ABSTRACT
INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.
Subject(s)
Eating , Gastric Bypass/methods , Gastric Outlet Obstruction/surgery , Gastrointestinal Transit , Neoplasms/complications , Palliative Care/methods , Aged , Aged, 80 and over , Cohort Studies , Duodenal Neoplasms/complications , Female , Gallbladder Neoplasms/complications , Gastric Outlet Obstruction/etiology , Humans , Laparoscopy/methods , Laparotomy/methods , Length of Stay , Male , Middle Aged , Neoplasm Staging , Operative Time , Pancreatic Neoplasms/complications , Postoperative Complications/epidemiology , Retrospective Studies , Stomach Neoplasms/complications , Survival Rate , Treatment OutcomeABSTRACT
Gelatin nanoparticles (GNPs) have demonstrated to be beneficial as a biodegradable and biocompatible delivery system. So far, nanoparticles prepared by the two-step desolvation technique were subsequently cross-linked by glutaraldehyde to guarantee storage stability. Although in vivo and in vitro toxicological studies have not revealed any glutaraldehyde related undesired effects, an alternative to chemical cross-linking could ease future clinical use in humans. Therefore, the recombinant enzyme microbial transglutaminase was used to examine its cross-linking abilities in nanoparticle production. Various process parameters, such as incubation time, temperature, medium, pH and the particle purification were evaluated regarding their impact on particle size and its distribution. Cross-linking reactions were best at 25°C using an ion-free solvent at a neutral pH and have been terminated after 12 h. Preliminary storage stability testing indicated adequate consistency of particle size and particle distribution making transglutaminase a potential candidate for glutaraldehyde substitution in future GNP production.
Subject(s)
Cross-Linking Reagents/chemistry , Gelatin/chemistry , Nanoparticles/chemistry , Transglutaminases/chemistry , Acetone , Animals , Catalysis , Drug Stability , Drug Storage , Escherichia coli/enzymology , Glutaral/chemistry , Nephelometry and Turbidimetry , Particle Size , Solvents , Swine , TemperatureABSTRACT
BACKGROUND: Vertebral artery dissection resulting in stroke is rare in children. We report here on a 7-year-old boy with Klippel-Feil abnormality, who presented with a pontine infarction after a supervised swimming session. METHODS: Evaluation after a second acute neurological event included a formal cerebral angiogram, which revealed a complete upper basilar artery occlusion and right vertebral arterial dissection. Cervical spine radiographs demonstrated an associated fusion of the C2 and C3 vertebrae. Anticoagulation therapy was initiated, and the neurological deficits associated with the pontine infarction resolved. Anticoagulation was discontinued after 6 months of therapy, with no recurrence of symptoms. CONCLUSION: Vertebral artery dissection may rarely be associated with Klippel-Feil abnormality in children.
Subject(s)
Aortic Dissection/etiology , Intracranial Aneurysm/etiology , Klippel-Feil Syndrome/complications , Vertebral Artery , Anticoagulants/therapeutic use , Cerebral Angiography , Cerebral Infarction/diagnosis , Cerebral Infarction/drug therapy , Cerebral Infarction/etiology , Cervical Vertebrae/diagnostic imaging , Child , Humans , Klippel-Feil Syndrome/diagnosis , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , PonsABSTRACT
Symptomatic venous malformations are uncommon at any age. They are extremely rare in the first decade of life. We describe a 3.5-year-old child with a cerebellar venous malformation presenting with a subacute course mimicking the more common posterior fossa tumors. The child's symptoms were due to a posterior fossa hemorrhage; she subsequently did well. The clinical, CT, angiographic, and pathologic features are described. Venous malformations should be included in the differential diagnosis of young children with evidence of posterior fossa disease.
