for a large volume of sensory data.

  16. AtomPy: an open atomic-data curation environment

    NASA Astrophysics Data System (ADS)

    Bautista, Manuel; Mendoza, Claudio; Boswell, Josiah S; Ajoku, Chukwuemeka

    2014-06-01

    We present a cloud-computing environment for atomic data curation, networking among atomic data providers and users, teaching-and-learning, and interfacing with spectral modeling software. The system is based on Google-Drive Sheets, Pandas (Python Data Analysis Library) DataFrames, and IPython Notebooks for open community-driven curation of atomic data for scientific and technological applications. The atomic model for each ionic species is contained in a multi-sheet Google-Drive workbook, where the atomic parameters from all known public sources are progressively stored. Metadata (provenance, community discussion, etc.) accompanying every entry in the database are stored through Notebooks. Education tools on the physics of atomic processes as well as their relevance to plasma and spectral modeling are based on IPython Notebooks that integrate written material, images, videos, and active computer-tool workflows. Data processing workflows and collaborative software developments are encouraged and managed through the GitHub social network. Relevant issues this platform intends to address are: (i) data quality by allowing open access to both data producers and users in order to attain completeness, accuracy, consistency, provenance and currentness; (ii) comparisons of different datasets to facilitate accuracy assessment; (iii) downloading to local data structures (i.e. Pandas DataFrames) for further manipulation and analysis by prospective users; and (iv) data preservation by avoiding the discard of outdated sets.

  17. Clinical significance of No. 10 and 11 lymph nodes posterior to the splenic vessel in D2 radical total gastrectomy: An observational study.

    PubMed

    Wang, Wei; Xiong, Wenjun; Liu, Zhiwei; Luo, Lijie; Zheng, Yansheng; Tan, Ping; Diao, Dechang; Zou, Liaonan; Wan, Jin

    2016-08-01

    D2 lymphadenectomy is widely performed for advanced proximal gastric cancer, but complete dissection of No. 10 and 11 lymph nodes (LNs) is technically challenging, especially for those posterior to the splenic vessel. This study aimed to investigate the clinical significance of removing No. 10 and 11 LNs posterior to the splenic vessel in radical total gastrectomy. Between January 2013 and February 2015, 53 patients who underwent spleen-preserving D2 radical total gastrectomy were enrolled. While dissecting No. 10 and 11 LNs, we divided them into 2 parts, namely LNs anterosuperior and posterior to the splenic vessel, and the pathological data were reviewed. Sixteen patients underwent laparoscopy and 37 underwent laparotomy. No mortality was recorded. According to the pathological results, the TNM stages of the tumor were IIA in 11 patients (20.8%), IIB in 5 (9.4%), IIIA in 7 (13.2%), IIIB in 10 (18.9%), and IIIC in 20 (18.9%). The mean number of LNs retrieved was 30.3 ± 12.3. The sum of No. 10 and 11 LNs posterior to the splenic vessel was 59 and the mean number was 1.11 ± 1.47. One LN with metastasis was found in the special 59 regional LNs, and the metastasis rate was 1.9% (1/53). Concerning the low metastasis rate (1.9%) and difficult complete dissection of No. 10 and 11 LNs posterior to the splenic vessel, our initial analysis suggests that the rate of No. 10 and 11 LNs posterior to the splenic vessel metastasis was 1.9%, but further studies are needed to reveal its clinical significance in D2 radical total gastrectomy for advanced proximal gastric cancer.

  18. Clinical significance of No. 10 and 11 lymph nodes posterior to the splenic vessel in D2 radical total gastrectomy: An observational study.

    PubMed

    Wang, Wei; Xiong, Wenjun; Liu, Zhiwei; Luo, Lijie; Zheng, Yansheng; Tan, Ping; Diao, Dechang; Zou, Liaonan; Wan, Jin

    2016-08-01

    D2 lymphadenectomy is widely performed for advanced proximal gastric cancer, but complete dissection of No. 10 and 11 lymph nodes (LNs) is technically challenging, especially for those posterior to the splenic vessel. This study aimed to investigate the clinical significance of removing No. 10 and 11 LNs posterior to the splenic vessel in radical total gastrectomy. Between January 2013 and February 2015, 53 patients who underwent spleen-preserving D2 radical total gastrectomy were enrolled. While dissecting No. 10 and 11 LNs, we divided them into 2 parts, namely LNs anterosuperior and posterior to the splenic vessel, and the pathological data were reviewed. Sixteen patients underwent laparoscopy and 37 underwent laparotomy. No mortality was recorded. According to the pathological results, the TNM stages of the tumor were IIA in 11 patients (20.8%), IIB in 5 (9.4%), IIIA in 7 (13.2%), IIIB in 10 (18.9%), and IIIC in 20 (18.9%). The mean number of LNs retrieved was 30.3 ± 12.3. The sum of No. 10 and 11 LNs posterior to the splenic vessel was 59 and the mean number was 1.11 ± 1.47. One LN with metastasis was found in the special 59 regional LNs, and the metastasis rate was 1.9% (1/53). Concerning the low metastasis rate (1.9%) and difficult complete dissection of No. 10 and 11 LNs posterior to the splenic vessel, our initial analysis suggests that the rate of No. 10 and 11 LNs posterior to the splenic vessel metastasis was 1.9%, but further studies are needed to reveal its clinical significance in D2 radical total gastrectomy for advanced proximal gastric cancer. PMID:27512888

  19. Science Support: The Building Blocks of Active Data Curation

    NASA Astrophysics Data System (ADS)

    Guillory, A.

    2013-12-01

    While the scientific method is built on reproducibility and transparency, and results are published in peer reviewed literature, we have come to the digital age of very large datasets (now of the order of petabytes and soon exabytes) which cannot be published in the traditional way. To preserve reproducibility and transparency, active curation is necessary to keep and protect the information in the long term, and 'science support' activities provide the building blocks for active data curation. With the explosive growth of data in all fields in recent years, there is a pressing urge for data centres to now provide adequate services to ensure long-term preservation and digital curation of project data outputs, however complex those may be. Science support provides advice and support to science projects on data and information management, from file formats through to general data management awareness. Another purpose of science support is to raise awareness in the science community of data and metadata standards and best practice, engendering a culture where data outputs are seen as valued assets. At the heart of Science support is the Data Management Plan (DMP) which sets out a coherent approach to data issues pertaining to the data generating project. It provides an agreed record of the data management needs and issues within the project. The DMP is agreed upon with project investigators to ensure that a high quality documented data archive is created. It includes conditions of use and deposit to clearly express the ownership, responsibilities and rights associated with the data. Project specific needs are also identified for data processing, visualization tools and data sharing services. As part of the National Centre for Atmospheric Science (NCAS) and National Centre for Earth Observation (NCEO), the Centre for Environmental Data Archival (CEDA) fulfills this science support role of facilitating atmospheric and Earth observation data generating projects to ensure

  20. How should the completeness and quality of curated nanomaterial data be evaluated?

    PubMed

    Marchese Robinson, Richard L; Lynch, Iseult; Peijnenburg, Willie; Rumble, John; Klaessig, Fred; Marquardt, Clarissa; Rauscher, Hubert; Puzyn, Tomasz; Purian, Ronit; Åberg, Christoffer; Karcher, Sandra; Vriens, Hanne; Hoet, Peter; Hoover, Mark D; Hendren, Christine Ogilvie; Harper, Stacey L

    2016-05-21

    Nanotechnology is of increasing significance. Curation of nanomaterial data into electronic databases offers opportunities to better understand and predict nanomaterials' behaviour. This supports innovation in, and regulation of, nanotechnology. It is commonly understood that curated data need to be sufficiently complete and of sufficient quality to serve their intended purpose. However, assessing data completeness and quality is non-trivial in general and is arguably especially difficult in the nanoscience area, given its highly multidisciplinary nature. The current article, part of the Nanomaterial Data Curation Initiative series, addresses how to assess the completeness and quality of (curated) nanomaterial data. In order to address this key challenge, a variety of related issues are discussed: the meaning and importance of data completeness and quality, existing approaches to their assessment and the key challenges associated with evaluating the completeness and quality of curated nanomaterial data. Considerations which are specific to the nanoscience area and lessons which can be learned from other relevant scientific disciplines are considered. Hence, the scope of this discussion ranges from physicochemical characterisation requirements for nanomaterials and interference of nanomaterials with nanotoxicology assays to broader issues such as minimum information checklists, toxicology data quality schemes and computational approaches that facilitate evaluation of the completeness and quality of (curated) data. This discussion is informed by a literature review and a survey of key nanomaterial data curation stakeholders. Finally, drawing upon this discussion, recommendations are presented concerning the central question: how should the completeness and quality of curated nanomaterial data be evaluated?

  1. Co-Curate: Working with Schools and Communities to Add Value to Open Collections

    ERIC Educational Resources Information Center

    Cotterill, Simon; Hudson, Martyn; Lloyd, Katherine; Outterside, James; Peterson, John; Coburn, John; Thomas, Ulrike; Tiplady, Lucy; Robinson, Phil; Heslop, Phil

    2016-01-01

    Co-Curate North East is a cross-disciplinary initiative involving Newcastle University and partner organisations, working with schools and community groups in the North East of England. Co-curation builds on the concept of the "ecomuseum" model for heritage based around a virtual territory, social memory and participative input from the…

  2. The Library as Partner in University Data Curation: A Case Study in Collaboration

    ERIC Educational Resources Information Center

    Latham, Bethany; Poe, Jodi Welch

    2012-01-01

    Data curation is a concept with many facets. Curation goes beyond research-generated data, and its principles can support the preservation of institutions' historical data. Libraries are well-positioned to bring relevant expertise to such problems, especially those requiring collaboration, because of their experience as neutral caretakers and…

  3. Cold curation of pristine astromaterials: Insights from the Tagish Lake meteorite

    NASA Astrophysics Data System (ADS)

    Herd, Christopher D. K.; Hilts, Robert W.; Skelhorne, Aaron W.; Simkus, Danielle N.

