How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery? Report of two cases and a review of the literature

<p>Abstract</p> <p>Background</p> <p>Recently, the right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative arterial graft. Unfortunately, an increased incidence of gastric cancers has been reported after CABG using the RGEA. Handling of the RGEA during gastrectomy in these patients may cause lethal complications, which sometimes reduces the feasibility of curative dissection of lymph nodes at the base of the graft.</p> <p>Case presentations</p> <p>We describe two cases of gastric cancer undergoing gastrectomy after CABG with the use of RGEA. To avoid the potentially fatal coronary event during gastrectomy, safe handling of the conduit including preparations for injuries and prevention of vessel spasm was performed in both cases, accompanied by an adequate monitoring of the systemic circulation. Intraoperative frozen section examination showed no lymph node metastasis around the graft in any of the cases; therefore, complete lymph node dissection at the base of the graft was not undertaken. No complications occurred during the operation. In addition to these two cases, twenty-four cases reported in the literatures were reviewed (a total of 26 cases). Ten early and 16 advanced gastric cancers were included. Among the 16 advanced gastric cancer cases, an alternative graft was employed in 8 due to the resection of an original graft to complete lymph node dissection. Mere handling of a graft often caused lethal complications suggesting that the operation should be completed by isolation of the graft. A pedicled graft harvesting via the ante-gastric route was popular. However, a skeletonized harvesting with resection of the pyloric branches of the RGEA would be better because this would interrupt the original lymph flow, which could eliminate the need for lymph node dissection and graft isolation. Among the 10 cases having early gastric cancers, 6 were found within 1.5 years after CABG. Early detection in these 6 cases was possible due to the use of gastric fiberscopic examination before and after CABG, which gave them opportunities to receive a less extensive operation such as endoscopic mucosal resection.</p> <p>Conclusion</p> <p>Adequate intraoperative care as well as an optimal lymph node dissection considering the graft harvesting method at the first CABG leads to successful gastrectomy after CABG using the RGEA graft. Therefore, this operation should be carried out with careful management by both gastrointestinal and cardiovascular surgeons.</p

Pod Dehiscence in Relation to Pod Position and Moisture Content in Soybean

The relationship between pod dehiscence and the position and moisture content of pods was examined in two soybean cultivars, Fukuyutaka and Keito-daizu. The frequency of pod dehiscence at different parts of the stem was assessed by the strain-gauge method. Pods of the two cultivars were classifi ed into indehiscent, dehiscent (dehisced by the strain-gauge method) and naturally dehiscent pods. The moisture content of pods was measured after drying in a hot-air oven at 105±1°C for 24 hrs. In both Fukuyutaka and Keito-daizu, the pods at maturity were not dehisced at any part of the stem due to the high moisture content of pods. After maturity, the frequency of pod dehiscence at the upper part of the stem increased as the moisture content of pods decreased in both Fukuyutaka and Keito-daizu. A similar tendency was observed in both the fi eld and the pot experiments. The frequency of pod dehiscence was higher at the upper part of the stem and increased as the moisture content of pods decreased

Pod Dehiscence in Relation to Chemical Components of Pod Shell in Soybean

The relationship between chemical components of pod shell and pod dehiscence was investigated using 25 soybean cultivars; 16 with easily dehiscing pods (susceptible cultivars) and 9 with hardly dehiscing pods (resistant cultivars). After air-drying for about three weeks, the pod shells were ground and analyzed for the contents of neutral detergent fiber (NDF), acid detergent fiber (ADF), acid detergent lignin (ADL), hemi-cellulose (HCe), cellulose (Ce), uronic acid and calcium. The correlation of the contents of chemical components with the percentage of pod dehiscence (%PD) was examined by principal component analysis. The first principal ingredient score was given by the formula; score = – 0.421[ADF] – 0.038[ADL] + 0.821[HCe] – 0.382[Ce] + 20.556, where, [ADF], [ADL], [HCe] and [Ce] are percentage of each component in dried pod shell. This score gave an eigenvalue of 30.2 and contribution rate of 97.1%, and the score was higher in the susceptible cultivars than in the resistant cultivars on the average. The multiple regression analysis of the relationship between %PD and the content of chemical components also showed that %PD was best predicted by the regression equation with two chemical components, [HCe] and [Ce]. Water retention capacity and cellulose crystallinity of the pod shell were less different between the susceptible and resistant cultivars. The results in this study suggested that the chemical analysis of dry pod shell may provide useful information on breeding and selection of the resistant cultivars