We combined endoscopic submucosal dissection (ESD) and sentinel node navigation surgery with the purpose of achieving complete resection of early gastric cancer while preserving the organ and assessing pathological nodal status. A total of 13 patients with cT1( ≤ 3 cm)N0 early gastric cancer underwent combined ESD and sentinel node navigation surgery (ESN) at a single tertiary referral center. Sentinel node navigation surgery using indocyanine green was performed during ESD and all suspected sentinel nodes were removed laparoscopically and examined intraoperatively. ESN was converted to gastrectomy with D2 dissection if there was evidence of metastasis on frozen section. ESN was completed in 12 patients and in 1 patient was converted to gastrectomy after sentinel node navigation surgery. En bloc tumor resection was achieved in all cases. Two patients underwent additional gastrectomy because they had tumor-positive vertical margins. In all cases ESN was conducted without intraoperative or postoperative adverse events. ESN is a feasible minimally invasive procedure that allows en bloc tumor resection to be achieved while assessing the pathological status of the lymph nodes.
This chapter quantitatively analyzed the biokinetic models of iodine thyroid and the gastrointestinal tract (GI tract) using MATLAB software. Biokinetic models are widely used to analyze the internally absorbed dose of radiation in patients who have undergone a nuclear medical examination, or to estimate the dose of I-131 radionuclide that is absorbed by a critical organ in patients who have undergone radiotherapy (ICRP-30, 1978). In the specific biokinetic model, human organs or tissues are grouped into many compartments to perform calculations. The defined compartments vary considerably among models, because each model is developed to elucidate a unique function of the human metabolic system. The solutions to the time-dependent simultaneous differential equations that are associated with both the iodine and the GI tract model, obtained using the MATLAB default programming feature, yield much medical information, because the calculations that are made using these equations provide not only the precise time-dependent quantities of the radionuclides in each compartment in the biokinetic model but also a theoretical basis for estimating the dose absorbed by each compartment. The results obtained using both biokinetic models can help a medical physicist adjust the settings of the measuring instrumentation in the radioactive therapy protocol or the radio-sensitivity of the dose monitoring to increase the accuracy of detection and reduce the uncertainty in practical measurement. In this chapter, MATLAB algorithms are utilized to solve the time-dependent simultaneous differential equations that are associated with two biokinetic models and to define the correlated uncertainties that are related to the calculation. MATLAB is seldom used in the medical field, because the engineering-based definition of the MATLAB parameters reduces its ease of use by unfamiliar researchers. Nevertheless, using MATLAB can greatly accelerate analysis in a practical study. Some firm recommendations concerning future studies on similar topics are presented and a brief conclusion is drawn.
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