Objective: We aimed to explore the feasibility of a single-port thoracoscopy- assisted five-step laparoscopic procedure via transabdominal diaphragmatic(TD) approach(abbreviated as five-step maneuver) for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma (AEG). Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) age 18-80 years; (2) diagnosis of Siewert type II AEG; (3) clinical tumor stage cT2-4aNanyM0; (4) meeting indications of the transthoracic single-port assisted laparoscopic five-step procedure incorporating lower mediastinal lymph node dissection via a TD approach; (5) Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1; and (6) American Society of Anesthesiologists classification I, II, or III. The exclusion criteria included previous esophageal or gastric surgery, other cancers within the previous 5 years, pregnancy or lactation, and serious medical conditions. We retrospectively collected and analyzed the clinical data of 17 patients (age [mean ± SD], [63.6±11.9] years; and 12 men) who met the inclusion criteria in the Guangdong Provincial Hospital of Chinese Medicine from January 2022 to September 2022. No.111 lymphadenectomy was performed using five-step maneuver as follows: superior to the diaphragm, starting caudad to the pericardium, along the direction of the cardio-phrenic angle and ending at the upper part of the cardio-phrenic angle, right to the right pleura and left to the fibrous pericardium , completely exposing the cardio-phrenic angle. The primary outcome includes the numbers of harvested and of positive No.111 lymph nodes. Results: Seventeen patients (3 proximal gastrectomy and 14 total gastrectomy) had undergone the five-step maneuver including lower mediastinal lymphadenectomy without conversion to laparotomy or thoracotomy and all had achieved R0 resection with no perioperative deaths. The total operative time was (268.2±32.9) minutes, and the lower mediastinal lymph node dissection time was (34.0±6.0) minutes. The median estimated blood loss was 50 (20-350) ml. A median of 7 (2-17) mediastinal lymph nodes and 2(0-6) No. 111 lymph nodes were harvested. No. 111 lymph node metastasis was identified in 1 patient. The time to first flatus occurred 3 (2-4) days postoperatively and thoracic drainage was used for 7 (4-15) days. The median postoperative hospital stay was 9 (6-16) days. One patient had a chylous fistula that resolved with conservative treatment. No serious complications occurred in any patient. Conclusion: The single-port thoracoscopy-assisted five-step laparoscopic procedure via a TD approach can facilitate No. 111 lymphadenectomy with few complications.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Diaphragm/surgery* ; Retrospective Studies ; Feasibility Studies ; Esophagogastric Junction/surgery* ; Lymph Node Excision/methods* ; Stomach Neoplasms/pathology* ; Laparoscopy/methods* ; Gastrectomy/methods* ; Esophageal Neoplasms/pathology* ; Adenocarcinoma/pathology* ; Thoracoscopy

Gastric volvulus (GV) is an uncommon pathology, with 10-20% of cases occurring in children, typically before one year of age. It often occurs in people with congenital diaphragmatic hernias, intestinal malrotation, eventration of the diaphragm, paraesophageal hernias, wandering spleens, asplenism, or intra-abdominal adhesions. We report a rare case of chronic GV after left hemihepatectomy for hepatoblastoma in a child. The patient was a 9-year-old boy who complained of upper abdominal pain and postprandial upper abdominal distension for one year. At the age of 4 months, he was diagnosed with hepatoblastoma and had undergone left hemihepatectomy. The upper gastrointestinal contrast study revealed chronic organoaxial gastric volvulus. After a surgical procedure involving adhesiolysis and an anterior wall gastropexy, the patient improved and the symptoms resolved. Although GV is a rare disease, it should be suspected in a patient with a previous abdominal surgical history who is complaining of abdominal distension and pain.
Abdominal Pain ; Child ; Diaphragm ; Gastropexy ; Hepatectomy ; Hepatoblastoma ; Hernia, Hiatal ; Hernias, Diaphragmatic, Congenital ; Humans ; Male ; Pathology ; Rare Diseases ; Stomach Volvulus ; Wandering Spleen

Focal segmental glomerulosclerosis (FSGS) is characterized by focal and segmental obliteration of glomerular capillary tufts with increased matrix. FSGS is classified as collapsing, tip, cellular, perihilar and not otherwise specified variants according to the location and character of the sclerotic lesion. Primary or idiopathic FSGS is considered to be related to podocyte injury, and the pathogenesis of podocyte injury has been actively investigated. Several circulating factors affecting podocyte permeability barrier have been proposed, but not proven to cause FSGS. FSGS may also be caused by genetic alterations. These genes are mainly those regulating slit diaphragm structure, actin cytoskeleton of podocytes, and foot process structure. The mode of inheritance and age of onset are different according to the gene involved. Recently, the role of parietal epithelial cells (PECs) has been highlighted. Podocytes and PECs have common mesenchymal progenitors, therefore, PECs could be a source of podocyte repopulation after podocyte injury. Activated PECs migrate along adhesion to the glomerular tuft and may also contribute to the progression of sclerosis. Markers of activated PECs, including CD44, could be used to distinguish FSGS from minimal change disease. The pathogenesis of FSGS is very complex; however, understanding basic mechanisms of podocyte injury is important not only for basic research, but also for daily diagnostic pathology practice.
Actin Cytoskeleton ; Age of Onset ; Capillaries ; Diaphragm ; Epithelial Cells ; Foot ; Glomerulosclerosis, Focal Segmental* ; Nephrosis, Lipoid ; Pathology ; Permeability ; Podocytes ; Rabeprazole ; Sclerosis ; Wills

OBJECTIVETo explore the diaphragmatic toxicity in doxorubicin (DOX)-treated rats and the related mechanisms, as well as the effects of Shengmai Injection (SMI, ) on the diaphragmatic dysfunction.