    2016-03-01

    The curation and handling of volatile-bearing astromaterials is of prime importance in current and future plans for sample return missions to targets containing organic compounds, ices, or other volatile components. We report on the specific curation constraints required for the preservation of the Tagish Lake meteorite, a C2 ungrouped chondrite that contains significant concentrations of organic matter, including compounds of prebiotic interest or volatile in character, and which was recovered from a frozen lake surface a few days after its fall. Here, we review the circumstances of the meteorite's handling, its complement of intrinsic and contaminant organic compounds, and an unusual reaction between some of the specimens and the Al foil in which they were enclosed. From our results, we derive the requirements for curation of the meteorite, and describe a specialized facility that enables its curation and handling. The Subzero Facility for Curation of Astromaterials consists of a purified Ar glove box enclosed within a freezer chamber, and enables investigations relevant to curation of samples at or below -10 °C. We provide several recommendations based on insights obtained from the commissioning and initial use of the facility that are relevant to collection of freshly fallen meteorites, curation of volatile-bearing meteorites and other astromaterials, and planning and implementation of curation plans for future sample return missions to volatile-bearing targets.

  4. 76 FR 26322 - Curators of the University of Missouri, Columbia, MO, Pickard Hall; License Amendment Request...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-06

    ... accordance with the NRC E-Filing rule (72 FR 49139, August 28, 2007). The E-Filing process requires... COMMISSION Curators of the University of Missouri, Columbia, MO, Pickard Hall; License Amendment Request... received, by letter dated February 17, 2011, a license amendment application from the Curators of...

  5. How should the completeness and quality of curated nanomaterial data be evaluated?

    PubMed

    Marchese Robinson, Richard L; Lynch, Iseult; Peijnenburg, Willie; Rumble, John; Klaessig, Fred; Marquardt, Clarissa; Rauscher, Hubert; Puzyn, Tomasz; Purian, Ronit; Åberg, Christoffer; Karcher, Sandra; Vriens, Hanne; Hoet, Peter; Hoover, Mark D; Hendren, Christine Ogilvie; Harper, Stacey L

    2016-05-21

    Nanotechnology is of increasing significance. Curation of nanomaterial data into electronic databases offers opportunities to better understand and predict nanomaterials' behaviour. This supports innovation in, and regulation of, nanotechnology. It is commonly understood that curated data need to be sufficiently complete and of sufficient quality to serve their intended purpose. However, assessing data completeness and quality is non-trivial in general and is arguably especially difficult in the nanoscience area, given its highly multidisciplinary nature. The current article, part of the Nanomaterial Data Curation Initiative series, addresses how to assess the completeness and quality of (curated) nanomaterial data. In order to address this key challenge, a variety of related issues are discussed: the meaning and importance of data completeness and quality, existing approaches to their assessment and the key challenges associated with evaluating the completeness and quality of curated nanomaterial data. Considerations which are specific to the nanoscience area and lessons which can be learned from other relevant scientific disciplines are considered. Hence, the scope of this discussion ranges from physicochemical characterisation requirements for nanomaterials and interference of nanomaterials with nanotoxicology assays to broader issues such as minimum information checklists, toxicology data quality schemes and computational approaches that facilitate evaluation of the completeness and quality of (curated) data. This discussion is informed by a literature review and a survey of key nanomaterial data curation stakeholders. Finally, drawing upon this discussion, recommendations are presented concerning the central question: how should the completeness and quality of curated nanomaterial data be evaluated? PMID:27143028

  6. Digital Curation: A Framework to Enhance Adolescent and Adult Literacy Initiatives

    ERIC Educational Resources Information Center

    Sharma, Sue Ann; Deschaine, Mark E.

    2016-01-01

    Digital curation provides a way to transcend traditional academic fields of study and create instructional materials available to support adolescent and adult literacy initiatives. The instructional capabilities that Web 2.0 tools offer provide curators with the ability to reach audiences in a way that has not been possible in the past. The…

  7. Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion.

    PubMed

    Galos, David K; Konda, Sanjit R; Kaplan, Daniel J; Ryan, William E; Alaia, Michael J

    2016-04-01

    Extensor mechanism disruptions are relatively uncommon injuries involving injury to the quadriceps tendon, patella, or patellar tendon. Patellar tendon avulsions from the tibial tubercle in adults are rare; as such, little technical information has been written regarding surgical management of this injury in the adult. Transosseous-equivalent repairs have been described in the management of several types of tendon ruptures, including rotator cuff and distal triceps tendon ruptures, but not previously in patellar injuries. We present a technique for repairing an avulsion injury of the patellar tendon from the tibial tubercle using suture anchors in a transosseous-equivalent manner. This technique for treating distal patellar tendon avulsion injuries likely increases contact area at the repair site while potentially improving fixation strength. PMID:27462538

  8. [Results following percutaneous intramedullary pin fixation in distal radius fractures].

    PubMed

    Kirchner, R; Hüttl, T; Krüger-Franke, M; Rosemeyer, B

    1994-01-01

    42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures. PMID:7516105

  9. Pendulum Therapy of Molar Distalization in Mixed Dentition

    PubMed Central

    Prakash, Amit; Agarwal, Anshu

    2016-01-01

    ABSTRACT Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient’s compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73. PMID:27274159

  10. Pendulum Therapy of Molar Distalization in Mixed Dentition.

    PubMed

    Patil, Raju Umaji; Prakash, Amit; Agarwal, Anshu

    2016-01-01

    Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient's compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73. PMID:27274159

  11. Pendulum Therapy of Molar Distalization in Mixed Dentition.

    PubMed

    Patil, Raju Umaji; Prakash, Amit; Agarwal, Anshu

    2016-01-01

    Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient's compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73.

  12. Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVil™) following laparoscopic total or proximal gastrectomy - comparison with extracorporeal anastomosis

    PubMed Central

    2013-01-01

    Background There have been several attempts to develop a unique and easier way to perform esophagojejunostomy during laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy. The OrVil™ system (Covidien, Mansfield, MA, USA) is one of those methods, but its technical and oncologic feasibility have not been proven and need to be observed. Methods Among 87 patients who underwent laparoscopy-assisted total gastrectomy (LATG; 79 cases) and laparoscopy-assisted proximal gastrectomy with double tract anastomosis (LAPG_DT; 8 cases) from April 2004, 47 patients underwent the conventional extracorporeal method (Group I; 2004–2008) were compared with 40 patients treated with the intracorporeal OrVil™ system (Group II; 2009–2012). Results There was no significant difference in clinicopathologic characteristics between the two groups except tumor location; more cardia lesions were involved in group II (p = 0.012). The mean time for esophagojejunostomy (E-J), defined as the time from anvil insertion to closure of the jejunal entry site has no significant difference (Group I vs II: 22.2 ± 3.2 min vs 18.6 ± 3.5 min, p = 0.623). In terms of anastomotic complication, there was no significant difference in E-J leakage and stricture. E-J leakage occurred in 2 out of 47 (4.3%) cases in group I and 2 out of 40 (5%) in group II (p = 0.628); half of them were treated conservatively in each group and the others underwent reoperation. E-J stricture occurred in 2 (4.3%) cases in group I and 1 (2.5%) in group II (p = 0.561), which required postoperative gastrofiberscopic balloon dilatation. Conclusions Esophagojejunostomy using the OrVil™ system was a feasible and safe technique compared with the conventional extracorporeal method through mini-laparotomy in terms of anastomotic complications. Moreover, it can help to reduce surgeon’s stress regarding esophagojejunostomy because it needs no purse-string procedure and serves a secure operation view

  13. Medical management of fragility fractures of the distal radius.

    PubMed

    Morgan, Emily N; Crawford, David A; Scully, William F; Noce, Nicholas J

    2014-12-01

    Fragility fractures of the distal radius represent an opportunity to diagnose and treat osteoporosis before further fractures occur. The goal of this study was to determine the prevalence of prescriptions for calcium/vitamin D supplementation and the prevalence of dual-energy x-ray absorptiometry (DEXA) scans in patients who sustained fragility fractures of the distal radius. A further goal was to determine the prevalence of patients who received prescriptions for the treatment of osteoporosis after DEXA scans. The authors performed a retrospective review of all patients 50 years and older who sustained a fragility fracture of the distal radius and were treated by the orthopedic surgery service at the authors' institution from 2004 to 2010. After a fragility fracture of the distal radius, fewer than 25% of previously unidentified at-risk patients received a prescription for vitamin supplementation and underwent a DEXA scan. Women were 7 times more likely than men to receive calcium/vitamin D supplementation, 14 times more likely to undergo a DEXA scan for the evaluation of osteoporosis, and 25 times more likely to receive a prescription for bisphosphonates. Patients who underwent a DEXA scan were 9 times more likely to receive pharmacologic treatment than those who did not undergo this scan. More than half of patients did not receive a prescription for calcium/vitamin D supplementation and did not undergo DEXA scanning as recommended by current National Osteoporosis Foundation guidelines. Most patients who received prescriptions or underwent DEXA scans did so before rather than after fracture, indicating poor compliance with National Osteoporosis Foundation guidelines. PMID:25437080

  14. Opening lines of communication in the distal nephron.

    PubMed

    Kleyman, Thomas R; Satlin, Lisa M; Hallows, Kenneth R

    2013-10-01

    The distal nephron is composed of two main cell types: principal cells and intercalated cells. These cells have distinct morphologic features that allow them to be readily distinguished by light microscopy, as well as distinct suites of proteins that facilitate cell-specific transport properties. In this issue of the JCI, Gueutin and colleagues describe a new mechanism by which β-intercalated cells, via release of ATP and prostaglandin E2 (PGE2), influence the activity of transporters in principal cells.

  15. Epithelioid Hemangioendothelioma of the Distal Radius: A Case Report.

    PubMed

    Duncan, Scott F M; Krochmal, Daniel J; Craft, Randall O; Merritt, Marianne V; Smith, Anthony A

    2007-01-01

    Epithelioid hemangioendothelioma is a rare vascular tumor with cytologic behavior between angiosarcoma and hemangioma. We present the case of a 58-year-old male with primary epithelioid hemangioendothelioma of the distal radius measuring 6.2 × 5 cm with extension into the pronator quadratus and brachioradialis muscles. We discuss our approach to performing a limb-sparing resection combined with reconstruction to preserve upper extremity function. A review of the clinical, radiographic, and pathologic features of epithelioid hemangioendothelioma is also presented.

