Park Kuhn;Lee Jong Ho;Kim Jin Ho;Jin Ung;Kwon Jong Bum;Kim Chi Kyeong;Wang Young Pil
Journal of Chest Surgery
/
v.38
no.12
s.257
/
pp.807-814
/
2005
Background: Cardiopulmonary bypass is an essential process to maintain circulation for saving life during the cardiac surgery, But it is a process in which systemic inflammation was evoked inevitably because of the exposure of blood to foreign surface. The injuries to distal organs during the cardiopulmonary bypass were resulted from systemic inflammation and the disturbances of micro-circulations in the organs. We designed this study to research the effects of leukocyte depletion from pump-oxygenator priming solution on the systemic inflammation, and the micro-circulation of gastric mucosa that is suggested by the gastric mucosal $CO_{2}$ partial pressure and acidity. Material and Method: The dogs were divided into three groups according to the different pump-oxygenator priming solutions; non-hemic crystalloid solution; leukocyte-depleted homologous blood; and non leukocyte-depleted homo-logous blood. Each priming solution group contained five dogs. In all three groups, 2 hours of cardiopulmonary bypass, and 4 consecutive hours of general anesthesia was maintained on the mechanical ventilation. Each dog was evaluated for the gastric mucosal pH, $CO_{2}$ partial Pressure, arterial pH, $CO_{2}$ partial pressure, the exhaled air $CO_{2}$ partial pressure and the level of IL-8 on before the cardiopulmonary bypass, 1 hour after the cardiopulmonary bypass, 2 hours after the cardiopulmonary bypass, 2 hours after the restoration of normal circulation, and 4 hours after the restoration of normal circulation after the cardiopulmonary bypass. The levels of IL-8 were measured with ELISA (enzyme linked immunosorbent assay) technique. Result: 1. There were significant differences of gastric mucosal $CO_{2}$ partial pressure between the leukocyte-depleted homologous blood group and other two groups(vs non leukocyte-depleted homologous blood group; P=0.02, vs non-hemic crystalloid solution group; P=0,01). 2. The gastric mucosal pH of leukocyte-depleted homologous blood group was significantly different from non leukocyte-depleted homologous blood group (p=0.01). 3. The levels of IL-8, which examine the systemic inflammation, showed signi- ficantly better results in leukocyte-depleted homologous blood group and non-hemic crystalloid solution group than non leukocyte-depleted homologous blood group (p=0.01, 0.01). Conclusion: Based upon these results, we concluded that the leukocyte depletion from the pump-oxygenator priming solution has a beneficial effects in reducing systemic inflammation and the preserving of gastric mucosal micro-circulation.
Willian Ferreira Igi;Victor Lira de Oliveira;Ayah Matar;Diogo Turiani Hourneaux de Moura
Clinical Endoscopy
/
v.57
no.3
/
pp.309-316
/
2024
The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article comprehensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern exists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongoing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to support its routine use in clinical practice.
From Nov. 1987 to Aug. 1989, 12 patients with coronary occlusive disease underwent coronary bypass surgery at the Department of Thoracic and Cardiovascular Surgery, Catholic University Medical College. The results were as follows: 1. There were 9 males and 3 females ranged in age from 25 to 69 years with a mean of 50.4 years. 2. The prevalent locations of coronary artery stenosis were left anterior descending branch [9 cases], right coronary artery[4 cases], first diagonal branch[3 cases], left circumflex artery [2 cases] in order of frequency. 3, Among 12 cases, 5 cases had an episode of previous myocardial infarction respectively. 4. We performed triple bypass operation in 3 cases, double bypass in 2 cases and single bypass in 7 cases using great saphenous vein. 5. Postoperative complications were cerebral embolism[1, died], pleural effusion[1], temporary cardiac arrest[1], supraventricular tachycardia[1] and late gastric ulcer bleeding[1]. 6. The follow up periods were ranged from 8 months to 30 months and all survivors were on antiplatelet medication showing free of angina.
A 65 year-old male had chest pain which was diagnosed as unstable angina needing urgent coronary artery bypass surgery. Physical examination demonstrated signs of severe anemia and hemoglobin level was 5.7 g/dL. Gastrofiberscopy showed a 4 cm sized fungating mass at the lesser curvature with active bleeding. The mass was adenocarcinoma by pathologic examination. Simultaneous coronary artery bypass surgery and total gastrectomy were planned due to bleeding of the mass. Off-pump coronary bypass grafting was done first, followed by total gastrectomy. The postoperative course was smooth. He was discharged from the hospital after 12 days and was on surveillance for 9 months. We report a rare case of simultaneous surgery for angina and gastric cancer.
In the past, conservative bypass surgery was usually performed for palliation of malignant obstruction of the gastrointestinal tract. However, endoscopic stenting was developed recently, and technical advances and clinical experience have made it possible to establish stent implantation as one of the main treatment options. There are several advantages in stent implantation over bypass surgery, such as high feasibility and technical success rate, non-invasiveness, rapid symptomatic response, short hospitalization, and cost-effect benefits. Complications, such as stent ingrowth, stent injury by bile or acid, and migration, may occur and early re-insertion is frequently needed. Recently, diverse novel stents which are powered to predict stent migration or ingrowth have been developed and are being used in the clinical setting. In general, stent implantation is known to be beneficial in patients who are expected to survive <6 months, and surgical bypass may be more effective in patients who can survive >6 months. In this review, we have compared the technical feasibility, clinical outcomes, complications, and cost-benefit between stent implantation and bypass surgery, and determined the optimal treatment strategy in malignant upper gastrointestinal obstruction.
Kim, Min-Gyu;Kim, Beom-Su;Kim, Tae-Hwan;Kim, Kap-Choong;Yook, Jeong-Hwan;Oh, Sung-Tae;Kim, Byung-Sik
Journal of Gastric Cancer
/
v.10
no.2
/
pp.75-78
/
2010
Because of advancement of medical treatment, surgical management of gastric or duodenal ulcer was indicated for treatment of perforation, massive hemorrhage and obstruction. The distal gastrectomy including ulcer was known as principle method of duodenal ulcer obstruction, but actually many surgeons have performed only bypass surgery for the difficulty of formation of duodenal stump. In our case, 61-year-old male with repetitive duodenal ulcer obstruction transferred with obstruction due to deformities and inflammations of duodenal ulcer. We had performed totally laparoscopic distal gastrectomy with ROUX-EN-Y reconstruction using the clear visibility of laparoscopy and fine dissections of harmonic scalpel. The patient started soft diet on postoperative day 5 and discharged on postoperative day 8. He returned to work after discharging immediately.
Hirokazu Honda;Jeffrey D. Mosko;Ryosuke Kobayashi;Andras Fecso;Bong Sik Kim;Schoeman Scott;Gary R. May
Clinical Endoscopy
/
v.55
no.6
/
pp.736-741
/
2022
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.
Jo, Seung-Jin;Yoon, Ki-Young;Choi, Kyung-Hyun;Park, Moo-In;Park, Seun-Ja;Ko, Ji-Ho;Lee, Sang-Ho
Journal of Gastric Cancer
/
v.7
no.2
/
pp.82-87
/
2007
Purpose: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral slanting and patients that had received a bypass gastrojejunostomy. Materials and Methods: One hundred patients underwent palliative entering stenting and 3f patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. Results: There were significant differences between the group of patients that underwent slanting and the group of patients that received a gastrojejunostomy regarding the age of patients ($67{\pm}12$ vs. $57{\pm}9$, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 :1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-slanting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was $4{\pm}2$ days in the stent group of patients and $6{\pm}2$ days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). Conclusion: There were no significant differences In the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the slanting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-slanting was a concern due to tumor ingrowth and stent migration.
Jung, Jae Jun;Cho, Jong Ho;Shin, Sumin;Shim, Young Mog
Journal of Chest Surgery
/
v.47
no.3
/
pp.269-274
/
2014
Background: The purpose of this study was to evaluate the outcome of reoperation with curative intent for the treatment of anastomotic recurrent gastric cancer. Methods: Ten patients with anastomotic recurrence of gastric cancer who underwent reoperation from November 1995 to February 2011 were analyzed retrospectively. The time interval between the first operation and reoperation, recurrence pattern, type of surgery, survival, and postoperative outcome were analyzed. Results: The average time to recurrence after initial surgery was 48.8 months (median, 23.5 months). Of the ten patients, eight (80.0%) had recurrence at the esophagojejunostomy, one (10.0 %) at the esophagogastrostomy, and two (20.0%) at the esophagus. Among these patients, five had combined metastasis or invasion to major organs in addition to anastomotic recurrence. Complete resection was achieved in five patients (50.0%), and incomplete resection or bypass surgery was performed in the remaining five patients (50.0%). The overall median survival time was 7.0 months (range, 2.2 to 105.5 months). The median survival time following complete resection and palliative surgery (incomplete resection or bypass surgery) was 28.1 months (range, 4.2 to 105.5 months) and 5.5 months (range, 2.2 to 7.5 months), respectively. Conclusion: Surgical resection of anastomotic recurrent gastric cancer should be implemented only in selected patients in whom complete resection is possible.
Purpose: Malignant bowel obstruction caused by recurrent gastric cancer must be treated appropriately to improve the effects of treatment and to prolong survival. We reviewed the surgical treatments for malignant bowel obstruction caused by recurrent gastric cancer. Materials and Methods: The subjects were patients with malignant bowel obstruction caused by recurrent gastric cancer and these patients were treated by surgical procedures at our hospital from 1998 to 2008. The patients were treated by resection, ostomy or bypass. The success of treatment was decided when the patients were able to tolerate more than a liquid diet. Results: 42 patients were treated 46 times by surgical procedures. Resection was done12 times, ostomy was done 24 times and bypass was done 10 times. The hospital stay and the period to liquid diet after the operation were shorter in the ostomy group. The post operative morbidity rate was 21.7% and the post operative death rate was 8.7%. There was no significant difference in survival according to the type of surgery. Conclusion: Ostomy is good choice for selected patients because it has a shorter hospital stay and period to liquid diet. There was no significant difference in survival according to the type of surgery because curative resection is difficult to perform in patients with malignant bowel obstruction.
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