Choice of procedure in patients with "acid antrum".
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Congo Red↗
Biomedical subjects
T Popiela
Publications and source records attributed to T Popiela.
The value of modern ultrasonographic techniques and computed tomography in detecting and staging of pancreatic carcinoma.
OBJECTIVE: to assess the clinical value of ultrasonographic methods and computed tomography in diagnosing and staging pancreatic carcinoma. METHODS: prospective clinical trial of 140 patients (64 women and 77 men; mean age 59,6) operated on for pancreatic carcinoma between 2000 and 2004. In each case helical CT, routine-, color- and power Doppler and 3-D USG were performed to detect and stage cancer. Analyses of accuracy, sensitivity, specificity, PPV and NPV of ultrasonographic methods and CT were made. RESULTS: 3-D USG showed the best accuracy of local staging (T): 95.6%. CT was the most accurate in lymph node assessment: 91.3%. The accuracy of CT, 3-D USG and power-Doppler at detecting vascular infiltration was 93.1%. CONCLUSIONS: diagnostic accuracy of modern ultrasound techniques is comparable to helical CT in detecting and staging pancreatic carcinoma. USG is recommended due to the relatively low cost, non-invasiveness and availability of the procedure.
Adult↗
Late complications after antireflux procedures using intraoperative continuous computer-video manometry monitoring.
BACKGROUND: Gastroesophageal Reflux Disease (GERD) is a common non-malignant gastrointestinal disease. The introduction of minimally invasive surgical techniques and the high costs of pharmacotherapy increased the number of patients subjected to surgical antireflux treatment. Furthermore, the use of advanced technique of manometry--including intraoperative video-assisted continuous pressure monitoring--made possible complicated but objective analysis of the pressure profile in the newly created area of gastroesophageal junction. MATERIAL AND METHOD: The current study was conducted in 159 patients. A group consisted of 93 men and 66 women, mean age of 38 years (range 18-72), subjected to antireflux surgery with continuous intraoperative video-assisted manometry of pressure in the newly created gastroesophageal junction (fundoplication wrap). Surgical procedure was individually tailored in each case depending on the motility parameters and GERD etiology. Eighty seven patients (55%) underwent 360 degrees Nissen fundoplication, 17 "floppy" Nissen procedure (11%), 22 Dor hemifundoplication (14%), and 33 Toupet hemifundoplication (21%). RESULTS: Out of the 159 patients subjected to antireflux procedures only 8 (5.0%) developed dysphagia, and 12 (7.5%) recurrent reflux disease. Recurrent reflux symptoms were most frequently caused by the dislocation of the fundoplication wrap. Dysphagia occurred in patients with too tight fundoplication wrap or because of its dislocation with subsequent rotation and angulation that impaired food passage. In some patients objective causes of dysphagia have not been found. In these patients no abnormalities were detected by the postoperative visualising examinations, and mean pressure in the fundoplication wrap did not exceed critical values. In these cases, dysphagia was caused probably by impaired gastric motility. CONCLUSIONS: 1. GERD with multifactor etiology requires individually tailored surgery based on the results of motility studies. 2. Final result depends on appropriate calculations of the intraoperative pressure in the newly created fundoplication wrap. 3. Appropriate fixing of the fundoplication wrap to the diaphragm is very important in order to decrease the rate of GERD recurrences due to wrap dislocation.
Adolescent↗
A clinico-epidemiological study on gastritis in gastric carcinoma and in non-cancerous gastric pathology in Poland.
