Management of gastrointestinal stromal tumours in the Imatinib era: a surgeon's perspective

<p>Abstract</p> <p>Background</p> <p>Surgical resection has remained the mainstay of treatment of GIST with a 5-year-survival of 28–35%. Tyrosine kinase inhibitor (Imatinib) has revolutionised the treatment of these tumours. The current research is directed towards expanding the role of this drug in the treatment of GIST. We present our experience of managing GIST in this institute.</p> <p>Methods</p> <p>This is a case note study of patients identified from a prospectively kept database from January 2000 to August 2007.</p> <p>Results</p> <p>16 patients were diagnosed with GIST. The median age was 66 years (range 46 to 82) and the male to female ratio was 9:7. Eleven patients underwent surgery, 9 of which had R0 resection (2 laparoscopic, 1 converted to open), one had an open biopsy and one had a debulking procedure. 3 patients were inoperable and 2 were found to be unfit for surgery. Five patients received Imatinib (2 postoperatively). The risk assessment based on morphological criteria showed that 4 patients had low, 4 had intermediate and 8 had high malignant potential. The median follow up was for 12 months (range 3–72); 2 patients died of unrelated causes at 6 and 9 months after diagnosis.</p> <p>Conclusion</p> <p>Most GISTs can be managed effectively using existing protocols. However currently there is no evidence based guidance available on the management of GIST in the following situations-role of debulking surgery, the follow up of benign tumours not requiring surgical resection and role of laparoscopic surgery. Further research is needed to answer these questions.</p

Galbladder perforation: The importance of standardised treatment algorithms

Von H. Barfo

Structural and optical properties of CdTe thin films deposited using RF Magnetron sputtering

In this work, we have studied the influence of RF power on structural and optical properties of CdTe thin films deposited by indigenously designed locally fabricated RF magnetron sputtering. Films were analyzed by using variety of techniques such as low angle X- ray diffraction, UV-Visible spectroscopy, Raman spectroscopy etc. to study its structural and optical properties. Low angle XRD analysis showed that CdTe films are polycrystalline and has cubic structure with preferred orientation in (111) direction. Raman scattering studies revealed the presence of CdTephase over the entire range of RF power studied. The UV-Visible spectroscopy analysis showed that the band gap decreases with increase in RF power. However, CdTe films deposited at higher RF power has optimum band gap values (1.44-1.60 eV). Such optimum band gap CdTe can be use as absorber material in CdS/CdTe and ZnO/CdTe solar cells

Jejunal perforation caused by a feeding jejunostomy tube: a case report

<p>Abstract</p> <p>Introduction</p> <p>Percutaneous endoscopic gastrostomy and feeding jejunostomy are used for providing long-term nutritional support to patients with neurological disorders. Various mechanical complications of these procedures are described.</p> <p>Case presentation</p> <p>We report a case of a 17-year-old boy with cerebral injury who had a percutaneous endoscopic gastrostomy tube changed to a feeding jejunostomy tube. Twenty-four hours later he developed abdominal pain and became clinically septic. A contrast study through the feeding tube and a subsequent computed tomography scan did not reveal any intra-abdominal pathology. At laparotomy it was discovered that the tip of the feeding tube had perforated through the jejunal wall and was lying outside the lumen. This was successfully treated by re-inserting a feeding jejunostomy tube distally and closure of the perforation and previous FJ site</p> <p>Conclusion</p> <p>We suggest that the threshold for contrast studies and operative intervention should be low in neurologically impaired patients to avoid the delay in treatment of tube-related complications.</p

Growth of hydrogenated nano-crystalline silicon (nc-Si:H) films by plasma enhanced chemical vapor deposition (PE-CVD)

Hydrogenated nanocrystalline silicon (nc-Si:H) thin films were prepared by home-made PE-CVD systemfromgas mixture of pure SiH4 and H2 at various deposition pressures. Obtained results exhibited that deposition rate increases with increase in deposition pressure. Raman spectroscopy analysis revealed that deposition pressure in PE-CVD is a critical process parameter to induce nanocrystallization in Si:H films. The FTIR spectroscopy analysis results indicate that with increase in deposition pressure hydrogen bonding in films shifts from Si-H to Si-H2 and (Si-H2)n bonded species bonded species. The bonded hydrogen content didn’t show particular trend with optical band gap with change in deposition pressure. The obtained results indicates that 400 mTorr is an optimized deposition pressure of our PE-CVD unit to synthesize nc-Si:H films. At this optimized deposition pressure nc-Si:H films with crystallite size ∼ 5.43 nm having good degree of crystallinity (∼77%) and high band gap (ETauc∼ 1.85 eV) were obtained with a low hydrogen content (4.28 at. %) at moderately high deposition rate (0.75 nm/s). The ease of the present work is to optimize deposition pressure to obtain device quality intrinsicnc-Si:H layer in view of its used in p-i-n solar cells

Raman spectral discrimination in human liquid biopsies of oesophageal transformation to adenocarcinoma

