Needlescopic intragastric surgery facilitated by newly developed 2mm instruments

Background: Intragastric surgery is a percutaneous endoluminal surgery in the stomach aimed at resection of tumors located at the esophagogastric junction (EGJ). We developed needlescopic intragastric surgery performed via 2?mm, 2?mm, and 5?mm ports (PEIGS-225).

Material and methods: In cooperation with Niti-On Co., Ltd. we developed a series of 2?mm instruments including grasping forceps, a cannula, a laparoscope, an electrocautery, scissors, and a needle holder. Operative technique: Two 2?mm trocars and a 5?mm one are inserted into the gastric lumen percutaneously. Intragastric procedures are performed by the instruments brought through those three ports. The specimen is extracted via the esophageal-oral route. The defect in the gastroesophageal wall is closed by hand-suture. After the intragastric procedure, the 5?mm stab wound on the gastric wall is closed by hand-suture, while the 2?mm wounds are left untreated. Patients: Between March and August 2015 PEIGS-225 was performed in five patients.

Results: There was no operative conversion. The mean operation time was 96?minutes. There were no perioperative complications. Pathological findings indicated that the margin was negative in all cases.

Conclusion: Needlescopic intragasric surgery performed via the smallest access (2?mm, 2?mm, 5?mm) is enabled by the 2?mm instruments developed by us.     

Effectiveness of an Intravenous Protection Device in Pediatric Patients on Catheter Dwell Time and Phlebitis Score

PurposeThe study aimed to examine the efficacy of the I.V. House UltraDressing for protecting peripheral intravenous catheters (PIVCs) in pediatric patients.MethodsThis randomized controlled trial comprised 60 pediatric patients (aged 2–24 months): 30 in the experimental group and 30 in the control group. The PIVC dwell time and phlebitis scores were also reported for both groups. The degree of phlebitis was determined using the Visual Infusion Phlebitis Scale (VIPS) and was recorded every 8 hours from the start of antibiotic therapy until catheter removal.ResultsThe mean catheter dwell time in the experimental group (2.10 ± 1.55 days) was significantly longer than that in the control group (1.27 ± 0.45 days) (p < .01). However, there were no significant differences between the scores and signs of phlebitis in both groups (p > .05).ConclusionThe I.V. House UltraDressing is a useful device that can be used to increase catheter dwell time and protect and stabilize PIVCs in pediatric patients.     

神经内镜下治疗基底节区高血压脑出血的效果研究

目的探讨传统开颅手术与神经内镜手术在治疗基底节区高血压脑出血(HICH)患者中的疗效与安全性,为其临床治疗提供一定依据。方法 86例基底节区HICH患者,根据手术方式不同将患者分为神经内镜组(40例)和开颅手术组(46例),开颅手术组采用开颅血肿清除手术治疗,神经内镜组采用神经内镜微创血肿清除手术治疗,对比两组基底节区HICH患者皮肤切口大小、骨窗大小、皮层切口大小、手术时间、术中出血量、血肿清除率、术后并发症、近期与远期疗效和病死率。结果神经内镜组患者的皮肤切口大小、骨窗大小、皮层切口大小、手术时间、术中出血量均明显低于开颅手术组(P 0.01);两组患者血肿清除率差异无统计学意义(P0.05);神经内镜组患者术后并发症发生率为10.0%,明显低于开颅手术组的28.3%(P 0.05);神经内镜组患者近期疗效良好率为90.0%明显高于开颅手术组的60.9%(P 0.01);神经内镜组患者远期疗效良好率为92.5%明显高于开颅手术组的63.0%(P 0.01);开颅手术组患者死亡3例,病死率6.5%;神经内镜组患者死亡2例,病死率5.0%;两组患者病死率差异无统计学意义(P0.05)。结论神经内镜手术治疗基底节区HICH可以减小手术创伤,缩短手术时间,降低出血量,提升近期与远期疗效,降低并发症发生率。     