  16. Medical management of fragility fractures of the distal radius.

    PubMed

    Morgan, Emily N; Crawford, David A; Scully, William F; Noce, Nicholas J

    2014-12-01

    Fragility fractures of the distal radius represent an opportunity to diagnose and treat osteoporosis before further fractures occur. The goal of this study was to determine the prevalence of prescriptions for calcium/vitamin D supplementation and the prevalence of dual-energy x-ray absorptiometry (DEXA) scans in patients who sustained fragility fractures of the distal radius. A further goal was to determine the prevalence of patients who received prescriptions for the treatment of osteoporosis after DEXA scans. The authors performed a retrospective review of all patients 50 years and older who sustained a fragility fracture of the distal radius and were treated by the orthopedic surgery service at the authors' institution from 2004 to 2010. After a fragility fracture of the distal radius, fewer than 25% of previously unidentified at-risk patients received a prescription for vitamin supplementation and underwent a DEXA scan. Women were 7 times more likely than men to receive calcium/vitamin D supplementation, 14 times more likely to undergo a DEXA scan for the evaluation of osteoporosis, and 25 times more likely to receive a prescription for bisphosphonates. Patients who underwent a DEXA scan were 9 times more likely to receive pharmacologic treatment than those who did not undergo this scan. More than half of patients did not receive a prescription for calcium/vitamin D supplementation and did not undergo DEXA scanning as recommended by current National Osteoporosis Foundation guidelines. Most patients who received prescriptions or underwent DEXA scans did so before rather than after fracture, indicating poor compliance with National Osteoporosis Foundation guidelines.

  17. Value, but high costs in post-deposition data curation

    PubMed Central

    ten Hoopen, Petra; Amid, Clara; Luigi Buttigieg, Pier; Pafilis, Evangelos; Bravakos, Panos; Cerdeño-Tárraga, Ana M.; Gibson, Richard; Kahlke, Tim; Legaki, Aglaia; Narayana Murthy, Kada; Papastefanou, Gabriella; Pereira, Emiliano; Rossello, Marc; Luisa Toribio, Ana; Cochrane, Guy

    2016-01-01

    Discoverability of sequence data in primary data archives is proportional to the richness of contextual information associated with the data. Here, we describe an exercise in the improvement of contextual information surrounding sample records associated with metagenomics sequence reads available in the European Nucleotide Archive. We outline the annotation process and summarize findings of this effort aimed at increasing usability of publicly available environmental data. Furthermore, we emphasize the benefits of such an exercise and detail its costs. We conclude that such a third party annotation approach is expensive and has value as an element of curation, but should form only part of a more sustainable submitter-driven approach. Database URL: http://www.ebi.ac.uk/ena PMID:26861660

  18. Towards curative therapy in gastric cancer: Faraway, so close!

    PubMed Central

    Cravo, Marília; Fidalgo, Catarina; Garrido, Rita; Rodrigues, Tânia; Luz, Gonçalo; Palmela, Carolina; Santos, Marta; Lopes, Fábio; Maio, Rui

    2015-01-01

    Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer (GC), the overall prognosis is still poor. Surgery is the only curative treatment and should be performed in experienced centers. Due to high relapse following surgery, complementary and systemic treatment aimed at eradicating micrometastasis should be performed in most cases. Cytotoxic treatments are effective in downstaging locally advanced cancer, but different sensitivities and toxicities probably exist in different GC subtypes. Current treatment protocols are based primarily on clinical data and histological features, but molecular biomarkers that would allow for the prediction of treatment responses are urgently needed. Understanding how host factors are responsible for inter-individual variability of drug response or toxicity will also contribute to the development of more effective and less toxic treatments. PMID:26556990

  19. Chemical databases: curation or integration by user-defined equivalence?

    PubMed

    Hersey, Anne; Chambers, Jon; Bellis, Louisa; Patrícia Bento, A; Gaulton, Anna; Overington, John P

    2015-07-01

    There is a wealth of valuable chemical information in publicly available databases for use by scientists undertaking drug discovery. However finite curation resource, limitations of chemical structure software and differences in individual database applications mean that exact chemical structure equivalence between databases is unlikely to ever be a reality. The ability to identify compound equivalence has been made significantly easier by the use of the International Chemical Identifier (InChI), a non-proprietary line-notation for describing a chemical structure. More importantly, advances in methods to identify compounds that are the same at various levels of similarity, such as those containing the same parent component or having the same connectivity, are now enabling related compounds to be linked between databases where the structure matches are not exact. PMID:26194583

  20. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    PubMed Central

    Fantry, Amanda J.; Elia, Gregory; Vopat, Bryan G.; Daniels, Alan H.

    2015-01-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization. PMID:25874066

  1. Neural pattern in the human pollical distal phalanx.

    PubMed

    Johnson, Richard K; Shrewsbury, Marvin M

    2005-09-01

    A morphological study of the neural pattern in the human ungual region of the pollical distal phalanx was carried out on eight male cadavers. The dissections showed a palmar neural arrangement consisting of four designated ungual nerves, two proximal and two distal, for each of the ulnar and radial palmar digital nerves at the lateral sides of the thumb. This neural configuration was associated with the compartmentalization of its ungual pulp, the difference between the type of sensory receptors within the ungual pulp, the overlapping of the tactile composition at the thumb tip, seen clinically after laceration of one of the palmar digital nerves, and the sensory supply to the nail bed in the dorsal portion of the thumb. The proximal ungual pulp compartment had a single proximal medial ungual nerve, which did not appear, as far as visually possible, to overlap at the midline of the proximal ungual pulp. In contrast, the distal ungual pulp compartment was supplied by a medial and a lateral ungual nerve, both of which did appear to overlap to their contralateral sides in the thumb tip. A single proximal dorsal sensory nerve branched dorsally from each of ulnar and radial palmar digital nerves at the level of the proximal ungual pulp to supply the nail bed on the dorsum of the thumb.

  2. Early Distal Axonopathy of the Visual Pathway in Experimental Diabetes

    PubMed Central

    Fernandez, Diego C.; Pasquini, Laura A.; Dorfman, Damián; Aldana Marcos, Hernán J.; Rosenstein, Ruth E.

    2012-01-01

    Diabetic retinopathy is a leading cause of acquired blindness. Visual function disorders have been observed in diabetic patients with very early retinopathy or even before the onset of retinopathy. The aim of the present work was to analyze the visual pathway in an early stage of experimental diabetes. Diabetes was induced in Wistar rats by an i.p. injection of streptozotocin. A deficit in anterograde transport from the retina to the superior colliculus was observed 6 weeks after streptozotocin injection. At this time point, morphologic studies did not reveal retinal ganglion cell loss or substantial alterations in the superior colliculus. The optic nerve was morphometrically evaluated at intraorbital (unmyelinated and myelinated) and intracranial sections. In animals that had been diabetic for 6 weeks, a large increase in astrocyte reactivity occurred in the distal (but not the intraorbital) portion, which coincided with significant axon loss. Moreover, profound myelin alterations and altered morphologic features of oligodendrocyte lineage were observed at the distal (but not the proximal) optic nerve portion. The present results suggest that axoglial alterations at the distal portion of the optic nerve could be the first structural change in the diabetic visual pathway. PMID:22079928

  3. Distal histidine conformational flexibility in dehaloperoxidase from Amphitrite ornata

    SciTech Connect

    Chen, Zuxu; de Serrano, Vesna; Betts, Laurie; Franzen, Stefan

    2009-01-28

    The enzyme dehaloperoxidase (DHP) from the terebellid polychaete Amphitrite ornata is a heme protein which has a globin fold but can function as both a hemoglobin and a peroxidase. As a peroxidase, DHP is capable of converting 2,4,6-trihalophenols to the corresponding 2,6-dihaloquinones in the presence of hydrogen peroxide. As a hemoglobin, DHP cycles between the oxy and deoxy states as it reversibly binds oxygen for storage. Here, it is reported that the distal histidine, His55, exhibits conformational flexibility in the deoxy form and is consequently observed in two solvent-exposed conformations more than 9.5 {angstrom} away from the heme. These conformations are analogous to the open conformation of sperm whale myoglobin. The heme iron in deoxy ferrous DHP is five-coordinate and has an out-of-plane displacement of 0.25 {angstrom} from the heme plane. The observation of five-coordinate heme iron with His55 in a remote solvent-exposed conformation is consistent with the hypothesis that His55 interacts with heme iron ligands through hydrogen bonding in the closed conformation. Since His55 is also displaced by the binding of 4-iodophenol in an internal pocket, these results provide new insight into the correlation between heme iron ligation, molecular binding in the distal pocket and the conformation of the distal histidine in DHP.

  4. A novel, new robotic platform for natural orifice distal pancreatectomy.

    PubMed

    Thakkar, Shyam; Awad, Michael; Gurram, Krishna C; Tully, Steven; Wright, Cornell; Sanan, Siddharth; Choset, Howie

    2015-06-01

    Laparoendoscopic technology has revolutionized the practice of surgery; however, surgeons have not widely accepted laparoscopic techniques for pancreatic surgeries due to the complexity of the operation. Natural orifice transluminal endoscopic surgery (NOTES) offers a great new potential for pancreatic procedures, with early data showing benefits of reduced visible scarring and the potential for decreased wound infections, hernias, pain, and postoperative complications. However, there are significant limitations to the currently used flexible endoscopy tools, including a diminished visual field, spatial orientation and tissue manipulation issues, and 2-dimensional visual feedback. We have adopted a novel snake-like robot, the minimally invasive cardiac surgery (MICS) robot, which addresses these issues. In the current pilot study, the MICS robot was evaluated for transrectal distal pancreas exploration and resection in 2 nonsurvival porcine models. Abdominal navigation and accessing the pancreas was investigated in the first pig, and based on its success, pancreas resection was studied in pig 2. The MICS robot was successful in accessing and visualizing the right upper, left upper, and left lower quadrants of the abdomen in pig 1 and was able to perform a successful complex NOTES procedure with distal pancreas resection in pig 2, with only minimal laparoscopic retraction assistance. In conclusion, preliminary results showing the MICS robot in natural orifice distal pancreatectomy are positive. Enhancements to optics and instrumentation will help further increase the usability in pancreatic interventions. Future indications may include transgastric NOTES approaches, endoluminal procedures, and single-port applications.