The aim of this study was to determine whether Raman spectroscopy combined with chemometric analysis can be applied to interrogate biofluids (plasma, serum, saliva and urine) towards detecting oesophageal stages through to oesophageal adenocarcinoma (normal/squamous epithelium, inflammatory, Barrett's, low-grade dysplasia [LGD], high-grade dysplasia [HGD], and oesophageal adenocarcinoma [OAC]). The chemometric analysis of the spectral data was performed using principal component analysis (PCA), successive projections algorithm (SPA) or genetic algorithm (GA) followed by quadratic discriminant analysis (QDA). The GA-QDA model using a few selected wavenumbers for saliva and urine samples achieved 100% classification for all classes. For plasma and serum, the GA-QDA model achieved excellent accuracy in all oesophageal stages (>90%). The main GA-QDA features responsible for sample discrimination were: 1012 cm (C-O stretching of ribose), 1336 cm (Amide III and CH wagging vibrations from glycine backbone), 1450 cm (methylene deformation), and 1660 cm (Amide I). The results of this study are promising and support the concept that Raman on biofluids may become a useful and objective diagnostic tool to identify oesophageal disease stages from squamous epithelium to OAC. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.

Attenuated Total Reflection Fourier-Transform Infrared Spectral Discrimination in Human Tissue of Oesophageal Transformation to Adenocarcinoma

This study presents ATR-FTIR (attenuated total reflectance Fourier-transform infrared) spectral analysis of ex vivo oesophageal tissue including all classifications to oesophageal adenocarcinoma (OAC). The article adds further validation to previous human tissue studies identifying the potential for ATR-FTIR spectroscopy in differentiating among all classes of oesophageal transformation to OAC. Tissue spectral analysis used principal component analysis quadratic discriminant analysis (PCA-QDA), successive projection algorithm quadratic discriminant analysis (SPA-QDA), and genetic algorithm quadratic discriminant analysis (GA-QDA) algorithms for variable selection and classification. The variables selected by SPA-QDA and GA-QDA discriminated tissue samples from Barrett’s oesophagus (BO) to OAC with 100% accuracy on the basis of unique spectral “fingerprints” of their biochemical composition. Accuracy test results including sensitivity and specificity were determined. The best results were obtained with PCA-QDA, where tissues ranging from normal to OAC were correctly classified with 90.9% overall accuracy (71.4–100% sensitivity and 89.5–100% specificity), including the discrimination between normal and inflammatory tissue, which failed in SPA-QDA and GA-QDA. All the models revealed excellent results for distinguishing among BO, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and OAC tissues (100% sensitivities and specificities). This study highlights the need for further work identifying potential biochemical markers using ATR-FTIR in tissue that could be utilised as an adjunct to histopathological diagnosis for early detection of neoplastic changes in susceptible epithelium

Attenuated total reflection Fourier-transform infrared spectral discrimination in human bodily fluids of oesophageal transformation to adenocarcinoma

Diagnostic tools for the detection of early-stage oesophageal adenocarcinoma (OAC) are urgently needed. Our aim was to develop an accurate and inexpensive method using biofluids (plasma, serum, saliva or urine) for detecting oesophageal stages through to OAC (squamous; inflammatory; Barrett's; low-grade dysplasia; high-grade dysplasia; OAC) using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy. ATR-FTIR spectroscopy coupled with variable selection methods, with successive projections or genetic algorithms (GA) combined with quadratic discriminant analysis (QDA) were employed to identify spectral biomarkers in biofluids for accurate diagnosis in a hospital setting of different stages through to OAC. Quality metrics (Accuracy, Sensitivity, Specificity and F-score) and biomarkers of disease were computed for each model. For plasma, GA-QDA models using 15 wavenumbers achieved 100% classification for four classes. For saliva, PCA-QDA models achieved 100% for the inflammatory stage and high-quality metrics for other classes. For serum, GA-QDA models achieved 100% performance for the OAC stage using 13 wavenumbers. For urine, PCA-QDA models achieved 100% performance for all classes. Selected wavenumbers using a Student's t-test (95% confidence interval) identified a differentiation of the stages on each biofluid: plasma (929 cm−1 to 1431 cm−1, associated with DNA/RNA and proteins); saliva (1000 cm−1 to 1150 cm−1, associated with DNA/RNA region); serum (1435 cm−1 to 1573 cm−1, associated with methyl groups of proteins and Amide II absorption); and, urine (1681 cm−1 to 1777 cm−1, associated with a high frequency vibration of an antiparallel β-sheet of Amide I and stretching vibration of lipids). Our methods have demonstrated excellent efficacy for a rapid, cost-effective method of diagnosis for specific stages to OAC. These findings suggest a potential diagnostic tool for oesophageal cancer and could be translated into clinical practice

Acute presentation of a solitary caecal diverticulum: a case report

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction: Solitary caecal diverticulitis is a rare cause of abdominal pain in Caucasian patients. The condition is often misdiagnosed and only correctly identified on exploration for suspected acute appendicitis. Our aim is to improve awareness of this condition amongst surgical trainees to ensure that its first encounter is not in the operating theatre. We review the role of pre-operative radiological imaging in this condition and the wide and controversial management options are als

Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients

Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.status: publishe