术前疼痛知识教育对腹部术后疼痛控制效果的影响

目的了解术前疼痛知识教育对腹部术后患者对疼痛控制的认识、所采取的疼痛控制措施及疼痛控制效果的影响。方法采用非同期对照方法，将84例腹部手术患者分成两组，每组42例。术前对试验组进行疼痛知识教育及常规指导，对照组只进行常规指导，术后第2天下午完成“术后疼痛控制问卷”调查。结果试验组对疼痛控制的认识高于对照组（P〈0．05）。试验组术后采取深呼吸、听音乐的患者较对照组多（P〈0．05）；试验组患者能更为正确地使用镇痛泵（P〈0．05）；两组主动要求使用止痛药的人次及疼痛分值差异无统计学意义（P〉0．05）。试验组术后疼痛分值较对照组低（P〈0．05）。结论术前疼痛知识教育能提高腹部术后患者对疼痛控制的认识，促使其主动参与术后疼痛控制，从而提高术后疼痛控制效果。     

A new oval multichannel port to facilitate reduced port distal gastrectomy

Background: This report describes the techniques and outcomes of reduced port distal gastrectomy (RPDG) using a new oval multichannel port. Material and methods: We performed reduced port distal gastrectomy through the E·Z Access? oval type device with three trocars in the umbilical incision, plus the use of additional 5 mm and 2 mm ports. All routine procedures performed in conventional laparoscopic distal gastrectomy (CLDG) were achieved in RPDG. Results: We employed this technique without the use of additional trocars or conversion to laparotomy in all 25 patients. The median length of the operation was 340 (range, 220–487) minutes, and the median estimated blood loss was 30 (range, 5–440) ml. Neither major postoperative complications, such as anastomotic leakage and stricture, nor postoperative mortality were observed. The mean length of the hospital stay was 11 days. The umbilical wound was indistinct. The patients were also highly satisfied with the cosmetic outcome. Conclusion: Reduced port surgery using the E·Z Access? oval type device was successfully applied for gastric cancer. This method is technically feasible, produces superior cosmetic results and thus could be an attractive surgical option for gastric cancer patients.     

Kopfschmerz – diagnostisches Vorgehen

In headache diagnosis primary and secondary “symptomatic” headache disorders have to be distinguished. Although there are more than 300 medical conditions that can cause headache, the majority of headaches are benign. The basic tool for diagnosing a primary headache disorder is a careful history, supplemented by a general and neurologic examination without neuroimaging or other confirmatory tests. If a secondary headache disorder is suspected on the basis of the history or clinical examination, further diagnostic tests have to be performed. Neuroimaging can exclude brain tumors, hydrocephalus and intracranial haemorrhage, but its yield in patients with a normal neurologic examination is quite low. Further diagnostic tools such as Doppler and duplex sonography, CSF examination, X-ray and blood tests should be employed with respect to a specific clinical question. EEG is not useful in the routine evaluation of patients with headache.     

Post-treatment fistulas in patients with rectal cancer: MRI with rectal superparamagnetic contrast agent

MRI is the standard modality in the pre- and post-treatment evaluation of patients with rectal cancer, particularly in those cases with locally advanced disease. We routinely employ a superparamagnetic iron oxide (SPIO) contrast enema to distend the rectal lumen and achieve maximal tumor-to-lumen contrast gradient. This practice also allowed the identification of a fistula in 24% of patients treated for rectal cancer. Contrast agent-related low intensity signal could be seen filling the tract and eventually opacifying surrounding organs (i.e., vagina) or collections (i.e., presacral abscess). Fistula formation after radiochemotherapy and surgery for rectal cancer is not uncommon. MRI with dark lumen contrast enema allows an effective demonstration of this complication in a high number of patients.     

Gastric diverticula following subtotal gastrectomy

Four cases of gastric diverticula following subtotal gastrectomy are described. This type of diverticula associated with partial gastrectomy are probably true, acquired, pulsion diverticula. In two of our patients the diverticula were associated with significant prolapse of gastric mucosa causing obstruction at the anastomosis.     

