Presented here is a case of unilateral pulmonary edema following acute subglottic edema after removal of an endotracheal tube. A 3-year-old boy, diagnosed as having nondiphtheric croup and pectus excavatum deformity, was scheduled for repair of a cleft lip. No complication occurred during the operation. After removal of the endotracheal tube, he showed dyspnea and cyanosis and was later found to have acute subglottic edema. After reintubation of the trachea, frothy pink fluid was discharged from the tube, and chest roentgenogram showed a right-sided alveolar infiltrate. Many factors may cause unilateral pulmonary edema, but it is suggested that acute subglottic edema and unilateral bronchial fragility strongly affected this episode.

Acute Disease↗

PubMedDate not supplied

Ectasis and pallor of peripheral airways during mechanical ventilation.

STUDY OBJECTIVE: To evaluate morphologic changes in peripheral airways associated with positive-pressure ventilation (PPV). DESIGN: Single-blind study. SETTING: Intensive care unit of a university hospital. PATIENTS: Ten patients who required mechanical ventilation due to acute respiratory failure but had no history of prior pulmonary disease. INTERVENTIONS: Seventeen fiberoptic bronchoscopy procedures were performed using a fine fiberoptic bronchoscope of 1.8 mm outside diameter. MEASUREMENTS AND MAIN RESULTS: The main morphologic findings were pallor and ectasis. Increased secretions, pigmentation, and stenosis or collapse in peripheral airways also were observed. Patients with ectasis were more likely to have had prolonged mechanical ventilation (17 +/- 9 days) as compared with those patients without ectasis (9 +/- 5 days). CONCLUSION: The structural alterations in peripheral airways noted in patients on prolonged PPV suggest that barotrauma may be more widespread than previously recognized.

Adult↗

PubMedDate not supplied

The clinical efficacy of CA 72-4 as serum marker for gastric cancer in comparison with CA19-9 and CEA.

The clinical efficacy in preoperative assessment with CA72-4 for gastric cancer was studied in comparison with CA19-9 and CEA. These three tumor markers were examined simultaneously, preoperatively in 100 cases (44: early cancer, 56: advanced cancer) of gastric cancer. Additionally the efficacy of CA72-4 in follow-up postoperative monitoring for the recurrence was investigated. Positive rate of CA72-4, CA19-9 and CEA for early cancer was 2.3%, 11.4% and 9.1% and that for advanced cancer was 37.5%, 17.9% and 35.7% respectively, thus CA72-4 gave the highest positive rate for advanced cancers. And CA72-4 revealed higher positive findings in stage IV, in infiltrating type, in diffuse type, in cancer invading deeper than p-T3. Further, CA72-4 was positive in 50% for cancer with peritoneal dissemination, whereas CEA was positive in 8.3%, CA19-9 in 16.3%. The most beneficial combination among these three tumor markers was CA72-4 and CEA, and by which, positive rate was 53.6%. Regarding follow-up, CA72-4 showed first elevation prior to other markers in some cases before clinical recurrence was confirmed. CA72-4 appeared to be a useful marker for managing gastric cancer.

Antigens, Tumor-Associated, Carbohydrate↗

PubMedDate not supplied

Gallstones and gallbladder disorder after gastrectomy for gastric cancer.

The incidence of gallbladder diseases, in particular of gallstones, was investigated in 268 cases during follow-up after resection of a gastric cancer. Factors investigated for correlation with any incidence included the extent of gastrectomy, reconstruction, and the degree of lymph node dissection. Moreover, in 20 of these, the contractile function test using a cerulein injection was performed, while in a further 6 cases, a sequential contractile function test with fatty meal was performed. The incidence of gallstones was 10.5% after total gastrectomy, 12.4% after distal gastrectomy. Debris was found in a further 6.7% after total gastrectomy and in 1.2% after distal gastrectomy. There was no difference in the incidence of gallstones among the reconstruction methods. With respect to lymph node dissection, the incidence of gallstone formation was 16.3% after D3 and 8.5% after D2-1. In the contractile function test, although the basal area was significantly larger after D3 than after D2-1, there was no difference in the contractile rate. The sequential contractile function test showed a peak contraction at 15 minutes after feeding with gradual refilling in both those after D3 and those after D2-1.

Case-Control Studies↗

PubMedDate not supplied

Abdominal wall lifting with spinal anesthesia vs pneumoperitoneum with general anesthesia for laparoscopic herniorrhaphy.

BACKGROUND: Laparoscopic herniorrhaphy has generally been very successful since any postoperative inguinal pain or tension is considerably less troublesome than after other open methods. The conventional laparoscopic approach in the treatment of inguinal hernia involves the use of pneumoperitoneum and general anesthesia. Nevertheless, some complications can be encountered and the procedure is costly. We, therefore, examined the possibility of using a more practical and cost efficient method. MATERIALS AND METHODS: Based on our findings, we propose the use of a Kirschner lifting wire as a means of separating the abdominal wall during laparoscopic herniorrhaphy. Two Kirschner wires are introduced through the subcutaneous tissue, between the umbilicus and inguinal ligament, and parallel to the inguinal ligament. Furthermore, we recommend the use of spinal anesthesia as a means by which the problems associated with general anesthesia and the potential cardiopulmonary complications of carbon dioxide insufflation, are circumvented. Fifteen cases of inguinal hernia have been treated with this new method and compared to the more conventional procedure of pneumoperitoneum under general anesthesia. RESULTS: Visibility of the operative field when used in the inguinal region was not limited at all, and Kirschner wire is considerably less expensive. The postoperative course for the patients who were operated by the new method was uneventful. CONCLUSIONS: Our results indicate that this new method can be useful for the treatment of inguinal hernia.

