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Is Pylorus Resecting Pancreaticoduodenectomy a Better Surgical Alternative Than Pylorus Preserving Pancreaticoduodenectomy Regarding Delayed Gastric Emptying?
Editorial Page 1 of 3 Is pylorus resecting pancreaticoduodenectomy a better surgical alternative than pylorus preserving pancreaticoduodenectomy regarding delayed gastric emptying? Shengliang He, Jin He Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Correspondence to: Jin He, MD, PhD, FACS. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 665, Baltimore, MD 21287, USA. Email: [email protected]. Provenance: This is an invited Editorial commissioned by Section Editor Dr. Ang Li (Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China). Comment on: Hackert T, Probst P, Knebel P, et al. Pylorus Resection Does Not Reduce Delayed Gastric Emptying After Partial Pancreatoduodenectomy: A Blinded Randomized Controlled Trial (PROPP Study, DRKS00004191). Ann Surg 2018;267:1021-7. Received: 28 February 2018; Accepted: 19 March 2018; Published: 19 July 2018. doi: 10.21037/dmr.2018.07.04 View this article at: http://dx.doi.org/10.21037/dmr.2018.07.04 Pylorus preserving pancreaticoduodenectomy (PPPD) incidences (5). has been popularized as the surgical approach for patients As the currently largest, randomized controlled trial, with periampullary lesions by Traverso and Longmire PROPP study included 188 patients with statistical since 1978 (1). It was first hypothesized to reduce the superiority hypothesis (pylorus resection is associated occurrence of dumping, diarrhea, bile reflux gastritis and with less DGE than pylorus preservation). In the control improve overall nutritional status compared with classic group, duodenum was divided 2 cm distal to the pylorus. pancreaticoduodenectomy, also known as classic Whipple An antecolic end-to-side (ETS) duodenojejunostomy (CW). Based on the Cochrane database review in 2016, was performed 50 cm distal to the hepaticojejunostomy. -
Vomiting in Children
Vomiting in Children T. Matthew Shields, MD,* Jenifer R. Lightdale, MD, MPH* *Division of Pediatric Gastroenterology and Nutrition, UMass Memorial Children’s Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA Education Gaps 1. There are at least 4 known physiologic pathways that can trigger vomiting, 3 of which are extraintestinal. 2. Understanding which pathway is causing a patient’s vomiting will help determine best treatment options, including which antiemetic is most likely to be helpful to mitigate symptoms. 3. Bilious emesis in a newborn should indicate bowel obstruction. 4. Cyclic episodes of vomiting may be indicative of a migraine variant. Objectives After completing this article, readers should be able to: 1. Understand the main pathways that trigger vomiting via the emetic reflex. 2. Differentiate among acute, chronic, and cyclic causes of vomiting. 3. Create a broad differential diagnosis for vomiting based on a patient’s history, physical examination findings, and age. 4. Recognize red flag signs and symptoms of vomiting that require emergent evaluation. 5. Recognize when to begin an antiemetic medication. AUTHOR DISCLOSURE Dr Shields has 6. Select antiemetic medications according to the presumed underlying disclosed no financial relationships relevant to this article. Dr Lightdale has disclosed that she mechanism of vomiting. has a research grant from AbbVie and receives honorarium as a speaker for Mead Johnson. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Vomiting is a common symptom of numerous underlying conditions for which children frequently present for healthcare. Although vomiting can originate from ABBREVIATIONS the gastrointestinal (GI) tract itself, it can also signal more generalized, systemic 5-HT 5-hydroxytryptamine disorders. -
Journal of Pediatric Surgery Case Reports 40 (2019) 71–75
