The prevalence of proximal third gastric carcinoma increases rapidly in the Western world. An analysis of prognostic factors indicates that the poor prognosis usually associated with these tumors is due at least in part to late presentation and advanced tumor stages. The current TNM classification usually understages these tumors because it does not take the partly retroperitoneal location of the proximal stomach into account. After correction of the TNM classification a proximal tumor location has no influence on survival. Because these tumors benefit most from radical lymph node dissection, the retroperitoneal lymphatic drainage must be taken into account when performing lymphadenectomy for proximal third gastric cancer. To avoid pancreatic fistulas and the associated morbidity, a pancreas-preserving splenectomy and lymphadenectomy should be adapted if an extended lymph node resection of the retroperitoneum is performed. Because of the high prevalence of "intestinal type" tumors in the proximal third of the stomach the extent of the luminal resection margins can be limited; that is, a total gastrectomy with transhiatal resection of the distal esophagus usually suffices to achieve complete tumor removal at the oral margin.

Aged↗

PubMedDate not supplied

Site of coronary sinus drainage does not significantly affect coronary flow reserve in patients long term after Fontan operation.

This study was designed to investigate the impact of postoperative coronary sinus drainage pressure on coronary flow reserve (CFR) assessed by Doppler guidewire in patients long term after Fontan operation. Twenty-nine patients (median age, 17.4 years female, 11) at a median of 10.6 years after Fontan operation were examined with intracoronary Doppler guidewire during cardiac catheterization. Fourteen patients had coronary sinus (CS) drainage to the systemic venous atrium and 15 patients had CS drainage to the pulmonary venous atrium after Fontan operation. Median CS drainage pressure was significantly higher in systemic venous CS drainage compared to pulmonary venous CS drainage (11 vs 5 mmHg, p < 0.0001). Median CFR values for the right and left coronary artery did not differ significantly with respect to CS drainage. There was a positive correlation between coronary flow reserve and pulmonary arteriolar resistance (p < 0.05) in multivariate regression analysis. The site of coronary drainage into the systemic atrium or the pulmonary venous atrium did not significantly affect CFR. Our data do not support a surgical strategy of elective redirection of coronary sinus blood to a low-pressure compartment but support an early staged approach. The positive correlation between CFR and pulmonary resistance demands further evaluation.

Adolescent↗

PubMedDate not supplied

Glucose-monitoring with continuous subcutaneous microdialysis in neonatal diabetes mellitus.

BACKGROUND: Neonatal diabetes mellitus can be extremely brittle. In this situation close glucose monitoring is essential for adequate insulin treatment. Continuous subcutaneous microdialysis is a promising approach for the babies to reduce the painful stress caused by diagnostic blood sampling. The goal of this study was to evaluate the feasibility of continuous subcutaneous microdialysis for glucose monitoring in a baby with neonatal diabetes and to assess the correlation between the blood and the subcutaneous glucose profile. PATIENT AND METHOD: During a period of seven days glucose monitoring was performed on a six month old infant with neonatal diabetes mellitus. In addition to frequent capillary blood glucose determinations, a continuous subcutaneous microdialysis device was used for the detection of the subcutaneous interstitial glucose concentration. RESULTS: Subcutaneous tissue glucose concentrations were measured in a wide range from 1.7 to 23.8 mM. Variations in the adipose tissue glucose concentration closely paralleled changes in the capillary blood glucose. Based on 104 reference pairs there was a high overall correlation (r = 0.89) between the subcutaneous interstitial tissue (X) and the blood (Y) glucose concentration (Y = 1.1 X + 0.29). However the glucose profiles demonstrated a considerable variation of the time lag, up to one hour, between blood and subcutaneous interstitial glucose concentration. CONCLUSIONS: Continuous subcutaneous microdialysis helps the glucose monitoring of infants with diabetes mellitus by providing additional informations about the rise and fall of the glucose concentration. Further studies should focus on how to get a tighter link between blood glucose and the subcutaneous interstitial glucose concentration in the area around the microdialysis probe. Thus monitoring the subcutaneous interstitial glucose concentration will become a reliable procedure for real-time glucose monitoring.

Blood Glucose↗

PubMedDate not supplied

[Influence on load transfer of different femoral neck endoprostheses].

