Prevention and management of complications related to laparoscopic spleen-preserving hilar lymph node dissection for gastric cancer / 中华胃肠外科杂志

Hilar splenic lymph node metastasis is one of the risk factors for poor prognosis in patients with proximal gastric cancer. Laparoscopic spleen-preserving splenic hilar lymph node dissection (LSPSHLD) can effectively improve the survival benefits of patients at high risk of splenic hilar lymph node metastasis. However, LSPSHLD is still a challenging surgical difficulty in radical resection of proximal gastric cancer. Moreover, improper operation can easily lead to splenic vascular injury, spleen injury and pancreatic injury and other related complications, due to the deep anatomical location of the splenic hilar region and the intricate blood vessels.Therefore, in the prevention and treatment of LSPSHLD-related complications, we should first focus on prevention, clarify the indication of surgery, and select the benefit group of LSPSHLD individually, so as to avoid the risk caused by over-dissection. Meanwhile, during the perioperative period of LSPSHLD, it is necessary to improve the cognition of related risk factors, conduct standardized and accurate operations in good surgical field exposure and correct anatomical level to avoid surrounding tissues and organs injury, and master the surgical skills and effective measures to deal with related complications, so as to improve the surgical safety of LSPSHLD.

Predictive values of TNF-alpha, IL-6, IL-10 for radiation Pneumonitis

Background: To investigate the expression of TNF-alpha, IL-6, IL-10 in the plasma of patients with lung cancer who received radiation therapy [RT], and to analyze the correlation between these cytokines and radiation pneumonitis [RP]. Materials and Methods: Patients with lung cancer who received 3D-CRT in our hospital were prospectively evaluated. Circulating cytokine levels were measured with ELISA before RT and at the end of RT. Regular follow-up was undertaken 3 months after RT. Statistical analysis was applied to determine the relevance of cytokines to radiation-induced lung injury. Results: Of 104 patients, 29 [27.9%] developed RP. The levels of TNF-alpha and IL-6 levels in the plasma after RT were significantly higher than before RT [p<0.05], whereas IL -10 levels were significantly lower after RT than before RT [p<0.05]. Before RT, TNF-alpha levels were higher in RP group [p<0.05],but there were no differences in TNF-alpha levels after RT. No association was observed between IL-6 and IL-10 levels and the risk of RP. Univariate analysis showed that baseline pulmonary function, smoking history, histopathology, lung volume receiving >/=20 Gy [V20], Mean lung dose [MLD] and total radiation dose were related to RP, but only MLD was an independent risk factor for RP in lung cancer patients [OR>1]. Conclusion: TNF-alpha levels in plasma were closely related to RP but still cannot be used as predictors for RP

Are endoscopic grading and scoring systems in inflammatory bowel disease the same?

To assess the correlation and difference between various endoscopic grades and indices for assessment of endoscopic disease activity in inflammatory bowel disease [IBD]. Eighty consecutive patients with ulcerative colitis [UC], and 31 patients with Crohn's disease [CD] were evaluated based on multiple endoscopic criteria between June 2006 and February 2007 at the Department of Gastroenterology of Renji Hospital, Shanghai, China. Two experienced endoscopists evaluated the endoscopic findings using various systems independently. Data were analyzed using Kendall's coefficient of concordance and Spearman correlations. For the systems of UC and CD, Kendall's coefficients of concordance were 0.714 [p<0.001] and 0.342 [p<0.001]. There was no significant difference between the 2 systems of UC [all p<0.01]. However, no statistically significant concordances were found between Chinese Grading System of Crohn's Disease [CGSCD] and Crohn's Disease Endoscopic Index of Severity [CDEIS] [rs=0.323, p=0.076]. Significant differences in frequencies were detected among endoscopic systems for UC [p=0.001]. It was suggested in our study that endoscopic grading and scoring systems of UC had satisfactory concordance, and CGSCD showed room for improvement. However, the modified Baron scale was tend to severe category, while Jeroen classification was tend to mild category