Journal of Pediatric Surgery Case Reports 40 (2019) 71–75 Contents lists available at ScienceDirect Journal of Pediatric Surgery Case Reports journal homepage: www.elsevier.com/locate/epsc Laparoscopic resection of pancreatic neck lesion with Roux-en-Y T pancreatico-jejunostomy ∗ ∗ Martin Sidlera, , Pratik Shahb, Michael Ashworthc, Paolo De Coppia, a Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom b Paediatric Endocrinology, Great Ormond Street Hospital, London, United Kingdom c Paediatric Histopathology, Great Ormond Street Hospital, London, United Kingdom ABSTRACT Background: Congenital hyperinsulinism is a rare disease and patients not re- sponding to medical treatment need near-total or partial pancreatectomy, dependent on whether they have diffuse or focal hyperinsulinism, respectively. While laparoscopic technique for distal and for total pancreatectomy has been developed, minimally invasive resection of the pancreatic neck with pancreatico-jejunostomy has not been reported in children before. Case summary: A 2-year old boy suffered from congenital hyperinsulinism, which was refractory to high-dose medical treatment. The nuclear-medicine scanrevealed a focal lesion of the pancreatic neck, hence partial pancreatectomy was indicated. On laparoscopy, a slightly prominent tissue mass was apparent in the area of the pancreatic neck. We proceeded with laparoscopic mobilisation of the pancreas from the underlying splenic vessels and resected the pancreatic neck and adjacent parts of the body and the head. After macroscopic resection of the mass, the patient's intraoperative blood glucose levels increased to a point where insulin had to be substituted. To drain the pancreatic tail, we formed an end-to-side anastomosis in the proximal Jejunum and brought the open end to the pancreatic tail and performed a laparoscopic pancreatico-jejunostomy. -
Gastroparesis and Dumping Syndrome: Current Concepts and Management
Journal of Clinical Medicine Review Gastroparesis and Dumping Syndrome: Current Concepts and Management Stephan R. Vavricka 1,2,* and Thomas Greuter 2 1 Center of Gastroenterology and Hepatology, CH-8048 Zurich, Switzerland 2 Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland * Correspondence: [email protected] Received: 21 June 2019; Accepted: 23 July 2019; Published: 29 July 2019 Abstract: Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. Although gastroparesis results from delayed gastric emptying and dumping syndrome from accelerated emptying of the stomach, the two entities share several similarities among which are an underestimated prevalence, considerable impairment of quality of life, the need for a multidisciplinary team setting, and a step-up treatment approach. In the following review, we will present an overview of the most important clinical aspects of gastroparesis and dumping syndrome including epidemiology, pathophysiology, presentation, and diagnostics. Finally, we highlight promising therapeutic options that might be available in the future. Keywords: gastroparesis; dumping syndrome; pathophysiology; clinical presentation; treatment 1. Introduction Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. While gastroparesis results from significantly delayed gastric emptying, dumping syndrome is a consequence of increased flux of food into the small bowel [1,2]. The two entities share several important similarities: (i) gastroparesis and dumping syndrome are frequent, but also frequently overlooked; (ii) they affect patient’s quality of life considerably due to possibly debilitating symptoms; (iii) patients should be taken care of within a multidisciplinary team setting; and (iv) treatment should follow a step-up approach from dietary modifications and patient education to pharmacological interventions and, finally, surgical procedures and/or enteral feeding. -
Endoscopic Approaches to Gastroparesis
Endoscopic Approaches to Gastroparesis Kevin Liu, MD,1 Thomas Enke, MD,2 and Aziz Aadam, MD1 1Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 2Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Corresponding author: Abstract: Gastroparesis is a complex syndrome with multiple Dr Aziz Aadam underlying etiologies and pathophysiologies that can cause signif- 676 North Saint Clair St, Suite 1400 icant morbidity for patients. Currently, there are limited effective Chicago, IL 60611 and durable medical and surgical treatments for patients with Tel: (312) 695-3364 E-mail: [email protected] gastroparesis. As such, there has been recent innovation and development in minimally invasive endoscopic treatments for gastroparesis. Endoscopic therapies that have been investigated for gastroparesis include enteral feeding tube placement, intrapyloric botulinum toxin injection, transpyloric stenting, gastric peroral endoscopic myotomy, and gastric electrical stimulation. This article aims to assess the effectiveness of current endoscopic therapies, as well as discuss future directions for endoscopic therapies, in the management of gastroparesis. astroparesis is defined as a complex syndrome of symp- toms, including early satiety, postprandial fullness, nausea, vomiting, bloating, and upper abdominal pain, with a Gcorresponding objective delay in gastric emptying in the absence of mechanical obstruction.1 The primary etiologies -
Laparoscopic Vs. Open Pyloromyotomy in Treatment of Infantile Hypertrophic Pyloric Stenosis
ORIGINAL RESEARCH published: 21 August 2020 doi: 10.3389/fped.2020.00426 Laparoscopic vs. Open Pyloromyotomy in Treatment of Infantile Hypertrophic Pyloric Stenosis Ibrahim Ismail, Radi Elsherbini, Adham Elsaied, Kamal Aly and Hesham Sheir* Pediatric Surgery Department, Mansoura University Chlidren Hospital, Mansoura University, Mansoura, Egypt Background/Purpose: Laparoscopic pyloromyotomy gained wide popularity in management of pyloric stenosis with contradictory results regarding its benefits over classic open approach. This study aimed at comparing both regarding their safety, efficiency, and outcome. Methods: This is a prospective randomized controlled study performed from April 2017 to April 2019. It included 80 patients, divided randomly into two groups, where laparoscopic pyloromyotomy was performed in group A and open pyloromyotomy Edited by: in group B. Both groups were compared regarding operative time, post-operative Henri Steyaert, pain score, time required to reach full feeding, hospital stay, complications, and Queen Fabiola Children’s University Hospital, Belgium parents’ satisfaction. Reviewed by: Results: Median operative time was 21 min in group A vs. 30 min in group B (P = 0). Oliver J. Muensterer, Johannes Gutenberg University Pain Assessment in Neonates scores were generally higher in group B with more doses Mainz, Germany of analgesics required (P = 0). Mean time needed to reach full feeding was 15.2 and Matthijs Oomen, 18.8 h in groups A and B, respectively (P = 0). Median hospital stay was 19 h in group Amsterdam University Medical Centers – AMC, Netherlands A and 22 h in group B (P = 0.004). Parents’ satisfaction also was in favor of group *Correspondence: A (P = 0.045). Although no significant difference was reported between both groups Hesham Sheir regarding early and late complications, some complications such as mucosal perforation [email protected] and incomplete pyloromyotomy occurred in the laparoscopic group only. -
Rheumatoide Arthritis Im Mausmodell - Immunologische Und Strukturelle Verän- Derungen Im Darm
Rheumatoide Arthritis im Mausmodell - immunologische und strukturelle Verän- derungen im Darm in Medizin 3 Rheumatologie/ Immunologie des Universitätsklinikums Erlangen Klinikdirektor: Prof. Dr. med. univ. Georg Schett Dissertation der Medizinischen Fakultät der Friedrich-Alexander-Universität Erlangen-Nürnberg zur Erlangung des Doktorgrades Dr. med. vorgelegt von Oscar Theodor Schulz aus Burgwedel Als Dissertation genehmigt von der Medizinischen Fakultät der Friedrich-Alexander-Universität Erlangen-Nürnberg Vorsitzender des Promotionsorgans: Prof. Dr. Markus F Neurath Gutachter: Prof. Dr. Mario Zaiss Gutachter: Prof. Dr. Gerhard Krönke Tag der mündlichen Prüfung: 16. März 2021 Inhaltsverzeichnis 1. Zusammenfassung / Abstract ...................................................................... - 1 - 1.1.1 Hintergrund und Ziele ......................................................................... - 1 - 1.1.2 Methoden (Patienten, Material und Untersuchungsmethoden) .......... - 1 - 1.1.3 Ergebnisse und Beobachtungen ......................................................... - 2 - 1.1.4 Schlussfolgerung ................................................................................ - 3 - 1.2.1 Background and aims ......................................................................... - 4 - 1.2.2 Methods (patients, material and examination methods) ..................... - 4 - 1.2.3 Results ................................................................................................ - 5 - 1.3.4 Conclusion ......................................................................................... -