To investigate the risk of gastric cancer development in subjects with atrophic and nonatrophic gastritis, we studied 221 consecutive gastric cancer patients and 7647 non-cancer subjects for whom endoscopic biopsy of the gastric mucosa was available. In gastritis patients, the relative risk (RR) estimates of gastric cancer were as follows: corpus atrophic gastritis RR = 8.7 (95% CI = 5.4-14.1), antral atrophic gastritis RR = 4.5 (2.4-8.1), chronic atrophic pangastritis RR = 7.6 (3.8-15.3), corpus nonatrophic gastritis RR = 1.6 (0.9-2.7), antral non-atrophic gastritis RR = 1.2 (0.7-2.3), and pangastritis RR = 1.3 (0.6-2.8). The latter was of borderline significance (p = 0.07). In peptic ulcer, a significant excess risk was calculated for subjects with either corpus atrophic gastritis (RR = 3.1 [2.5-3.9] or antral atrophic gastritis (RR = 3.5 [2.6-4.8]). For stomach polyps, the risk was significantly increased only in subjects with corpus atrophic gastritis (RR = 2.1 [1.3-3.5]). The risks for both peptic ulcer and polyps, however, were significantly increased in chronic atrophic pangastritis. A substantial excess risk of gastric cancer was found for atrophy in the corpus (RR = 20.9 [9.0-48.9]) and in the antrum (RR = 14.9 [5.3-41.9]). An increased risk of peptic ulcer was also confirmed in subjects with atrophy in the corpus (RR = 3.0 [1.3-6.9]) and in the antrum (RR = 4.9 [2.0-12.1]).
Adolescent↗
Risk of colorectal cancer from alcohol consumption at lower vitamin intakes. A hospital-based case-control study in Poland.
The purpose of the study was to assess the relation between the simultaneous exposure to alcohol and consumption of micronutrients that have protective properties against colorectal cancer. A hospital-based case-control study of colorectal cancer was carried out between January 1998 and November 1999 at the University Hospital in Krakow, Poland. In total, 180 incident cases of colorectal cancer, confirmed by histopathology, were recruited and an equal number of controls, individually matched by gender and age (+/-5 y), were chosen amongst patients with no history of cancer. A food-frequency questionnaire for 148 food items, combined with the quantity of foods eaten, was used to assess the normal dietary pattern. The data confirmed the reported inverse association between the intake of retinol, thiamine, or antioxidant micronutrients (vitamins C, E) and the occurrence of colorectal cancer. Alcohol intake was found to be an important risk factor for this cancer site, and the risk escalated in parallel with increased intake of retinol, carotene, vitamins C and E, but with high consumption of alcohol ran a noticeably high risk of colorectal cancer (OR= 6.79; 95% CI: 2.08-22.18). The risk was markedly lower, however, among alcohol drinkers who reported a high intake of micronutrients (OR = 1.35; 95% CI: 0.39-4.67). The data suggest that a combination of high consumption of alcohol and low intake of retinol and antioxidant vitamins may considerably increase the risk of colorectal cancer.
Adult↗
Early effects of standard and pylorus-preserving pancreatectomy on myoelectric activity and gastric emptying.
BACKGROUND/AIMS: The main concern about pylorus preserving pancreatectomy (PPP) is delayed gastric emptying (GE). Both cancer and surgical procedures cause damage to the enteric nervous system and induce profound changes in gastric motility and emptying. The aim was to evaluate the effects of primary disease and type of surgical procedure used (standard pancreatoduodenectomy, SP vs. PPP) on myoelectric activity (MA), and solid and liquid GE in pancreatectomy patients. METHODOLOGY: Twenty-eight subjects were included, 18 after Whipple (group A) and 10 after a Traverso (group B) procedure. MA was captured by cutaneous electrodes (Synectics) and simultaneously LGE tested with ultrasonography. On separate days, the SGE of a radiolabelled meal was measured. MA and GE studies were done before and within three months after surgery. RESULTS: Before surgery LGE/SGE were delayed in 5/8 patients in group A and 2/2 in group B. Gastric dysrhythmia was observed in 6 patients in group A and 1 in group B. After PPP, the nasogastric tube was removed within 8.4+/-4.9 days and after SP within 4.6+/-4.1 days. GE studies showed accelerated LGE/SLG in 16/12 and delayed in 6/5 patients, respectively, in group A and B. Dysrhythmia was observed in 16 patients in group A and in 4 in group B. There was a strong relationship between SGE delay and dysrhythmia in patients after PPP. CONCLUSIONS: We conclude that papilla of Vater neoplasia damages mechanisms responsible for gastric emptying to a lesser extent than pancreatic cancer. In patients after PPP, post-operative MA disturbances are partially responsible for delayed GE.
Adolescent↗
Adherence of bile-isolated bacteria to the bile ducts mucosa as a pathogenic factor in the development of inflammatory lesions.
