Reconstruction after gastrectomy and quality of life

To evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n=59) or simple esophagojejunostomy (n=24) and distal subtotal gastrectomy (n=21). No significant differences were found between total gastrectomy with pouch reconstruction and distal gastric resection with respect to dumping or heartburn, whereas patients with total gastrectomy and restoration with esophagojejunostomy suffered from both. The latter group of patients also had reduced nutritional status. Although there is a lack of a proper definition of quality of life, all instruments applied to its measurement indicated improved results for patients with pouch reconstruction and those after distal gastrectomy, but we could not state any significant differences. We conclude that in terms of postoperative functional results as well as quality of life distal gastric resection has no advantage over total gastrectomy with pouch reconstruction; hence a reduction of surgical radicality in an attempt to improve postoperative results is not justified. Pouch reconstruction should be considered the treatment of choice for reconstruction after total gastrectomy.

---

Resumen Con miras a evaluar la calidad de la vida y los resultados funcionales luego de cirugía por cáncer gástrico, estudiamos 104 pacientes que se encontraban libres de enfermedad a un mínimo de 12 meses postoperatorios. Los pacientes fueron tratados con gastrectomía total y reconstrucción con una bolsa yeyunal de tipo Hunt-Lawrence-Rodino (n=59) o simple esofagoyeyunostomía (n=24) y gastrectomía subtotal distal (n=21). No se encontraron diferencias significantivas entre los pacientes sometidos a gastrectomía total con reconstrucción con bolsa yeyunal y los sometidos a resección distal con respecto a dumping o pirosis, en tanto que los pacientes sometidos a gastrectomía total y restauración mediante esofagoyeyunostomía exhibieron ambos síntomas. Además, los últimos desarrollaron deterioro de su estado nutricional. Aparte de la falta de una adecuada definición de calidad de la vida, todos los parámetros aplicados para su medición demostraron mejores resultados en los casos de gastrectomía total con reconstrucción con bolsa yeyunal y en los casos de gastrectomía distal, pero sin que pudiéramos hallar diferencias significativas. Nuestra conclusión es que en términos de los resultados funcionales postoperatorios así como de calidad de la vida, la resección gástrica distal no tiene ventaja sobre la operación con reconstrucción con bolsa yeyunal y que no se justifica una reducción de la radicalidad quirúrgica con el objeto de mejorar los resultados postoperatorios. La reconstrucción con bolsa yeyunal debe ser considerada como el procedimiento de elección en la gastrectomía total.

---

Résumé Afin d'évaluer la qualité de vie et les résultats fonctionnels après chirurgie pour cancer gastrique, nous avons étudié 104 patients qui semblaient guéris à 12 mois. Les patients ont eu soit une gastrectomic totale suivie ou de la confection d'un néogastre jéjunal selon le procédé de Hunt-Lawrence-Rodino (n=59) ou une simple anastomose oesojéjunale (n=24), soit d'une gastrectomie distale subtotale (n=21). Il n'y avait aucune différence significantive entre la gastrectomie totale suivie de reconstruction par néogastre et la gastrectomie distale subtotale en ce qui concerne le dumping syndrome ou le reflux, alors que les patients qui avaient eu une gastrectomie totale suivie d'anastomose oesojéjunale avaient les deux. Chez ces derniers, on a également noté une certaine malnutrition. En dépit du manque de définition précise de la qualité de vie, tous les moyens utilisés pour la mesurer ont indiqué um meilleur résultat pour les patients ayant eu une reconstruction avec néogastre par rapport à la gastrectomie distale, sans toutefois atteindre la signification statistique. Nous concluons qu'en terme de résultats fonctionnels postopératoires ainsi que de la qualité de vie, la gastrectomie distale ne présente aucun avantage par rapport à la gastrectomie totale suivie de néogastre, et une réduction dans l'importance de l'intervention pour améliorer les résultats fonctionnels n'est pas justifiée. La confection d'un néogastre doit être la méthode de reconstruction de choix après gastrectomie totale.

     

Patterns of Connectivity in the Neocortex of the Echidna (Tachyglossus aculeatus)

Patchy connections were traced in the visual and auditory cortexof the echidna (Tachyglossus aculeatus). Labeled neurons andclusters of axon collaterals were distributed in regular arraysafter the application of a small crystal (100–300 µmdiameter) of the carbocyanine dye Dil (1,1'-dioctadecyl-3,3,3',3'-tetramethylindocart)ocyaninepar-chlorate) into the upper cortical layers. In general, theanterograde and retrograde labels were in register, but whereasthe anterograde label was distributed throughout all six layers,the retrogradely filled neurons were absent from layer 1 andthe highest density of labeled cells was in layers 5 and 6.The cells contained within the patches were all pyramidal orpyramid-like and contained long spines on their dendrites. Therefore,despite their unusual location within the lateral posteriorcortex, the internal structure of the echidna visual and auditorycortices resembled that of eutherian mammals in containing aregular columnar array of connections that may represent thecorti-cocortical projections.     

