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Explanation of the 7 Clinical Questions in Japanese Gastric Cancer Treatment Guidelines of Version 4
Issue:
Volume 6, Issue 5, October 2018
Pages:
112-115
Received:
15 July 2018
Accepted:
8 August 2018
Published:
5 September 2018
Abstract: Surgery is the main treatment for curing gastric cancer, standard D2 gastrectomy and systematical therapy provides an excellent survival outcome in East Asian countries, especially Japan, Korea, and China, however, there are many clinical questions still under debate for a long time. Japanese gastric cancer treatment guidelines has produced a great effect on the surgical treatment of gastric cancer. The treatment of gastric cancer is more standardized, rationalized and normalized. In recent years, new research results made the guideline revised. The 4th Edition of 2014 has proposed a solution for Stage IV patients with single non-curative factors. Patients with No.16a2, b1 lymphnodes metastasis, liver metastasis, or with peritoneal metastasis/CY1 disease are scheduled to receive combined treatment of operation and chemotherapy. The 4th edition incorporated new evidence that includes those delivered as a quick bulletin in the website of the Japan Gastric Cancer Association after publication of the previous version. It remains largely conformed to the textbook style, but a new section has summarized 7 clinical questions to address some important clinical issues for which hard evidence is unavailable. These questions makes the basic principles for the treatment of gastric cancer and the concept more scientific and accurate. It will provide important guidance for the future clinical practice. We provided additional comments and deeply interpreted the questions proposed by the guideline according to some new research and our clinical experience.
Abstract: Surgery is the main treatment for curing gastric cancer, standard D2 gastrectomy and systematical therapy provides an excellent survival outcome in East Asian countries, especially Japan, Korea, and China, however, there are many clinical questions still under debate for a long time. Japanese gastric cancer treatment guidelines has produced a great...
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Fluorescence-Guided Resection of Glial Brain Tumors with Fotoditazin
Artemii Yurievich Rynda,
Dmitrii Michailovich Rostovtsev,
Victor Emelijanovich Olyushin,
Yliay Michaiylovna Zabrodskaya
Issue:
Volume 6, Issue 5, October 2018
Pages:
116-122
Received:
24 July 2018
Accepted:
15 August 2018
Published:
12 September 2018
Abstract: Objective: the purpose of this study was to assess the usefulness and accuracy of visualization of glial brain tumors of varying degrees of malignancy when surgically removed with fluorescent control of fotoditazine. Evaluation of the edges of tumor tissue was also carried out in order to increase the degree gross total resection (GTR), and to evaluate the specificity and sensitivity of the fluorescence method. Design and methods: thirty one glial tumor patients, with varying degrees of malignancy, underwent controlled fluorescence-guided resection in the presence of the indicator molecule fotoditazine. To detect fluorescence, a OHS-1 operating microscope Leica with a special fluorescence module was used. Evaluation of the efficacy, sensitivity and specificity of the method was assessed using various histo-morphological studies. GTR was assessed using postoperative MRI. Results: for grade I and II gliomas, the sensitivity of the surgical tumor removal method was 68.3%, and the specificity was 60.1%. For grade III and IV gliomas, the sensitivity of the surgical tumor removal method was 85.4%, and the specificity was 76.2%. The extent to which total surgical resection was achieved was 79.3% in grade I-II and 95.6% in grade III-IV. Conclusions: intraoperative fluorescent imaging with fotoditazine is a highly effective, sensitive, and specific method which permits glial tumors of various histologic types to be resected more completely and effectively.
Abstract: Objective: the purpose of this study was to assess the usefulness and accuracy of visualization of glial brain tumors of varying degrees of malignancy when surgically removed with fluorescent control of fotoditazine. Evaluation of the edges of tumor tissue was also carried out in order to increase the degree gross total resection (GTR), and to eval...