METHODSThirty Sprague-Dawley male rats were randomly divided into three groups: control, DOX-treated and DOX+SMI treated groups. DOX was given to rats in DOX and DOX+SMI groups in 6 equal doses [2.5 mg/kg, intraperitoneal injection (i.p.)], on alternate days, over a period of 2 weeks for a cumulative dose of 15 mg/kg. SMI was given to DOX+SMI rats in 12 doses (3 mL/kg, i.p.) for a period of 2 weeks before the administration of DOX and 2 weeks during the administration of DOX. The rats in the control group received equal volume of normal saline. Subsequently, the twitch and tetanic characteristics and force-frequency relationships, and the malondialdehyde (MDA) levels and the superoxide dismutase (SOD) activities, as well as the mRNA content and proteins of inducible nitric oxide synthase (iNOS) were determined.

RESULTSThe DOX-treated rats had decreased the peak twitch tension (Pt), maximal tetanic tension (P0) and force-frequency relationship as compared with the control rats (P<0.01), while the diaphragm contractility in rats treated with SMI were significantly higher than that in DOX-treated rats (P<0.01). The DOX-treated rats had increased MAD levels and decreased SOD activities (P<0.05), and SMI decreased the MDA levels and increased the SOD activities in DOX-treated rats (P<0.05). Ultrastructure of diaphragm in the DOX-treated rats revealed typical alterations including fracture of diaphragm fibers, and edema and degeneration of mitochondria; these changes were relieved by SMI treatment. The mRNA content and protein of iNOS in DOX-treated rats were remarkably higher than those in control rats (P<0.01), while SMI decreased the mRNA expression level of iNOS in DOX-treated rats (P<0.05).

CONCLUSIONSLipid peroxidation is responsible for DOX-induced diaphragm toxicity. SMI protects diaphragm muscles and their function from DOX impairment, and these beneficial effects may be somehow correlated with the decrease in expression of iNOS and lipid peroxidation.

Animals ; Biomechanical Phenomena ; drug effects ; Blotting, Western ; Diaphragm ; drug effects ; pathology ; physiology ; ultrastructure ; Doxorubicin ; adverse effects ; Drugs, Chinese Herbal ; pharmacology ; Gene Expression Regulation ; drug effects ; In Vitro Techniques ; Injections ; Male ; Malondialdehyde ; metabolism ; Muscle Contraction ; drug effects ; Nitric Oxide Synthase Type II ; genetics ; metabolism ; Oxidative Stress ; drug effects ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the molecular mechanisms of diaphragm injury in rats with liver cirrhosis.

METHODSThirty adult male Sprague-Dawley rats were randomized into control group (n=10) and carbon tetrachloride-induced liver cirrhosis group (LC group, n=20). In the 9th week, the rat body weight and diaphragm to body weight ratio were measured, and the parameters of diaphragm contractility including peak twitch tension (Pt), maximum tetanic tension (Po), time to peak contraction (CT), half relaxation time (1/2RT), and force-frequency curve were assessed using a Medlab-U/4C biological signal collecting system. The activities of superoxide dismutase (SOD), succinic dehydrogenase (SDH) and myeloperoxidase (MPO) and malondiadehyde (MDA) content in the diaphragm were detected. The mRNA expression levels of sarcoplasmic reticulum calcium ATPase (SERCA) and cytoskeletal proteins (titin and nebulin) in the diaphragm were detected by RT-PCR, and the diaphragm ultrastructure was examined with electron microscopy.

RESULTSCompared with those in the control group, body weight, diaphragm to body weight ratio, Pt, Po, and tetanic force under the stimulus frequency of 10, 20, 40, 60, 100 Hz were all significantly decreased (P<0.01), while CT and 1/2RT were significantly prolonged in LC group (P<0.01). SOD and SDH activities were significantly lowered (P<0.01) while the contents of MDA and MPO activity were significantly increased in LC group (P<0.01) with significantly decreased SERCA, titin and nebulin mRNA expressions in the diaphragm (P<0.01). Electron microscopy of the diaphragm in LC group revealed myofibrillar degeneration, absence of the Z line, and mitochondria swelling and edema.

CONCLUSIONLiver cirrhosis increases free radicals and aggravates inflammatory response and lipid peroxidation in the diaphragm, thus leading to mitochondrial damages and decreased expressions of cytoskeletal proteins and SERCA to cause diaphragmatic dysfunction.

