Does Contouring of the Sleeve Help Prevent de novo GERD after Laparoscopic Sleeve Gastrectomy? A Nonrandomized Study

PURPOSE: The authors undertook this study to compare their modified version of sleeve gastrectomy with conventional sleeve gastrectomy in terms of the severity and incidence of gastroesophageal reflux. MATERIALS AND METHODS: This study was conducted for the patients that underwent primary laparoscopic sleeve gastrectomy in a single center from 2011 to 2015. Patients that underwent conventional LSG were allocated to Group A (n=46), and sleeve contouring gastrectomy to Group B (n=45). Postoperatively %EBMIL, PPI use, and endoscopy findings, and receipt of conversion surgery were compared. RESULTS: Age, gender (F:M), and baseline BMI in groups A and B were 34.2±10.5 years vs. 30.9±8.9 years (P=0.142), 28:18 vs. 30:15 (P=0.565), and 36.8±8.9 kg/m² vs. 35.5±5.8 kg/m² (P=0.046), respectively. %EBMIL values at 1 year postoperatively were not different (P=0.946), mean durations of PPI use were 141.2±240.3 (30–1160) days vs. 71.9±24.3 (60–128) days, respectively (P=0.058). Endoscopic findings at 1 year were LA-M in 22/32 (68.8%) vs 19/24 (79.2%), LA-A in 7/32 (21.9%) vs. 5/24 (20.8%), LA-B in 1/32 (3.1%) vs. 0/24 (0.0%), and LA-C in 2/32 (6.3%) vs. 0/24 (0.0%) (P=0.483). Numbers of patients used PPIs over 1 year were 4/46 (8.77%) vs. 0/45 (0.0%) (P=0.043), and conversions to RYGP were 1/46 (2.21%) vs. 0/45 (0.0%), respectively (P=0.320). CONCLUSION: Contouring of the sleeve in LSG in this study might reduce the incidence of de novo GERD without compromising weight loss.

Acute spontaneous spinal epidural hematoma: A report of two cases

A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoagulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with an immediate laminectomy and decompression. If the neurologic symptom improves within 12 hours, a conservative treatment is effective; however few cases have been reported. We report this case with a review of the relevant literature.

The Expression of Fas Antigen and Apoptosis in Patients with Myelodysplastic Syndromes and Its Clinical Relevance / 대한혈액학회지

BACKGROUND: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by the peripheral cytopenias and hypercellular or normocellular dysplastic bone marrow. The event responsible for the development of MDS is generally not known. Several recent reports have described an increased frequency of apoptosis in bone marrow cells from patients with aplastic anemia or MDS. Gersuk et al observed that Fas ligand expression was significantly increased on bone marrow cells from MDS patients as compared to normal individuals. METHODS: We examined apoptosis and Fas antigen expression using ISNEL method and immunohistochemistry on marrow cells from 36 patients with MDS. RESULTS: Among the 36 patients, 15 patients (42%) demonstrated apoptosis positive cells (>15%) and 9 patients (25%) demonstrated positive Fas antigen expression (>20%). The presence of apoptosis significantly correlated with hemoglobin level at diagnosis (P<0.05) and the expression of Fas antigen significantly correlated with bone marrow cellularity and CD34 positive cell aggregate group at diagnosis (P<0.05). There was no statistically significant relationship between apoptosis and Fas antigen expression. The median survival of all patients with MDS was 44 months (2-117+). Multivariate analysis showed that FAB classification and hemoglobin level at diagnosis were significant prognostic factor but presence of apoptosis and expression of Fas antigen had no significance. CONCLUSION: The data indicate that the apoptosis and expression of Fas antigen are present in patients with MDS and correlate with some clinical parameters but not significantly associated with survival period of the patients with MDS.

A Case of Recurrent Subacute Necrotizing Lymphadenitis with Pancytopenia / 대한혈액학회지

We report a case of recurrent subacute necrotizing lymphadenitis with pancytopenia in 21-years-old-woman. She was admitted to our hospital 4-years interval with fever and abdominal pain. Laboratory findings of the last admission showed pancytopenia, such as WBC 700/microliter, hemoglobin 6.0mmol/L (9.7g/dL), hematocrit 28.8%, and platelet 54,000/microliter. Abdominal CT showed hepatosplenomegaly, enlarged conglomerated lymph nodes in splenic hilum, lesser sac, celiac root, and paraaortic areas. Bone marrow biopsy showed hypocellular marrow (20%) with increased number of megakaryocyte, myeloid hyperplasia, and hemophagocytic histiocytes suggesting infectious process. We performed exploratory laparotomy, and pathologic finding revealed subacute necrotizing lymphadenitis-Kikuchi disease-. She was recovered on 26th hospital day with conservative treatment.

Two Cases of Torsade de Pointes after Astemizole Overdose

A 52-year-old women, suffering from generalized pruritus due to intrahepatic and common hepatic duct stones, was treated with astemizole, 30mg daily. Sixty one days later, convulsions and syncope developed suddenly during hospitalization. She had no history of arrhythmia, heart disease, electrolytes imbalance, or CNS disorders. As another case, a 44-year-old man suffering from pruritus due to liver cirrhosis, was treated with astemizole, 30mg daily. Thirty two days later, palpitations and syncope also developed suddenly during hospitalization. He was diagnosed liver cirrhosis, 3 years ago and there was no history of arrhythmia, heart disease, electrolytes imbalance, or CNS disorders. Administration of astemizole was stopped immediately. The laboratory investigations revealed the normal range of serum potassium, calcium and magnesium in both cases. The ECG finding showed the prolongation of QTc interval, frequent VPCs and intermittent polymorphic drugs. On 1st and 3rd day, after discontinue of astemisole, the ECG abnormalities disappeard. It is suggested that astemizole overdose can induce prolongation of QTc interval and torsade de pointes, especially in the patient with liver disease.

Estimating the Volume of Pericardial Effusion by M-Mode and 2-D Echocardiographic Method

BACKGROUND: This study was undertaken to test the validity of M-mode and a new cross sectional cehocardiographic quantification of pericardial effusion. METHODS: This study was performed in 12 patients with large pericardial effusion of whom hed M-mode and 2-D echocardiography just before therpeutic drainage of the effusion. The volume of Pericardial fluid removed by pericardiocentesis was compared with te echo-free space estimated by M-mode echocardiography and the volume estimated by new 2-D echocardiographic method. The pericardial sac volume and the cardiac volume were calculated by applying the formula for the volume of a prolate ellipse. RESULTS: 1) There was a good correlation between 2-D echocardiographic estimate and the actual volume removed by pericardiocentesis(r=0.72, p<0.05). 2) The correlation between the echo-free space estimated by M-mode echocardiography at the level of mitral valve and the actual volume was also good(r=0.81,p<0.001). CONCLUSION: The M-mode and 2-D echocardiographic method is successful in helping to estimate large pericardial effusion.