Naiyana Gujral
University of Alberta ANTIBODY-BASED DIAGNOSTIC AND THERAPEUTIC APPROACHES ON GLUTEN-SENSITIVE ENTEROPATHY by Naiyana Gujral A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Pharmaceutical Sciences Faculty of Pharmacy and Pharmaceutical Sciences © Naiyana Gujral Fall 2013 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission. DEDICATION I dedicate this thesis to my beloved family with all my love respect, and gratitude. ABSTRACT Gluten-sensitive enteropathy, called Celiac disease (CD), is one of the most frequent autoimmune diseases, occurring in 1% people worldwide, upon gliadin ingestion. Currently, the only treatment available for CD individual is a strict life-long gluten-free diet. Chicken egg yolk immunoglobulin Y (IgY) is produced and examined for its efficacy in vitro, ex vivo, and in vivo to prevent enteric absorption of gliadin. This antibody was also used to develop sensitive and rapid detection kits for gluten. The extracted toxic gliadin was immunized into chickens inducing humoral immune response to produced gliadin-specific IgY antibodies. -
Endoscopic Pyloromyotomy for Postesopha- Gectomy Gastric Outlet Obstruction
Cases and Techniques Library (CTL) E345 Endoscopic pyloromyotomy for postesopha- gectomy gastric outlet obstruction Fig. 1 A 54-year-old woman presented with vomiting 2 weeks after esophagectomy with gastric pull-up. a Esophagography revealed marked delay in passage of contrast through the pylorus. b Fluid retention was noted on esophago- gastroduodenoscopy (EGD) and the scope could not be passed through the pylorus. Postesophagectomy gastric outlet ob- vomiting. Esophagogastroduodenoscopy The mucosal entry was then closed using struction occurs in 20% –30% of patients (EGD) revealed significant food stasis in four endoscopic clips (●" Video 1). who undergo esophagectomy and is asso- the pulled-up stomach and again the en- On the following day, fluoroscopy showed ciated with significant morbidity and de- doscope could not be passed through the significant improvement in passage of layed recovery [1]. Recently, endoscopic pylorus. contrast (●" Fig. 3) and the gastroscope pyloromyotomy, also called gastric per- Endoscopic pyloromyotomy was per- (GIF-H260; Olympus) could pass smooth- oral endoscopic myotomy (POEM), has formed with the patient under conscious ly through the pylorus. The patient was been reported, in pigs and in a patient sedation. Saline solution mixed with indi- started on a liquid diet and was dis- with refractory diabetic gastroparesis [2, go carmine was injected on the greater charged the next day. She remains well 3]. We report a case of postesophagec- curvature 5cm proximal to the pylorus. A 10 weeks after the procedure and appro- tomy delayed gastric emptying that was 1.5-cm mucosal incision was made priately tolerates a general diet. successfully treated with endoscopic (●" Fig.2) using a DualKnife (KD-650L; pyloromyotomy. -
The Pennsylvania State University the Graduate School College Of
The Pennsylvania State University The Graduate School College of Agricultural Sciences PHYSICOCHEMICAL MODIFICATION OF GLIADIN BY DIETARY POLYPHENOLS AND THE POTENTIAL IMPLICATIONS FOR CELIAC DISEASE A Dissertation in Food Science by Charlene B. Van Buiten © 2017 Charlene B. Van Buiten Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy August 2017 The dissertation of Charlene B. Van Buiten was reviewed and approved* by the following: Ryan J. Elias Associate Professor of Food Science Dissertation Advisor Chair of Committee Joshua D. Lambert Associate Professor of Food Science John N. Coupland Professor of Food Science Gregory R. Ziegler Professor of Food Science Connie J. Rogers Associate Professor of Nutritional Sciences Robert F. Roberts Professor of Food