Animals ; Body Weight ; Carbon Tetrachloride ; Connectin ; metabolism ; Diaphragm ; metabolism ; Lipid Peroxidation ; Liver ; enzymology ; pathology ; Liver Cirrhosis ; metabolism ; Male ; Muscle Contraction ; Muscle Proteins ; metabolism ; Oxidation-Reduction ; Rats ; Rats, Sprague-Dawley ; Sarcoplasmic Reticulum Calcium-Transporting ATPases ; metabolism

This paper is to determine relationship between MDCT features and anatomic-pathology of the diseases in central thoracic-abdominal junctional region. 3 cadavers were cut transversely and another 3 vertically to observe the anatomy of thoracic-abdominal junctional zone. 93 patients with diseases in central thoracic-abdominal junctional zone were scanned with MDCT. The correlation between MDCT features of the diseases in central thoracic-abdominal junctional region and the anatomic-pathology of the diseases in this region was evaluated. On cadaver sections, central thoracic-abdominal junctional region was an area between anterior chest wall and dorsal spine in vertical direction. The region was separated into upper and lower sections by diaphragm. The upper section mainly contains heart and pericardium, while the lower contains broad ligament and left lobe of liver. The hiatus of diaphragm are vena caval foramen, esophageal foramen and aortic foramen in anterior-posterior turn. In the present study, 23 patients had portal hypertension, 18 had dissection of aorta, 8 got diseases in inferior vena cava, 9 had lymphoma, 12 got diseases in multiple vertebrae, 7 had lower thoracic esophageal carcinoma accompanied with metastasis in upper abdominal lymph nodes, 9 had carcinoma of abdominal esophagus and/or gastric cardia, 4 had esophageal hiatal hernia and 3 patients had neurogenic tumor in posterior mediastinum and/or superior spatium retroperitoneale. The MDCT features and distribution of the diseases in central thoracic-abdominal junctional region influence the anatomic-pathology characteristics in this region.
Abdominal Cavity ; anatomy & histology ; diagnostic imaging ; pathology ; Adolescent ; Adult ; Aged ; Aneurysm, Dissecting ; diagnostic imaging ; Aortic Aneurysm, Thoracic ; diagnostic imaging ; Cadaver ; Child ; Diaphragm ; anatomy & histology ; diagnostic imaging ; pathology ; Female ; Humans ; Hypertension, Portal ; diagnostic imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; methods ; Radiography, Thoracic ; Thoracic Cavity ; anatomy & histology ; pathology ; Young Adult

This paper was objected to determine the relationship between MDCT features and anatomic-pathology of diseases in right thoracic-abdominal junctional region. We cut 3 cadavers transversely and another 3 vertically to observe the anatomy of thoracic-abdominal junctional zone. We scanned 69 patients with diseases in right thoracic-abdominal junctional zone by MDCT. The correlation between MDCT features of right thoracic-abdominal junctional region and the anatomic-pathology in this region was evaluated. We found results as that in cadaver sections, the right pulmonary ligament, which was below inferior pulmonary vein, attached the inferior lobe of right lung to the esophagus, that the coronary ligament, which interiorly extended from falciform ligament and laterally formed into right triangular ligament, contained two layers, and that the bare area of liver, which positioned between the two layers of coronary ligament, was directly next to diaphragm with no peritoneum covered. There were 50 cases with both pleural and ascitic fluid, while the pleural fluid was divided into anterior and posterior compartments by the right pulmonary ligament, whereas the ascitic fluid was limited in perihepatic space in majority. Among the 50 cases, 5 patients had lung cancer with diaphragmatic pleura, diaphragm and upper abdomen involved. 5 patients had right hepatic lobe cancer with subdiaphragmatic peritoneum, crura diaphragmatis and lower thoracic cavity involved. 1 patient had right adrenal carcinoma with phrenic metastasis. 8 patients had inflammation in right lower thorax and/or right upper abdomen. The spreads of these diseases include mainly direct invasion, blood and lymphatic spread routs in the region. Conclusion could be drawn that the MDCT features and distribution of right thoracic-abdominal junctional region diseases correlate with the anatomical characteristics in this region.
Abdominal Cavity ; anatomy & histology ; diagnostic imaging ; pathology ; Cadaver ; Diaphragm ; anatomy & histology ; diagnostic imaging ; pathology ; Humans ; Multidetector Computed Tomography ; methods ; Radiography, Thoracic ; Thoracic Cavity ; anatomy & histology ; pathology

Acupuncture Therapy ; Diaphragm ; pathology ; Humans ; Male ; Middle Aged ; Respiratory Paralysis ; pathology ; therapy

Diagnosis, Differential ; Diagnostic Errors ; Diaphragm ; diagnostic imaging ; physiopathology ; Echinococcosis, Hepatic ; diagnosis ; pathology ; surgery ; Female ; Hernia, Diaphragmatic ; diagnosis ; diagnostic imaging ; Humans ; Liver ; parasitology ; pathology ; surgery ; Tomography, X-Ray Computed

Aged ; Colonic Neoplasms ; complications ; diagnosis ; Diaphragm ; pathology ; Humans ; Liver Neoplasms ; pathology ; Male ; Neoplasm Metastasis ; pathology