Surgical management of interrupted aortic arch (IAA) with systemic outflow tract obstruction is clearly a challenge. If both ventricles are adequate, the Yasui operation is a useful option. Otherwise, a staged approach through initial hybrid palliation and delayed biventricular repair, tailored to the degree of obstructed outflow, serves to avoid a high-risk neonatal procedure. Herein, we present a patient with IAA and severe systemic outflow tract obstruction whose treatment involved hybrid palliation, followed by a Yasui operation.
Aorta, Thoracic ; Humans

Transient receptor potential vanilloid subtype 1 (TRPV1) on astrocytes prevents ongoing degeneration of nigrostriatal dopamine (DA) neurons in MPP⁺-lesioned rats via ciliary neurotrophic factor (CNTF). The present study determined whether such a beneficial effect of astrocytic TRPV1 could be achieved after completion of injury of DA neurons, rather than ongoing injury, which seems more relevant to therapeutics. To test this, the MPP⁺-lesioned rat model utilized here exhibited approximately 70~80% degeneration of nigrostriatal DA neurons that was completed at 2 weeks post medial forebrain bundle injection of MPP⁺. TRPV1 agonist, capsaicin (CAP), was intraperitoneally administered. CNTF receptor alpha neutralizing antibody (CNTFRαNAb) was nigral injected to evaluate the role of CNTF endogenously produced by astrocyte through TRPV1 activation on DA neurons. Delayed treatment of CAP produced a significant reduction in amphetamine-induced rotational asymmetry. Accompanying this behavioral recovery, CAP treatment increased CNTF levels and tyrosine hydroxylase (TH) activity in the substantia nigra pars compacta (SNpc), and levels of DA and its metabolites in the striatum compared to controls. Interestingly, behavioral recovery and increases in biochemical indices were not reflected in trophic changes of the DA system. Instead, behavioral recovery was temporal and dependent on the continuous presence of CAP treatment. The results suggest that delayed treatment of CAP increases nigral TH enzyme activity and striatal levels of DA and its metabolites by CNTF endogenously derived from CAP-activated astrocytes through TRPV1, leading to functional recovery. Consequently, these findings may be useful in the treatment of DA imbalances associated with Parkinson's disease.
Animals ; Antibodies, Neutralizing ; Astrocytes ; Capsaicin ; Ciliary Neurotrophic Factor ; Dopamine ; Dopaminergic Neurons ; Medial Forebrain Bundle ; Models, Animal ; Neurons ; Parkinson Disease ; Pars Compacta ; Rats ; Receptor, Ciliary Neurotrophic Factor ; Tyrosine 3-Monooxygenase

Surgical management of interrupted aortic arch (IAA) with systemic outflow tract obstruction is clearly a challenge. If both ventricles are adequate, the Yasui operation is a useful option. Otherwise, a staged approach through initial hybrid palliation and delayed biventricular repair, tailored to the degree of obstructed outflow, serves to avoid a high-risk neonatal procedure. Herein, we present a patient with IAA and severe systemic outflow tract obstruction whose treatment involved hybrid palliation, followed by a Yasui operation.

BACKGROUND: Endotracheal intubation during anesthesia induction may increase airway resistance (R(aw)) and decrease dynamic lung compliance (Cdyn). We hypothesized that prophylactic treatment with a transdermal β2-agonist tulobuterol patch (TP) would help to reduce the risk of bronchospasm after placement of the endotracheal tube. METHODS: Eighty-two American Society of Anesthesiologists (ASA) category I or II adult patients showing obstructive patterns were divided randomly into a control and a TP group (n = 41 each). The night before surgery, a 2-mg TP was applied to patients in the TP group. Standard monitors were recorded, and target controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. Simultaneously, end-tidal carbon dioxide, R(aw), and Cdyn were determined at 5, 10, and 15 min intervals after endotracheal intubation. RESULTS: There was no significant difference in demographic data between the two groups. The TP group was associated with a lower R(aw) and a higher Cdyn, as compared to the control group. R(aw) was significantly lower at 10 min (P < 0.05) and 15 min (P < 0.01), and Cdyn was significantly higher at 5 min (P < 0.05) and 15 min (P < 0.01) in the TP group. A trend towards a lower R(aw) was observed showing a statistically significant difference 5 min after endotracheal intubation (P < 0.01) in each group. CONCLUSIONS: Prophylactic treatment with TP showed a bronchodilatory effect through suppressing an increase in R(aw) and a decrease in C(dyn) after anesthesia induction without severe adverse effects.
Adult ; Airway Resistance ; Anesthesia ; Bronchial Spasm ; Carbon Dioxide ; Humans ; Intubation, Intratracheal* ; Lung Compliance ; Propofol ; Respiratory System*

PURPOSE: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. MATERIALS AND METHODS: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. RESULTS: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). CONCLUSIONS: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
Bile ; Bile Reflux ; Gastrectomy* ; Gastric Stump ; Gastritis ; Hand ; Humans ; Methods ; Prospective Studies ; Stomach Neoplasms*

