Purpose: The preventive effect of oral management on postoperative infectious complications (POICs) is still unclear in gastrointestinal surgery. We previously reported in a retrospective study that periodontal disease (PD) is an independent risk factor for POICs. To elucidate the bacterial relationship between the oral cavity and stomach, we evaluated the preoperative oral environment and examined bacterial culture tests in both periodontal pockets and the stomach mucosa in patients undergoing radical resection for gastric cancer.
Methods: This was a single-arm prospective cohort study. Patients scheduled to undergo gastrectomy for gastric adenocarcinoma were enrolled. Before surgery, the dentists assessed the severity of PD by measuring the periodontal pocket probing depth, collected specimens from periodontal pockets, and submitted those specimens for a bacterial culture examination. Surgeons cut out a piece of the stomach mucosa (20 × 20 mm) from the resected stomach immediately after surgery. We then evaluated the kinds of bacterial strain and the association between the severity of PD and the positive rate of stomach bacterial culture. When patients had POICs, we identified the pathogen.
Background: Ultrasound has become increasingly important in the diagnosis of acute pathology of the abdominal cavity as an accessible, non-radiation-related method. In the present study, we evaluated the effectiveness of ultrasound diagnostics for cases of tumor with intestinal obstruction.
Methods: An ultrasound examination was performed in 41 patients (28 men and 13 women) between 26 and 78 years of age with intestinal obstruction who were treated at the surgical department of the hospital of Tashkent Medical Academy from 2014 to 2018. An ultrasound examination was performed without prior preparation using the ultrasonic devices Landwind Mirror 2 and SonoScape. Patients were examined in the supine position for their epi-, meso- and hypogastric areas and from the side of the abdomen for the frontal and oblique sections with compressing these sensor to the abdominal wall.
Results: All patients had chronic intestinal obstruction. The cause of the mechanical obstruction was a colonic tumor in 34 (83%) cases, tumor of the small intestine in 1 (2.5%) case and bowel torsion in 6 (14.5%) cases. The duration from the onset of the first clinical symptoms to the primary ultrasound examination ranged from 2 h to approximately 3 days. Ultrasound for evaluating the dynamics of acute intestinal obstruction allow for an accurate assessment of the state of the intestine, regardless of when the disease first manifested.
Conclusions: Repeated ultrasound studies of patients with colonic obstruction are more informative because the swelling of the colon was observed only in combination with evaluation of intestinal wall changes which is specific for the tumor.
Small cell lung cancer (SCLC) is a highly malignant tumor and can metastasize to the bone marrow. Bone marrow metastasis could cause bone marrow dysfunction, such as anemia, leukopenia, and thrombocytopenia. Chemotherapy might aggravate thrombocytopenia, and therefore, it is not certain whether patients with severe thrombocytopenia due to bone marrow metastasis should be treated with chemotherapy. We report the case of a 70-year-old woman with SCLC who developed severe thrombocytopenia (below 20,000/μL) due to bone marrow metastasis. Chemotherapy restored her platelet count to normal levels. Although she discontinued chemotherapy because of higher brain dysfunction that occurred after prophylactic cranial irradiation, thrombocytopenia could be controlled using chemotherapy throughout her clinical course. Chemotherapy may be carried out safely in patients with severe thrombocytopenia due to bone marrow metastasis of SCLC.
Herein we describe a 42-year-old female with mesenteric phlebosclerosis of her ascending colon. She visited our hospital due to abdominal pain, and computed tomography revealed edematous ascending colon and remarkable calcification of the ileocolic and right colic veins. She had been taking kampo medicine for nearly 20 years, and ‘drug-induced’ mesenteric phlebosclerosis was diagnosed. Treatment with fasting and intravenous infusion therapy did not alleviate the symptom, therefore she underwent resection of the right side of the colon. Subsequent pathological examination confirmed the preoperative diagnosis, and the postoperative recovery was uneventful.
Kampo medicine is frequently used to alleviate multiple symptoms in patients with various medical problems, including gastrointestinal cancers. Although mesenteric phlebosclerosis is a rare condition, this should be considered when patients are on kampo medicine for a long period of time.
Background: The aim of the present study was to determine the optimal treatment strategy for patients with acute obturative intestinal obstruction due to colonic cancer.
Patients and Methods: We analyzed the results of examinations and treatments of 46 patients with tumors of the colon complicated by Colonic obstruction (CO) in the Department of Surgery, Tashkent Medical Academy from 2013 to 2018.
