PubMed · 150712
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F Robicsek, H K Daugherty, J W Cook, B J Owen. A new method to revascularize the celiac axis.. https://doi.org/10.1177/153857447701100107
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OBJECTIVE: To evaluate GI symptoms in patients submitted to systematic para-aortic lymphadenectomy (PALN) and to compare them in a contemporary series of patients only submitted to systematic pelvic lymphadenectomy (PLN). METHODS: A prospective study of 51 consecutive patients submitted to systematic (minimum number of aortic nodes removed > or =10) laparotomic para-aortic lymphadenectomy for any gynecological cancer. The following parameters have been monitored prospectively: nausea and vomiting, bowel movements, nasogastric tube insertion or reinsertion, the time of removal of the nasogastric tube, duration of ileus, time to first passage of stool, regular diet consumption and postoperative stay and complications. RESULTS: Twenty-three of 46 valuable patients (50%) submitted to systematic para-aortic lymphadenectomy complain of GI symptoms during recovery and 2 more cases have been readmitted for the appearance of nausea and vomiting with respect to 3 cases (5%) in the group of only pelvic lymphadenectomies (p=0.00001). According to multivariate analysis, the main determinant of post/operative GI dysfunction is the systematic aortic lymphadenectomy. Twenty-two out of a total of 28 symptomatic patients (78.6%) have accused mild symptoms and have been therefore treated by fasting, by intravenous fluid administration and by anti-emetic drugs. Out of the six remaining patients, three patients (10.7%) have been classified as moderate cases because they have required the insertion of a nasogastric tube for gastric decompression, whereas in the remaining refractory patients (10.7%, severe cases) prokinetics drugs have been used. An exploratory laparotomy has never been performed. CONCLUSIONS: GI dysfunction symptoms are very common in patients submitted to systematic para-aortic lymphadenectomy. However, only 20% of the patients complain about moderate/severe symptoms. In these cases, we strongly recommend a conservative management.
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Our purpose was to identify and quantify hemodynamic factors contributing to the generation, proliferation, and rupturing of abdominal aorta aneurysms (AAAs) using a computational investigation of steady laminar and turbulent flow in AAA models. Steady laminar and turbulent flows were computed using the incompressible Navier-Stokes equations. Flow fields in symmetric shapes of different extents and degrees of expansion are presented first. Two representative cases of asymmetric AAAs are considered next: an aneurysm with an elliptic cross section and an aneurysm with preferential expansion in one direction. For symmetric aneurysms, parametric studies are presented. For asymmetric aneurysms, flow fields are computed only for high flow rates representative of systolic flow. For all cases, a recirculating flow region was found in the expanded part of the AAA. Recirculation is accompanied by a minor increase in pressure but a significant increase in wall shear stress. For cases where turbulent flow was considered, it was found that the recirculation zone diminishes but the computed wall shear stress reaches levels higher than laminar flow. The levels of wall shear stress reached in turbulent flow may cause lesions of the aneurysmal wall. The minor variation of pressure within the aneurysms with smooth expansions indicates that the structural properties of the arterial wall tissue may play a significant role for the generation and subsequent proliferation of the aneurysm. However, the high values of the wall shear stress in AAAs appear to be an important hemodynamic factor that may contribute to wall degeneration and eventual rupturing. The recirculating flow in AAAs may explain the generation of intraluminal thrombi. Furthermore, the asymmetry and complexity of the flow in asymmetric AAAs may explain the frequently observed asymmetric thrombi distribution.