  5. Corrective Osteotomy for Intra-Articular Distal Humerus Malunion

    PubMed Central

    Kinaci, Ahmet; Buijze, Geert A.; Leeuwen, Diederik H.van; Jupiter, Jesse B.; Marti, Rene K.; Kloen, Peter

    2016-01-01

    Background: An intra-articular distal humerus malunion can be disabling. To improve function, reduce pain and/or prevent further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we provide long-term results in a small series. Methods: We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At lastest follow up elbow function was assessed according to standardized questionnaires and classification systems. Results: All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. The elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life. Conclusion: An intra-articular corrective osteotomy for a malunited distal humerus fracture is a worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain. PMID:27200396

  6. Distal Radius Attachments of the Radiocarpal Ligaments: An Anatomical Study

    PubMed Central

    Zumstein, M. A.; Hasan, A. P.; McGuire, D. T.; Eng, Kevin; Bain, Gregory Ian

    2013-01-01

    Background Understanding the anatomy of the ligaments of the distal radius aids in the surgical repair of ligamentous injuries and the prediction of intraarticular fracture patterns. Purposes (1) to measure the horizontal and vertical distances of the origins of the radiocarpal ligaments from the most ulnar corner of the sigmoid notch and the joint line, respectively; and (2) to express them as a percentile of the total width of the bony distal radius. Methods We dissected 8 cadaveric specimens and identified the dorsal radiocarpal, radioscaphocapitate, and the long and short radiolunate ligaments. Results The dorsal radiocarpal ligament attached from the 16th to the 52nd percentile of the radial width. The radioscaphocapitate ligament attached around the radial styloid from the 86th percentile volarly to the 87th percentile dorsally. The long radiolunate ligament attached from the 59th to the 85th percentile, and the short radiolunate ligament attached from the 14th to the 41st percentile. Discussion There was a positive correlation between the radial width and the horizontal distance of the ligaments from the sigmoid notch. These findings may aid individualized surgical repair or reconstruction adjusted to patient size and enable further standardized research on distal radial fractures and their relationship with radiocarpal ligaments. PMID:24436840

  7. Slipped Distal Femoral Epiphysis in Congenital Insensitivity to Pain

    PubMed Central

    Shaikh, M Javed; Rex, C; Vignesh, R; Chavan, Madhav

    2016-01-01

    Introduction: Congenital insensitivity to pain (CIP) is a rare disorder, and often presents to an orthopaedic surgeon as recurrent fractures, dislocations, pseudoarthrosis, osteomyelitis etc. Here, we report a case of congenital insensitivity to pain presenting with distal femoral physeal separation in a child. Case Report: A 12-year-old girl child came with complaints of limp while walking and swelling in the left knee for past 5 weeks. Mother gave a history that the girl is a known case of congenital insensitivity to pain with clear history of no pain on intramuscular injection since birth. She was born of consanguineous marriage and had no significant trauma, fever, other joint involvement or any features of rheumatism. On local examination, she had no bony tenderness, mild warmth, and moderate knee effusion with restricted range of movement. Plain radiograph showed epiphysiolysis of distal femur with widening of physis. Examination under anaesthesia demonstrated gross movement indicating lower femoral physeal separation. This unstable distal femoral epiphysis was treated under general anaesthesia with closed reduction, percutaneous cross pinning and above knee plaster cast. Conclusion: Congenital insensitivity to pain (CIP) is a rare disorder to diagnose. Emphasis is given on early diagnosis of orthopaedic problems and prompt treatment, educating parents and prevention of accidents. Physeal separation without significant trauma must prompt an orthopaedic surgeon to think about congenital insensitivity to pain as a differential diagnosis. PMID:27703943

  8. Complications of pediatric distal radius and forearm fractures.

    PubMed

    Chia, Benjamin; Kozin, Scott H; Herman, Martin J; Safier, Shannon; Abzug, Joshua M

    2015-01-01

    Distal radius and forearm fractures represent a large percentage of pediatric fractures. The most common mechanism of injury is a fall onto an outstretched arm, which can lead to substantial rotational displacement. If this rotational displacement is not adequately addressed, there will be resultant loss of forearm motion and subsequent limitations in performing the activities of daily living. Good initial reductions and proper casting techniques are necessary when treating distal radius and forearm fractures nonsurgically; however, maintaining an acceptable reduction is not always possible. Atraumatic reduction of a displaced physeal fracture should occur within 7 days of the injury. If an impending malunion presents at 2 weeks or later after injury, observation is warranted because of concerns about physeal arrest with repeated attempts at manipulation, and it should be followed by a later assessment of functional limitations. Pediatric patients and their parents have higher expectations for recovery, which has contributed to an increase in the surgical management of pediatric distal radius and forearm fractures. In addition, surgical interventions, such as intramedullary nailing, have their own associated complications.

  9. [Distal tibia peri-implant fracture with an intramedullary nail: a case report].

    PubMed

    Reyes-Cabrera, J M; González-Alconada, R; García-Mota, M D

    2013-01-01

    Peri-implant fractures of the distal tibia after intramedullary nailing are rare. We present a case of a fracture of the distal tibia at the site of the distal interlocking screw. We found two cases reported in the world literature. There are no cases reported in the Spanish literature.

  10. Avascular necrosis of the distal phalangeal epiphysis following physeal fracture: a case report.

    PubMed

    Nissenbaum, M

    1999-05-01

    Avascular necrosis of the distal phalangeal epiphysis following an unrecognized angulated Salter II fracture of the distal phalanx treated by open reduction and internal fixation resulted in premature closure of the growth plate and mild shortening. The epiphysis itself revascularized and good function of the distal interphalangeal joint was maintained.

  11. A New Suggestion for the Radiation Target Volume After a Subtotal Gastrectomy in Patients With Stomach Cancer

    SciTech Connect

    Nam, Heerim; Lim, Do Hoon Kim, Sung; Kang, Won Ki; Sohn, Tae Sung; Noh, Jae Hyung; Kim, Yong Il; Park, Chan Hyung; Park, Chul Keun; Ahn, Yong Chan; Huh, Seung Jae

    2008-06-01

    Purpose: To compare treatment results between the use of two different radiation fields including and excluding remnant stomach and suggest new target volumes excluding remnant stomach after subtotal gastrectomy (STG) in patients with stomach cancer. Methods and Materials: We retrospectively analyzed 291 patients treated with adjuvant chemoradiotherapy after STG and D2 dissection at the Samsung Medical Center, Seoul, South Korea. Eighty-three patients registered from 1995 to 1997 underwent irradiation according to the INT 0116 protocol that recommended the inclusion of remnant stomach within the target volume (Group A). After this period, we excluded remnant stomach from the target volume for 208 patients (Group B). Median follow-up was 67 months. Results: Treatment failure developed in 93 patients (32.0%). Local and regional recurrence rates for Group A vs. Group B were 10.8% vs. 5.3% (p = not significant) and 9.6% vs. 6.3% (p = not significant), and recurrence rates for remnant stomach were 7.2% vs. 1.4% (p = 0.018), respectively. Overall and disease-free survival rates were not different between the two groups. Grade 3 or 4 vomiting and diarrhea developed more frequently in Group A than Group B (4.8% vs. 1.4% and 6.0% vs. 1.9%, respectively; p = 0.012; p < 0.001). Conclusion: Exclusion of remnant stomach from the radiation field had no effect on failure rates or survival, and a low complication rate occurred in patients treated excluding remnant stomach. We suggest that remnant stomach be excluded from the radiation target volume for patients with stomach cancer who undergo STG and D2 dissection.

  12. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    PubMed Central

    Liu, Guozheng; Jian, Fengguo; Wang, Xiuqin; Chen, Lin

    2016-01-01

    Aim To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients. Methods Eighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21), FTS + laparotomy group (Group B, n=21), conventional perioperative care (CC) + laparoscopic group (Group C, n=21), and CC + laparotomy group (Group D, n=21). Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators. Results Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05). There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05). Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest. Conclusion FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction, and hence is safe and effective for elderly GC patients. PMID:27330314

  13. Laparoscopic sleeve gastrectomy in obese Korean patients: up to 4-year follow-up in a single center

    PubMed Central

    Park, Ji Yeon

    2015-01-01

    Purpose Laparoscopic sleeve gastrectomy (LSG) has been gaining marked popularity as a stand-alone treatment for morbid obesity. This study aimed to evaluate the midterm outcomes and efficacy of LSG performed at a single center in Korea. Methods The records of 192 consecutive patients who underwent LSG between April 2009 and December 2012 were retrospectively reviewed. The patients' demographics and surgical outcomes including anthropometric data were analyzed. Results The mean preoperative body mass index was 40.0 ± 7.2 kg/m2, and 120 patients (62.5%) had at least one obesity-related comorbidity. Three patients (1.6%) required endoscopic or surgical intervention to manage postoperative bleeding or leakage. At the postoperative 1-, 2-, 3-, and 4-year follow-ups, the mean percent of excess weight loss (%EWL) values were 72.6%, 80.6%, 71.1%, and 57.8%, respectively, with follow-up rates of 81%, 56%, 58%, and 30% respectively. The overall mean %EWL reached 68.3% ± 27.2% at a mean follow-up of 25 months. Obesity-related comorbidities were resolved in >70% of the patients after surgery. Twelve months after LSG, 25 patients (13.0%) showed a %EWL of <50%; 9 (4.7%) required conversion to gastric bypass due to inadequate weight loss, intolerable reflux symptoms, or intractable diabetes. Conclusion These midterm results show that LSG is a safe and effective surgical procedure for morbidly obese patients. However, a longer follow-up period is necessary to elucidate whether LSG can achieve durable weight loss and long-term outcomes, comparable to those of more aggressive procedures. PMID:25960987

  14. Quality of life after subtotal gastrectomy for gastric cancer: Does restoration method matter? – A retrospective cohort study

