scholarly journals Vissza a jövőbe: gastro-oesophagealis junctio subepitheliális tumorának laparoszkópos transgastricus resectiója

2021 ◽  
Vol 74 (2) ◽  
pp. 43-48
Author(s):  
Zsolt Varga ◽  
Péter Sárkány ◽  
Dezső Tóth
Keyword(s):  
Wedge Resection ◽  
Abdominal Cavity ◽  
Gastroesophageal Junction ◽  
Functional Results ◽  
Large Tumor ◽  
Intraoperative Complication ◽  
Orogastric Tube ◽  
Plastic Bag ◽  
Subepithelial Tumors

Összefoglaló. Esetismertetés: A gyomor subepitheliális tumorainak laparoszkópos ékresectiója egy széleskörűen elfogadott és alkalmazott eljárás. A gastro-oesophagealis junctio (GOJ) közeli elváltozások esetén ez a technika azonban a gyomorbemenet szűkületének magas kockázata miatt erősen korlátozott. Ilyen lokalizáció esetén megfelelő technika lehet a laparoszkópos transgastricus resectio. Esetünkben egy 44 éves férfi dysphagiájának hátterében azonosított subepitheliális tumor resectióját végeztük el ilyen módon. A műtét során a pneumoperitoneum készítését követően a gyomrot orogastricus szonda segítségével insuffláltuk, majd 3 darab ballonnal rendelkező portot vezettünk a gyomorba. A 6 × 3 × 3 cm-es elváltozás intragastricus kimetszését követően a nyálkahártyát tovafutó öltéssorral zártuk. A speciment zsákba helyeztük, majd a gyomorból és a hasüregből eltávolítottuk. A portok gastrotomiás nyílásait zártuk. 24 órán át nasogastricus szondát hagytunk hátra, hasűri draint nem hagytunk vissza. A pneumoperitoneum idő 115 perc volt, vérveszteséget vagy intraoperatív szövődményt nem észleltünk. Eseménytelen posztoperatív szak után a beteget a műtétet követő harmadik napon otthonába bocsátottuk. A szövettani vizsgálat leiomyomát igazolt. Megbeszélés: Bár a páciens utánkövetése még folyamatban van, az irodalmi adatok alapán GOJ közeli elváltozások esetén a transgastricus technika biztonságos, hatékony, valamint jó funkcionális eredményt biztosító eljárás, a kiújulás magasabb kockázata nélkül. Summary. Case report: Laparoscopic wedge resection of the subepithelial tumors of the stomach is a widely accepted and utilized approach. The use of this technique for lesions located near the gastroesophageal junction (GEJ) is rather limited by the high risk of consequential stenosis of the gastric inlet. The laparoscopic transgastric resection can be a feasible choice for this location. A 44-year-old male patient had been investigated for dysphagia, which confirmed a subepithelial gastric lesion. We performed the resection of the tumor using this technique. After the creation of pneumoperitoneum, the stomach was insufflated using an orogastric tube, then 3 balloon-type ports were inserted intragastrically. The 6×3×3 cm large tumor was resected and the mucosa was closed by running sutures. The specimen was placed into a plastic bag, then retrieved from the stomach and the abdominal cavity. The gastrotomy sites of the ports on the stomach were closed. A nasogastric tube was left in situ for 24-hours without any intraabdominal drains. The pneumoperitoneum time was 115 minutes long, blood loss or intraoperative complication was not noticed. The postoperative period was uneventful, and the patient was discharged from the hospital three days after surgery. The histological examination confirmed the diagnosis of leiomyoma. Summary: Even though the follow-up of the patient is ongoing, according to the scientific literature, transgastric resection of subepithelial tumors located near the GEJ is a safe and effective technique, which provides good functional results, without having a higher risk for recurrence.

scholarly journals A Biphasic Pleural Tumor with Features of an Epithelioid and Small Cell Mesothelioma: Morphologic and Molecular Findings

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Sarah Hackman ◽  
Richard D. Hammer ◽  
Lester Layfield
Keyword(s):  
Abdominal Cavity ◽  
Molecular Genetic ◽  
Genetic Alterations ◽  
Small Cell ◽  
Comparative Genomic ◽  
Cell Nuclei ◽  
Pleural Tumor ◽  
Young Males ◽  
Round Cell Tumors

