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Cellular therapy of the corneal stroma: a new type of corneal surgery for keratoconus and corneal dystrophies

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Eye and Vision 2018年第1期5卷 250-259页

作者： Jorge L.Aliódel Barrio Jorge L.Alió Cornea Cataract and Refractive Surgery UnitVissum CorporaciónAlicanteSpain Division of Ophthalmology Universidad Miguel HernándezAlicanteSpain. Vissum Instituto Oftalmologico de AlicanteAvda de Denia s/n03016 AlicanteSpain

Cellular therapy of the corneal stroma,with either ocular or extraocular stem cells,has been gaining a lot of interest over the last *** publications from different research groups are showing its potential benefits in relation to its capacity to improve or alleviate corneal scars,improve corneal transparency in metabolic diseases by enhancing the catabolism of the accumulated molecules,generate new organized collagen within the host stroma,and its immunosuppressive and immunomodulatory *** extraocular stem cells do not require a healthy contralateral eye and they do not involve any ophthalmic procedures for their *** stem cells have been the most widely assayed and have the best potential to differentiate into functional adult keratocytes in vivo and in *** embryonic stem cells have been partially abandoned due to ethical implications,the discovery of the induced pluripotent stem cells(iPSC)has opened a new and very promising field for future research as they are pluripotent cells with the capacity to theoretically differentiate into any cell type,with the special advantage that they are obtained from adult differentiated *** delivery into the corneal stroma has been experimentally assayed in vivo in multiple ways:systemic versus local injections with or without a *** preliminary human clinical data is already available although still very limited,and further research is necessary in order to consolidate the clinical applications of this novel therapeutic line.

关键词： Stem cells Regenerative medicine Corneal transplant decellularized cornea Cornea Corneal stroma Cellular therapy MSC Mesenchymal stem cells

Massive presacral bleeding during rectal surgery: From anatomy to clinical practice

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World Journal of Gastroenterology 2013年第25期19卷 4039-4044页

作者： Zheng Lou Wei Zhang Rong-Gui Meng Chuan-Gang Fu department of Colorectal surgery Changhai Hospital

AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the department of Colorectal surgery, Changhai Hospital, Shanghai, China from January 2008 to december 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral ***: Two different techniques were used to con-trol the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to "weld" closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7. CONCLUSION: Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively.

关键词： Massive presacral bleeding Rectal surgery Suture ligation Welding

Neuroendocrine liver metastases: Contributions of endoscopy and surgery to primary tumor search

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World Journal of Gastroenterology 2012年第10期18卷 1009-1014页

作者： Herwig Cerwenka department of surgery Medical University of Graz

Neuroendocrine tumors (NETs) are diagnosed with increasing frequency and patients often present with liver metastases at the time of diagnosis. Apart from treatment of the metastases, resection of the primary tumor at an early phase is recommended to prevent complications, although it may be difficult to locate, especially in patients with functionally inactive NETs. Small and multifocal tumors in the jejunum and ileum represent a particular challenge. Primary hepatic neuroendocrine carcinoma is extremely rare and is diagnosed only after exclusion of other primary tumors. Therefore, some uncertainty may remain, as small non-hepatic primary tumors may escape detection. Diagnostic work-up in these patients includes biochemical assays and imaging modalities (also comprising specific techniques of scintigraphy and positron emission tomography). This editorial highlights the contributions of endoscopy and operative exploration to the search for the primary tumor. Besides esophagogastro-duodenoscopy, endoscopic ultrasonography, colonoscopy and bronchoscopy, special endoscopic techniques such as balloon enteroscopy or capsule endoscopy are used with growing experience. Compared with balloon enteroscopy, capsule endoscopy is noninvasive and better tolerated, but it cannot localize a lesion precisely and does not allow biopsy or removal of lesions. Before proceeding to surgery, a discussion of the findings by a tumor board should be a standard procedure. Improvements in diagnostic tools have created new perspectives for the detection of obscure primary tumors in patients with neuroendocrine liver metastases, and these searches are best coordinated by a multidisciplinary team.

