Surgery of gastric cancer in patients over 80 years old

A retrospective study on postoperative complications and factors affecting prognosis was performed on elderly patients with gastric cancer. We studied the correlation of age, pathological depth, preoperative laboratory data, physical status, duration of surgery, volume of blood loss, blood transfusion, curability, and extent of lymph node dissection to postoperative complications and prognosis in 47 patients with gastric cancer over 80 years old. Preoperative function of lung and liver frequently showed abnormal data. Postoperative complications were noted in 47% of patients, especially in the pulmonary system, liver and heart. Curability and extent of lymph node dissection were the significant factor affecting survival. Some mortalities caused by initial malignancy were recognized in the conservative lymph node dissection in the stage I . The incidence of postoperative complications was not significantly different according to extent of lymph node dissection. Blood transfusion was the only significant factor for the incidence of postoperative complication. The most frequent cause of death was the initial malignancy. We recommend that a low grade lymph node dissection should not be readily chosen for elderly patients in early cases.</p

Portacaval shunt causes apoptosis and liver atrophy in rats despite increases in endogenous levels of major hepatic growth factors

Background/Aims: The response to the liver damage caused by portacaval shunt (PCS) is characterized by low-grade hyperplasia and atrophy. To clarify mechanisms of this dissociation, we correlated the expression of 'hepatotrophic factors' and the antihepatotrophic and proapoptotic peptide, transforming growth factor (TGF)-β, with the pathologic changes caused by PCS in rats. Methods: PCS was created by side-to-side anastomosis between the portal vein and inferior vena cava, with ligation of the hilar portal vein. Hepatic growth mediators were measured to 2 months. Results: The decrease in the liver/body weight ratio during the first 7 days which stabilized by day 15, corresponded to parenchymal cell apoptosis and increases in hepatic TGF-β concentration that peaked at 1.4 × baseline at 15 days before returning to control levels by day 30. Variable increases in the concentrations of growth promoters (hepatocyte growth factor, TGF-α and augmenter of liver regeneration) also occurred during the period of hepatocellular apoptosis. Conclusions: The development of hepatic atrophy was associated with changes in TGF-β concentration, and occurred despite increased expression of multiple putative growth promoters. The findings suggest that apoptosis set in motion by TGF-β constrains the amount of hepatocyte proliferation independently from control of liver volume. © 2002 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved

Successful living donor kidney transplantation in a patient with prothrombin gene mutation: Case report and literature review

We present a patient with known prothrombin gene mutation and a history of prior vascular events, who underwent living donor kidney transplantation. Given the presumed elevated risk of complication from known prothrombin mutation, clinical management was directed towards optimizing living donor allograft function

Role of initially formed cake layers on limiting membrane fouling in membrane bioreactors

In this study, an interesting phenomenon was observed that when the levels of soluble polysaccharides (SP) and soluble transparent exopolymer particles (sTEP) in the MBR unexpectedly and suddenly increased, the cleaned membranes tended to be more easily fouled compared to the membranes with the initial cake layers formed in a slow TMP increase stage. Foulant analysis indicated great accumulation amounts of SP and sTEP on the cleaned membrane. FT-IR spectra further confirmed that hydroxyl and amide groups in the soluble substances preferred to attach on the cleaned membranes. While, the initially formed cake layers on the membranes played a role to decrease zeta potential of cleaned membranes, which created less interaction with the soluble substances. It suggests that forming loose-structured cake layers on the primary membranes could be thought as an effective membrane fouling control strategy

Fouling reduction in MBR-RO processes : the effect of MBR F/M ratio

This work investigated fouling propensities of microfiltration membranes and reverse osmosis (RO) membranes and analyzed the characteristics of deposited foulants on the membranes in two parallel Membrane bioreactor (MBR)-RO systems, with MBRs operated at different food to micro-organism (F/M) ratios. The results show that a high F/M ratio (0.50 g/g MLSS day) in the MBR caused greater membrane fouling rates of the MBR and RO membranes than a low F/M ratio (0.17 g/g MLSS day). In the MBRs, deposited microbial flocs were major foulants at low flux (10 L/m2 h), whereas soluble substances in the cake foulants predominantly induced membrane fouling at high fluxes (20 and 30 L/m2 h). In order to investigate the contributions of the protein, polysaccharides, and transparent exopolymer in the soluble substances to membrane fouling, bovine serum albumin, sodium alginate, and gum xanthan were used as model compounds, respectively, in experiments with the activated sludge samples from the MBR. The results imply that soluble polysaccharides (SP) and soluble transparent exopolymer particles (sTEP) were associated with fouling propagation. On the RO membranes, SP and sTEP were identified as major contributors to RO fouling rather than microbial cells and soluble protein. Our findings emphasize that the important role of the nature of soluble substances in membrane fouling and highlight that optimization of MBR operation is crucial to alleviate RO membrane fouling.Published versio

Use of Methylene Blue for Treatment of Severe Sepsis in an Immunosuppressed Patient after Liver Transplantation

Sepsis in the immunosuppressed patient is associated with very high mortality and morbidity. Treatment of sepsis in immunocompromised patients is especially challenging due to an unbalanced systemic inflammatory reaction with subsequent development of profound vasoplegia. Methylene blue (MB) has been successfully used for the treatment of refractory hypotension, but its use has not previously been reported for treatment of sepsis in immunosuppressed patients. The mechanism of MB's action is thought to be due to its inhibitory effect on cGMP-mediated vasodilatation. This case report describes the successful use of MB for treatment of severe septic shock in an immunosuppressed patient after liver transplantation. Hypotension in this patient was refractory to volume repletion and a combination of vasopressors. After MB administration, hemodynamic stability was rapidly reestablished. In the setting of severe sepsis in an immunosuppressed patient, MB should be considered early as a therapeutic option for treatment of refractory vasoplegia