Uric acid accumulated in isolated kidney grafts: An assessment of agonal ischaemia

Hypoxanthine-xanthine washed out from kidney tissue during preservation has previously been found to be a reliable measure of thein vitro assessment of the deleterious effect of ischaemia on the functional regenerative ability of the graft. We have now studied the question: can uric acid accumulation in the isolated kidney graft be employed as a retrospective measure of the agonal ischaemia? We have found that uric acid alone accumulates in renal tissue during the agonal phase, in an amount that remains unchanged during the subsequentin vitro ischaemia. The determination of hypoxanthine-xanthine and uric acid in kidney perfusate samples during preservation must thus be presumed to be an optimal clinical-chemical method of assessing the graft ischaemia.     

A Hodgkin cell-specific antigen is expressed on a subset of auto- and alloactivated T (helper) lymphoblasts

A Hodgkin cell-specific antigen detected by the monoclonal antibody Ki- 1 was found on T helper lymphocytes after activation by autologous and allogeneic stimulator cells. About 50% of lymphoblasts generated by auto- and alloactivation reacted with the antibody. In contrast, only less than 6% of lymphoblasts stimulated with Con-A, phytohemagglutinin (PHA), or protein A, and none of lymphoblasts activated by oxidative mitogenesis, expressed this antigen. Among several permanent cell lines tested, the K562, MOLT-4, HL-60, and EBV transformed B lymphoblastoid cells reacted with the Ki-1 antibody. The results may indicate possible relationships between the autoreactive subset of T lymphocytes and the pathogenesis of Hodgkin's disease.     

Measurement of long‐term iron absorption and loss during iron supplementation using a stable isotope of iron (57Fe)

We report the first measurements of long‐term iron absorption and loss during iron supplementation in African children using a stable isotope of iron (⁵⁷Fe). After uniform labelling of body iron with ⁵⁷Fe, iron absorption is proportional to the rate of decrease in the ⁵⁷Fe tracer concentration, while iron loss is proportional to the rate of decrease in the ⁵⁷Fe tracer amount. Anaemic Gambian toddlers were given 2 mg ⁵⁷Fe orally to equilibrate with total body iron over 8–11 months. After assignment to the positive control arm of the HIGH study, 22 toddlers consumed a micronutrient powder containing 12 mg iron for 12 weeks followed by 12 weeks without iron supplementation. Their daily iron absorption increased 3·8‐fold during the iron supplementation period compared to the control period [median (interquartile range, IQR): 1·00 (0·82; 1·28) mg/day vs. 0·26 (0·22; 0·35) mg/day; P = 0·001]. Unexpectedly, during the supplementation period, daily iron loss also increased by 3·4‐fold [0·75 (0·55; 0·87) mg/day vs. 0·22 (0·19; 0·29) mg/day; P = 0·005]. Consequently, most (~72%) of the absorbed iron was lost during supplementation. Long‐term studies of iron absorption and loss are a promising and accurate method for assessing and quantifying long‐term iron balance and may provide a reference method for evaluating iron intervention programs in vulnerable population groups. This study was registered as ISRCTN 0720906.     

A role for fast rhythmic bursting neurons in cortical gamma oscillations in vitro

Basic cellular and network mechanisms underlying gamma frequency oscillations (30-80 Hz) have been well characterized in the hippocampus and associated structures. In these regions, gamma rhythms are seen as an emergent property of networks of principal cells and fast-spiking interneurons. In contrast, in the neocortex a number of elegant studies have shown that specific types of principal neuron exist that are capable of generating powerful gamma frequency outputs on the basis of their intrinsic conductances alone. These fast rhythmic bursting (FRB) neurons (sometimes referred to as "chattering" cells) are activated by sensory stimuli and generate multiple action potentials per gamma period. Here, we demonstrate that FRB neurons may function by providing a large-scale input to an axon plexus consisting of gap-junctionally connected axons from both FRB neurons and their anatomically similar counterparts regular spiking neurons. The resulting network gamma oscillation shares all of the properties of gamma oscillations generated in the hippocampus but with the additional critical dependence on multiple spiking in FRB cells.