Search

Spontaneous esophageal perforation in Boerhaave’s syndrome results in significant morbidity and mortality. The gold standard treatment for this disease is thoracotomy and laparotomy because it can be a life-saving procedure that can be performed in emergencies; however, minimally invasive surgery has recently been reported. This report describes three cases of Boerhaave’s syndrome that were treated using laparoscopic transhiatal suture and omental patch. One patient recovered uneventfully and was discharged from the hospital after 12 days. The other 2 patients had postoperative complications, such as minor leakage and remnant abscess (Clavien-Dindo Grade II), but were discharged from the hospital after 17 days and 30 days, respectively. In the case of Boerhaave’s syndrome with localized mediastinal collections, a good clinical course can be obtained by laparoscopic transhiatal esophageal repair to avoid surgical invasion due to thoracotomy.

Background: Internal hernia (IH) is one of the critical complications after gastrectomy with Roux-en-Y reconstruction, which can be prevented by closing mesenteric defects. However, only few studies have investigated the incidence of IH after laparoscopic total gastrectomy (LTG) with Roux-en-Y reconstruction for gastric cancer till date. This study aimed to assess the efficacy of defect closure for the prevention of IH after LTG. Methods: This multicenter, retrospective cohort study collected data from 714 gastric cancer patients who underwent LTG with Rou-en-Y reconstruction between 2010 and 2016 in 13 hospitals. We evaluated the incidence of postoperative IH by comparing closure and non-closure groups of Petersen’s defect, jejunojejunostomy mesenteric defect, and transverse mesenteric defect. Results: The closure group for Petersen’s defect included 609 cases, while the non-closure group included 105 cases. The incidence of postoperative IH in the closure group for Petersen’s defect was significantly lower than it was in the non-closure group (0.5% vs. 4.8%, p< 0.001). The closure group for jejunojejunostomy mesenteric defect included 641 cases, while the non-closure group included 73 cases. The incidence of postoperative IH in the closure group of jejunojejunostomy mesenteric defect was significantly lower than that in the non-closure group (0.8% vs. 4.1%, p= 0.004). Out of 714 patients, 41 underwent retro-colic reconstruction. No patients in the transverse mesenteric defect group developed IH. Conclusion: Mesenteric defect closure after LTG with Roux-en-Y reconstruction may reduce postoperative IH incidence. Endoscopic surgeons should take great care to prevent IH by closing mesenteric defects.

Background: Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. Methods: We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. Results: After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p= 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p= 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p= 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p= 0.771). Conclusion: The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.

In previous studies, we have treated real written texts as time series data and have tried to investigate dynamic correlations of word occurrences by utilizing autocorrelation functions (ACFs) and also by simulation of pseudo-text synthesis. The results showed that words that appear in written texts can be classified into two groups: a group of words showing dynamic correlations (Type-I words), and a group of words showing no dynamic correlations (Type-II words). In this study, we investigate the characteristics of these two types of words in terms of their waiting time distributions (WTDs) of word occurrences. The results for Type-II words show that the stochastic processes that govern generating Type-II words are superpositions of Poisson point processes with various rate constants. We further propose a model of WTDs for Type-I words in which the hierarchical structure of written texts is considered. The WTDs of Type-I words in real written texts agree well with the predictions of the proposed model, indicating that the hierarchical structure of written texts is important for generating long-range dynamic correlations of words.

Lithiation of 1-[3,5-bis-O-(tert-butyldimethylsilyl)-2-deoxy-d-erythro-pent-1-enofuranosyl)uracil (1) takes place exclusively at the 6-position of the uracil base. The 6-tributylstannyl (or 6-trimethylsilyl) derivative prepared by quenching the C6-lithiated species with Bu3SnCl (or Me3SiCl) was found to undergo an intramolecular anionic migration to the 2′-positon of the furanoid glycal portion. By manipulation of the 2′-stannyl group, 2′-halogeno and 2′-carbon-substituted 1′,2′-unsaturated uridines were prepared for the first time. In contrast to the reported instability of 1during deprotection, the 2′-substituted analogs synthesized in the present study gave the corresponding free nucleosides uniformly in high yields upon treatment with NH4F in MeOH.

A new technique of superresolution which makes use of a multi-exposed image hologram is described. The basic idea of this method is to use the hologram as storage medium for complex amplitude of the image of an object to be superresolved and to add up the complex amplitudes of the images of different spatial frequency ranges by multiple exposure on the hologram to synthesize the superresolved image. In this paper, a detailed analysis of the theory of this method, and the results of experiments for one-dimensional and two-dimensional objects, are presented. As a whole, the bandwidth of the optical system could be extended to the theoretically expected value.

Abstract: Multiple cysts and benign cystadenomas of the pancreas have been documented occasionally in von Hippel-Lindau syndrome (HLS); however, the malignant involvement of the pancreas in HLS is very rare. We report a case of HLS in which metastatic tumors from renal cell carcinoma (RCC) coexisted with multiple cysts in the pancreas. A 22-year-old woman with a history of HLS had undergone a partial resection of the left kidney for RCC 3 years earlier, at which time a solid mass in the pancreatic tail and multiple pancreatic cysts were also incidentally detected by computed tomography. Over the following 3 years, the mass enlarged slightly, thus raising suspicions that it might be a primary neoplasm of the pancreas. She was referred to the Department of Surgery and Surgical Basic Science to undergo surgery. In addition to the tumor in the pancreatic tail, however, further tumors in the pancreatic head were also disclosed by preoperative celiac arteriography and intraoperative palpation and ultrasonography. A distal pancreatectomy was performed, because the enucleation of all the tumors in the pancreatic head was technically impossible and because the patient declined a total pancreatectomy. A histologic examination of the mass in the pancreatic tail revealed metastatic RCC. This case emphasizes that metastatic disease should be included in the differential diagnosis when evaluating the pancreas in a patient with HLS.:

ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a “Full Text” option. The original article is trackable via the “References” option.

ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a “Full Text” option. The original article is trackable via the “References” option.

ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 100 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a “Full Text” option. The original article is trackable via the “References” option.