AIM: Aiming to reduce known complications of stemmed implants, such as resorptive bone remodeling or bone damage in revision, implants with only epi-metaphyseal anchorage have been developed. In the following study the influence of three different femoral neck endoprostheses, CUT, CIGAR (ESKA Implants Lübeck) and TPP (SulzerMedica) on the postoperative load transfer to the femur was investigated in comparison to a cementless hip stem. METHODS: Using a composite femur model and photoelastic coating technique, the pre- and postoperative osseous strain was measured under static loading. The load corresponded to the absolute maximum of the hip joint load during walking. Statistical analysis was based on the interval of 99 % confidence which was generated by the preoperative measurements. RESULTS: The different anchorage concepts of the femoral neck endoprostheses exhibited a significant influence on the load transfer, especially along the medial and lateral cortical bone. But, in comparison, the cementless hip stem caused more pronounced stress-shielding which can induce resorptive bone remodelling. CONCLUSION: One specific femoral neck anchorage concept led to a change from preoperative tension to postoperative compression at the lateral cortical bone. This regionally limited effect may influence in the mid- or long-term the local bone remodeling in a negative manner.

Cementation↗

PubMedDate not supplied

Fixation of testicular tissue for immunohistochemical and ultrastructural examination.

The fixation of testicular tissue with glutardialdehyde destroys the antigenicity of cell epitopes in many cases. To obtain both, morphological and immunohistochemical examination, a fixation which could preserve the antigenicity and condition of the testicular structure was sought. The solution obtained was a mixture of 3.7% formalin with 0.2% glutardialdehyde and 0.05% saponin in a phosphate buffer of pH 7.4. Blocks of human tests were immersed in this fixative, embedded in Epon 812 or paraffin for conventional light and electron microscopy and immunohistochemical staining. The immunohistochemical examination was focused on the lamina propria of the human seminiferous tubules. Good preservation of the structure was observed both in light and electron microscopy. Cytological details were seen by light microscopy, especially the recognition of single tumour cells. Electron microscopically, all cells of the seminiferous tubules and the lamina propria showed a well-preserved internal structure. At the same time the peritubular cells of the lamina propria exhibited a well-expressed vimentin and desmin immunoreactivity, thus providing evidence that the corresponding epitopes retain their antigenicity under these fixation conditions. The applied fixation procedure provides comparable results in preservation of the structure to glutardialdehyde but does not destroy the antigenicity of epitopes.

Acetates↗

PubMedDate not supplied

The role of surgery in the treatment of liver metastases for colorectal cancer patients.

BACKGROUND/AIMS: Liver metastases deriving from colorectal cancer can be treated with curative intention in a select number of patients. Controversy does, however, persist pertaining to the impact of adjuvant treatment strategies. The aim of this study is to elucidate upon the various treatment modalities for patients suffering from liver metastases of colorectal primary tumor as well as to provide a rationale for surgical and adjuvant treatment. METHODOLOGY: From November 1987 to September 1998, a total of 449 consecutive patients suffering from liver metastases deriving from a colorectal cancer were documented at our institution in a prolective study. Prognostic factors providing the most beneficial outcome (whether with surgical and/or adjuvant treatment modalities) were analyzed by univariate and multivariate analysis. RESULTS: Whenever possible, curative (R0) surgical resection of colorectal liver metastases provides the most benefit to the patient. Multivariate analysis revealed tumor infiltration of the lymph nodes of the hepatoduodenal ligament and metachronous occurrence of liver metastases as most independent factors related to survival. CONCLUSIONS: Adjuvant post-operative chemotherapy fails to significantly improve survival following resection of liver metastases when compared to the liver resection only group. In patients with unresectable metastases, regional arterial chemotherapy did not improve survival significantly when compared with systemic chemotherapy.

Adult↗

PubMedDate not supplied

New aspects of prognostic factors in adenocarcinomas of the small bowel.

BACKGROUND/AIMS: Primary small bowel tumors are rare and the prognosis is generally considered to be poor. Histologically chiefly adenocarcinomas are reported. The surgeon is challenged in their treatment, because of the infrequency, unspecific symptoms and delay in diagnosis. Retrospectively we investigated the surgical therapy, combined morbidity, survival rates and prognostic factors in a large series of primary adenocarcinomas of the small bowel at a single surgical center. METHODOLOGY: Between 1985 and 1998, 94 patients with a primary tumors of the small bowel (malignant n = 62 [65.9%], benign n = 32 [34.1%]) were operated on. The subgroup of the adenocarcinomas (n = 22) were considered for this study. RESULTS: The median follow-up is 8.4 years (range: 0.9-14.2 years). Sixteen patients had a follow-up more than 5 years. The main surgical procedure was a small bowel segment resection. Morbidity was 13.6% (only in patients with a duodenal tumors) and the 30-day mortality 5.6%. The estimated 2-year-survival rate was 66%, the 5-year-survival rate 45%. Univariate analysis identified the presence of the residual tumor (R-status) (P = 0.004), tumor stage according to the UICC (P = 0.01), lymph node metastasis (P = 0.007), distant metastasis (P = 0.001), lymphangiosis carcinomatosa (P = 0.001) and vascular invasion (P = 0.0008) as prognostic factors. CONCLUSIONS: A complete macroscopic and microscopic tumor resection including a systemic lymph node dissection has to be the aim of any curative surgical approach in patients with adenocarcinoma of the small bowel.

