A Randomized Crossover Comparison of Airway Sealing with the Laryngeal Mask Airway Ambu AuraFlex at Three Intracuff Pressures in Pediatric Laparoscopic Surgery

Objective An adequate intracuff pressure is important to ensure sufficient sealing function when using supraglottic airway devices to protect the airway from secretions and achieve adequate positive pressure ventilation. The aim of this study is to analyze a feasible and effective alternative Ambu AuraFlex intracuff pressure in child's laparoscopic surgery. Study Design Seventy-two children were included in this study. After insertion of the laryngeal mask airway AuraFlex, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 10, 30, and 60-cmH2O according to one of six sequences produced on the basis of 3 × 6 Williams crossover design. During the intraoperative period, AuraFlex was maintained using the last intracuff pressure of the allocated sequence. Oropharyngeal leak pressure, peak airway pressure, the fiberoptic view, mucosal change, and complications were assessed at three intracuff pressures. Results The OLP at the intracuff pressure of 10 cmH2O was significantly lower than that of 30 cmH2O (2# 18.1 ± 1.5 vs. 19.5 ± 1.4 cmH2O, p = 0.001; 2.5# 17.7 ± 1.2 vs. 20.2 ± 1.4, p = 0.001) and 60 cmH2O (2# 18.1 ± 1.5 vs. 20.0 ± 1.3 cmH2O, p = 0.002; 2.5# 17.7 ± 1.2 vs. 20.8 ± 1.1, p = 0.003). Compared with the peak airway pressure in pre-and postpneumoperitoneum, the OLP was significantly higher. Subgroup analysis showed no differences in mucosal change and complications. Conclusion Intracuff pressures of 30 may be sufficient for the Ambu AuraFlex in child's laparoscopic surgery, and there may be no added benefit of an intracuff pressure of 60 cmH2O, as oropharyngeal leak pressures were similar.

Endoscopic Prediction of Tumor Invasion Depth in Early Gastric Signet Ring Cell Carcinoma

Introduction: Signet ring cell carcinoma (SRC) is a poorly differentiated cancer of the stomach. Recent studies imply that early gastric SRC can be well managed by endoscopic resection. Unfortunately, unlike differentiated cancers, the endoscopic features of early gastric SRC have not been well studied. This study evaluated the endoscopic features of early gastric SRC, as well as the risk factors for submucosal (SM) invasion. Method: The medical records of patients from 7 tertiary hospitals (Daejeon and Chungcheong province) were reviewed to examine endoscopic findings and clinical data. These patients underwent surgery or endoscopic resection between January 2011 and December 2016 and were divided into 2 groups (derivation group and validation group) in order to develop and validate an endoscopic scoring system for SM invasion. Results: In total, 331 patients (129 in the derivation group and 202 in the validation group) were enrolled in this study. In the derivation group, the risk factors for SM invasion, namely, fold convergence, nodular mucosal change, and deep depression, were identified by logistic regression analysis (ORs 3.4, 5.9, and 6.0, p < 0.05). A depth-prediction score was created by assigning 1 point for fold convergence and 2 points for other factors. When validation lesions of 0.5 point or more were diagnosed as SM invasion, the sensitivity and specificity were 76.8–78.6% and 61.6–74.7% respectively. Conclusion: Fold convergence, nodular mucosal change, and deep depression are risk factors for SM invasion in early gastric SRC. Our depth-prediction scoring system may be useful for differentiating SM cancers.

Clinical outcomes of gastric cardia cancer during a recent decade of Korea.

87 Background: To date, the incidence of adenocarcinomas of the gastric cardia has been increasing worldwidely. In 7th edition of the American Joint Commission on Cancer, a tumor within 5 cm of the EGJ is classified and staged according to the esophageal cancer. There are two different etiologies of gastric cardia cancer - Barrett's esophagus and Helicobacter pylori (H. pylori) associated intestinal metaplasia. We aimed to evaluate the clinical characteristics and outcome between gastric cardia and non-cardia cancer. Methods: We performed a retrospective cohort study of 90 patients with gastric cardia cancer from Jan. 2003 to Dec. 2013. We selected 180 patients with gastric non-cardia cancer as age and sex matched control during the same period (by AGE, SEX PROGRAM). Results: The rate of curative resection (R0) was significantly low in gastric cardia cancer (74/81 vs. 146/149) (91.4% vs 98.0%, P=.02) The recurrence rate was lower in patents with non-cardia cancer than those with cardia cancer (21/74 vs. 12/146) (28.4% vs 8.0%, P=.00). Subgroup analysis was done for patients with cardia cancer according to BMI and helicobacter infection and atrophic mucosal change. The median follow up period of obese patients and non-obese patients were 35.0month and 28.0month, which revealed there was no difference (P=.70). We determined patients with mucosal atrophic change and HP infection as a group1, and patients with no mucosal change with non- infective status as a group 2. The median follow up period of group 1 patient and group 2 patients were 26.0month and 36.0month, there was no significant difference. (P=.96). Conclusions: Gastric cardia cancer had a negative prognostic impact, compared with gastric non-cardia cancer. Although a possible heterogeneity in the pathogenesis and biological behavior of gastric cardia cancer would be present, there was no difference in prognosis.