    PubMed Central

    Smolskas, Edgaras; Lunevicius, Raimundas; Samalavicius, Narimantas Evaldas

    2015-01-01

    Introduction The aim of this study was to evaluate the impact on the quality of life (QoL) status of three gastrointestinal continuity restoration methods following a subtotal gastrectomy in patients with gastric cancer. Methods QoL data from 153 patients were obtained and evaluated in this retrospective cross-sectional case series study. A list of patients who responded to questionnaires on QoL was stratified into three arms based on which gastrointestinal continuity restoration method was used – Billroth I (n = 37), Roux-en-Y (n = 15), and Balfour (n = 101). Results The mean global health status scores for the patients following the Billroth I, Roux-en-Y and Balfour reconstructive surgery arms were 62 ± 20.09, 61 ± 24.08 and 56 ± 21.2, respectively, (p = 0.182). The mean scores of the functional scales were not lower than 60 in any of the patient groups. For physical, role, cognitive, social functional scales, the Billroth I method had the best mean QoL score. Comparisons of the global QoL, functional activities, and majority of the postgastrectomy symptom scores at different time points after the surgeries (6–12 months vs > 1 year) did not reveal major significant differences between the groups. However, the results highlighted trends and ranked the gastrointestinal continuity restoration methods over time. Conclusions The best QoL scores were obtained from the patients who underwent the Billroth I surgery. The Roux-en-Y method was better than the Balfour method 6–12 months after surgery. However, the Balfour method was better than the Roux-en-Y after one year. Further prospective randomized controlled trials are needed. PMID:26904188

  15. β-Cell Glucagon-Like Peptide-1 Receptor Contributes to Improved Glucose Tolerance After Vertical Sleeve Gastrectomy.

    PubMed

    Garibay, Darline; McGavigan, Anne K; Lee, Seon A; Ficorilli, James V; Cox, Amy L; Michael, M Dodson; Sloop, Kyle W; Cummings, Bethany P

    2016-09-01

    Vertical sleeve gastrectomy (VSG) produces high rates of type 2 diabetes remission; however, the mechanisms responsible for this remain incompletely defined. Glucagon-like peptide-1 (GLP-1) is a gut hormone that contributes to the maintenance of glucose homeostasis and is elevated after VSG. VSG-induced increases in postprandial GLP-1 secretion have been proposed to contribute to the glucoregulatory benefits of VSG; however, previous work has been equivocal. In order to test the contribution of enhanced β-cell GLP-1 receptor (GLP-1R) signaling we used a β-cell-specific tamoxifen-inducible GLP-1R knockout mouse model. Male β-cell-specific Glp-1r(β-cell+/+) wild type (WT) and Glp-1r(β-cell-/-) knockout (KO) littermates were placed on a high-fat diet for 6 weeks and then switched to high-fat diet supplemented with tamoxifen for the rest of the study. Mice underwent sham or VSG surgery after 2 weeks of tamoxifen diet and were fed ad libitum postoperatively. Mice underwent oral glucose tolerance testing at 3 weeks and were euthanized at 6 weeks after surgery. VSG reduced body weight and food intake independent of genotype. However, glucose tolerance was only improved in VSG WT compared with sham WT, whereas VSG KO had impaired glucose tolerance relative to VSG WT. Augmentation of glucose-stimulated insulin secretion during the oral glucose tolerance test was blunted in VSG KO compared with VSG WT. Therefore, our data suggest that enhanced β-cell GLP-1R signaling contributes to improved glucose regulation after VSG by promoting increased glucose-stimulated insulin secretion. PMID:27501183

  16. Health promotion, preventive and curative aspects of diseases in astrology.

    PubMed

    Sharma, Bhuvnesh Kumar; Subhakta, P K J P; Narayana, A

    2007-01-01

    The whole universe is intermingling into a unit in the period of globalization. Different cultures, life-styles and sciences are co-operating with each other in this situation. World Health Organization is working towards collaborating all prevalent medical sciences for attainment of good health and family welfare for each and every individual by 2020. Astrology is a part of Indian heritage. Astrology means the art of predicting or determining the influence of the planets and stars on human affairs. The origin of this word is from Greek word astron, star + logos (discourse). The account of deeds of good and bad during the present life and previous lives, their consequences of health or ill health during this life i.e. what, when and how the things takes place will be clearly known through Astrology. Highly advanced knowledge related to Astrology on medicine is preserved in Indian scriptures and the knowledge was transmitted from generation to generation. It is also a good source for health promotion, preventive, curative and other medical aspects. Brief direction related to astrological medical aspects is also available in Ayurvedic literature (Carakasamhită, Suśrutasamhhită, Aşţăngasangraha, Aşţăngahŗdaya, Sărngadharasamhită , Băvaprakăśa etc.) Some Ayurvedic practitioners, scholars and scientists realize the need of astrological knowledge related to medicine in the present time. In ancient times physician, astrologer and purŏhita (Hindu priest) simultaneously looked after the health and family welfare of individual, families and country. Astrologer guides medication and suitable time for the better cure of ailments. Even the medicinal herbs were collected and treated at appropriate time for their efficacy. Astrology and Ayurvĕda are inseparable sciences of life. Hence, in this article, a concise astrological evaluation related to health promotion, preventive and curative aspects of Astrology is being presented.

  17. Role of Radiotherapy as Curative Treatment of Extramammary Paget's Disease

    SciTech Connect

    Hata, Masaharu; Omura, Motoko; Koike, Izumi; Wada, Hidefumi; Miyagi, Etsuko; Tayama, Yoshibumi; Odagiri, Kazumasa; Minagawa, Yumiko; Ogino, Ichiro; Inoue, Tomio

    2011-05-01

    Purpose: Extramammary Paget's disease (EMPD) is a relatively rare malignancy that usually arises in the genital areas. Wide surgical excision remains the standard and most reliable curative treatment of EMPD. However, surgery is sometimes not possible, because many patients are elderly, and complete excision can be difficult owing to the tumor location. We, therefore, performed a review to determine the role of radiotherapy (RT) for EMPD. Methods and Materials: A total of 22 patients with EMPD in their external genitalia (4 men and 18 women, age 52-94 years at RT) underwent RT with curative intent. Nine patients had regional lymph node metastases. A total dose of 45-70.2 Gy (median, 60) was delivered to the pelvis, including the tumors, in 25-39 fractions (median, 33). Results: In all but 3 patients, the irradiated tumors were controlled during a follow-up period of 8-133 months (median, 42). Of the 22 patients, 13 developed recurrences, including local progression within the radiation field in 3 and lymph node and/or distant metastases outside the radiation field in 10, at 3-43 months after treatment. The 2- and 5-year local progression-free rates were 91% and 84%, respectively. Of the 22 patients, 7 patients had died at 33-73 months after RT. The cause of death was tumor progression in 4, infectious pneumonia in 2, and renal failure in 1 patient. The overall and cause-specific survival rates were 100% for both at 2 years and 53% and 73% at 5 years, respectively. No therapy-related Grade 3 or greater toxicity was observed. Conclusions: RT is safe and effective for patients with EMPD. It appears to contribute to prolonged survival as a result of good tumor control.

  18. Patterns of failure following curative resection of gastric carcinoma

    SciTech Connect

    Landry, J.; Tepper, J.E.; Wood, W.C.; Moulton, E.O.; Koerner, F.; Sullinger, J. )

    1990-12-01

    To identify patterns of failure following curative resection of gastric carcinoma, the records of 130 patients undergoing resection with curative intent at the Massachusetts General Hospital were reviewed. The total local-regional failure rate was 38% (49/130 patients), with 21 patients having local-regional failure alone and 28 patients having local-regional failure and distant metastases. The incidence of local failure rose with the more advanced stages of disease. Tumors staged B2, B3, C2, and C3 had local-regional failure rates in excess of 35%. This group of patients might benefit from adjuvant radiation therapy to the tumor bed and regional lymphatics. Local-regional failure rate was highest in the anastomosis or stump 33/130 (25%), followed by the stomach bed 27/130 (21%). The overall incidence of distant metastases was 52% (67/130 patients) and rose in the more advanced disease stages. Tumors staged B2, B3, C2, and C3 had rates of distant metastases greater than 50%. Sixty-one patients (77%) had failure in the abdomen (liver, peritoneal surface, adrenal, kidney, and spleen, but excluding tumor bed, anastomosis, or regional nodes). Patients with Stage B2, B3, C2, and C3 tumors had total abdominal failure rates greater than 40%. The highest failure rates in the liver were in Stages B3 and C3, in which the subsequent development of liver metastasis was 40% and 47%, respectively. Peritoneal seeding occurred in 30/130 (23%) of patients and was highest in Stages C2 and C3, with rates of 27% and 41%, respectively.