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Grading System Based on Intra Operative Findings at Laparoscopic Cholecystectomy
Brajesh Kumar,
Saurov Ghose,
Vipul Krishan Sharma,
Manashi Ghosh
Issue:
Volume 6, Issue 5, October 2018
Pages:
123-128
Received:
15 August 2018
Accepted:
1 September 2018
Published:
19 September 2018
Abstract: Laparoscopic Cholecystectomy has become the standard of care for Gall Stone Disease. There are numerous studies and scoring system which considers the pre-operative factors for conversion to open cholecystectomy but there was no scoring system which considers intra operative findings. The objective of this study was to outline the scoring system based on intra operative findings to predict the conversion of laparoscopic cholecystectomy to open cholecystectomy. This prospective study was carried out on 158 patients who underwent cholecystectomy. Surgery in all patients were started with laparoscopic cholecystectomy and based on multiple factors the surgery was completed as open or laparoscopic cholecystectomy. Based on the intra operative findings the patients were divided into easy, moderate, very difficult and extreme. The patients with severe and extreme scoring had highest number of conversions to open cholecystectomy and those patients who had total score of less than 5 had negligible conversion to open cholecystectomy. This paper reports the scoring system which considers the intra operative findings during laparoscopic cholecystectomy. Based on this scoring system it can be predicted weather conversion to open cholecystectomy is required or not.
Abstract: Laparoscopic Cholecystectomy has become the standard of care for Gall Stone Disease. There are numerous studies and scoring system which considers the pre-operative factors for conversion to open cholecystectomy but there was no scoring system which considers intra operative findings. The objective of this study was to outline the scoring system ba...
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A Retrospective Study of Patients Undergoing Radical Cystectomy and Receiving Peri-Operative Naloxegol or Alvimopan: Comparison of Length of Stay
Taylor Goodstein,
Bryn Launer,
Sharon White,
Madison Lyon,
Nicholas George,
Kailynn DeRonde,
Michelle Burke,
Colin O’Donnell,
Clark Lyda,
Tyree H. Kiser,
Shandra Wilson
Issue:
Volume 6, Issue 5, October 2018
Pages:
129-134
Received:
27 August 2018
Accepted:
10 September 2018
Published:
12 October 2018
Abstract: Alvimopan is a µ-opioid receptor antagonist used in the post-operative period to decrease rates of post-operative ileus (POI) following radical cystectomy (RC) and thereby shorten length of stay (LOS). Naloxegol is a much less expensive drug of the same class that has yet to be studied for prevention of POI in the peri-operative period. The purpose of the current study is to evaluate the differences in LOS and development of POI in patients post-RC who take alvimopan versus those who take naloxegol, with the hope that drug efficacy can be evaluated against the significant difference in cost burden between the two drugs. The study population included all adult patients between 18–89 years of age with bladder cancer undergoing radical cystectomy with urostomy at University of Colorado Hospital. Those patients who received usual post-operative care as well as either alvimopan or naloxegol between September 2011 and December 2017 were selected for analysis. Patients who did not take either medication or were switched from one drug to the other were excluded from the study. A zero-truncated binomial regression analysis was used to analyze differences in length of stay in patients who received alvimopan versus those who received naloxegol. Additionally, the incidence of post-operative ileus was compared between treatment groups. 130 patients who underwent RC and received either alvimopan or naloxegol were included in the study: 75 (58%) received alvimopan and 55 (42%) received naloxegol. Baseline characteristics were similar between treatment groups. There was no significant difference in the length of stay between patients who received alvimopan and patients who received naloxegol after adjusting for age, sex, BMI, length of surgical time, or stage of disease (p = 0.41). There was no significant between the two drugs for development of POI (p = 0.85). Development of POI was significantly associated with a longer LOS (p = 0.007). The analysis showed that naloxegol was comparable to alvimopan when it came to length of hospital stay following RC. Therefore, naloxegol may be offered as a less expensive, effective alternative to alvimopan.
Abstract: Alvimopan is a µ-opioid receptor antagonist used in the post-operative period to decrease rates of post-operative ileus (POI) following radical cystectomy (RC) and thereby shorten length of stay (LOS). Naloxegol is a much less expensive drug of the same class that has yet to be studied for prevention of POI in the peri-operative period. The purpose...
