Silent pulmonary aspiration of barium after esophagogastroduodenography and subtotal gastrectomy

We describe a 66-year-old patient who underwent subtotal gastrectomy and omentectomy for gastric adenocarcinoma six days after esophago-gastro-duodenography with barium contrast medium. In the postoperative period a series of chest films showed bronchogram due to aspiration of the contrast medium from the stomach, and finally multiple cottony infiltrates bilaterally. The patient had no respiratory symptoms and 6 days after admission to the intensive care recovery unit, he was moved to the general surgery ward for observation. Follow-up later passed to the outpatient with satisfactory evolution. We conclude that pulmonary aspiration occurred after extubation in the operating theater, since during the operation the patient remained stable hemodynamically and respiratorily. This case corroborates the theory of the existence of silent aspiration without pulmonary complications and the need to adjust clinical treatment, which can be conservative when, once the process is diagnosed, no symptoms present.     

Calcium regulating hormones and bone mineral content in patients after subtotal gastrectomy

Twenty-nine men who had undergone Billroth I gastrectomy and 19 men who had undergone Billroth II gastrectomy were studied to examine the changes in their calcium regulating hormones and bone mineral content following surgery. The serum calcium and phosphate concentrations in the patients with Billroth I and Billroth II were normal. The Billroth II group had an elevated level of serum alkaline phosphatase and reduced bone mineral content. The 24,25(OH)2D concentration was reduced (P < 0.01) and 25(OH)D and 1,25(OH)2D concentrations were increased (P < 0.01, P < 0.05, respectively) in the Billroth II group. It was suggested by our study that the Billroth II patients had a reduced bone mineral content and an elevated 1,25(OH)2D concentration. Therefore, the pathophysiology of postgastrectomy bone metabolic disease is not due to vitamin D deficiency, but may instead be due to reduced calcium absorption in the intestine.     

A comparative analysis of the rheographic indices of the pancreatic blood flow in patients who have undergone a subtotal gastric resection and gastrectomy

Overall ninety-two patients with carcinoma of the stomach were studied, 45 of whom had undergone subtotal resection, and 47--gastrectomy. During the first postoperative 10 days a study was made of the pancreatic hemocirculation by contact bipolar rheography. After surgery on the stomach, the pancreas shows phasic changes in bloodflow that include the time of arterial hyperemia, that of insufficiency of arterial blood-filling, and time period of restoration of bloodflow. Fluctuations in pancreatic arterial blood filling in those patients who had survived gastrectomy within the first 48 hours following the operation are more definite than in those having undergone subtotal resection of the stomach.     

Simultaneous MIDCAB and subtotal gastrectomy in an elderly patient with severe ischemic heart disease

An 81 year old man with severe ischemic heart disease and left ventricular dysfunction was scheduled for a subtotal gastrectomy for his advanced gastric cancer. His cardiac function was so poor that we performed minimally invasive coronary artery bypass grafting (MIDCAB; coronary artery bypass grafting without cardiopulmonary bypass for LAD through a small left thoracotomy), just before the abdominal operation. Anesthesia was induced and maintained with fentanyl, vecuronium and sevoflurane. To control heart rate below 60 bpm during local coronary occlusion for bypass grafting, edrophonium 5 mg was administered just before the occlusion. During the bypass grafting procedure, the patient's heart rate was maintained at 50-60 bpm and his hemodynamic profile slightly declined but was permissible. After bypass grafting, his cardiac performance was improved with low dose dobutamine. Subsequently subtotal gastrectomy was carried out. His postoperative course was uneventful. Combined MIDCAB and abdominal operation may be beneficial for selected patients with severe ischemic heart disease.     

正电子湮没技术原理及应用

主要介绍了正电子湮没技术的基本原理、基本实验方法,并对正电子湮没在点阵缺陷、相结构与相转变、非晶和纳米晶合金研究中的应用作了简单说明.     

Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study

PURPOSE: To investigate whether pancreas preservation together with a strict quality-control system could ameliorate the outcome of D2 resections for gastric cancer in Western patients. PATIENTS AND METHODS: Italian patients with potentially curable proven adenocarcinoma of the stomach were registered from nine general and/or university hospitals in the area of Turin, Northern Italy. The study was performed according to the guidelines of the Japanese Research Society for Gastric Cancer (JRSGC). A strict quality-control system was guaranteed by a supervising surgeon of the reference center, who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy. The standard procedure entailed removal of the level 1 and 2 lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. RESULTS: Between May 1994 and December 1996, 191 eligible patients were entered onto the study. The mean number of lymph nodes removed was 39. The overall morbidity rate was 20.9%. Surgical complications were observed in 16.7% of patients. Reoperation was necessary in six patients and was always successful. The overall hospital mortality rate was 3.1%; it was higher after total gastrectomy (7.46%) than after distal gastrectomy (0.8%). The average length of hospital stay was 17 days. CONCLUSION: Given that postoperative morbidity and mortality rates are favorably comparable with those reported after the Western standard gastrectomy, the more extensive Japanese procedure with pancreas preservation can be regarded as a safe radical treatment of gastric cancer for selected Western patients treated in experienced centers.     