  19. Health promotion, preventive and curative aspects of diseases in astrology.

    PubMed

    Sharma, Bhuvnesh Kumar; Subhakta, P K J P; Narayana, A

    2007-01-01

    The whole universe is intermingling into a unit in the period of globalization. Different cultures, life-styles and sciences are co-operating with each other in this situation. World Health Organization is working towards collaborating all prevalent medical sciences for attainment of good health and family welfare for each and every individual by 2020. Astrology is a part of Indian heritage. Astrology means the art of predicting or determining the influence of the planets and stars on human affairs. The origin of this word is from Greek word astron, star + logos (discourse). The account of deeds of good and bad during the present life and previous lives, their consequences of health or ill health during this life i.e. what, when and how the things takes place will be clearly known through Astrology. Highly advanced knowledge related to Astrology on medicine is preserved in Indian scriptures and the knowledge was transmitted from generation to generation. It is also a good source for health promotion, preventive, curative and other medical aspects. Brief direction related to astrological medical aspects is also available in Ayurvedic literature (Carakasamhită, Suśrutasamhhită, Aşţăngasangraha, Aşţăngahŗdaya, Sărngadharasamhită , Băvaprakăśa etc.) Some Ayurvedic practitioners, scholars and scientists realize the need of astrological knowledge related to medicine in the present time. In ancient times physician, astrologer and purŏhita (Hindu priest) simultaneously looked after the health and family welfare of individual, families and country. Astrologer guides medication and suitable time for the better cure of ailments. Even the medicinal herbs were collected and treated at appropriate time for their efficacy. Astrology and Ayurvĕda are inseparable sciences of life. Hence, in this article, a concise astrological evaluation related to health promotion, preventive and curative aspects of Astrology is being presented. PMID:19580109

  20. Distal Pancreatectomy With En Bloc Resection of the Celiac Trunk for Extended Pancreatic Tumor Disease: An Interdisciplinary Approach

    SciTech Connect

    Denecke, Timm; Andreou, Andreas; Podrabsky, Petr; Grieser, Christian; Warnick, Peter; Bahra, Marcus; Klein, Fritz; Hamm, Bernd; Neuhaus, Peter; Glanemann, Matthias

    2011-10-15

    Purpose: Infiltration of the celiac trunk by adenocarcinoma of the pancreatic body has been considered a contraindication for surgical treatment, thus resulting in a very poor prognosis. The concept of distal pancreatectomy with resection of the celiac trunk offers a curative treatment option but implies the risk of relevant hepatic or gastric ischemia. We describe initial experiences in a small series of patients with left celiacopancreatectomy with or without angiographic preconditioning of arterial blood flow to the stomach and the liver. Materials and Methods: Between January 2007 and October 2009, six patients underwent simultaneous resection of the celiac trunk for adenocarcinoma of the pancreatic body involving the celiac axis. In four of these cases, angiographic occlusion of the celiac trunk before surgery was performed to enhance collateral flow from the gastroduodenal artery. Radiologic and surgical procedures, findings, and outcome were analyzed retrospectively. Results: Complete tumor removal (R0) succeeded in two patients, whereas four patients underwent R1-tumor resection. After surgery, one of the two patients without angiographic preparation experienced an ischemic stomach perforation 1 week after surgery. The other patient died from severe bleeding from an ischemic gastric ulcer. Of the four patients with celiac trunk embolization, none presented ischemic complications after surgery. Mean survival was 371 days. Conclusion: In this small series, ischemic complications after celiacopancreatectomy occurred only in those patients who did not receive preoperative celiac trunk embolization.

  1. A survey of locus-specific database curation. Human Genome Variation Society.

    PubMed

    Cotton, Richard G H; Phillips, Kate; Horaitis, Ourania

    2007-04-01

    It is widely accepted that curation of variation in genes is best performed by experts in those genes and their variation. However, obtaining funding for such variation is difficult even though up-to-date lists of variations in genes are essential for optimum delivery of genetic healthcare and for medical research. This study was undertaken to gather information on gene-specific databases (locus-specific databases) in an effort to understand their functioning, funding and needs. A questionnaire was sent to 125 curators and we received 47 responses. Individuals performed curation of up to 69 genes. The time curators spent curating was extremely variable. This ranged from 0 h per week up to 5 curators spending over 4 h per week. The funding required ranged from US$600 to US$45,000 per year. Most databases were stimulated by the Human Genome Organization-Mutation Database Initiative and used their guidelines. Many databases reported unpublished mutations, with all but one respondent reporting errors in the literature. Of the 13 who reported hit rates, 9 reported over 52,000 hits per year. On the basis of this, five recommendations were made to improve the curation of variation information, particularly that of mutations causing single-gene disorder: 1. A curator for each gene, who is an expert in it, should be identified or nominated. 2. Curation at a minimum of 2 h per week at US$2000 per gene per year should be encouraged. 3. Guidelines and custom software use should be encouraged to facilitate easy setup and curation. 4. Hits per week on the website should be recorded to allow the importance of the site to be illustrated for grant-giving purposes. 5. Published protocols should be followed in the establishment of locus-specific databases.

  2. The Nanomaterial Data Curation Initiative: A Collaborative Approach to Assessing, Evaluating, and Advancing the State of the Field

    EPA Science Inventory

    The Nanomaterial Data Curation Initiative (NDCI) explores the critical aspect of data curation within the development of informatics approaches to understanding nanomaterial behavior. Data repositories and tools for integrating and interrogating complex nanomaterial datasets are...

  3. Successful Return to Sport Following Distal Femoral Varus Osteotomy

    PubMed Central

    Voleti, Pramod Babu; Degen, Ryan; Tetreault, Danielle; Krych, Aaron John; Williams, Riley J.

    2016-01-01

    Objectives: Distal femoral varus osteotomy is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and return to sport for athletic patients that underwent distal femoral varus osteotomy. Methods: A consecutive series of athletic patients that had undergone distal femoral varus osteotomy for symptomatic lateral compartment overload and valgus knee malalignment were prospectively reviewed. All patients had a minimum of 2-year follow-up. Radiographs were assessed to determine pre-operative and post-operative alignment. Details regarding sport of interest, ability to return to sport, and timing of return were obtained from the patients. Prospective institutional registries were utilized to collect pre-operative and post-operative Marx Activity Scale and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) scores; these values were compared using paired t-tests with p < 0.05 as the threshold for significance. Results: A total of 13 patients with a mean age of 24 years (range: 17-35) and a mean follow-up of 43 months (range: 24-74) were included in the study. Six patients underwent medial closing wedge osteotomy, and seven patients underwent lateral opening wedge osteotomy. The mean alignment correction was 8 degrees (range: 5-13). Nine patients underwent one or more concomitant procedures at the time of the osteotomy: 6 lateral femoral condyle osteochondral allografts, 2 partial lateral meniscectomies, 1 lateral meniscus allograft transplantation, and 1 revision anterior cruciate ligament reconstruction. All patients were able to successfully return to their sport of choice (4 soccer, 2 softball, 2 running, 1 football, 1 basketball, 1 ice hockey, 1 volleyball, 1 rowing) at a mean of 11 months (range: 9-13). Furthermore, all 13 patients demonstrated an

  4. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors.

    PubMed Central

    Nakeeb, A; Pitt, H A; Sohn, T A; Coleman, J; Abrams, R A; Piantadosi, S; Hruban, R H; Lillemoe, K D; Yeo, C J; Cameron, J L

    1996-01-01

    OBJECTIVE: The objective of this article is to introduce a simple method for classifying cholangiocarcinomas and to apply this system to analyze a large number of patients from a single institution. SUMMARY BACKGROUND DATA: For the past 2 decades, most western reports on cholangiocarcinoma have separated intrahepatic from extrahepatic tumors and have subclassified this latter group into proximal, middle, and distal subgroups. However, "middle" lesions are uncommon and are managed most often either with hilar resection or with pancreatoduodenectomy. The spectrum of cholangiocarcinoma, therefore, is best classified into three broad groups: 1) intrahepatic, 2) perihilar, and 3) distal tumors. These categories correlate with anatomic distribution and imply preferred treatment. METHODS: The records of all patients with histologically confirmed cholangiocarcinoma who underwent surgical exploration at The Johns Hopkins Hospital over a 23-year period were reviewed. RESULTS: Of 294 patients with cholangiocarcinoma, 18 (6%) had intrahepatic, 196 (67%) had perihilar, and 80 (27%) had distal tumors. Age, gender, race, and associated diseases were similar among the three groups. Patients with intrahepatic tumors, by definition, were less likely (p < 0.01) to be jaundiced and more likely (p < 0.05) to present with abdominal pain. The resectability rate increased with a more distal location (50% vs. 56% vs. 91%), and resection improved survival at each site. Five-year survival rates for resected intrahepatic, perihilar, and distal tumors were 44%, 11%, and 28%, and median survival rates were 26, 19, and 22 months, respectively. Postoperative radiation therapy did not improve survival. In a multivariate analysis resection (p < 0.001. hazard ratio 2.80), negative microscopic margins (p < 0.01, hazard ratio 1.79), preoperative serum albumin (p < 0.04, hazard ratio 0.82), and postoperative sepsis (p < 0.001, hard ratio 0.27) were the best predictors of outcome. CONCLUSIONS

  5. Evaluation of laparoscopic sleeve gastrectomy compared with laparoscopic Roux-en-Y gastric bypass for people with morbid obesity: A systematic review and meta-analysis

    PubMed Central

    Arabi Basharic, Fateme; Olyaee Manesh, Alireza; Ranjbar Ezzat Abadi, Mohammad; Shiryazdi, Seyed Mostafa; Shabahang, Hussein; Jangjoo, Ali

    2016-01-01

    Background: Prevalence of obesity in the world, in both developed and developing countries, is growing rapidly. Bariatric surgery is now accepted as the treatment for morbid obesity. Objective: This study compares laparoscopic sleeve gastrectomy's effectiveness (LSG) with the most common bariatric surgery, laparoscopic Roux-en-Y (LRYGB) gastric bypass. Methods: A systematic review was performed using relevant search data bases, including Cochrane library, PubMed, Magi ran, Iranmedex, SID and Trip database, with no time limit. Data bases were searched until July 2014 for randomized control trials. The studied population included people aged between 18–60 years, with BMI≥35 and at least one obesity-related disease, or people with BMI≥40. BMI change, as the research outcome, was investigated at least in one-year follow-up period. Cochrane criteria were used to assess quality of studies. The results were extracted from the articles. Results: In total, 384 articles were obtained in the search; six RCTs were included in this study. There was no significant difference between the two laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass procedures in BMI, and both groups were similar in weight loss CI [-.1.31, 0.43], p=0.32. Conclusion: The two procedures of bariatric surgery are effective and reliable treatments. Performing more trial studies with greater sample size and longer follow-up period for making final decision in selecting a certain surgical procedure is essential.

  6. An investigation of the factors effecting high-risk individuals' decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC).

