AIM： To investigate the effect of epidural anaesthesia （EA） on pancreatic microcirculation during acute pancreatitis （AP）. METHODS： AP was induced by injection of sodium taurocholate into the pancreatic duct of ...AIM： To investigate the effect of epidural anaesthesia （EA） on pancreatic microcirculation during acute pancreatitis （AP）. METHODS： AP was induced by injection of sodium taurocholate into the pancreatic duct of Sprague-Dawley rats. To realize EA, a catheter was introduced into the epidural space between T7 and T9 and bupivacaine was injected. Microcirculatory flow was measured by laser Doppler flowmetry. Arterial blood gas analyses were performed. At the end of the experiment （≤ 5 h）, pancreas was removed for histology. The animals were divided into three groups： Group 1 （n =9）, AP without EA, Group 2 （n = 4）, EA without AP; and Group 3 （n = 6）, AP treated by EA. RESULTS： In Group 1, pancreatic microcirculatory flow prior to AP was 1414, 39 perfusion units （PU）. After AP, microcirculatory flow obviously decreased to 9 4-6 PU （P〈0.05）. Metabolic acidosis developed with base excess （BE） of - 14 4, 3 mmol/L. Histology revealed extensive edema and tissue necrosis. In Group 2, EA did not significantly modify microcirculatory flow. BE remained unchanged and histological analysis showed normal pancreatic tissue. In Group 3, AP initially caused a significant decrease in microcirculatory flow from 155 ± 25 to 11± 7 PU （P〈0.05）. After initiation of EA, microcirculatory flow obviously increased again to 81±31 PU （P〈0.05）. BE was -6±4 retool/L, which was significantly different compared to Group 1 （P〈0.05）. Furthermore, histology revealed less extensive edema and necrosis in pancreatic tissue in Group 3 than that in Group 1. CONCLUSION： AP caused dramatic microcirculatory changes within the pancreas, with development of metabolic acidosis and tissue necrosis. EA allowed partial restoration of microcirculatory flow and prevented development of tissue necrosis and systemic complications. Therefore, EA should be considered as therapeutic option to prevent evolution from edematous to necrotic AP.展开更多
Dear Editor,We present a case of a healthy 32-year-old man who developed bilateral corneal ulceration 3 wk after commencing dupilumab for atopic dermatitis. Dupilumab is a recently introduced systemic monoclonal antib...Dear Editor,We present a case of a healthy 32-year-old man who developed bilateral corneal ulceration 3 wk after commencing dupilumab for atopic dermatitis. Dupilumab is a recently introduced systemic monoclonal antibody used in the treatment of moderate-to-severe atopic dermatitis, showing efficacy in clinical trials;. Several publications have reported ocular surface complications associated with dupilumab.展开更多
PURPOSE:Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed.There have been several hypotheses concerning the mode of action of sac...PURPOSE:Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed.There have been several hypotheses concerning the mode of action of sacral nerve stimulation,but the mechanism is still unclear.This study was designed to evaluate the results of rectal volume tolerability,rectal pressure-volume curves,and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation.METHODS:Twenty-nine patients with incontinence(male/female ratio = 6/23;median age,58(range,29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test.Wexner incontinence score,rectal distention with thresholds for “ first sensation,” “ desire to defecate,” and “ maximal tolerable volume,” rectal pressure-volume curves,anal resting pressure,and maximum squeeze pressure were evaluated at baseline and at six months follow-up.RESULTS:Median Wexner incontinence score decreased from 16(range,6-20) to 4(range,0-12;P < 0.0001) .Median “ first sensation” increased from 43(range,16-230) ml to 62(range,4-186) ml(P = 0.1) ,median “ desire to defecate” from 70(range,30-443) ml to 98(range,30-327) ml(P = 0.011) ,and median “ maximal tolerable volume” from 130(range,68-667) ml to 166(range,74-578) ml(P = 0.031) .Rectal pressure-volume curves showed a significant increase in rectal capacity(P < 0.0001) .The anal resting pressure increased significantly from 31(range,0-109) cm H2O to 38(range,0-111) cm H2O(P = 0.045) .No significant increase in maximum squeeze pressure was observed.CONCLUSIONS:For patients with fecal incontinence successfully treated with sacral nerve stimulation,there was a significant increase in rectal volume tolerability and rectal capacity.A significant increase in anal resting pressure,but not in maximum squeeze pressure,was found.We suggest that sacral nerve stimulation causes neuromodulation at spinal level.展开更多
Background: After sedated colonoscopy, patients are discharged on the basis of their subjective judgment that they have recovered, corroborated by the nursing staff. The aim of this study was to assess objectively whe...Background: After sedated colonoscopy, patients are discharged on the basis of their subjective judgment that they have recovered, corroborated by the nursing staff. The aim of this study was to assess objectively whether patients were in fact fully recovered at the time of discharge, and to demonstrate whether the methods of testing applied could detect any influence of sedation on short-term memory, psychomotor function and postural stability. Methods: Twenty-two patients were investigated. At the beginning of the procedure, a defined bolus of propofol/alfentanil was given intravenously. During the procedure, an additional bolus was injected one or more times as requested by the patient. After colonoscopy, the patients stayed in the recovery room until the patients judged that they had recovered completely, which was also the judgement of the nursing staff at that time. Before colonoscopy and again before discharge, tests were performed of short-term memory, psychomotor function and postural stability (balance). Results: A positive correlation was found between the duration of colonoscopy and the amount of sedative given (p that they have recovered fully, some patients are still affected by the sedative at the time of discharge, as demonstrated by tests of short-term memory, reaction time and postural stability.展开更多
Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sew...Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.展开更多
文摘AIM： To investigate the effect of epidural anaesthesia （EA） on pancreatic microcirculation during acute pancreatitis （AP）. METHODS： AP was induced by injection of sodium taurocholate into the pancreatic duct of Sprague-Dawley rats. To realize EA, a catheter was introduced into the epidural space between T7 and T9 and bupivacaine was injected. Microcirculatory flow was measured by laser Doppler flowmetry. Arterial blood gas analyses were performed. At the end of the experiment （≤ 5 h）, pancreas was removed for histology. The animals were divided into three groups： Group 1 （n =9）, AP without EA, Group 2 （n = 4）, EA without AP; and Group 3 （n = 6）, AP treated by EA. RESULTS： In Group 1, pancreatic microcirculatory flow prior to AP was 1414, 39 perfusion units （PU）. After AP, microcirculatory flow obviously decreased to 9 4-6 PU （P〈0.05）. Metabolic acidosis developed with base excess （BE） of - 14 4, 3 mmol/L. Histology revealed extensive edema and tissue necrosis. In Group 2, EA did not significantly modify microcirculatory flow. BE remained unchanged and histological analysis showed normal pancreatic tissue. In Group 3, AP initially caused a significant decrease in microcirculatory flow from 155 ± 25 to 11± 7 PU （P〈0.05）. After initiation of EA, microcirculatory flow obviously increased again to 81±31 PU （P〈0.05）. BE was -6±4 retool/L, which was significantly different compared to Group 1 （P〈0.05）. Furthermore, histology revealed less extensive edema and necrosis in pancreatic tissue in Group 3 than that in Group 1. CONCLUSION： AP caused dramatic microcirculatory changes within the pancreas, with development of metabolic acidosis and tissue necrosis. EA allowed partial restoration of microcirculatory flow and prevented development of tissue necrosis and systemic complications. Therefore, EA should be considered as therapeutic option to prevent evolution from edematous to necrotic AP.
文摘Dear Editor,We present a case of a healthy 32-year-old man who developed bilateral corneal ulceration 3 wk after commencing dupilumab for atopic dermatitis. Dupilumab is a recently introduced systemic monoclonal antibody used in the treatment of moderate-to-severe atopic dermatitis, showing efficacy in clinical trials;. Several publications have reported ocular surface complications associated with dupilumab.
文摘PURPOSE:Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed.There have been several hypotheses concerning the mode of action of sacral nerve stimulation,but the mechanism is still unclear.This study was designed to evaluate the results of rectal volume tolerability,rectal pressure-volume curves,and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation.METHODS:Twenty-nine patients with incontinence(male/female ratio = 6/23;median age,58(range,29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test.Wexner incontinence score,rectal distention with thresholds for “ first sensation,” “ desire to defecate,” and “ maximal tolerable volume,” rectal pressure-volume curves,anal resting pressure,and maximum squeeze pressure were evaluated at baseline and at six months follow-up.RESULTS:Median Wexner incontinence score decreased from 16(range,6-20) to 4(range,0-12;P < 0.0001) .Median “ first sensation” increased from 43(range,16-230) ml to 62(range,4-186) ml(P = 0.1) ,median “ desire to defecate” from 70(range,30-443) ml to 98(range,30-327) ml(P = 0.011) ,and median “ maximal tolerable volume” from 130(range,68-667) ml to 166(range,74-578) ml(P = 0.031) .Rectal pressure-volume curves showed a significant increase in rectal capacity(P < 0.0001) .The anal resting pressure increased significantly from 31(range,0-109) cm H2O to 38(range,0-111) cm H2O(P = 0.045) .No significant increase in maximum squeeze pressure was observed.CONCLUSIONS:For patients with fecal incontinence successfully treated with sacral nerve stimulation,there was a significant increase in rectal volume tolerability and rectal capacity.A significant increase in anal resting pressure,but not in maximum squeeze pressure,was found.We suggest that sacral nerve stimulation causes neuromodulation at spinal level.
文摘Background: After sedated colonoscopy, patients are discharged on the basis of their subjective judgment that they have recovered, corroborated by the nursing staff. The aim of this study was to assess objectively whether patients were in fact fully recovered at the time of discharge, and to demonstrate whether the methods of testing applied could detect any influence of sedation on short-term memory, psychomotor function and postural stability. Methods: Twenty-two patients were investigated. At the beginning of the procedure, a defined bolus of propofol/alfentanil was given intravenously. During the procedure, an additional bolus was injected one or more times as requested by the patient. After colonoscopy, the patients stayed in the recovery room until the patients judged that they had recovered completely, which was also the judgement of the nursing staff at that time. Before colonoscopy and again before discharge, tests were performed of short-term memory, psychomotor function and postural stability (balance). Results: A positive correlation was found between the duration of colonoscopy and the amount of sedative given (p that they have recovered fully, some patients are still affected by the sedative at the time of discharge, as demonstrated by tests of short-term memory, reaction time and postural stability.
文摘Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.