A Case of Thermal Esophageal Injury Induced by Sodium Picosulfate with Magnesium Citrate

Although thermal esophageal injuries caused by hot food or tea have been reported, thermal esophageal injury due to sodium picosulfate with magnesium citrate (PSMC) used for bowel preparation is rarely reported. We report the case of a 56-year-old man who presented with esophageal injury after ingestion of PSMC. Instead of dissolving the PSMC in water before ingestion, he drank water immediately after swallowing PSMC powder. As soon as he drank water, he developed severe chest pain and hematemesis. Upper endoscopy revealed severe hemorrhagic, ulcerative mucosal change from upper to mid-esophagus. He was hospitalized for nine days, received conservative treatment (fasting and parenteral nutrition), and recovered without complications. When PSMC is used as a colonic cleansing agent, patients should be educated to take it after dissolving it sufficiently in 150 mL of water to avoid esophageal thermal injury.

Serum pepsinogen level and abomasal ulcerations in experimental abomasal displacement in sheep

It is believed that serum pepsinogen levels could be useful for diagnosis of abomasal changes in cattle. Diagnosis of abomasal displacement (AD) is made via invasive and non-invasive techniques. None of the extant methods is a reliable indication of mucosal change. The applicability of serum pepsinogen levels for the diagnosis of changes in the mucous membrane of the abomasum in experimentally induced left and right AD in sheep was investigated in fourteen rams. Abomasal fluid samples were taken and the pH was recorded. Twelve sheep underwent induced left and right AD (six for each group). Two sheep underwent exploratory laparatomy alone to assess the effect of surgical stress on the abomasum. Blood samples were taken before surgery, at the 1^st, 3^rd, 5^th, 7^th, 9^th and 11^th days after surgery and at the time of necropsy and serum pepsinogen levels were measured. After two weeks the animals were slaughtered and abomasal fluid pH and types of abomasal ulcers were recorded. Significant changes in pepsinogen levels in the left displaced abomasums (LDA) group were seen on days 11 and 14 after surgery (P &lt; 0.05). Significant changes in pepsinogen levels in the right displaced abomasum (RDA) group were seen on Days 9, 11 and 14 after surgery (P &lt; 0.05). There was no association among the types of ulcers and the serum pepsinogen levels in AD cases. The pH increased significantly (P &lt; 0.05) after induced AD in both groups. There were no significant changes in serum pepsinogen levels on different days after surgery among ulcerated and non ulcerated cases in both LDA and RDA groups (P &lt; 0.05). Serum pepsinogen levels were significantly higher in AD groups. There was no association between the types of ulcers and serum pepsinogen levels in AD cases. It seems that the increase in concentration of serum pepsinogen is a good reflection of the damage to the abomasal mucousa due to AD, as was shown by the earlier increase in levels in the course of displacement in the RDA group.

Paradoxical Nasal Obstruction: Analysis of Characteristics using Acoustic Rhinometry

Background The aim of this study was to determine the characteristics of acoustic rhinometric parameters in patients with paradoxical nasal obstruction. Methods The medical records of 1844 patients who had nasal septal deviation between 1998 and 2004 at our institute were assessed retrospectively. The authors selected 31 subjects for the experimental group and 256 subjects for the control group. Minimal cross-sectional area (MCA), volume, and degree of mucosal change at baseline and decongested phase were analyzed. Results MCA of the convex side in the baseline state for the experimental (paradoxical) group is wider than that for the control group (p = 0.005). Degree of mucosal change of the experimental group is smaller than that of the control group in the convex side (p = 0.001). Other parameters are similar for the two groups. Conclusion Patients with paradoxical nasal obstruction might be explained by less degree of mucosal change in the concave side of the nasal cavity during nasal cycle than the control group.