    PubMed

    Hallowell, Nina; Badger, Shirlene; Richardson, Sue; Caldas, Carlos; Hardwick, Richard H; Fitzgerald, Rebecca C; Lawton, Julia

    2016-10-01

    Hereditary diffuse gastric cancer has an early onset and poor prognosis, therefore, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual's life stage. These findings have implications for advising this patient group. PMID:27256430

  7. Phase 3 Trial of Postoperative Chemotherapy Alone Versus Chemoradiation Therapy in Stage III-IV Gastric Cancer Treated With R0 Gastrectomy and D2 Lymph Node Dissection

    SciTech Connect

    Kim, Tae Hyun; Park, Sook Ryun; Ryu, Keun Won; Kim, Young-Woo; Bae, Jae-Moon; Lee, Jun Ho; Choi, Il Ju; Kim, Yeon-Joo; Kim, Dae Yong

    2012-12-01

    Purpose: To compare chemotherapy alone with chemoradiation therapy in stage III-IV(M0) gastric cancer treated with R0 gastrectomy and D2 lymph node dissection. Methods and Materials: The chemotherapy arm received 5 cycles of fluorouracil and leucovorin (FL), and the chemoradiation therapy arm received 1 cycle of FL, then radiation therapy of 45 Gy concurrently with 2 cycles of FL, followed by 2 cycles of FL. Intent-to-treat analysis and per-protocol analyses were performed. Results: Between May 6, 2002 and June 29, 2006, a total of 90 patients were enrolled. Forty-four were randomly assigned to the chemotherapy arm and 46 to the chemoradiation therapy arm. Treatment was completed as planned by 93.2% of patients in the chemotherapy arm and 87.0% in the chemoradiation therapy arm. Overall intent-to-treat analysis showed that addition of radiation therapy to chemotherapy significantly improved locoregional recurrence-free survival (LRRFS) but not disease-free survival. In subgroup analysis for stage III, chemoradiation therapy significantly prolonged the 5-year LRRFS and disease-free survival rates compared with chemotherapy (93.2% vs 66.8%, P=.014; 73.5% vs 54.6%, P=.056, respectively). Conclusions: Addition of radiation therapy to chemotherapy could improve the LRRFS in stage III gastric cancer treated with R0 gastrectomy and D2 lymph node dissection.

  8. An investigation of the factors effecting high-risk individuals' decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC).

    PubMed

    Hallowell, Nina; Badger, Shirlene; Richardson, Sue; Caldas, Carlos; Hardwick, Richard H; Fitzgerald, Rebecca C; Lawton, Julia

    2016-10-01

    Hereditary diffuse gastric cancer has an early onset and poor prognosis, therefore, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual's life stage. These findings have implications for advising this patient group.

  9. Comparison of dual protection and distal filter protection as a distal embolic protection method during carotid artery stenting: a single-center carotid artery stenting experience.

    PubMed

    Kajihara, Yosuke; Sakamoto, Shigeyuki; Kiura, Yoshihiro; Mukada, Kazutoshi; Chaki, Takahiro; Kajihara, Shiro; Kurisu, Kaoru

    2015-10-01

    There are several protection methods used to prevent distal embolism during carotid artery stenting (CAS). The aim of this study was to compare the dual protection method (proximal balloon and distal filter protection) with the distal filter protection during CAS performed at a single center. Between April 2008 and November 2013, 78 consecutive patients with internal carotid artery stenosis were treated with CAS at Istukaichi Memorial Hospital. Twenty-four consecutive patients were treated with CAS using distal filter protection (distal filter protection group), and 54 consecutive patients were treated with CAS using dual protection with a proximal balloon and distal filter protection (dual protection group). We examined the hyperintensity lesions on diffusion-weighted imaging (DWI) and perioperative complications after CAS. All stenotic lesions were successfully dilated. DWI showed hyperintensity lesions among 54.2 % (13/24 patients) in the distal filter protection group and in 27.8 % (15/54 patients) in the dual protection group (p = 0.024). The average number of hyperintensity lesions on DWI was 1.75 (range, 0 to 6) in the distal filter protection group and 0.59 (range, 0 to 5) in the dual protection group (p = 0.0087). Postprocedural persistent ischemic complications occurred in 4.2 % (1/24 patients) in the distal filter protection group and 3.7 % (2/54 patients) in the dual protection group (p = 0.67). In this study, the dual protection method reduced the number of hyperintensity lesions seen on DWI when compared with the distal filter protection method when used for distal embolic protection during CAS.

  10. Preservation of segment 4 inferior by distal middle hepatic vein reconstruction combined with extended right hepatectomy after portal vein embolization in a patient with a huge initially unresectable HCC.

    PubMed

    Nakano, Hiroshi; Kikuchi, Keita; Seta, Shin-ichi; Katayama, Masafumi; Yamamura, Takuya; Otsubo, Takehito

    2007-01-01

    An extended hepatectomy combined with preoperative portal venous embolization can offer curative resection in patients with initially unresectable hepatocellular carcinoma. However, hypertrophy of the future remnant liver is occasionally unsatisfactory after portal venous embolization in some patients to remove the initially unresectable tumor. In these patients, hepatic venous reconstruction to preserve hepatic parenchyma may contribute to the possibility of resection. The present case report shows a patient with an initially unresectable huge hepatocellular carcinoma in whom transarterial chemoembolization, portal vein embolization, and an extended right hepatectomy combined with distal middle hepatic venous reconstruction were performed to preserve Segment 4 inferior. The patient was a 66-year-old male. He presented with a huge hepatocellular carcinoma located at Segment 8, 7 and 4 superior, but the volume of the left lateral segment was only 267 mL. Transarterial chemoembolization was performed twice and right portal vein embolization was performed once, but the volume of the left lateral segment was only 318 mL compared to 487 mL which was a limit of future remnant liver volume. We therefore performed an extended right hepatectomy combined with distal middle hepatic venous reconstruction to preserve Segment 4 inferior. The left saphenous venous graft was used for this hepatic venous reconstruction. His postoperative course was almost uneventful. Postoperative abdominal computed tomography showed the satisfactorily preserved Segment 4 inferior. Distal hepatic venous reconstruction combined with an extended hepatectomy may further offer a chance of a curative resection for patients in whom enough hypertrophy of the future remnant liver is not obtained after portal venous embolization.

  11. Towards pathway curation through literature mining--a case study using PharmGKB.

    PubMed

    Ravikumar, K E; Wagholikar, Kavishwar B; Liu, Hongfang

    2014-01-01

    The creation of biological pathway knowledge bases is largely driven by manual effort to curate based on evidences from the scientific literature. It is highly challenging for the curators to keep up with the literature. Text mining applications have been developed in the last decade to assist human curators to speed up the curation pace where majority of them aim to identify the most relevant papers for curation with little attempt to directly extract the pathway information from text. In this paper, we describe a rule-based literature mining system to extract pathway information from text. We evaluated the system using curated pharmacokinetic (PK) and pharmacodynamic (PD) pathways in PharmGKB. The system achieved an F-measure of 63.11% and 34.99% for entity extraction and event extraction respectively against all PubMed abstracts cited in PharmGKB. It may be possible to improve the system performance by incorporating using statistical machine learning approaches. This study also helped us gain insights into the barriers towards automated event extraction from text for pathway curation. PMID:24297561

  12. TimeLineCurator: Interactive Authoring of Visual Timelines from Unstructured Text.

    PubMed

    Fulda, Johanna; Brehmel, Matthew; Munzner, Tamara

    2016-01-01

    We present TimeLineCurator, a browser-based authoring tool that automatically extracts event data from temporal references in unstructured text documents using natural language processing and encodes them along a visual timeline. Our goal is to facilitate the timeline creation process for journalists and others who tell temporal stories online. Current solutions involve manually extracting and formatting event data from source documents, a process that tends to be tedious and error prone. With TimeLineCurator, a prospective timeline author can quickly identify the extent of time encompassed by a document, as well as the distribution of events occurring along this timeline. Authors can speculatively browse possible documents to quickly determine whether they are appropriate sources of timeline material. TimeLineCurator provides controls for curating and editing events on a timeline, the ability to combine timelines from multiple source documents, and export curated timelines for online deployment. We evaluate TimeLineCurator through a benchmark comparison of entity extraction error against a manual timeline curation process, a preliminary evaluation of the user experience of timeline authoring, a brief qualitative analysis of its visual output, and a discussion of prospective use cases suggested by members of the target author communities following its deployment. PMID:26529709

  13. Towards pathway curation through literature mining--a case study using PharmGKB.

    PubMed

    Ravikumar, K E; Wagholikar, Kavishwar B; Liu, Hongfang

    2014-01-01

    The creation of biological pathway knowledge bases is largely driven by manual effort to curate based on evidences from the scientific literature. It is highly challenging for the curators to keep up with the literature. Text mining applications have been developed in the last decade to assist human curators to speed up the curation pace where majority of them aim to identify the most relevant papers for curation with little attempt to directly extract the pathway information from text. In this paper, we describe a rule-based literature mining system to extract pathway information from text. We evaluated the system using curated pharmacokinetic (PK) and pharmacodynamic (PD) pathways in PharmGKB. The system achieved an F-measure of 63.11% and 34.99% for entity extraction and event extraction respectively against all PubMed abstracts cited in PharmGKB. It may be possible to improve the system performance by incorporating using statistical machine learning approaches. This study also helped us gain insights into the barriers towards automated event extraction from text for pathway curation.