Malignant mesotheliomas are generally classified into epithelioid, sarcomatoid, desmoplastic, and biphasic types with rare reports of a small cell form. These small cell variants display some morphologic overlap with desmoplastic small round cell tumors (DSRCTs) which generally occur within the abdominal cavity of young males and are defined by a characteristic t(11;22)(p13;q12) translocation. However, there are rare reports of DSRCTs lacking this translocation. We present a 78-year-old man with a pleura-based biphasic neoplasm with features of both epithelioid mesothelioma and a small cell blastema-like neoplasm. The epithelioid portion showed IHC reactivity for pan cytokeratin, CK5/6, D2-40, and calretinin and the small cell portion marked with CD99, pan cytokeratin, WT1, FLI1, S100, CD200, MyoD1, and CD15. Fluorescence in situ hybridization testing for the t(11;22)(p13;q12) translocation disclosed loss of theEWSR1gene in 94% of tumor cell nuclei, but there was no evidence of the classic translocation. Array based-comparative genomic hybridization (a-CGH) confirmed the tumor had numerous chromosome copy number losses, including 11p15.5-p11.12 and 22q12.1-q13.33, with loss of theEWSR1andWT1gene regions. Herein, we report novel complex CGH findings in a biphasic tumor and review the molecular genetic alterations in both mesothelioma and DSRCTs.

Adrenoreceptor subtype mediating sympathetic-sensory coupling in injured sensory neurons

1996 ◽  
Vol 76 (6) ◽  
pp. 3721-3730 ◽  
Author(s):  
Y. Chen ◽  
M. Michaelis ◽  
W. Janig ◽  
M. Devor
Keyword(s):  
Sciatic Nerve ◽  
Nerve Injury ◽  
Expression Profiles ◽  
Functional Results ◽  
Firing Frequency ◽  
Receptor Type ◽  
Afferent Neurons ◽  
Sympathetic Efferents ◽  
Frequency Excitation

1. Teased axon recordings were made from 167 spontaneously active A beta- and A delta-afferents that ended in sciatic nerve end neuromas of 6-12 days standing. When challenged with a standard bolus of systemically applied adrenaline, 100 (60%) responded, either with an increase in baseline firing frequency (excitation, 96/100) or with a decrease (suppression, 4/100). 2. Experiments using receptor type-selective antagonists indicated that the adreno-sensitivity was mediated by alpha 2 adrenoreceptors in 65% of the afferents sampled, by alpha 1 adrenoreceptors in 13%, and about equally by alpha 1 and alpha 2 adrenoreceptors in approximately 10%. In the remaining 13%, neither type of antagonist blocked adrenaline-evoked excitation, at least not at the doses used. Both excitatory and suppressive responses were primarily sensitive to alpha 2 antagonists. 3. Experiments using receptor type-selective agonists substantiated the conclusion that sympathetic-sensory coupling at sites of nerve injury is mediated primarily by alpha 2 adrenoreceptors. 4. Recordings were also made from 14 afferent neurons with spontaneous ectopic discharge originating in dorsal root ganglia (DRGs) L4 and L5. The rats had undergone transection of the ipsilateral sciatic nerve 8–93 days previously. All neurons responded to systemic adrenaline and/or trains of activity evoked in postganglionic sympathetic efferents with either excitation or suppression. As in the neuroma endings, responses in the large majority of cases were blocked by alpha 2-selective, but not by alpha 1-selective adrenoreceptor antagonists. 5. The results indicate that sympathetic-sensory coupling, both at nerve injury sites and in axotomized DRG neurons, is mediated primarily by alpha 2 adrenoreceptors. In a minority of afferent neurons, however, it appears to be mediated by alpha 1 adreno-receptors or by both alpha 1 and alpha 2 adrenoreceptors. These functional results are consistent with receptor-type expression profiles from studies based on in situ hybridization and immunocytochemistry.

scholarly journals THE STUDYOF IN-SITU MARINE PHOTOSYNTHESIS USING A LARGE PLASTIC BAG

1961 ◽  
Vol 6 (1) ◽  
pp. 93-96 ◽  
Author(s):  
J. D. H. STRICKLAND ◽  
L.D.B. TERHUNE
Keyword(s):  
Plastic Bag

Minimally Invasive Resection of Benign Gastric Tumors in Challenging Locations: Prepyloric Region or Gastroesophageal Junction