Adenocarcinoma↗

PubMedDate not supplied

Platelet-activating factor-induced coronary constriction in the isolated perfused guinea pig heart and antagonistic effects of the PAF antagonist WEB 2086.

Platelet-activating factor (PAF) has been called an important mediator of cardiovascular shock due to immunological reactions including anaphylaxis and endotoxic reactions. According to previous reports, PAF dose-dependently decreases ventricular contractility and coronary flow rates. Diverse mechanisms of the PAF-induced cardiodepressive effects have been postulated. Besides direct receptor stimulation, the release of other vasoactive mediators such as the eicosanoids has been reported. In this study, an attempt was made to characterize the direct PAF effects on the coronary circulation of the isolated constant pressure perfused guinea pig heart. A further objective was to evaluate whether PAF releases the potent vasoconstrictor thromboxane A2 in biologically relevant amounts. A continuous intracoronary infusion of the selective PAF antagonist WEB 2086 (3.7 x 10(-9) mol/min and 1.1 x 10(-7) mol/min, related to coronary flow rates of 1 ml/min) induced a dose-dependent vasodilation resulting in final perfusate concentrations of 2.5 x 10(-6) mol/l and 5.5 x 10(-5) mol/l, respectively. An intracoronary bolus injection of PAF in a submaximal dose (2.3 x 10(-10) mol, related to coronary flow rates of 1 ml/min) markedly decreased coronary flow rates and produced a significant increase in immunoreactive thromboxane B2 levels in the coronary effluent. WEB 2086 antagonized the PAF-induced coronary constriction in a dose-dependent manner. In addition, thromboxane release ceased entirely. In contrast, the selective thromboxane A2 receptor antagonist BM 13505 (0.9 x 10(-4) mol/1) attenuated the initial phase of coronary constriction only moderately. It is therefore concluded that the detected thromboxane release plays a subordinate role in the PAF-mediated coronary effects.

Animals↗

PubMedDate not supplied

Cytotoxic effects of hexadecylphosphocholine in neoplastic cell lines including drug-resistant sublines in vitro.

Hexadecylphosphocholine (HPC) was tested in comparison with the membrane-toxic reference ether lipid ET-18-OCH3 for cytotoxic (trypan blue dye exclusion) and cytostatic/antiproliferative [( 3H]thymidine uptake) activity in six cell lines of human hematologic malignancies, six cell lines of human solid tumors and four drug-resistant sublines and their respective non-resistant parent lines in vitro. HPC showed time- and dose-dependent antiproliferative and cytotoxic activity in almost all cell lines, including drug-resistant sublines over a dose range of 2-120 microM and after incubation times of 24, 48 and 72 h. However, ET-18-OCH3 showed a significantly higher activity than HPC, when both compounds were compared on an equimolar basis. The human tumor clonogenic assay confirmed these results. Furthermore, no cross-resistance for HPC with colchicine or methotrexate and partial cross-resistance for HPC with adriamycin was found in cell lines selected for drug resistance. In conclusion, HPC is cytotoxic for neoplastic cells of different histologies including drug-resistant sublines in vitro. Although its cytotoxicity starts at somewhat higher doses when compared to ET-18-OCH3, further testing as an experimental anticancer drug in vivo and comparative cytotoxicity studies with hematopoietic progenitor cells from bone marrow are recommended.

Antineoplastic Agents↗

PubMedDate not supplied

Influence of phase I early clinical trials on the quality of life of cancer patients. A pilot study.

A non-randomized, prospective, two-arm pilot study was conducted to assess the impact of clinical phase I trials with new cytotoxic drugs on the quality of life (QOL) of cancer patients, comparing a 10-item linear analog self-assessment (LASA) and Karnofsky performance scale (KPS) of 18 patients treated in phase I protocols versus 8 patients treated with standard/low efficacy cytotoxic or endocrine 1-2 drug regimens. There was no negative significant influence of treatment in phase I protocols either on LASA and KPS at the times before, during and after study or on changes (delta LASA, delta KPS) occurring with treatment. On the contrary, there was a slight positive influence of treatment within phase I protocols on self-assessed social activity (delta LASA) and on delta KPS when the groups were compared throughout the complete observation period. In addition, within the total study population there was significant positive influence of overall anticancer medication on psychological and social aspects of LASA, as indicated by feeling of well being, mood, level of activity and level of anxiety. Moreover, KPS and questions regarding appetite within LASA correlated with prognosis as measured by survival time, and intra-individual response comparison revealed the dominance of a differentiated reliable response type among our patients.

Activities of Daily Living↗

PubMedDate not supplied

[The significance of malformations for fetal and infant mortality].

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Congenital Abnormalities↗