  14. MET network in PubMed: a text-mined network visualization and curation system

    PubMed Central

    Dai, Hong-Jie; Su, Chu-Hsien; Lai, Po-Ting; Huang, Ming-Siang; Jonnagaddala, Jitendra; Rose Jue, Toni; Rao, Shruti; Chou, Hui-Jou; Milacic, Marija; Singh, Onkar; Syed-Abdul, Shabbir; Hsu, Wen-Lian

    2016-01-01

    Metastasis is the dissemination of a cancer/tumor from one organ to another, and it is the most dangerous stage during cancer progression, causing more than 90% of cancer deaths. Improving the understanding of the complicated cellular mechanisms underlying metastasis requires investigations of the signaling pathways. To this end, we developed a METastasis (MET) network visualization and curation tool to assist metastasis researchers retrieve network information of interest while browsing through the large volume of studies in PubMed. MET can recognize relations among genes, cancers, tissues and organs of metastasis mentioned in the literature through text-mining techniques, and then produce a visualization of all mined relations in a metastasis network. To facilitate the curation process, MET is developed as a browser extension that allows curators to review and edit concepts and relations related to metastasis directly in PubMed. PubMed users can also view the metastatic networks integrated from the large collection of research papers directly through MET. For the BioCreative 2015 interactive track (IAT), a curation task was proposed to curate metastatic networks among PubMed abstracts. Six curators participated in the proposed task and a post-IAT task, curating 963 unique metastatic relations from 174 PubMed abstracts using MET. Database URL: http://btm.tmu.edu.tw/metastasisway PMID:27242035

  15. MET network in PubMed: a text-mined network visualization and curation system.

    PubMed

    Dai, Hong-Jie; Su, Chu-Hsien; Lai, Po-Ting; Huang, Ming-Siang; Jonnagaddala, Jitendra; Rose Jue, Toni; Rao, Shruti; Chou, Hui-Jou; Milacic, Marija; Singh, Onkar; Syed-Abdul, Shabbir; Hsu, Wen-Lian

    2016-01-01

    Metastasis is the dissemination of a cancer/tumor from one organ to another, and it is the most dangerous stage during cancer progression, causing more than 90% of cancer deaths. Improving the understanding of the complicated cellular mechanisms underlying metastasis requires investigations of the signaling pathways. To this end, we developed a METastasis (MET) network visualization and curation tool to assist metastasis researchers retrieve network information of interest while browsing through the large volume of studies in PubMed. MET can recognize relations among genes, cancers, tissues and organs of metastasis mentioned in the literature through text-mining techniques, and then produce a visualization of all mined relations in a metastasis network. To facilitate the curation process, MET is developed as a browser extension that allows curators to review and edit concepts and relations related to metastasis directly in PubMed. PubMed users can also view the metastatic networks integrated from the large collection of research papers directly through MET. For the BioCreative 2015 interactive track (IAT), a curation task was proposed to curate metastatic networks among PubMed abstracts. Six curators participated in the proposed task and a post-IAT task, curating 963 unique metastatic relations from 174 PubMed abstracts using MET.Database URL: http://btm.tmu.edu.tw/metastasisway. PMID:27242035

  16. Digital Curation of Earth Science Samples Starts in the Field

    NASA Astrophysics Data System (ADS)

    Lehnert, K. A.; Hsu, L.; Song, L.; Carter, M. R.

    2014-12-01

    Collection of physical samples in the field is an essential part of research in the Earth Sciences. Samples provide a basis for progress across many disciplines, from the study of global climate change now and over the Earth's history, to present and past biogeochemical cycles, to magmatic processes and mantle dynamics. The types of samples, methods of collection, and scope and scale of sampling campaigns are highly diverse, ranging from large-scale programs to drill rock and sediment cores on land, in lakes, and in the ocean, to environmental observation networks with continuous sampling, to single investigator or small team expeditions to remote areas around the globe or trips to local outcrops. Cyberinfrastructure for sample-related fieldwork needs to cater to the different needs of these diverse sampling activities, aligning with specific workflows, regional constraints such as connectivity or climate, and processing of samples. In general, digital tools should assist with capture and management of metadata about the sampling process (location, time, method) and the sample itself (type, dimension, context, images, etc.), management of the physical objects (e.g., sample labels with QR codes), and the seamless transfer of sample metadata to data systems and software relevant to the post-sampling data acquisition, data processing, and sample curation. In order to optimize CI capabilities for samples, tools and workflows need to adopt community-based standards and best practices for sample metadata, classification, identification and registration. This presentation will provide an overview and updates of several ongoing efforts that are relevant to the development of standards for digital sample management: the ODM2 project that has generated an information model for spatially-discrete, feature-based earth observations resulting from in-situ sensors and environmental samples, aligned with OGC's Observation & Measurements model (Horsburgh et al, AGU FM 2014

  17. Genesis Contingency Planning and Mishap Recovery: The Sample Curation View

    NASA Technical Reports Server (NTRS)

    Stansbery, E. K.; Allton, J. H.; Allen, C. C.; McNamara, K. M.; Calaway, M.; Rodriques, M. C.

    2007-01-01

    Planning for sample preservation and curation was part of mission design from the beginning. One of the scientific objectives for Genesis included collecting samples of three regimes of the solar wind in addition to collecting bulk solar wind during the mission. Collectors were fabricated in different thicknesses for each regime of the solar wind and attached to separate frames exposed to the solar wind during specific periods of solar activity associated with each regime. The original plan to determine the solar regime sampled for specific collectors was to identify to which frame the collector was attached. However, the collectors were dislodged during the hard landing making identification by frame attachment impossible. Because regimes were also identified by thickness of the collector, the regime sampled is identified by measuring fragment thickness. A variety of collector materials and thin films applied to substrates were selected and qualified for flight. This diversity provided elemental measurement in more than one material, mitigating effects of diffusion rates and/or radiation damage. It also mitigated against different material and substrate strengths resulting in differing effects of the hard landing. For example, silicon crystal substrates broke into smaller fragments than sapphire-based substrates and diamond surfaces were more resilient to flying debris damage than gold. The primary responsibility of the curation team for recovery was process documentation. Contingency planning for the recovery phase expanded this responsibility to include not only equipment to document, but also gather, contain and identify samples from the landing area and the recovered spacecraft. The team developed contingency plans for various scenarios as part of mission planning that included topographic maps to aid in site recovery and identification of different modes of transport and purge capability depending on damage. A clean tent, set-up at Utah Test & Training Range

  18. Enchondroma in the distal phalanx of the finger

    PubMed Central

    Lu, Hui; Chen, Qiang; Yang, Hu; Shen, Hui

    2016-01-01

    Abstract The goal of our study was to report the clinical presentation, treatment, and complications of enchondroma in the distal phalanx of the finger. This was a retrospective study of 34 patients (19 women and 15 men) who underwent surgery between May 2004 and September 2012 for enchondroma in the distal phalanx of the finger. The average age of the patients was 39.38 ± 10.97 years old (range 14–59). The presenting symptoms and imaging features were recorded. The surgical procedure was performed under regional or general anesthesia. The surgical technique involved removal of tumors by opening a cortical window and curetting the cavity. The defects were filled with an injectable calcium phosphate cement. All patients received follow-up in our outpatient clinic every 6 months. Expansion of bone or thinning of the cortex present in the radiological imaging, including anteroposterior and lateral plain radiographs of the fingers, was used to assess for tumor recurrence. The observational end-point was reoperation. All tumors were confirmed as enchondromas by the pathological results. None of the patients had a tumor recurrence. Three patients (9% of cases) developed an infection. After antibiotic treatment, 2 patients were cured, and 1 patient required an amputation. Enchondroma in the distal phalanx of the finger presents with a variety of clinical symptoms. Injectable calcium phosphate cement is adequate for bone grafting. Postoperative infection is more common than tumor recurrence. If patients have an infection or bilateral bone cortex defects, bone grafting is challenging. Level of Evidence: Therapeutic study, Level IV PMID:27661057

  19. Temporary bridging external fixation in distal tibial fracture.

    PubMed

    Lavini, F; Dall'Oca, C; Mezzari, S; Maluta, T; Luminari, E; Perusi, F; Vecchini, E; Magnan, B

    2014-12-01

    Fractures that involve the distal area of the tibia are associated with a high percentage of complications. Soft tissue oedema, swelling, blisters, skin abrasions and open wounds could compromise the outcome of these lesions. The waiting time before surgery with ORIF is mostly due to soft tissue conditions. Early application of a simple joint-spanning external fixator would achieve the initial goal of stability and the respect of soft tissue, thereby decreasing the time necessary for definitive treatment. A total of 40 consecutive patients (22 male and 18 female) with a mean age of 52 years (range 17-82 years) with distal tibial fracture treated between January 2010 and January 2013 were evaluated. Early temporary external fixation was the first treatment step. Twenty patients had pilon fractures, characterised by the intra-articular involvement of the distal tibia with metaphyseal extension, and 20 patients had malleolar fracture-dislocation. Patients were divided into two groups, A and B. Group A comprised 10 patients with ankle fracture-dislocation and bone fragmentation, who were treated with a temporary bridging external fixation that was maintained after ORIF to exploit ligamentotaxis during the first phases of bone healing. In Group B (30 patients), the external fixation was removed after ORIF. The results of the study are in line with the recent literature: temporary external fixation in high-energy trauma and fracture-dislocation of the ankle enables soft tissue to be restored, which facilitates postoperative assessment of bone fragments by CT scan. The complication rate in this study was 5% in patients with malleolar fractures and 20% in patients with pilon fractures. The maintenance of temporary external fixation after ORIF synthesis during the entire first stage of bone healing seems to be a good method of treatment that has a low rate of soft tissue complications.

  20. Octreotide acetate inhibits motility in the rabbit distal colon.

    PubMed

    John, K D; Ballantyne, G H; Modlin, I M

    1997-01-01

    Octreotide, the long-acting somatostatin analogue, has been reported to modulate gastrointestinal motility in both animals and humans. A role in colonic peristalsis and a possible clinical application in common disorders, such as chronic constipation and irritable bowel syndrome, have not been evaluated. It has been previously suggested that octreotide promotes the descending relaxation of the peristaltic reflex arc. We hypothesized that this effect may involve inhibition of the motility index (MI) of the distal colon. To test this proposal, we studied peristalsis in isolated rabbit colons and also in the intact distal colons of anesthetized rabbits undergoing octreotide administration. Left colons of New Zealand white rabbits were harvested, placed in an isolated organ chamber and perfused with Krebs-Ringer bicarbonate solution via the inferior mesenteric artery. In a separate preparation, the colons were left in situ. Motility was quantified with a 6-port continuous infusion manometry catheter. The MI (mm Hg/min) was calculated by integration of the area of the digitalized signal (8/s), which reflected high-pressure peaks of different magnitudes. High-pressure waves were defined as > 20 mm Hg. Octreotide was infused via the inferior mesenteric artery in the isolated specimen or the lateral ear vein in the anesthetized animals in concentrations of 10(-12) to 10(-6) M. Octreotide inhibited high-pressure waves in a dose-dependent manner. These effects resulted in a decreased MI, with the maximum inhibition of 24.6% at 10(-11) M (p < 0.05 by ANOVA). At that concentration, the number of peaks > 20 mm Hg were reduced by 62.2%. The data indicate that octreotide decreases the MI by inhibition of high-pressure waves in the distal rabbit colon. These findings are consistent with the proposal that somatostatin may augment descending relaxation of the peristaltic reflex arc. This effect is independent of neural modulation.