Techniques and Current Role of Sentinel Lymph Node (SLN) Concept in Gastric Cancer Surgery

Gastric cancer patients represent a rather divergent patient group and in certain carefully selected cases of early forms of gastric cancer the D2 gastrectomy could be considered a more radical procedure than the biological and oncological characteristics of the primary tumor on the gastric wall would require. As any unnecessary dissection increases morbidity without always respective survival benefits, an approach that could accurately predict and actually dictate the exact extent of lymph node dissection would be ideal. It is more than logical the assumption that the standard D2 lymphadenectomy could represent an overtreatment in distinct patients groups such as patients with early gastric cancer with favorable pathological characteristics and clinically negative nodes not suitable for endoscopic treatment because this early stage disease shows limited lymph node metastasis incidence and excellent overall survival. Considering that the D2 gastrectomy has a negative impact on the quality of life of gastric cancer patients due to the post-gastrectomy functional results, a concept of a more targeted lymph node dissection, when appropriate, is certainly appealing. It is yet to be proven whether sentinel lymph node navigation surgery can fulfill such expectations providing the appropriate balance between morbidity and oncological safety in selected gastric cancer patients

Advanced trauma life support course for medical students. A new era?

IntroductionTrauma represents a major public health issue and is one of the leading causes of death and disability worldwide. A systematic approach toward dealing with trauma patients was facilitated through the ATLS program, which has become a milestone in trauma care. Our new ATLS course for medical students was set in motion in 2015. Our aim was to make medical students familiar with trauma patients interactively, through a program like ATLS, and here we present the results of this endeavor.MethodsA two-day ATLS-Medical Student (MS) course was offered from November 2015 to July 2018, and analysis was performed retrospectively on the data gathered over a three-month period through online questionnaires. Before graduating, 261 newly qualified medical doctors were interviewed and evaluated as part of the ATLS course.ResultsAfter the course, the vast majority of medical students (251 MSs; 96.16%) felt more capable of managing severely injured patients and 58% of students felt that the medical services they offered were better due to the ATLS training. Regarding the educational fee for the course, 56.7% of the students reported that they felt the fee of 100 euros was fair.DiscussionThe interactive format of the course, which differs from more traditional methods of teaching, has been endorsed by medical students. Though they lack clinical experience, that does not prohibit them from acquiring more specialized or specific knowledge, enabling them to excel. Most of the students improved their skillset either in theoretical knowledge, practical skills, or even in the emotional component of the course, i.e., dealing with treating a severely injured patient. It was decided that the program would be re-evaluated and extended to all Greek Medical Schools.ConclusionThe advantage of providing doctors with trauma training at the beginning of their careers is evident. For that reason, it was decided that the program would be re-evaluated and extended to all Greek Medical Schools

Evidence of functional deficits at the single muscle fiber level in experimentally-induced renal insufficiency

Chronic kidney disease patients present with metabolic and functional muscle abnormalities, called uremic myopathy, whose mechanisms have not yet been fully elucidated. We investigated whether chronic renal insufficiency (CRI) affects skeletal muscle contractile properties at the cellular level. CRI was induced surgically in New Zealand rabbits (UREM), with sham-operation for controls (CON), and samples were collected at 3 months post-surgery, following euthanasia. All protocols had University Ethics approval following national and European guidelines. Sample treatments and evaluations were blinded. Maximal isometric force was assessed in 382 permeabilized psoas fibers (CON, n=142, UREM, n=240) initially at pH7, 10oC (‘standard’ conditions), in subsets of fibers in acidic conditions (pH6.2, 10oC) but also at near physiological temperature (pH7, 30oC and pH6.2, 30oC). CRI resulted in significant smaller average CSA (~11%) for UREM muscle fibers (vs CON, P<0.01). At standard conditions, UREM fibers produced lower absolute and specific forces (i.e. normalized force per fiber CSA) (vs CON, P<0.01); force increased in 30oC for both groups (P<0.01), but the disparity between UREM and CON remained significant. Acidosis significantly reduced force (vs pH7, 10oC P<0.01), similarly in both groups (in UREM by -48% and in CON by -43%, P>0.05). For the first time, we give evidence that CRI can induce significant impairments in single psoas muscle fibers force generation, only partially explained by fiber atrophy, thus affecting muscle mechanics at the cellular level

The contribution of herniography and intraperitoneal methylene-blue infusion identification and diagnosis of inguinal hernias

The technique and the results of 98 methylene-blue herniographies are reported in this study. The patients were divided in three groups. Group A included cases of clinically diagnosed primary inguinal hernia, group Β cases of probable inguinal hernia recurrence and group C cases of obscure groin pain. Our study showed the following: - Herniography constitutes a diagnostic examination of high sensitivity and specificity for identification of inguinal hernias. - Herniography proved to be a first choice examination for the diagnosis of nonpalpable or asymptomatic hernias. - The intraperitoneal infusion of methylene-blue may be useful in some cases, facilitating the identification and dissection of small or "drowned" beneath adhesions hernial sacs. However, there is no adequate evidence to consider this method as a routine examination providing greater diagnostic possibilities during the surgical exploration of the inguinal canal.Περιγράφονται τεχνικά στοιχεία και αποτελέσματα 98 κηλογραφιών με ταυτόχρονη ενδοπεριτοναϊκή έγχυση του μεθυλενίου. Οι ασθενείς ταξινομήθηκαν σε τρείς ομάδες. Η ομάδα Α περιελάμβανε περιπτώσεις κλινικά διαγνωσμένης πρωτοπαθούς βουβωνοκήλης, η ομάδα Β περιπτώσεις υποτροπής βουβωνοκήλης και η ομάδα Γ περιπτώσεις άτυπου βουβωνικού άλγους με αμφίβολη σημειολογία βουβωνοκήλης. Η μελέτη έδειξε ότι: - Η κηλογραφία αποτελεί αυξημένης ευαισθησίας και ειδικότητας μέθοδο ανάδειξης και ταυτοποίησης κηλών της βουβωνικής χώρας. - Η μέθοδος αποτελεί την εξέταση εκλογής για την διάγνωση αψηλάφητων ή ασυμπτωματικών κηλικών σάκων. - Η ενδοπεριτοναϊκή έγχυση κυανού του μεθυλενίου μπορεί κατά περίπτωση να φανεί χρήσιμη στην αναγνώριση και παρασκευή προβληματικών ή μικρών κηλικών σάκων, αλλά σαν μέθοδος ρουτίνας δεν φαίνεται να αυξάνει τις διαγνωστικές δυνατότητες της χειρουργικής διερεύνησης του βουβωνικού πόρου

Modification of end-loop ileostomy for the treatment of ischemic or radiation enteritis

AIM: To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability