Retrograde jejunojejunogastric intussusception.
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Aged↗
Biomedical subjects
Kent-Man Chu
Publications and source records attributed to Kent-Man Chu.
A prospective evaluation of catheter probe EUS for the detection of ascites in patients with gastric carcinoma.
BACKGROUND: Gastric carcinoma is known for its propensity to spread to the peritoneum. This study assessed the value of EUS in the detection of ascites not visible on CT in patients with gastric carcinoma. METHODS: A total of 402 consecutive patients with histopathologically confirmed gastric adenocarcinoma underwent catheter-probe EUS. The accuracy of catheter-probe EUS in the detection of ascites was compared with subsequent findings at laparoscopy or laparotomy. RESULTS: There was a slight predominance of men in the study population (M:F=1.6:1). Mean patient age was 65.4+/-0.7 years. Ascites was noted by catheter-probe EUS in 36 patients (9.0%). There was no procedure-related morbidity or mortality. Ascites and peritoneal seeding subsequently were found in, respectively, 56 (13.9%) and 66 (16.4%) patients. The finding of ascites by EUS was significantly related to the presence of peritoneal seeding (p<0.001). The sensitivity, specificity, and positive and negative predictive values of EUS in the detection of ascites were, respectively, 60.7%, 99.4%, 94.4%, and 94.0%. The positive and negative likelihood ratios were, respectively, 105.0: 95% CI[26, 425] and 0.40: 95% CI[0.29, 0.55]. CONCLUSIONS: EUS is useful for the detection of ascites in patients with gastric carcinoma.
Adenocarcinoma↗
Expression profiling identifies chemokine (C-C motif) ligand 18 as an independent prognostic indicator in gastric cancer.
BACKGROUND & AIMS: Gastric cancer is one of the major cancers worldwide. Expression profiling has proven useful in delineating novel prognostic markers in various cancer types. We previously analyzed gene-expression patterns in 90 gastric adenocarcinomas by using complementary DNA microarrays and prioritized a list of genes whose expression levels predict patient outcome. METHODS: We identified a specific gene of interest, chemokine (C-C motif) ligand 18 (CCL18), on the basis of a high absolute standardized log Cox hazard ratio, a high variance in expression among all tumor samples, and putative biologic function. Detailed analysis of CCL18 expression with clinicopathologic and survival data was performed (n = 89). Quantitative reverse-transcription polymerase chain reaction was used to verify the microarray expression data and was further applied to analyze an independent cohort of tumor samples (n = 59). The cellular source of CCL18 was determined with immunohistochemistry and in situ hybridization. RESULTS: High CCL18 expression levels were associated with prolonged overall (P = 0.001; hazard ratio, 0.586) and disease-free (P = 0.002; hazard ratio, 0.416) patient survival in the array-based data set by univariate analysis. The observations were confirmed in an independent set of 59 patients by using quantitative reverse-transcription polymerase chain reaction. In multivariate analysis, tumor stage and CCL18 levels were independent prognostic factors for predicting both overall and disease-free survival. We found that CCL18 was expressed by a subpopulation of tumor-associated macrophages that were preferentially located at the tumor invasion front. CONCLUSIONS: Macrophage-derived CCL18 may function as a local antitumor immunomodulator that affects patient outcome. Our study suggests CCL18 as a novel candidate for antitumor therapeutics and risk stratification in gastric cancer patients.
Adenocarcinoma↗
Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer.
