Postoperative effects of bariatric surgery on heart rate recovery and heart rate variability / 고신대학교의과대학학술지

Background@#Several studies have reported associations between obesity and autonomic dysfunction. However, little research has investigated the effect of bariatric surgery on heart rate recovery (HRR) in the treadmill test and heart rate variability (HRV) in 24-hour Holter monitoring. We investigated the effects of bariatric surgery on HRR and HRV, which are parameters related to autonomic dysfunction. @*Methods@#We retrospectively investigated patients who underwent bariatric surgery in 2019. The treadmill test, 24-hour Holter monitoring, and echocardiography were performed before and 6 months after surgery. We compared the changes in HRR in the treadmill test and HRV parameters such as the time domain and spectral domain in 24-hour Holter monitoring before and after surgery. @*Results@#Of the 40 patients who underwent bariatric surgery, 25 patients had the treadmill test or 24-hour Holter monitoring both before and after surgery. Body weight and body mass index significantly decreased after surgery (112.86±24.37 kg vs. 89.10±20.26 kg, p<0.001; 39.22±5.69 kg/m2 vs. 31.00±5.09 kg/m2, p<0.001, respectively). HRR significantly increased (n=23; 43.00±20.97 vs. 64.29±18.49, p=0.001). The time domain of HRV parameters increased (n=21; standard deviation of the N-N interval 123.57±28.05 vs. 152.57±39.49, p=0.002 and mean N-N interval 791.57±88.84 vs. 869.05±126.31, p=0.002). @*Conclusions@#Our data showed that HRR after exercise and HRV during 24-hour Holter monitoring improved after weight reduction with bariatric surgery through improved cardiac autonomic function.

Laparoscopic Appendectomy is Feasible for Inexperienced Surgeons in the Early Days of Individual Laparoscopic Training Courses

PURPOSE: Recently, laparoscopic appendectomy (LA) has been widely performed in developed countries. In addition, minimally invasive surgery such as LA is a challenge to surgical residents. The aim of this study is to evaluate learning curve of residents in comparison to that of experienced surgeons. METHODS: Fifty cases of LA that were performed by experienced surgeons (group A) and forty-seven cases of LA that were performed by 8 residents (group B) were reviewed retrospectively. RESULTS: Operative time was longer in group B (50.8+/-12 vs. 82.8+/-40 min. P<0.001). Hospital days of group B was shorter (4.8+/-2.4 vs. 3.7+/-2.1 days P=0.021). No other parameters were statistically significant. In group A, wound infection developed in 1 case. In group B, wound infection developed in 4 cases, intraabdominal abscess in 1, subcutaneous emphysema in 1. CONCLUSION: Inexperienced surgeons can perform laparoscopic appendectomy easily in the early days of individual laparoscopic training course.

A Study on the Chemosensitivity of Advanced Gastric Cancer

PURPOSE: Despite the reduced incidence and mortality of gastric cancer, this illness still remains the second leading cause of cancer death in Korea. Various adjuvant chemotherapies have been proposed for patients with advanced gastric cancer. Randomized trials comparing chemotherapies with best supportive care have consistently shown that cytotoxic treatment is of some benefit. Nevertheless, there has been no major improvement in the overall prognosis of advanced gastric cancer. METHODS: We have examined the chemotherapy sensitivity of advanced gastric cancer specimens by using an ex vivo ATP based chemosensitivity assay (ATP-TCA). A variety of chemotherapeutic agents were tested. The one hundred and forty specimens we tested were from resection specimens. RESULTS: The histological tumor classification, lymphatic invasion, neural invasion and venous invasion affected the chemosensitivity of some drugs. 5-FU was a more potent drug than cisplatin, doxorubicin, iriontecan and methotrexate. The chemosensitivity of differentiated cancer was different compared to that of undifferentiated cancer. Doxorubicin and iriontecan were more effective in poorly differentiated, signet ring cell and diffuse type cancers. The manner of tumor invasion affected the chemosensitivity to some drugs. CONCLUSISON: Further study is necessary to assess the effectiveness of some chemotherapy drugs on advanced gastric cancer, including their effect on tumor recurrence and patient survival.