Pneumosinus dilatans frontalis. Etiology, symptoms and surgical technique

BACKGROUND: Pneumosinus dilatans of the frontal sinus is a very rare condition in which deformity is caused by progressive enlargement of the brow ridges and lower forehead. PATIENTS: Etiology of the reported two cases was unknown although some hypotheses have been presented. RESULTS AND CONCLUSIONS: We corrected the aesthetic deformity using an osteoplastic flap and removing horizontal bone chips from the anterior wall of the frontal sinus. Postaoperative results were satisfactory. In one case, obliteration of the sinus with fat was necessary, because of polypous mucosa.     

Lumbosacral chordoma resection: image integration and surgical planning

Clinical, radiographic, and functional outcome parameters were analyzed before and after treatment of eight individuals with lumbosacral chordomas studied over a 3-year period. Emphasis was placed upon correlation of multiplane images and the pathoanatomy of the gross specimen. Surgical resections achieving wide margins can be curative. Magnetic resonance imaging of lumbosacral chordomas has revolutionized the preoperative anatomic localization of these tumors. Therefore, it is critical that the operating surgeon scrutinize the three-dimensional location of the tumor and its spatial relationship to surrounding structures prior to surgical eradication. A systematic approach for the radiographic analysis of tumor extent in lumbosacral chordomas is presented. Four strategic areas of preoperative analysis are identified for sacral chordomas and two for lumbar neoplasms. Functional outcome after resection is predicted by Stener's work. Contamination-free surgery is facilitated by accurate preoperative radiographic interpretation of the pathoanatomy by the surgeon.     

Final height and craniofacial development after surgical resection of craniopharyngioma

There is a subgroup of patients with coronary artery disease who are refractory to the therapeutical methods so far applied. We report on 128 patients who fulfill this definition and have therefore undergone pure transmyocardial laser revascularisation (TMLR) or transmyocardial laser revascularisation in combination with coronary bypass surgery at our institution. The patients can be characterized by a long history of coronary artery disease with multiple revascularizing procedures, e.g. bypass surgery or percutaneous transluminal coronary angioplasty (PTCA), pronounced symptoms of coronary artery disease and chronic heart failure in the presence of markedly reduced left ventricular ejection fractions and intense antiischemic medical therapy. The patients were 62.2 +/- 9.8 (SD) years of age, in 89.9% of them at least one bypass operation and in 44.5% up to more than three percutaneous transluminal coronary angioplasties (PTCAs) had been performed prior to TMLR. There was a history of myocardial infarction in 90.7% of patients and 89.8% were in the Canadian Cardiovascular Society (CCS) classes III or IV and 94.5% of them were in the NYHA classes III or IV. The left ventricular ejection fraction was 49.5 +/- 16.4% and all of the patients were under intense antiischemic medical treatment which included nitrates or molsidomine in 96.9%, beta blockers in 53.1%, angiotensin converting enzyme inhibitors (ACE inhibitors) in 44.5%, digitalis in 22.7% and diuretics in 52.3% of patients. The preoperative data on myocardial viability, inducible ischemia and coronary morphology provided important clinical information for the decision, which revascularizing method would be the most appropriate for each vessel or myocardial region. This had to be weighed against the patient's operative risk, which is predominantly determined by the left ventricular ejection fraction, the arteriosclerotic involvement of the remaining vascular system and concomitant diseases, particularly of pulmonary origin.     

Abdominoperineal resection and perineal colostomy for low rectal cancer. The Lazaro da Silva technique

PURPOSE: We sought to evaluate a new technique for creation of a continent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer. METHODS: Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as Dukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Following this, the original Lazaro da Silva technique was used as follows: 1) for performance of three circular myotomies in the distal sigmoid with a distance between each couple of no more than 8 cm; 2) repair of the myotomies, thus creating three circular colonic valves, the most distal of which remained extraperitoneally; 3) for construction of a perineal colostomy lying flush with the perineal skin; 4) after the patient starts consuming a regular diet, enemas through the perineal stoma are done, usually twice per week, to achieve defecation. Functional outcome was assessed by evaluation of bowel movements and neoanal continence. RESULTS: There were no deaths. From January 1994 until October 1995, no tumor recurrence has occurred, and fecal continence has been good. Four of the patients were able to defecate without enemas (2-4 times per week), and in five patients the self-administration of enemas (2-4 times a week) were necessary to accomplish defecation. CONCLUSION: Initial results with the Lazaro da Silva technique have been encouraging.     

金属粉末电磁压制基本机理及致密工艺

成型是粉末冶金工艺中比较重要的一环．文章分析了金属粉末电磁压制的基本机理和压制工艺参数对粉末压坯密度的影响，并对粉末压制致密工艺给出了理论参考．     

Early and late complications after surgical gastric resection for peptic ulcer

For evaluating early and late complications after partial gastrectomy in gastric and duodenal ulcer, performed in 1976-92 years, was investigated 585 patients. The surgery was carry out mutables Rydygier and Billroth-2 methods. The smallest complications early and late found after the operations Finney-Haberer and Billroth-2 with Braun anastomosis and vagotomy.     

Bulky superinfected tinea capitis of the scalp. Treatment by surgical resection and reconstruction by cutaneous expansion

BACKGROUND: Tinea capitis are usually cured by medical treatment. We present an unusual case which required a surgical treatment. CASE REPORT: A bulky infected kerion ignored for several weeks extended to a large part of the scalp of a 4-year-old girl. Antibiotics and antifungal agents were ineffective so that a total resection was necessary. The loss of substance was covered by a cutaneous graft; the large alopecia was secondarily repaired by a cutaneous expansion. Evolution has been followed for the past 10 years. CONCLUSION: It is exceptional that surgical treatment should be required for this condition.