Science Head of the Department of Food Science *Signatures are on file in the Graduate School ii ABSTRACT Celiac disease is an autoimmune enteropathy that affects approximately 1% of the world population. Characterized by an adverse reaction to gluten protein, celiac disease manifests in the small bowel and results in inflammation and increased permeability of the gut barrier. This is followed by an immune response mounted against not only gluten, but also tissue transglutaminase 2 (TG2), a gluten-reactive enzyme secreted by intestinal epithelial cells. Despite the growing number of individuals affected by this disease, the only reliable intervention strategy available is lifelong adherence to a gluten-free diet. Novel strategies for treating or preventing celiac disease include synthetic pharmaceuticals to modify the gut barrier, parabiotic infection to reduce inflammatory cytokine release and administration of a synthetic polymer that binds gluten proteins and prevents their digestion and absorption. -
Multisystem Inflammatory Syndrome in Children Is Driven by Zonulin-Dependent Loss of Gut Mucosal Barrier
The Journal of Clinical Investigation CLINICAL MEDICINE Multisystem inflammatory syndrome in children is driven by zonulin-dependent loss of gut mucosal barrier Lael M. Yonker,1,2,3 Tal Gilboa,3,4,5 Alana F. Ogata,3,4,5 Yasmeen Senussi,4 Roey Lazarovits,4,5 Brittany P. Boribong,1,2,3 Yannic C. Bartsch,3,6 Maggie Loiselle,1 Magali Noval Rivas,7 Rebecca A. Porritt,7 Rosiane Lima,1 Jameson P. Davis,1 Eva J. Farkas,1 Madeleine D. Burns,1 Nicola Young,1 Vinay S. Mahajan,3,6 Soroush Hajizadeh,3,8 Xcanda I. Herrera Lopez,3,8 Johannes Kreuzer,3,8 Robert Morris,3,8 Enid E. Martinez,1,3,9 Isaac Han,3,5 Kettner Griswold Jr.,3,5 Nicholas C. Barry,3,5 David B. Thompson,3,5 George Church,3,5,10 Andrea G. Edlow,3,11,12 Wilhelm Haas,3,8 Shiv Pillai,3,6 Moshe Arditi,7 Galit Alter,3,6 David R. Walt,3,4,5 and Alessio Fasano1,2,3,13 1Mucosal Immunology and Biology Research Center and 2Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA. 3Harvard Medical School, Boston, Massachusetts, USA. 4Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA. 5Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA. 6Ragon Institute of MIT, MGH and Harvard, Cambridge, Massachusetts, USA. 7Department of Pediatrics, Division of Infectious Diseases and Immunology, Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA. 8Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA. -
Basic Surgical Techniques
BASIC SURGICAL TECHNIQUES Textbook Authors: György Wéber MD, PhD, med. habil. János Lantos MSc, PhD Balázs Borsiczky MD, PhD Andrea Ferencz MD, PhD Gábor Jancsó MD, PhD Sándor Ferencz MD Szabolcs Horváth MD Hossein Haddadzadeh Bahri MD Ildikó Takács MD Borbála Balatonyi MD University of Pécs, Medical School Department of Surgical Research and Techniques 20 Kodály Zoltán Steet, H-7624 Pécs, Telephone: +36 72 535 820 Website:http://soki.aok.pte.hu 2008 1 PREFACE The healing is impossible without entering into suffering people’s feelings and to humble yourself in your profession. All these are completed by the ability to manage the immediate and critical situations dynamically and to analyze the diseases interdisciplinarily (e.g. diagnosis, differential diagnosis, appropriate decision among the alternative possibilities of treatment, etc.). A successful surgical intervention requires even more than this. It needs the perfect, aimful and economical coordination of operational movements. The refined technique of the handling and uniting the tissues –in the case of manual skills– is attainable by many practices, and the good surgeon works on the perfection of this technique in his daily operating activities. The most important task in the medical education is to teach the problem-oriented thinking and the needed practical ability. The graduate medical student will notice in a short time that a medical practitioner principally needs the practical knowledge and manual skill in provision for the sick. “The surgical techniques” is a popular subJect. It is a subJect in which the medical students -for the first time- will see the inside of the living and pulsating organism.