Aged↗

PubMedDate not supplied

Efficacy of transgastrostomal endoscopic surgery (TGES) for early gastric cancer.

Early gastric cancer is now treated successfully by endoscopic mucosal resection (EMR). This technique, however, is not indicated when the tumoral lesion is located near the esophagogastric (EG)-junction, on the lesser curvature, or in the upper body or near the pylorus ring, and not indicated when the tumor size is greater than 20 mm. For these cases, we have developed what we term, "transgastrostomal endoscopic surgery" (TGES), using a Buess-type scope system. The aim of this study was to evaluate the efficacy of this technique in the treatment of those gastric cancers that could not be treated by EMR. In 4 patients selected for TGES, a Buess-type tube (external diameter: 40 mm) was inserted into the stomach through a temporary gastrostoma, and the whole operation was performed through the Buess-tube, using a video-camera for visualization. Using electrocautery scissors and forceps, complete resection of each lesion was performed, and the wound was closed by sutures. The average operation duration was 195 (130-240) minutes and the average blood loss was 59 (30-100) ml. The average size and margin of the resected specimens were 48 (30-59) and 13 (5-23) mm respectively. TGES is a substitutive, minimally invasive surgery to treat an early gastric cancer for which EMR would be difficult. This technique appeared to be simpler and easier than that of laparoscopic resection especially for a lesion on the posterior side of the stomach.

Adenoma↗

PubMedDate not supplied

Early gastric cancer in the remnant stomach.

BACKGROUND/AIMS: Early gastric cancer in the remnant stomach is rare. Periodical endoscopic examinations are mandatory for patients with partial gastrectomy for a good prognosis. Our goal is to improve the surgical management of gastric cancer in the remnant stomach. We have retrospectively investigated a total of 15 rare cases of early gastric cancer after partial gastrectomy. METHODOLOGY: From 1976 to 1994, a total of 2,102 cases of gastric cancer were resected in our Department. Among these resected cases, 845 cases were histologically diagnosed as having early gastric cancer of the stomach. Of these, 15 patients had previously undergone a partial gastric resection. The time interval between the initial partial gastrectomy and the second resection of the remnant stomach, was more than 10 years for 8 patients (Group 1) and less than 10 years for 7 patients (Group 2). Here we investigate these rare cases of remnant early gastric cancer. RESULTS: The incidence of early gastric cancer in the remnant stomach was 1.8% (15/845). The cancer location in the remnant stomach was around the stoma and suture line in 75% of Group 1 and in 28.6% of Group 2. The incidence rate of mucosal cancer (m-cancer) was 87.5% for Group 1, and 14.3% for Group 2. Total gastrectomy was selected for 37.5% of Group 1, and for 100% of Group 2. No lymph node metastasis was discovered in both groups. The postoperative mortality was zero in both groups. One patient from Group 2, later died of liver metastasis 2 years after the second total gastrectomy, while the other 9 patients continued to live for more than 5 years with no gastric cancer recurrence to date. CONCLUSIONS: The outcome for patients with gastric cancer in the remnant stomach is generally considered poor. However, the outcome of early gastric cancer in the remnant stomach was good without major postoperative complications. Therefore, to improve surgical management of remnant-stump gastric cancer, early diagnosis is most important, using periodic endoscopic follow-up examinations, especially around the stoma. When mucosal cancer around the stoma is diagnosed, subtotal gastrectomy can be selected even in gastrectomized patient for a good prognosis.

Adult↗

PubMedDate not supplied

Lymph node metastasis and lymphadenectomy for carcinoma in the gastric cardia: clinical experience.

METHOD AND MATERIALS: To suggest improved guidelines for treating lymphatic spread and to understand the results of extended lymphadenectomy. A total of 141 cases of cardia carcinoma admitted to our hospital during 1980 to 1993 were analyzed. RESULTS: 123 of 141 cases underwent resection. The incidence of mediastinal lymph node involvement rose from 8.7% in cases with 1-2 cm invasion to 52.9% in cases with more than 4 cm invasion into the esophagus. The incidence of abdominal lymph node involvement also rose with increasing esophageal invasion. Paraaortic lymph node metastasis was frequently observed in cases of more than 1 cm esophageal invasion. D4 lymphadenectomy (extended lymphadenectomy) revealed better results for the cases with lymph node involvement (P<0.05). There was no difference in the incidence of postoperative complication or in operative death, between the abdominal approach and the thoracoabdominal approach, or between the D4 lymphadenectomy and D2 lymphadenectomy. CONCLUSION: Sufficient mediastinal and abdominal lymphadenectomy under a clear wide surgical field achieved through the thoracoabdominal approach appeared to bring better results.

Adenocarcinoma↗