Functional outcomes of 100 patients with adenocarcinoma of the esophagogastric junction undergoing Cheng's GIRAFFE(®) reconstruction after proximal gastrectomy / 中华胃肠外科杂志

Objective: To investigate the functional outcomes and postoperative complications of Cheng's GIRAFFE reconstruction after proximal gastrectomy. Methods: A descriptive case series study was conducted. Clinical data of 100 patients with adenocarcinoma of the esophagogastric junction who underwent Cheng's GIRAFFE reconstruction after proximal gastrectomy in Cancer Hospital of University of Chinese Academy of Sciences (64 cases), Zhejiang Provincial Hospital of Chinese Medicine (24 cases), Lishui Central Hospital (10 cases), Huzhou Central Hospital (1 case) and Ningbo Lihuili Hospital (1 case) from September 2017 to June 2021 were retrospectively analyzed. Of 100 patients, 64 were males and 36 were females; the mean age was (61.3 ± 11.1) years and the BMI was (22.7±11.1) kg/m(2). For TNM stage, 68 patients were stage IA, 24 were stage IIA and 8 were stage IIB. Postoperative functional results and postoperative complications of radical gastrectomy with Giraffe reconstruction were analyzed and summarized. Gastroesophageal reflux disease questionnaire (RDQ) score and postoperative endoscopy were used to evaluate the occurrence of reflux esophagitis and its grade (grade N, grade A, grade B, grade C, and grade D from mild to severe reflux). The continuous data conforming to normal distribution were expressed as (mean ± standard deviation), and those with skewed distribution were presented as median (Q1, Q3). Results: All the 100 patients successfully completed R0 resection, including 77 patients undergoing laparoscopic surgery and 23 patients undergoing laparotomy. The Giraffe anastomosis time was (38.6±14.0) min; the blood loss was (73.0±18.4) ml; the postoperative hospital stay was 9.5 (8.2, 13.0) d; the hospitalization cost was (6.0±0.3) ten thousand yuan. Fourteen cases developed perioperative complications (14.0%), including 7 cases of pleural effusion or pneumonia, 3 cases of anastomotic leakage, 2 cases of gastric emptying disorder, 1 case of gastrointestinal hemorrhage and 1 case of anastomotic stenosis, who were all improved and discharged after symptomatic management. Patients were followed up for (33.3±1.6) months. Eight patients were found to have reflux symptoms by RDQ scale six months after surgery, and 11 patients (11/100,11.0%) were found to have reflux esophagitis by gastroscopy, including 6 in grade A, 3 in grade B, and 2 in grade C. All the patients could control their reflux symptoms with behavioral guidance or oral PPIs. Conclusion: Cheng's GIRAFFE reconstruction has good anti-reflux efficacy and gastric emptying function; it can be one of the choices of reconstruction methods after proximal gastrectomy.

Preliminary efficacy analysis of Cheng's Giraffe reconstruction after proximal gastrectomy in adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

Objective@#To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG).@*Methods@#Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux.@*Result@#All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9.@*Conclusion@#Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.

A rare case of unilateral diffuse melanocytic proliferation

A 67-year-old woman presented with metamorphopsia in the right eye. Leopard mottling was seen temporal to the fovea oculus dexter with corresponding hyper- and hypo-autofluorescent lesions on fundus autofluorescence. Spectral domain-optical coherence tomography revealed hyperreflective dots in the retinal pigment epithelium and choroid with subretinal fluid (SRF). Intravitreal bevacizumab was administered with which SRF resolved, albeit with increase in the areas of mottling. The patient was diagnosed to have metastatic ductal carcinoma of the right breast. It is important to bear in mind that the well-known entity of bilateral diffuse uveal melanocytic proliferation can rarely present unilaterally.

Anatomy of the mouth of the giraffe (giraffa camelopardalis rothschildi) / Anatomía de la boca de la jirafa (giraffa camelopardalis rothschildi)

The giraffe (Giraffa camelopardalis) is both the largest extant ruminant and a strict browser. We dissect and describe the macroscopic anatomy of the mouth of the giraffe. The heads of two adult giraffes and one fetus were used in this study. The lips were well developed, the upper one was predominant and dorsally flattened near the nostrils. The tongue had a lift or lingual torus and rostrally to it a groove-shaped depression or fossa linguae. There was no adipose body of cheek (Corpus adiposum buccae). The hard palate in the giraffe had 18 Rugae palatinae. The final roughness reaches the caudal border of the premolar 3. Caudal ridges had no papillae. The parotid gland was small and consisted of two lobes, one rostral and one caudal to be separated dorsally to accommodate the parotid lymph node. The parotid duct followed the same way as in the cow, ended in front of the upper premolar tooth 2 in the parotid papilla, (not evident at mucosal surface). Mandibular gland was divided into two lobes, the rostral one placed in the intermandibular space and the caudal hidden by the parotid gland. Giraffes have the monostomatic and polistomatic sublingual glands. The monostomatic sublingual gland was located rostrally and joined to the monostomatic of the other side in the very narrow rostral intermandibular space. The polistomatic sublingual gland was caudally located and reached the level of the third molar and at a deeper level than the monostomatic. The studied giraffes had dorsal, ventral and intermediate bucal salivary glands. Leaving aside the differences caused by different dimensions, the mouth of the giraffe had in general a similar anatomical arrangement to the cow.

La jirafa (Giraffa camelopardalis) es a la vez el rumiante más grande que existe y un ramoneador estricto. Nosotros disecamos y describimos la anatomía macroscópica de la boca de la jirafa. En este estudio se utilizaron las cabezas de dos jirafas adultas y de un feto. Los labios estaban bien desarrollados, el superior era el predominante y estaba aplastado dorsalmente cerca de las narinas. La lengua tenía una protuberancia o Torus lingual y rostralmente a él una depresión en forma de surco o Fossa linguae. No había cuerpo adiposo de la mejilla (Corpus adiposum buccae). El paladar duro en la jirafa tenía 18 rugae palatinae. Las rugosidades finales alcanzaban el borde caudal del premolar 3. Las crestas caudales no tenían papilas. La glándula parótida era pequeña y consistía de dos lóbulos, uno rostral y otro caudal que se separaban dorsalmente para acomodar al nódulo linfático parotídeo. El conducto parotídeo seguía el mismo trayecto que en la vaca, terminando frente al segundo diente premolar superior en la papila parotídea (no evidente en la superficie de la mucosa). La glándula mandibular estaba dividida en dos lóbulos, el rostral se colocaba en el espacio intermandibular y el caudal estaba oculto por la glándula parótida. Las jirafas tenían glándulas sublinguales monostomática y polistomática. La glándula sublingual monostomática estaba localizada rostralmente y se unía a la monostomática del otro lado en el muy estrecho espacio intermandibular. La glándula sublingual polistomática estaba localizada caudalmente y alcanzaba el nivel del tercer molar en un plano más profundo que la monostomática. Las jirafas estudiadas tenían glándulas salivares bucales dorsales, ventrales e intermedias. Dejando de lado las diferencias causadas por las diferentes dimensiones, la boca de la jirafa tenía en general una disposición anatómica similar a la de la vaca.