Leaves on this Family Tree

Friday, February 12, 2016

Surgery D-Day +18 and Staples Came Out

We have snow. Leaving the hospital Buffalo was messy. Next is the Village of Kenmore, it was almost spotless from the snow removal. Then the Town of Tonawanda was crappy but Tonawanda was good until I turned on our street. Looked like it might have been plowed at noon :(  Usually our street is one of the first really clean streets. Maybe they are expecting more tonight and are waiting.

As you can tell from the pictures the staples came out today. They took out every other one then put steri strips where they had been and remove the rest and strip them. They said this way the incision doesn't pop open :)  Most came out smooth as silk, a couple made him grimace and the last one, well, the one they tried and left until last took three nurses
trying to remove it. They said it was twisted so it made it harder.

Glimpses of home: Dr Kukar wants to talk to the Infectious Disease doctor to find out what type of antibiotics to send home with Gene. He also wants a CATScan for a last look at the liquid in his abdomen . . . the left drain is back to barely anything coming our but the two right ones are draining as good as ever.

We also will need to have our "going home conference" with the nutritionist. Hopefully that will be a day or two before he leaves so I can do a grocery run for some basics to start out with.

I got him on the list to get a visit from Murphy, the Portuguese Water Dog, who is the Therapy Dog, on Monday. I think that will be pretty neat.

Still need to ask the nurses if they can get hold of Physical Therapy and find out when he can walk, legally, without the walker. I think that as long as he has railings to grab onto he should be find. And his legs aren't weak at all, so I am perplexed. (WOW, now THAT was a $0.50 word!)

Thursday, February 11, 2016

Adenocarcinoma and The Whipple Procedure (Pancreaticoduodenectomy)

Gene was diagnosed with a Malignant Adenocarcinoma of the Duodenum.

Since most of the sites that talk about this and "The Whipple Procedure" which was the operation he had to remove the cancer talk above my language level, I am copying info from Wikipedia.

Adenocarcinoma[1] (/ˌædnkɑːrsˈnmə/; plural adenocarcinomas oradenocarcinomata /ˌædnkɑːrsˈnmtə/) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandularorigin, glandular characteristics, or both. Adenocarcinomas are part of the larger grouping ofcarcinomas, but are also sometimes called by more precise terms omitting the word, where these exist. Thus invasive ductal carcinoma, the most common form of breast cancer, is adenocarcinoma but does not use the term in its name—however, esophageal adenocarcinoma does to distinguish it from the other common type of esophageal cancer, esophageal squamous cell carcinoma. Several of the most common forms of cancer are adenocarcinomas, and the various sorts of adenocarcinoma vary greatly in all their aspects, so that few useful generalizations can be made about them.

In the most specific usage (narrowest sense), the glandular origin or traits are exocrine;endocrine gland tumors, such as a VIPoma, an insulinoma, or a pheochromocytoma, are typically not referred to as adenocarcinomas but rather are often called neuroendocrine tumors. Epithelial tissue sometimes includes, but is not limited to, the surface layer of skin, glands, and a variety of other tissue that lines the cavities and organs of the body. Epithelial tissue can be derived embryologically from any of the germ layers (ectodermendoderm, ormesoderm). To be classified as adenocarcinoma, the cells do not necessarily need to be part of a gland, as long as they have secretory properties. Adenocarcinoma is the malignant counterpart to adenoma, which is the benignform of such tumors. Sometimes adenomas transform into adenocarcinomas, but most do not.


Etymology The term adenocarcinoma is derived from adeno-, meaning "pertaining to a gland", and carcinoma, which describes a cancer that has developed in the epithelial cells


Source: https://en.wikipedia.org/wiki/Adenocarcinoma


Pancreaticoduodenectomy - Whipple Procedure
pancreaticoduodenectomypancreatoduodenectomy,[1] Whipple procedure, orKausch-Whipple procedure, is a major surgical operation involving the pancreas,duodenum, and other organs. This operation is performed to treat cancerous tumours on the head of the pancreas, malignant tumors involving the common bile ductduodenal papilla, or duodenum near the pancreas, and also some cases of pancreatitis with or without a definitive cause.



Anatomy Involved in the Procedure
The most common technique of a pancreaticoduodenectomy consists of the en bloc removal of the distal segment (antrum) of the stomach, the first and second portions of the duodenum, the head of the pancreas, the common bile duct, and the gallbladder.
The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply (the gastroduodenal artery). These arteries run through the head of the pancreas, so that both organs must be removed if the single blood supply is severed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum, resulting in tissue necrosis.

Medical Uses
The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach (antrectomy), the gall bladder and its cystic duct (cholecystectomy), the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal jejunum, and regional lymph nodes. Reconstruction consists of attaching the pancreas to the jejunum (pancreaticojejunostomy) and attaching the hepatic duct to the jejunum (hepaticojejunostomy) to allow digestive juices and bile respectively to flow into the gastrointestinal tract and attaching the stomach to the jejunum (gastrojejunostomy) to allow food to pass through. Whipple originally used the sequence: bile duct, pancreas and stomach, whereas presently the popular method of reconstruction is pancreas, bile duct and stomach, also known as Child's operation.
Originally performed in a two-step process, Whipple refined his technique in 1940 into a one-step operation. Using modern operating techniques, mortality from a Whipple procedure is around 5% in the United States (less than 2% in high-volume academic centers).

History
This procedure was originally described by Alessandro Codivilla, an Italian surgeon, in 1898. The first resection for a periampullary cancer was performed by the German surgeon Walther Kausch in 1909 and described by him in 1912. It is often called Whipple's procedure or the Whipple procedure, after the American surgeon Allen Whipple who devised an improved version of the surgery in 1935[12] and subsequently came up with multiple refinements to his technique.
Source: https://en.wikipedia.org/wiki/Pancreaticoduodenectomy