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Background: The jugular vein cutdown for a totally implantable central venous port (TICVP) has 2 disadvantages: 2 separate incisions are needed and the risk for multiple vein occlusions. We sought to evaluate the feasibility of a cephalic vein (CV) cutdown in children. Methods: We prospectively followed patients who underwent a venous cutdown for implantation of a TICVP between Jan. 1, 2002, and Dec. 31, 2006. For patients younger than 8 months, an external jugular vein cutdown was initially tried without attempting a CV cutdown. For patients older than 8 months, a CV cutdown was tried initially. We recorded information on age, weight, outcome of the CV cutdown and complications. Results: During the study period, 143 patients underwent a venous cutdown for implantation of a TICVP: 25 younger and 118 older than 8 months. The CV cutdown was successful in 73 of 118 trials. The 25th percentile and median body weight for 73 successful cases were 15.4 kg and 28.3 kg, respectively. There was a significant difference in the success rate using the criterion of 15 kg as the cutoff. The overall complication rate was 8.2%. Conclusion: The CV cutdown was an acceptable procedure for TICVP in children. It could be preferentially considered for patients weighing more than 15 kg who require TICVP. Contexte : La dissection de la jugulaire pour la mise en place d'un dispositif d'acces veineux central totalement implantable comporte 2 inconvenients : 2 incisions distinctes sont necessaires et il y a un risque de multiples occlusions veineuses. Nous avons voulu evaluer la faisabilite d'une dissection de la veine cephalique chez les enfants. Methodes : Nous avons suivi de maniere prospective des patients soumis a une dissection veineuse pour implantation d'un dispositif d'acces veineux central entre le 1er janvier 2002 et le 31 decembre 2006. Pour les patients de moins de 8 mois, une dissection de la jugulaire externe a d'abord ete tentee, sans tentative de dissection de la veine cephalique. Pour les patients de plus de 8 mois, une dissection de la veine cephalique a d'abord ete tentee. Nous avons note l'age, le poids, l'issue de la dissection de la veine cephalique et les complications. Resultats : Au cours de la periode de l'etude, 143 patients ont subi une dissection veineuse pour pose d'un dispositif d'acces veineux central totalement implantable : 25 avaient moins de 8 mois et 118 avaient plus de 8 mois. La dissection de la veine cephalique a reussi lors de 73 tentatives sur 118. Le poids du 25e percentile et le poids median pour les 73 cas reussis etaient de 15,4 kg et de 28,3 kg, respectivement. On a observe une difference significative du taux de reussite associe au critere du poids seuil de 15 kg. Le taux global de complications a ete de 8,2 %. Conclusion : La dissection de la veine cephalique a ete une intervention acceptable pour la pose de dispositifs d'acces veineux centraux totalement implantables chez les enfants. Elle pourrait etre envisagee chez les patients de plus de 15 kg qui ont besoin d'un dispositif d'acces veineux central implantable., As the last type of long-term central venous access device developed, (1) the totally implantable central venous port (TICVP) is widely used in children for various purposes, such as chemotherapy [...]

Obesity is a critical risk factor of several life-threatening diseases and the prevalence in adults has dramatically increased over the past ten years. In the USA the age-adjusted prevalence of obesity in adults was 42.4%, i.e., with a body mass index (BMI, weight (kg)/height (m)2) that exceeds 30 kg/m2. Obese individuals are at the higher risk of obesity-related diseases, co-morbid conditions, lower quality of life, and increased mortality more than those in the normal BMI range i.e., 18.5–24.9 kg/m2. Surgical treatment continues to be the most efficient and scientifically successful treatment for obese patients. Sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a relatively new gastric procedure to reduce body weight but is now the most popular bariatric operation. To date there have been few studies examining the changes in the cellular components and pacemaker activity that occur in the gastric wall following VSG and whether normal gastric activity recovers following VSG. In the present study we used a murine model to investigate the chronological changes of gastric excitability including electrophysiological, molecular and morphological changes in the gastric musculature following VSG. There is a significant disruption in specialized interstitial cells of Cajal in the gastric antrum following sleeve gastrectomy. This is associated with a loss of gastric pacemaker activity and post-junctional neuroeffector responses. Over a 4-month recovery period there was a gradual return in interstitial cells of Cajal networks, pacemaker activity and neural responses. These data describe for the first time the changes in gastric interstitial cells of Cajal networks, pacemaker activity and neuroeffector responses and the time-dependent recovery of ICC networks and normalization of motor activity and neural responses following VSG. [ABSTRACT FROM AUTHOR]