关键词： Neuroendocrine tumor Neuroendocrine carcinoma Liver metastasis Primary tumor Endoscopy

Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients

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World Journal of Gastroenterology 2011年第10期17卷 1343-1353页

作者： Masayuki Imamura Izumi Komoto Shuichi Ota Takuya Hiratsuka Shinji Kosugi Ryuichiro Doi Masaaki Awane Naoya Inoue department of surgery Kansa Electric Power Company Hospital departments of surgery and Pathology Saiseikai Noe Hospital Medical Gene Research Center Graduate School of Medicine Kyoto University department of surgery Graduate School of MedicineKyoto University

AIM： To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS： Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 （MEN 1） and Zollinger-Ellison syndrome （ZES） underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors （NETs） between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test （SASI test） with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy （SRS） and other imaging methods such as computed tomography （CT） or magnetic resonance imaging （MRI）. The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery： pancreaticoduodenectomy （PD） was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes （LR）, and recently pancreas-preserving total duodenectomy （PPTD） has been performed for multiple duodenal gastrinomas. RESULTS： Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients （87.5%）; that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR （although in 2 patients （33.3%） second LR was performed for recurrence of duodenal gastri- noma）, and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the

关键词： Gastrinoma Duodenopancreatic neuroendocrine tumors Multiple endocrine neoplasia type 1 Selective arterial secretagogue injection test 5omatostatin receptor scintigraphy Pancreas-preserving total duode- nectomy Pancreaticoduodenectomy

Three-dimensional computed tomography in laparoscopic surgery for coiorectal carcinoma

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World Journal of Gastroenterology 2005年第44期11卷 6932-6935页

作者： Hiroshi Ohtani Kohei Ohta Yuichi Arimoto Eui-Chul Kim Hiroko Oba Kenji Adachi Shoichi Terakawa Mitsuo Tsubakimoto department of surgery department of Gastroenterology department of Radiology

AIM： To evaluate the usefulness of three-dimensional computed tomography （3DCT） in laparoscopic surgery for colorectal carcinoma. METHODS： Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group （LG）, while 56 patients underwent conventional open surgery, open group （OG）. At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery （IMA） by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery （SMA）/superior mesenteric vein （SMV）, ileocecal artery （ICA）, middle colic artery （MCA）, and inferior mesenteric vein （IMV）. We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS： The mean length of the incision in LG was 4.6254-0.89 cm, which was significantly shorter than that in OG （P〈0.001）. The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage.CONCLUSION： Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma.

关键词： Three-dimensional computed tomography Laparoscopic colorectal surgery, Colorectal cancer

International consensus statement on robotic hepatectomy surgery in 2018

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World Journal of Gastroenterology 2019年第12期25卷 1432-1444页

作者： Rong Liu Go Wakabayashi Hong-Jin Kim Gi-Hong Choi Anusak Yiengpruksawan Yuman Fong Jin He Ugo Boggi Roberto I Troisi Mikhail Efanov Daniel Azoulay Fabrizio Panaro Patrick Pessaux Xiao-Ying Wang Ji-Ye Zhu Shao-Geng Zhang Chuan-Dong Sun Zheng Wu Kai-Shan Tao Ke-Hu Yang Jia Fan Xiao-Ping Chen Second department of Hepatopancreatobiliary surgery Chinese People’s Liberation Army (PLA) General Hospital Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases Ageo Central General Hospital department of surgery Yeungnam University Hospital Division of Hepatobiliary Pancreatic surgery Department of Surgery Yonsei University College of Medicine Minimally Invasive surgery Division Department of SurgeryFaculty of Medicine Siriraj Hospital Mahidol University department of surgery City of Hope Medical Center department of surgery the Johns Hopkins Hospital Division of General and Transplant surgery Pisa University Hospital department of Clinical Medicine and surgery Federico II University department of Hepato-Pancreato-Biliary surgery Moscow Clinical Scientific Center Hepato-Biliary Center Paul Brousse University Hospital Hepato-Biliary Center Tel Hashomer University Hospital department of surgery/Division of HBP surgery and Transplantation Montpellier University Hospital-School of Medicine Head of the Hepato-biliary and pancreatic surgical unit Nouvel Hopital Civil department of Liver surgery and Transplantation Liver Cancer Institute Zhongshan Hospital Fudan University department of Hepatobiliary surgery Peking University People’s Hospital department of Hepatobiliary surgery 302 Hospital of Chinese PLA department of Hepatobiliary and Pancreatic surgery the Affiliated Hospital of Qingdao University department of Hepatobiliary surgery the First Affiliated Hospital of Xi’an Jiaotong University department of Hepatobiliary surgery Xijing Hospital the Fourth Military Medical University Evidence Based Medicine Center School of Basic Medical Sciences Lanzhou University Hepatic surgery Center Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

The robotic surgical system has been applied in liver surgery. However,controversies concerns exist regarding a variety of factors including the safety,feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts' consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline development, a Consensus Steering Group and a Consensus development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRAde Grid method and delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRAde method using an evidence-based method, which focused on the safety, feasibility, indication,techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRAde method, further randomized-controlled trials are needed in the future to validate these recommendations.