OBJECTIVE: This study aimed at: (1) documenting the evolution of surgical results of esophagectomy in a high-volume center, (2) identifying predictive factors of pulmonary complications and mortality, and (3) examining whether preoperative chemoradiation therapy would complicate postoperative recovery. SUMMARY BACKGROUND DATA: Pulmonary complications and mortality rate after esophagectomy remain substantial, and factors responsible have not been adequately studied. Neoadjuvant chemoradiation is widely used; it is hypothesized that this may lead to adverse postoperative outcome. METHODS: Prospectively collected data were used to analyze outcome in 421 patients with intrathoracic squamous cell esophageal cancer who underwent resection. Logistic regression analyses determined independent predictors of pulmonary complications and death. Two time periods were compared: period I (January 1990 to June 1995) and period II (July 1995 to December 2001). In the later period, neoadjuvant chemoradiation therapy was introduced. RESULTS: Transthoracic resections were carried out in 83% of patients. Neoadjuvant chemoradiation was given to 42% of patients in period II. Major pulmonary complications occurred in 15.9%, and were primarily responsible for 55% of hospital deaths. Thirty-day and hospital mortality rates were 1.4% and 4.8%, respectively. Logistic regression analysis identified age, operation duration, and proximal tumor location as risk factors for pulmonary complications, whereas advanced age and higher blood loss were predictive of mortality. Chemoradiation did not lead to worse outcome. When period I and II were compared, hospital mortality rate reduced from 7.8% to 1.1%, P = 0.001, with correspondingly less blood loss (median blood loss was 700 ml (range: 200-2700 (period I) and 450 ml (range: 100-7000) (period II), P < 0.01). CONCLUSION: A 1.1% mortality rate was achieved in the last 6 years of the study period. Preoperative chemoradiation did not result in worse outcome. Reduction in mortality rate correlated with decreased blood loss.
Aged↗
Pleural drainage after transthoracic esophagectomy: experience with a vacuum system.
Conventional pleural cavity drainage after esophagectomy involves one to two large-bore drainage tubes connected to underwater bottles. The purpose of this study is to evaluate the use of a small mobile vacuum drainage system. Out of 173 patients who underwent transthoracic esophagectomy, 167 (97%) had the vacuum drain successfully placed at the end of the operation. Of those, use of the vacuum drain was uneventful for 131 until its removal (78%). Air leaks necessitating connection to underwater drainage occurred in 34 patients (20%), but in 26 of them this was only temporary. Overall success was therefore achieved in 157 patients (94%). Median in-situ placement of the vacuum drain was 4 days, and 85% of patients had their drains removed by the seventh postoperative day. The presence of lung adhesions significantly increased the need for underwater drainage. Postoperative outcomes were no different from a historical cohort with conventional underwater drainage. No drain-related complications were reported. The vacuum drain is an alternative to the conventional, large-bore, chest tube system after transthoracic esophagectomy.
Adult↗
Multiple BCL6 translocation partners in individual cases of gastric lymphoma.
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DNA-Binding Proteins↗
Soluble E-cadherin is an independent pretherapeutic factor for long-term survival in gastric cancer.
PURPOSE: To evaluate whether pretherapeutic serum soluble E-cadherin is an independent factor predicting long-term survival in gastric cancer. Gastric cancer remains the second leading cause of cancer-related deaths in the world, but a satisfactory tumor marker is currently unavailable for gastric cancer. Soluble E-cadherin has recently been found to have prognostic value in gastric cancer. PATIENTS AND METHODS: One hundred sixteen patients with histologically proven gastric adenocarcinoma were included in the trial. Pretherapeutic serum was collected, and soluble E-cadherin was assayed using a commercially available enzyme-linked immunosorbent assay kit. The patients were followed up prospectively at the outpatient clinic. RESULTS: There were 75 men and 41 women, with a mean (+/- SD) age of 66 +/- 14 years. Forty-eight percent of tumors were located in the gastric antrum. The median survival time was 11 months. The mean pretherapeutic value of soluble E-cadherin was 9,159 ng/mL (range, 6,002 to 10,025 ng/mL), and the mean pretherapeutic level of carcinoembryonic antigen was 11 ng/mL (range, 0.3 to 4,895 ng/mL). On multivariate analysis, soluble E-cadherin is an independent factor predicting long-term survival. Ninety percent of patients with a serum level of E-cadherin greater than 10,000 ng/mL had a survival time of less than 3 years (P =.009). CONCLUSION: Soluble E-cadherin is a potentially valuable pretherapeutic prognostic factor in patients with gastric cancer.
Adenocarcinoma↗
Variation in gene expression patterns in human gastric cancers.