2013 ◽  
Vol 79 (10) ◽  
pp. 968-972 ◽  
Author(s):  
Christopher Armstrong ◽  
Alana Gebhart ◽  
Brian R. Smith ◽  
Ninh T. Nguyen
Keyword(s):  
Minimally Invasive ◽  
Perioperative Complications ◽  
Wedge Resection ◽  
Gastroesophageal Junction ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Anatomic Resection ◽  
Submucosal Tumors ◽  
Gastric Tumors ◽  
Minimally Invasive Surgical

Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. Data on tumor size and location, type of minimally invasive surgical resection, perioperative complications, 90-day mortality, pathology, and recurrence were collected. A total of 70 consecutive patients underwent laparoscopic resection of benign-appearing submucosal gastric tumors; there were 24 patients with lesions close to the GEJ and nine patients with lesions close to the prepyloric region. All lesions were successfully resected laparoscopically. For prepyloric tumors, surgical approaches included enucleation (n = 1), wedge resection (n = 2), and distal gastrectomy with reconstruction (n = 6). For tumors close to the GEJ, surgical approaches included enucleation (n = 16), wedge resection (n = 3), and esophagogastrectomy (n = 5). Complications in this series of 33 patients included late strictures requiring endoscopic dilation in three patients who underwent esophagogastrectomy. The 90-day mortality rate was zero. There were no recurrences over a mean follow-up of 15 months (range, 1 to 86 months). Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.

scholarly journals European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis

2018 ◽  
Vol 29 (01) ◽  
pp. 053-061 ◽  
Author(s):  
Nigel Hall ◽  
Abidur Rahman ◽  
Francesco Morini ◽  
Alessio Pini Prato ◽  
Florian Friedmacher ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Perforated Appendicitis ◽  
Full Blood Count ◽  
First Episode ◽  
Abdominal Ultrasonography ◽  
Reactive Protein ◽  
Immediate Surgery ◽  
Evidence Based Guidelines ◽  
Work Up

Aim To define patterns in the management of pediatric appendicitis. Methods A total of 169 delegates from 42 (24 European) countries completed a validated survey administered at the EUPSA 2017 annual congress. Results In the work-up of children with suspected acute appendicitis, most surgeons rely on full blood count (92%), C-reactive protein (82%), and abdominal ultrasonography (76%), but rarely on computed tomography scans or magnetic resonance imaging. In suspected simple appendicitis, most surgeons (76%) do not perform appendectomy at night in clinically stable patients and start antibiotic preoperatively (64%), but only 15% offer antibiotic therapy alone (no appendectomy). In suspected perforated appendicitis, 96% start antibiotic preoperatively, and 92% perform an appendectomy. Presence of phlegmon/abscess is the main contraindication to immediate surgery. In case of appendix mass, most responders (75%) favor a conservative approach and perform interval appendectomy always (56%) or in selected cases (38%) between 2 and 6 months from the first episode (81%). Children with large intraperitoneal abscesses are managed by percutaneous drainage (59% responders) and by surgery (37% responders). Laparoscopy is the preferred surgical approach for both simple (89%) and perforated appendicitis (81%). Most surgeons send the appendix for histology (96%) and pus for microbiology, if present (78%). At the end of the operation, 58% irrigate the abdominal cavity only if contaminated using saline solution (93%). In selected cases, 52% leave a drain in situ. Conclusion Some aspects of appendicitis management lack consensus, particularly appendix mass and intraperitoneal abscess. Evidence-based guidelines should be developed, which may help standardize care and improve clinical outcomes.

Efficacy and safety of endoscopic resection for gastric subepithelial tumors.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 107-107
Author(s):  
Kyoungwon Jung ◽  
Ji Yong Ahn ◽  
Do Hoon Kim ◽  
Eun Jeong Gong ◽  
Charles J. Cho ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Medical Center ◽  
Wedge Resection ◽  
Endoscopic Management ◽  
Severe Bleeding ◽  
Related Factors ◽  
Pathologic Evaluation ◽  
Gastric Subepithelial Tumors ◽  
The Mean ◽  
Subepithelial Tumors