干燥综合征的靶向治疗进展

干燥综合征（SS）是一种以外分泌腺受累为主，可累及全身系统的自身免疫性疾病。患者常因口干、眼干、疲劳、疼痛、脏器受累等，严重影响生活质量。近年来，随着人们对干燥综合征发病机制的深入认识，多种靶向药物正在研发中，有望用于治疗此类患者。     

Successful emergency endovascular treatment of juxtarenal and infrarental mycotic aortic aneurysms in patients with small diameter aortae using Cook? Zenith ESLE Stentgrafts

BACKGROUND:

Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small.

METHODS:

A retrospective review was made of prospectively collected departmental computerised database.

RESULTS:

Three oriental patients with juxta- and infra-renal mycotic aortic aneurysms with a small aortic diameter of 17 mm to 18 mm underwent successful emergency endovascular treatment using Cook^® Zenith ESLE stentgrafts. These are ancillary devices aimed at iliac extensions usually.

CONCLUSION:

This is to our knowledge the first case series of Cook^® Zenith ESLE iliac component endografts for the treatment of aortic mycotic aneurysms with small aortae, and short- and mid-term results are encouraging.KEY WORDS: Endovascular, Mycotic, Small aorta, Oversizing, Cook^®, Zenith ESLE Stentgrafts     

Association of optic nerve sheath diameter measurement with hyponatremia in emergency department

ObjectiveInvestigation of association of ONSD with hyponatremia in symptomatic patients.Methods89 patients who were diagnosed to have hyponatremia (Na + <135 mmol/L) were prospectively analyzed and compared with 72 patients who have normal serum sodium levels presented to ED at the same time interval. Subjects' demographic properties including age and sex were recorded, as were admission symptoms, serum Na + level, and pre-treatment and post-treatment optic nerve sheath diameter (ONSD).ResultsThe mean age of the study population was 62.3 ± 17.6 years, and the control group 55.1 ± 20.0 years (p < 0.05). There was a significant difference between the patient group's pre-treatment and post-treatment OSNDs compared to the controls (p < 0.05). There was a significant negative correlation between the admission sodium level and ONSD in the patient group (p < 0.05). In the pre-treatment period, patients with symptoms had a significantly greater mean ONSD than those without symptoms (0.546 ± 0.068 mm vs 0.448 ± 0.081 mm; p < 0.05). The area under the curve was 0.870; the cut-off level calculated for hyponatremia was 0.49 mm, which had a sensitivity of 81% and a specificity of 81.9%.ConclusionUltrasonic imaging of ONSD measurement in the emergency department appears to reflect changes consistent with ICP changes in hyponatremia and change in serum sodium.     

Obstructive and enteropathic syndromes after jejunoileal bypass surgery

Small bowel bypass procedures for morbid obesity have been associated with many postoperative complications. With the use of the Scott procedure, the bypassed or excluded small bowel segment has recently been the focus of 2 syndromes — bypass enteritis and defunctioned bowel syndrome. We describe these postoperative complications and present their significant radiologic features.     

Roentgen manifestations of carcinoma in the gastric remnant

Awareness of the increased incidence of carcinoma in the gastric remnant has not been accompanied by improved diagnosis or prolonged survival. The long latent period prior to development of tumor, the insidious nature of symptoms, and the anatomical distortion produced by surgery contribute to the difficulty in detection of these lesions. The radiological spectrum of carcinoma of the gastric remnant is discussed and both characteristic and unique radiographic features are illustrated.     

Postgastrostomy deformity of the stomach

Temporary postoperative tube gastrostomy may produce permanent deformity of the stomach as visualized on an upper gastrointestinal series. Six cases were studied illustrating two configurations of the gastric deformity. These appear to be related to the location of the gastrostomy opening in the stomach. The findings were either anterior displacement of the gastric antrum with adherence to the anterior abdominal wall or acute angulation of the gastric body in a medial and anterior direction.     

Suture line ulceration: A complication of gastric partitioning

Gastric partition with formation of a proximal pouch by staples and reinforced sutures is a well-accepted operation for obesity. Experience at this institution has included 2 cases of ulcers occurring at the partition line, a complication not well-described previously. These ulcers were located on the lesser curvature, appeared benign, and were characterized by chronic, severe pain. A suture associated with the ulcer was demonstrated endoscopically in 1 patient, although it could not be removed perorally.