Results: Thirty-nine patients (84.7%) at the histological examination had adenocarcinoma of the colon. In 5 (10.9%) cases, the tumor were diagnosed as cricoid cell carcinoma, whereas in 2 (4.4%) patients, the diagnosis was undifferentiated carcinoma. A significantly high proportion of patients (62.9%) at the time of admission to the clinic had a severe stage of CO. All of them underwent X-ray of the abdominal cavity, ultrasound, multi-slice computed tomography; (MSCT) and colonoscopy, and had their laboratory data analyzed. Only 3 (6.6%) cases were diagnosed as CO due to colonic tumor in prehospital stage. The remaining cases were diagnosed as acute colonic obstruction (ACO) which is only acute intestinal obstruction. In the preoperative period, ultrasound examination revealed intestinal impassability without specifying the localization of obstruction in 92% of the cases. The presence of collapsed loops of the small intestine was one sign of colonic obstruction which may progress as “closed intestinal loop”.
Conclusion: X-ray and ultrasound examinations of the abdominal cavity revealed the presence of intestinal obstruction without specifying the localization of obstruction. The extent of surgical intervention should be determined differentially depending on the severity of the intestinal obstruction, peritonitis, the degree of tumor progression, the condition of the patient and accompanying pathology.
Background: This study aimed to demonstrate the usefulness of our rehabilitation program after extensive surgeries in patients with maxillofacial area (MFA) and neck tumors.
Methods: Data from patients who underwent surgery in the clinics of the Republican Oncological Research Center and the Tashkent Institute of Postgraduate Medical Education for MFA and neck tumors were retrospectively analyzed. The patients were enrolled to our rehabilitation program, which consisted of a three-staged technique involving a complex prosthesis, and several physical therapies for damaged functions, such as chewing, swallowing, and breathing.
Results: A total of 107 oncological patients with postsurgical defects were fitted with various types of prosthesis. The introduction of our rehabilitation program was performed at an interval between initial surgery and prosthesis formation of 10-15 days, and between initial surgery and preparation of the final prosthesis of 26–30 days. A restoration of the Karnofsky performance status to 80%–85% was observed.
Conclusion: The present study demonstrates that our rehabilitation program is useful for shortening the postoperative convalescent period and improving the quality of life of patients with defects of the MFA and neck.
The short-term results of our surgical technique to close the after surgical resection of benign maxillofacial tumors were retrospectively studied. The results of surgical treatment of 92 patients with maxillofacial tumors in Tashkent State Dental Institute were retrospectively analyzed.
In all cases, plastic closure of the defect and elimination of deformities of the maxillofacial area were performed. The techniques of skin plastics were selected depending on location, size, shape of the defect and other circumstances. Short-term observation revealed that the wounds healed naturally without the formation of coarse scars and/or deformities of the surrounding tissues.
Our surgical techniques treating defects in maxillofacial area are satisfiable.
ROS1 fusion gene is rarely found in squamous cell lung cancer (SQCLC). We report a patient with SQCLC with ROS1 fusion gene, in which crizotinib administered through gastrostoma achieved a good response. A 77-year-old Japanese woman with no history of smoking underwent right lower lobectomy, and was diagnosed as stage IIA SQCLC. One year later, the disease recurred and her lymph nodes were enlarged by metastasis occluded esophagus. She had difficulty in eating and underwent percutaneous endoscopic gastrostomy. ROS1 fusion gene was detected in a curated surgical specimen. Administration of crizotinib through gastrostoma resolved the occlusion, although the simultaneous administration of a low-dose of prednisolone was required to avoid neutropenia. She was then able to eat through her mouth. She has been on crizotinib therapy for more than one year and has remained symptom-free.
Introduction: Laparoscopic colorectal surgery (LCS) is considered an advanced minimally invasive procedure. Tools for assessing surgeon's skills in laparoscopic surgery, such as laparoscopic inguinal hernia repair and laparoscopic gastric bypass surgery, have been developed. However, no standardized training system has yet been established for the procedures of LCS. If a reliable assessment tool for trainees in LCS were made available, it would prove that is useful for establishing an educational system for LCS training. Trainee surgeons would then be able to learn the critical steps and important points of LCS procedures using this assessment tool. We therefore launched the “Development of an ASsessment tool for LAparoscopic Colectomy” (ASLAC) project to develop a reliable assessment tool for laparoscopic sigmoidectomy and right hemicolectomy.
Materials and Methods: We developed tools for two procedures: a laparoscopic sigmoidectomy and a laparoscopic right hemicolectomy. Our study was conducted in two steps: a cognitive task analysis (CTA) and the Delphi method (first and second round). The consensus was defined in advance using Cronbach's alpha ≥0.8 according to a global Delphi consensus study on defining and measuring the quality of surgical training. Subtasks for which 70% of experts cited a value of ≥4 (agree or strongly agree) were used as new tools. Ten expert surgeons (considered ‘qualified surgeons’ by the Endoscopic Surgical Skill Qualification System in Japan) were recruited as participants for the Delphi method.