107 Background: Because small gastric subepithelial tumors (SETs) less than 2.0 cm might have malignant potential, ambiguous cases should be removed for optimal diagnosis and treatment. With the recent advances in endoscopic technique, endoscopic resection (ER) has been attempted for pathologic confirmation of gastric SETs. Herein, we aim to investigate the clinical usefulness and safety of ER of gastric SETs. Methods: A total of 115 subjects who underwent ER for gastric SETs from January 2005 to December 2014 were eligible for the study at the Asan Medical Center, Seoul, Korea. Patient’s demographic status, tumor related factors, procedure related factors, and clinical outcomes were retrospectively reviewed by using electronic medical record. Results: Among the 115 patients, 53 were male (46.1%) and the mean age was 51.59 ± 14.59 years. The mean size of all tumors was 18.58 ± 10.71 mm. Complete endoscopic resection was achieved in 108 of 115 tumors (93.9%). The final histopathologic diagnoses included 38 gastrointestinal stromal tumors (GISTs) (33.0%), 21 heterotopic pancreas (18.3%), 18 neuroendocrine tumors (15.7%), 11 leiomyoma (9.6%), 10 inflammatory fibroid polyp (8.7%), and others tumors (n = 17, 14.8%). Perforations occurred in 12 patients (10.4%) and they were successfully managed with endoscopic clipping. Severe bleeding during endoscopic resection occurred in 13 patients (11.3%) and they were treated by endoscopic management. Six patients underwent sequential wedge resection or gastrectomy of stomach because of non-curative resection and the pathologic evaluation revealed residual tumors in 3 patients. There was no recurrence or metastasis during mean follow-up of 44.96 ± 32.62 months (range 3-120.7 months). The rate for complete resection in relation to the final pathology was lower in GISTs (86.8%) than others (97.4%, p = 0.026). The rate of perforation was significantly higher for the fundus (66.7%) than for other locations (0% for the cardia, 16.7% for high body, 8.3% for mid body and 8.3% for antrum) (p < 0.001). Conclusions: ER of gastric SETs may be feasible and safe method for pathologic confirmation and further strategy.

PS01.047: PROPHYLACTIC ANTI-REFLUX SURGERY AFTER LAPAROSCOPIC GASTRIC WEDGE RESECTIONS FOR GASTRIC SUBMUCOSAL TUMORS OF GASTROESOPHAGEAL JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 63-63
Author(s):  
Chang Hyun Kim ◽  
Jin-Jo Kim
Keyword(s):  
Conflicts Of Interest ◽  
Submucosal Tumor ◽  
Wedge Resection ◽  
Gastroesophageal Junction ◽  
Submucosal Tumors ◽  
Gastric Submucosal Tumors ◽  
Increased Risk ◽  
Group A ◽  
Group B ◽  
Gerd Symptoms

Abstract Background A laparoscopic wedge resection (LWR) for a gastric submucosal tumor (SMT) close to gastroesophageal junction (GEJ) is technically challenging due to increased risk of damage to the lower esophageal sphincter. We hypothesized that GERD would be less prevalent if a prophylactic anti-reflux surgery (ARS) was added after this surgery. The aim of this study is to analyze our experience of prophylactic ARS after LWR for a gastric SMT close to GEJ Methods We retrospectively collected data from 51 patients who diagnosed with SMT of near the GEJ and who underwent LWR between January 2000 and December 2017. The patients were divided into 2 groups, the patient with prophylactic ARS (group A) or not (group B). Results There was no difference in the frequency of the preoperative GERD symptoms between the 2 groups, whereas postoperative GERD symptoms and postoperative use of acid suppressive medications were more frequent in the group B (P = 0.032, P = 0.036). However, there were no differences in the follow-up endoscopic findings in terms of reflux esophagitis and Hill's grade between the 2 groups. Conclusion The prophylactic ARS after LWR for SMT close to GEJ is an effective method of prevent gastroesophageal reflux symptoms after surgery. Disclosure All authors have declared no conflicts of interest.