关键词： Minimally invasive surgery Robotic hepatectomy Laparoscopic hepatectomy Hepatectomy resection Consensus statement

Disrupted NF-κB activation after partial hepatectomy does not impair hepatocyte proliferation in rats

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World Journal of Gastroenterology 2005年第46期11卷 7345-7350页

作者： Stéphanie Laurent Yves Horsmans Peter Strkel Isabelle Leclercq Christine Sempoux Luc Lambotte GastroenterologyPathology and Experimental surgery Laboratories Universite catholique de Louvain1200 BrusselsBelgium

AIM： To analyze the effects of NF-kB inhibition by antioxidant pyrrolidine dithiocarbamate （PDTC） or TNF inhibitor pentoxifylline （PTX） on liver regeneration after partial hepatectomy （PH）. METHODS： Saline, PDTC or PTX were injected 1 h before PH and rats were killed at 0.5 and 24 h after PH. Several control groups were used for comparison （injection control groups）. RESULTS： Compared to saline injected controls, NF-kB activation was absent 0.5 h after PH in rats treated with PDTC or PTX. At 24 h after PH, DNA synthesis and PCNA expression were identical in treated and control rats and thus occurred irrespectively of the status of NF-kB activation at 0.5 h. Signal transducer and activator of transcription 3 （Stat3） acUvatJon was observed already 0.5 h after PH in saline, PDTC or PTX group and was similar to Stat3 activation in response to injection without PH. CONCLUSION： These data strongly suggest that （1） NF-kB p65/p50 DNA binding produced in response to PH is not a signal necessary to initiate the liver regeneration, （2） star3 activation is a stress response unrelated to the activation of NF-kB. In conclusion, NF-kB activation is not critically required for the process of liver regeneration after PH.

关键词： Partial hepatectomy Nuclear factor kappa B Signal transducer and activator of transcription 3 Hepatocyte proliferation Antioxidant

Impact of minimally invasive surgery on the treatment of benign esophageal disorders

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World Journal of Gastroenterology 2012年第46期18卷 6764-6770页

作者： Brian Bello Fernando A Herbella Marco E Allaix Marco G Patti department of surgery University of Chicago Pritzker School of Medicine

Thanks to the development of minimally invasive surgery, the last 20 years have witnessed a change in the treatment algorithm of benign esophageal disorders. Today a laparoscopic operation is the treatment of choice for esophageal achalasia and for most patients with gastroesophageal reflux disease. Because the pathogenesis of achalasia is unknown, treatment is palliative and aims to improve esophageal emptying by decreasing the functional obstruction at the level of the gastro-esophageal junction. The refinement of minimally invasive techniques accompanied by large, multiple randomized control trials with long-term outcome has allowed the laparoscopic Heller myotomy and partial fundoplication to become the treatment of choice for achalasia compared to endoscopic procedures, including endoscopic botulinum toxin injection and pneumatic dilatation. Patients with suspected gastroesophageal reflux need to undergo a thorough preoperative workup. After establishing diagnosis, treatment for gastroesophageal reflux should be individualized to patient characteristics and a decision about an operation made jointly between surgeon and patient. The indications for surgery have changed in the last twenty years. In the past, surgery was often considered for patients who did not respond well to acid reducing medications. Today, the best candidate for surgery is the patient who has excellent control of symptoms with proton pump inhibitors. The minimally invasive approach to antireflux surgery has allowed surgeons to control reflux in a safe manner, with excellent long term outcomes. Like achalasia and gastroesophageal reflux, the treatment of patients with paraesophageal hernias has also seen a major evolution. The laparoscopic approach has been shown to be safe, and durable, with good relief of symptoms over the long-term. The most significant controversy with laparoscopic paraesophageal hernia repair is the optimal crural repair. This manuscript reviews the evolution of these tec

关键词： Gastroesophageal reflux disease Esophageal achalasia Hiatal hernia Laparoscopic fundoplication Laparoscopic Heller myotomy

Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

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Hepatobiliary & Pancreatic Diseases International 2021年第5期20卷 485-492页

作者： Juli Busquets Josefina Lopez-Dominguez Ana Gonzalez-Castillo Marina Vila Nuria Pelaez Lluis Secanella Emilio Ramos Juan Fabregat department of Hepatobiliary and Pancreatic surgery Hospital Universitari de BellvitgeResearch Group of Hepato-biliary and Pancreatic DiseasesInstitut d'InvestigacióBiomèdica de Bellvitge-IDIBELLBarcelona UniversityL’Hospitalet de LlobregatBarcelona 08907Spain department of General surgery Hospital del MarBarcelona 08907Spain department of General surgery Hospital de MataróBarcelona 08907Spain

Background:There are no clearly defined indications for pancreas-preserving *** present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving ***:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were *** divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency ***:We included 35 *** duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in *** indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

关键词： Duodenectomy Duodenal neoplasms Organ sparing treatments Pancreatic surgery Duodenal diseases