Gastric cancer is the world's second most common cause of cancer death. We analyzed gene expression patterns in 90 primary gastric cancers, 14 metastatic gastric cancers, and 22 nonneoplastic gastric tissues, using cDNA microarrays representing approximately 30,300 genes. Gastric cancers were distinguished from nonneoplastic gastric tissues by characteristic differences in their gene expression patterns. We found a diversity of gene expression patterns in gastric cancer, reflecting variation in intrinsic properties of tumor and normal cells and variation in the cellular composition of these complex tissues. We identified several genes whose expression levels were significantly correlated with patient survival. The variations in gene expression patterns among cancers in different patients suggest differences in pathogenetic pathways and potential therapeutic strategies.
Adenocarcinoma↗
Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality.
OBJECTIVE: Postoperative atrial fibrillation complicates recovery in 20% to 25% of patients after esophagectomy for cancer. The purpose of this study is to understand this phenomenon. METHODS: Between 1982 and 2000, 198 (22% of 921) patients had postoperative atrial fibrillation after esophagectomy. Propensity scoring and the Greedy Match algorithm were used to develop a cohort of control patients for statistical comparisons. One hundred forty-four patients who had postoperative atrial fibrillation were matched. RESULTS: Pulmonary complications affected 42% of patients in the atrial fibrillation group compared with 17% in the control group (P <.001). Anastomotic leakage was more common in the atrial fibrillation group (6.9% vs 1.4%, P =.035). Surgical sepsis migrated with atrial fibrillation 4 times more frequently (P =.001). Multivariate analysis demonstrated that postoperative pulmonary complications (odds ratio, 2.5; 95% confidence interval, 1.42-4.3) and surgical sepsis (odds ratio, 3.4; 95% confidence interval, 1.2-9.6) were associated with postoperative atrial fibrillation. The mortality rates of the atrial fibrillation and control groups were 23% and 6.3%, respectively (P <.001). Median survival, excluding hospital deaths, was not different at 14.5 months (atrial fibrillation group) and 16.9 months (control group; P =.4). CONCLUSION: Atrial fibrillation is a surrogate for surgical morbidity and mortality after esophagectomy. The occurrence of atrial fibrillation after esophageal resection should prompt not only the appropriate management of the arrhythmia but also a search for a more ominous underlying cause.
Aged↗
Pyeloduodenocolic fistula.
A 75-year-old man presented with epigastric pain and melaena. Multiple right renal stones were seen on abdominal X-ray. Computed tomography of the abdomen and oesophagogastroduodenoscopy revealed features of a pyeloduodenal fistula. Elective surgery was planned but the patient developed torrential bleeding with shock. Emergency laparotomy revealed a necrotic right kidney with a pyeloduodenocolic fistula. This report is the first of a pyeloduodenocolic fistula caused by squamous cell carcinoma of the renal pelvis. We review the literature and discuss the aetiologies, clinical presentations, diagnosis, and treatment of pyeloduodenal fistula.
Abdominal Pain↗
Acute appendicitis presenting with distal duodenal obstruction.
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Acute Disease↗
Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy.
OBJECTIVE: To identify prognostic factors and reasons for improved survival over time in patients with esophageal cancer. SUMMARY BACKGROUND DATA: Management strategies for esophageal cancer have evolved with time. The impact of chemoradiation in the overall treatment results has not been adequately studied. METHODS: From 1990 to 2000, 399 (62.4%) of 639 patients with intrathoracic squamous cancers underwent resection. Two study periods were analyzed: period I (01/1990-06/1995), and period II (07/1995-12/2000); during period II, chemoradiation was introduced. Prognostic factors were identified by multivariate analysis and the 2 periods compared. RESULTS: Hospital mortality rate after resection decreased from 7.8% to 1.2%, P = 0.002. Five favorable prognostic factors were identified: female gender (female vs. male, HR = 0.66), infracarinal tumor location (infra vs. supra-carinal, HR = 0.63), low pTNM stage (III/IV vs. 0/I/II/T0N1, HR = 1.76), pM0 stage (M1a/b vs. M0, HR = 1.56), and R0 category (R1/2 vs. R0, HR = 2.49). Median survival was 15.8 and 25.6 months in periods I and II, respectively, P = 0.02. More R0 resections were evident in period II, being possible in 63% (period I) and 79% (period II) of patients, P = 0.001. This was attributed to tumor downstaging by chemoradiation and more stringent patient selection for resection in period II. Performing less R1/2 resections in period II coincided with using primary chemoradiation in treating advanced tumors. In patients treated without resection, survival also improved from 3 (period I) to 5.8 months (period II), P < 0.01. CONCLUSIONS: Survival has improved; chemoradiation enabled better patient selection for curative resections and also resulted in more R0 resections by tumor downstaging. This treatment strategy led to overall better outcome for the whole patient cohort, even in those treated by nonsurgical means.