PURPOSE: Sleeve gastrectomy (SG) is an emerging approach, but there have been a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. We describe results of a single fully experienced gastric surgeon's short-term outcomes of laparoscopic sleeve gastrectomy (LSG) and robotic sleeve gastrectomy (RSG) for morbidly obese patients. MATERIALS AND METHODS: We retrospectively reviewed 20 patients underwent LSG and RSG from July 2010 to February 2014. RESULTS: The mean age was 36.3+/-10.1 years, the mean preoperative body mass index (BMI) was 37.3+/-5.4 kg/m2. Mean operative time was 124.4+/-36.2 min. The postoperative length of stay was 5.1+/-4.1 day. There was no open conversion and mortality, nor severe postoperative complication found in the LSG and RSG cases. The mean BMI decreased to 26.1+/-2.5 kg/m2 at 1 year and the mean percentage excess weight loss was 69.8+/-24.9% at 1 year. CONCLUSION: Effective weight loss without complication would be achieved by sleeve gastrectomy if the procedure is performed by experienced gastric surgeon. However, further well-designed comparative studies with larger sample size are warranted to prove this preliminary result.
Body Mass Index ; Gastrectomy* ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Obesity, Morbid ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Sample Size ; Weight Loss

PURPOSE: Allergic rhinitis (AR) is a multifactorial disease whose genetic and environmental risk factors have been studied for decades. Many pediatric studies have pointed out the familial history of allergy, hygiene hypothesis, breast-feeding, pet ownership, and diets as risk factors of AR. However, most of factors are still up for debate. This preliminary report aimed to confirm the known risk factors and find the novel risk factors for AR in the Korean pediatric population. METHODS: A bi-seasonal, winter and summer, study in 2 elementary schools included all students whose parents completed the questionnaire of medical and social histories, quality of life, infant and early-childhood history, and the living styles. Skin prick tests and endoscopic examinations were conducted on all participants. RESULTS: Among total 1,020 children, 338 participants had AR. The multivariate logistic regression analysis highlighted 6 factors: male gender (OR, 2.10; 95% CI, 1.32-3.33), older age (1.65; 1.03-2.65), previous history of allergic conjunctivitis (14.25; 4.99-40.74), asthma (2.73; 0.96-7.76) and pneumonia (0.39; 0.19-0.82), and an hour increase in daily playing time (0.90; 0.80-1.00). CONCLUSIONS: Lack of pneumonia in early childhood and short playing time are newly found risk factors for Korean pediatric AR in this study confirming male gender, older age and previous history of allergic conjunctivitis and asthma as the risk factors.
Asthma ; Child* ; Conjunctivitis, Allergic ; Diet ; Humans ; Hygiene Hypothesis ; Hypersensitivity ; Infant ; Logistic Models ; Male ; Ownership ; Parents ; Pneumonia ; Quality of Life ; Rhinitis* ; Risk Factors* ; Skin ; Surveys and Questionnaires

PURPOSE: Although several clinical trials have proven the efficacy of adjuvant S-1 treatment in gastric cancers, it is still unclear which patients receive the most benefit. In this study, we prospectively recruited patients with locally advanced gastric cancer who had undergone curative resection followed by adjuvant S-1 administration to investigate which factors affect the outcomes. MATERIALS AND METHODS: Between July 2010 and October 2011, we enrolled 49 patients who underwent curative resection for stage II or III gastric cancer and who subsequently received adjuvant S-1 treatment for 1 year. RESULTS: Twenty-nine patients (59.2%) continued S-1 treatment for 1 year, and 12 patients (24.5%) experienced recurrent disease during the follow-up period. Patients with continuation of S-1 for 1 year had significantly increased rates of disease-free survival (P<0.001) and overall survival (P=0.001) relative to the patients who discontinued S-1 during year 1. Multivariate analysis indicated poor outcomes for patients with stage III disease and those who discontinued S-1 treatment. Excluding patients who discontinued S-1 due to cancer progression (n=7), adjuvant treatment with S-1 still demonstrated a significant difference in the disease-free survival rate between the patients who continued treatment and those who discontinued it (P=0.020). CONCLUSIONS: S-1 is tolerated as adjuvant treatment in gastric cancer patients. However, discontinuing S-1 treatment may be an unfavorable factor in the prevention of recurrence. S-1 adjuvant treatment should be continued for 1 year if possible through the proper management of toxicities.
Compliance ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis* ; Prospective Studies* ; Recurrence ; Stomach Neoplasms*

PURPOSE: The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. MATERIALS AND METHODS: We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. RESULTS: Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). CONCLUSIONS: Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure.
Abdominal Cavity ; Humans ; Neoplasm Metastasis ; Peritoneum ; Prospective Studies* ; Recurrence* ; Sensitivity and Specificity ; Stomach Neoplasms* ; Survival Rate

No abstract available.
Granuloma, Plasma Cell* ; Histiocytic Sarcoma*