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Management of Pleural Empyema Using VATS with Jet-Lavage System
Issue:
Volume 6, Issue 5, October 2018
Pages:
135-139
Received:
23 July 2018
Accepted:
21 September 2018
Published:
25 October 2018
Abstract: Pleural empyema is a serious medical condition that is treated according to the stage. Because of the protracted course of this disease, treatment is very problematic in many cases. In general, pleural empyema therapy should be early and stage-appropriate. In stage I a combination of antibiotic therapy and drainage of the infected pleural effusion via a chest tube is performed. In stage II, proper drainage of loculated pleural empyema is only possible with operative intervention (Video-assisted thoracoscopy). The III stage of the disease results in pleural thickening which hinders lung expansion and restricts pulmonary function significantly. Therefore, early thoracotomy within 3 to 4 weeks is advised to prevent the formation of pleural thickening. In this study, pleural empyema in stage II is treated by means of video-assisted thoracoscopy with jet lavage The purpose of video-assisted thoracoscopy is the resolution of septations and removal of fibrin patches to allow the re-expansion of the lung. The Pulsavac Plus system is highly efficient through a variety of attachments coupled with a high flushing performance. In general, 3 accesses are required: 1 x 10 mm trocar for the camera, 1 x 15 mm trocar for the Pulsavac Plus system and 1 x 5 mm trocar for additional instruments. Between 1998 and 2015, a total of 311 patients were treated successfully with the above technique. Pulsed lavage irrigation provided efficient debridement by most patients and can, therefore, be considered as a useful alternative to the already established procedures. 90% of patients (279/311) were successfully treated. In this paper, a not yet established surgical technique is presented (Video-assisted thoracoscopy with jet lavage), which offers an alternative to the conventional surgical techniques. The results are promising. The median hospital stay averaged 8 days. Randomized trials are still, of course, necessary to evaluate the effectiveness of the procedure.
Abstract: Pleural empyema is a serious medical condition that is treated according to the stage. Because of the protracted course of this disease, treatment is very problematic in many cases. In general, pleural empyema therapy should be early and stage-appropriate. In stage I a combination of antibiotic therapy and drainage of the infected pleural effusion ...
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Study the Incidence of Surgical Glove Perforation during Surgery and Evaluation for the Risk of Perforation and Risk of Surgical Site Infection
Brajesh Kumar,
Saurov Ghose,
Gaurav Pandey,
Manashi Ghosh
Issue:
Volume 6, Issue 5, October 2018
Pages:
140-145
Received:
22 September 2018
Accepted:
8 October 2018
Published:
30 October 2018
Abstract: In a surgical setting there is always a possibility of cross infection between patient and surgeon and surgical gloves act as an important barrier to prevent this infection. Use of double gloves provides more effective barrier for transfer of pathogens from surgical team to patient and vice versa. This study compares the benefit of using double gloves versus single gloves in various departments and its role in preventing Surgical Site Infection (SSI). This study was conducted at Army Hospital (R&R) where surgical gloves used by the operating surgeon were checked for any perforation in outer and inner gloves. In case of perforation was detected, culture of both gloves and surgical part were taken and examined for any cross infection. This study reveals that simultaneous perforation rate of both outer and inner gloves was very less and hence chances of cross infection between patient and surgeon was less when compared to single glove use. Also, the rate of perforation was less in laparoscopic surgery compared to open surgery however this is controversial as various studies which shows more perforation in laparoscopic surgery. The departments where surgeries were complex and were of longer duration had more perforation rate of gloves and consequently SSI. This study concludes that the use of double surgical gloves has got low chances of cross infection between patient and surgeon and hence low rate of Surgical Site Infection and hence should be encouraged.
Abstract: In a surgical setting there is always a possibility of cross infection between patient and surgeon and surgical gloves act as an important barrier to prevent this infection. Use of double gloves provides more effective barrier for transfer of pathogens from surgical team to patient and vice versa. This study compares the benefit of using double glo...
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