Antineoplastic Agents↗
The Kirschner operation in unresectable esophageal cancer: current application.
HYPOTHESIS: With the introduction of safe, effective nonoperative alternatives, bypass surgery for unresectable esophageal cancer is infrequently performed, but it has a limited role in palliation of esophageal cancer that needs to be defined. DESIGN: Retrospective cohort study. SETTING: Department of Surgery at Queen Mary Hospital in Hong Kong. PATIENTS: Patients who had unresectable esophageal cancer and underwent bypass surgery between January 1, 1991, and December 31, 1998. INTERVENTION: Bypass procedures were performed using a gastric or colonic conduit to the neck. MAIN OUTCOME MEASURES: Morbidity and mortality and quality of palliation. RESULTS: Thirty-eight patients underwent retrosternal bypass to the neck using a gastric (n = 27) or colonic (n = 11) conduit. Ten patients (26%) underwent unplanned bypass at the time of exploration for resection because of unexpected findings of T4 disease (n = 2) or technical difficulties in addition to advanced disease (n = 8). Between 1991 and 1994, 1 of 26 bypasses was unplanned and the hospital mortality was 42% (11/26), while between 1995 and 1998, 9 of 12 bypasses were unplanned and the hospital mortality was 8% (1/12). There were 12 hospital deaths in the planned bypass group (n = 28) and none in the unplanned bypass (n = 10) group (43% vs 0%, P =.01). The median survival in patients who underwent unplanned bypass was 6.9 months, compared with 1.9 months in patients who underwent planned bypass (P =.004). All patients were discharged from the hospital on at least a semisolid diet. CONCLUSIONS: The Kirschner operation is largely obsolete as a planned procedure because of high morbidity and mortality. Bypass surgery, however, is a reasonable option as an unplanned procedure when resection is precluded at the time of exploration because of unexpected adverse operative findings.
Adenocarcinoma↗
Iatrogenic Chilaiditi's syndrome.
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Aged↗
Specialized intestinal metaplasia and carditis at the gastroesophageal junction in Chinese patients undergoing endoscopy.
OBJECTIVE: Specialized intestinal metaplasia (SIM) is often found at a normal-looking gastroesophageal junction on routine biopsy. The prevalence of SIM in Asian populations has not been recorded. Its significance is also unclear. The objective of the study was to document the prevalence of SIM at the gastroesophageal junction in a Chinese population undergoing endoscopy. METHODS: Biopsies were taken at the gastroesophageal junction in 145 patients, both at the squamocolumnar junction and immediately below in the gastric cardia. Specimens were examined for the type of epithelium (squamous, cardiac, and fundic), the presence of SIM, and Helicobacter pylori (H. pylori). RESULTS: Of 145 patients who underwent endoscopy, 136 had a normal-looking gastroesophageal junction. Cardiac epithelium was found in 100 patients. Of these 100 patients, SIM was documented in 34% of patients and carditis in 20%. Patients with SIM were older compared with those without SIM (mean age 62 yr and 56 yr, p = 0.035). Carditis was more prevalent in patients with SIM. It was present in 11 out of 34 patients who had SIM (32.4%) compared with nine in 66 patients (13.6%) without SIM, p = 0.036. When carditis was found, H. pylori was present at the cardia in 40% of patients (eight of 20) compared with only 18% (14 of 80) in those without carditis, p = 0.039. CONCLUSIONS: SIM is prevalent at the gastroesophageal junction in Chinese patients undergoing endoscopy and is associated with carditis. Carditis in turn may be related to H. pylori infection.
Adult↗