HER2 testing in esophageal adenocarcinoma (EAC) using parallel tissue-based methods.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 2-2 ◽  
Author(s):  
Harry H. Yoon ◽  
Qian Shi ◽  
William R. Sukov ◽  
Christopher A. Sattler ◽  
Anne E. Wiktor ◽  
...  
Keyword(s):  
Gene Amplification ◽  
Predictive Value ◽  
Gastroesophageal Junction ◽  
Her2 Amplification ◽  
Her2 Protein ◽  
Her2 Testing ◽  
Blinded Manner ◽  
Testing Algorithm ◽  
Background Testing

2 Background: Testing for HER2 in EAC has become routine given its ability to predict benefit from HER2-targeted therapy. HER2 protein analysis by immunohistochemistry (IHC) is more rapid and generally less expensive than assessment of gene amplification by fluorescence in situ hybridization (FISH). However, the accuracy of IHC for predicting HER2 amplification has not been examined in a large EAC cohort. Methods: Surgical EAC specimens were examined from 675 patients who underwent curative resection at a single institution without preoperative therapy. Tumors were located in the esophagus (47%) or gastroesophageal junction (53%); most were node-positive (73%). Every tumor was evaluated by IHC in parallel with FISH in a blinded manner using FDA-approved assays. A consensus IHC score was determined by 2 pathologists using tumor-specific criteria (negative, 0 or 1+; equivocal, 2+; positive, 3+). Gene amplification by FISH was defined as a HER2/CEP17ratio ≥ 2. Results: HER2 amplification was detected in 89% of IHC 3+ cases, 13% of IHC 2+ cases, and 4% of IHC 0-1+ cases (Table). Accordingly, using FISH as the reference standard, the positive predictive value (PPV) of a positive IHC test (3+) was 89% (79/89 [95% CI 82%-95%]), and the negative predictive value of a negative IHC test (0-1+) was 96% (401/417 [94%-98%]). Importantly, the PPV of an equivocal IHC score (2+) for detecting HER2 amplification was 13% (22/169 [8%-18%]). Conclusions: In the largest study to date comparing HER2 testing methods in EAC, a negative IHC result (0 or 1+) nearly excludes the presence of gene amplification by FISH. Whereas a positive IHC result (3+) strongly predicts for the presence of amplification, an equivocal IHC result (2+) is a weak predictor. These findings in EAC support a HER2 testing algorithm where IHC is used for initial screening and FISH testing is restricted to cases with equivocal IHC results. [Table: see text]

Ecology of Phragmites communis. I. Photosynthesis of a single shoot in situ

1968 ◽  
Vol 46 (5) ◽  
pp. 549-555 ◽  
Author(s):  
Jennifer M. Walker ◽  
E. R. Waygood
Keyword(s):  
Specific Activity ◽  
Phragmites Communis ◽  
Plant Parts ◽  
Leaf Chlorophyll ◽  
Plastic Bag ◽  
Rate Of Photosynthesis ◽  
Single Shoot ◽  
Wet Weight ◽  
Assimilation Time

Photosynthesis of a single shoot of Phragmites communis Trin. var. berlandieri (Fourn.) Fern., growing isolated from a stand, was measured in situ by enclosing it in a plastic bag of volume 107 liters and administering 1 mcurie of 14CO2 (specific activity, 5 mcurie per mmole) for 1 hour under a cloudless sky (light intensity > 100 000 lux; photoperiod, 16.5 h). The plant was 164 cm in height with 15 internodes, 11 expanded leaves, and a terminal unrolled leaf. The leaves, leaf sheaths, and internodes were removed, frozen between blocks of solid CO2, and subsequently extracted by the method of Bieleski and Turner (Anal. Biochem. 17, 278–293 (1966)). 14CO2 incorporation was determined in extracts of the plant parts by a scintillation analyzer.Photosynthetic rates were calculated per leaf, per square decimeter of leaf, per gram wet weight, and per μmole of leaf chlorophyll. Greatest incorporation of 14CO2 was found in the centrally inserted leaves. Leaf sheaths and internodes fixed only 8% of the total. Leaf area was the only useful index of photosynthesis averaging 6.1 (S.D. ± 0.62) mg CO2/dm2 per hour. On a gram wet weight basis the rate of photosynthesis increased in a hyperbolic relationship from the lowest to the uppermost leaves. Chlorophyll was determined on leaves from an adjacent plant of similar size and structure. On this basis the centrally inserted leaves were the least and the upper leaves were the most efficient, the uppermost expanded leaf having a rate of 163 µmoles CO2 per µmole chlorophyll per hour (assimilation time = 22 seconds). Productivity, in terms of carbon fixed, was 3.5 g/m2 per day based on a mean density of 12.75 plants per 0.25 m2 and a 10-hour day.

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