Black garlic (BG) is a newly explored food stuff obtained via fermentation of raw, healthy garlic, especially in Asian countries. Interstitial cells of Cajal (ICC) are the pacemaker cells of gastrointestinal (GI) motility. The purpose of this study was to investigate the effects of BG extract on the pacemaker potentials of the ICC in the small intestines of mice and the possibility of controlling GI motility. The antioxidant activity of BG extract was also investigated. The whole-cell electrophysiological method was used to measure pacemaker potentials of the ICC in vitro, whereas GI motility was measured using the intestinal transit rate (ITR) in vivo. BG extract depolarized the pacemaker potentials of the ICC. Y25130 and RS39604 5-HT receptor antagonists could not inhibit the effect of BG extract on the pacemaker potentials of the ICC, whereas the 5-HT receptor antagonist SB269970 could. Pre-treatment with external Na+ (5 mM) or Ca2+-free solution inhibited the BG extract-induced depolarization of the ICC. With SB203580, PD98059, or c-jun NH2-terminal kinase II inhibitor pre-treatment, BG extract did not induce pacemaker potential depolarization. Moreover, the ITR values were increased by BG extract. Elevation of the ITR due to BG extract was related with increased protein expression of the 5-HT7 receptors. In addition, BG extract showed antioxidant activity. Collectively, these results highlight the ability of BG extract to regulate GI motility and the possibility of using it to develop GI motility modulators in the future. Moreover, BG showed immense potential as an antioxidant. [ABSTRACT FROM AUTHOR]

Background: Forme fruste choledochal cyst (FFCC), characterized by a minimally dilated common bile duct (CBD) and associated pancreaticobiliary maljunction (PBM), is difficult to diagnose in a timely manner in clinical practice. However, endoscopic retrograde cholangiopancreatography (ERCP) can clearly delineate CBD and PBM. Hence, we evaluated the value of ERCP in the diagnosis and management of FFCC. Methods: The medical records of patients diagnosed with FFCC were retrospectively reviewed. From January 2003 to December 2010, patients underwent surgery without ERCP (non‐ERCP group); from January 2011, all patients underwent pre‐operative ERCP (ERCP group). Demographics, laboratory results, perioperative data and post‐operative complications were compared between the two groups. Results: There were 24 patients in the ERCP group and 11 in the non‐ERCP group. Laboratory data improved to a greater extent after ERCP. ERCP was superior to both magnetic resonance cholangiopancreatography and ultrasonography in delineating CBD and PBM. In the ERCP group, 20 of the 24 patients were noted to have filling defects in the biliary tract and underwent pre‐operative endoscopic sphincterotomy. Intra‐operative blood loss was lower and transfusion less frequent in the ERCP group (P < 0.05). There were no ERCP‐related complications. Conclusions: ERCP can accurately delineate the minimal CBD dilatation, associated pancreaticobiliary tract abnormalities and PBM of FFCC. ERCP can improve the perioperative and post‐operative results of paediatric patients with FFCC. [ABSTRACT FROM AUTHOR]

Purpose: With the widespread use of the obstetrical ultrasound, identification of a fetal suprarenal mass has become more common. Most of these masses prove to be congenital neuroblastomas (CNB), but the diagnosis is often confused with other benign lesions and the postnatal management remains to be controversial.Methods: The medical records of 18 patients that underwent primary surgical excision for an antenatally detected suprarenal mass, between January 1995 and April 2009, were reviewed. The clinical, radiological, surgical, and pathological data were collected. Staging evaluation was performed after histological confirmation of the CNB.Results: There were 13 cases of CNB, 1 adrenal cyst, 2 adrenal hemorrhages, and 2 pulmonary sequestrations. The differential diagnosis was impossible before surgery. Most of the CNBs were stage I (N = 11), with 1 stage IV and 1 stage IV-S. Four patients (3 stage I and 1 stage IV-S) had more than one copy of N-myc gene. The stage I patients were cured by surgery alone, and stage IV patients underwent nine cycles of adjuvant chemotherapy and currently have no evidence of disease. The five benign lesions were cured with excision alone. There were no postoperative complications.Conclusion: For early diagnosis and treatment, surgical excision should be considered as the primary therapy for an antenatally detected suprarenal mass. The surgery can be safely performed during the neonatal period and provides a cure in most cases. [ABSTRACT FROM AUTHOR]

Purpose: For International Neuroblastoma Staging System (INSS) stages III or IV neuroblastoma (intermediate or high risk), complete excision of the primary tumor is not always feasible. Most current studies on the treatment outcome of these patients have reported on the complete excision status. The aim of this study is to review the treatment outcome after the incomplete resection.Methods: The medical records of 37 patients that underwent incomplete resection between January 1986 and December 2005 were reviewed retrospectively. Incomplete resection was assessed by review of the operative notes and postoperative computerized tomography. Age, gender, tumor location, INSS stage, N-myc gene copy number, pre- and postoperative therapy, and treatment outcome were reviewed. The treatment outcome was evaluated according to the postoperative treatment protocol in the high-risk group.Results: Intermediate-risk patients were treated with conventional chemotherapy, isotretinoin (ITT) and interleukin-2 (IL-2). High-risk patients were treated with peripheral blood stem cell transplantation (PBSCT), ITT, and IL-2 (N = 11). Before the introduction of PBSCT, the high-risk patients were also treated with the conventional chemotherapy (N = 19). Intermediate-risk patients (N = 5) currently have no evidence of disease (NED). For the high-risk patients (N = 32), 19 patients were treated with chemotherapy alone; 15 patients died of their disease while four patients currently have an NED status. Eight of 11 patients that underwent PBSCT are currently alive.Conclusions: For intermediate risk, conventional chemotherapy appears to be acceptable treatment. However, for high-risk patients, every effort should be made to control residual disease including the use of myeloablative chemotherapy, differentiating agents and immune-modulating agents. [ABSTRACT FROM AUTHOR]