Bacterial infection of the bile system appears to be an important factor in the formation of stones. In view of the hypothesis that strains of E. c. form an essential factor in infections of the bile ducts, an attempt has been made to determine the connection between infections of the bile ducts and the adherence of E. c. to the epithelium of the gallbladder. The research covered 148 patients operated electively for cholecystolithiasis (121), cholecystocholedocholithiasis (26) and recurrent lithiasis (1). In bile collected from the gallbladder in the course of the operation, E. coli strains were isolated. Cholangioscopy performed in 26 patients enabled the macroscopic evaluation and grading of inflammatory lesions of bile duct mucosa. The mucosa of the gallbladder was evaluated histologically. The adherence test was performed using homologous and heterologous strains of E. c. isolated from the bile of gallstone patients. The adherence occurred most frequently in the neck of the gallbladder (71-100%) in those patients in whom an infectious process of the bile ducts mucosa was endoscopically diagnosed. The adherence of bacteria to the epithelium of the gallbladder did not depend on the type of inflammation (acute, chronic).
Bacterial Adhesion↗
IGF-I triple helix strategy in hepatoma treatment.
BACKGROUND/AIMS: To investigate the effect of gene therapy for hepatocellular carcinoma based on inhibition of cellular IGF-I expression, the technique of IGF-I triple helix was investigated in mice developing programmed hepatoma. METHODOLOGY: mhAT1F1 mouse hepatoma cell line was transfected in vitro with IGF-I triple helix expression vector (pMT-AG-TH) or with IGF-I antisense expression vector (pMT-Anti-IGF-I). 10 x 10(6) transfected cells of either triple helix or antisense type were inoculated intraperitonealy into transgenic ATIIITB6 mice developing genetically programmed hepatoma (mice die between the age of 6 and 7 months). In parallel, human cell cultures established from surgically removed hepatomas were investigated. RESULTS: mhAT1F1 and human primary cell cultures, transfected with pMT-AG-TH or pMT-Anti-IGF-I vectors resulted in total inhibition of IGF-I demonstrated by immunocytochemical and Northern blot techniques. Transfected cells changed their phenotype and recovered major histocompatibility complex I expression showed by fluorescence-activated cell sorting analysis and Western blot. Moreover, two phenomena were observed in IGF-I "antisense" or "triple helix" transfected cells: 1) the apoptosis, demonstrated by TUNEL technique; 2) the presence of IL-6 simultaneously with disappearance of tumor necrosis factor-alpha and IL-10, investigated by reverse transcriptase-polymerase chain reaction technique. In in vivo experiments, injection of murine transfected cells into mice in terminal-phase prolonged their survival 3-4 months in 100% of cases, as well in "antisense" group (8/8) as in "triple helix" group (10/10). CONCLUSIONS: Injection of hepatoma cells transfected with IGF-I triple helix expression vector, and showing immunogenic and apoptotic characteristics, can constitute an effective cellular therapy against hepatocellular carcinoma.
Animals↗
Prognostic factors of long-term survival after resective procedures for pancreatic cancer.
BACKGROUND/AIMS: Five-year survival rates following surgical resection of pancreatic cancer reported by the leading medical centers do not exceed 25%. It necessitates further extensive research in this area. The aim of the study was to determine prognostic factors of long-term survival after surgical treatment for pancreatic cancer. METHODOLOGY: From 1980 to 1999, 212 patients underwent surgical resection for pancreatic carcinoma. Statistical analysis of prognostic factors of long-term survival after pancreatic cancer surgery estimated by Kaplan-Meier method was carried out using multiple regression model. RESULTS: A group of 212 patients underwent surgery, where 98 had Whipple's resection, 50 Traverso, 35 total pancreatic resections, 25 left subtotal resections, and the remaining 4 segmental pancreatic body resections. Perioperative mortality was below 8%, 5-year survival approximately 15%, increasing to 65% in patients with early cancer. It was observed, that the following prognostic factors influenced the long-term survival rate: tumor size, localization, histopathologic type, and metastases to lymph nodes. The type and extent of surgery was of significance in the case of small neoplasms. CONCLUSIONS: Based on the analysis carried out, the authors conclude that the main prognostic factors for long-term survival after pancreatic cancer surgery are related to the tumor itself and show associations with the natural development biology.
Aged↗
Pancreatic carcinoma-induced changes in gastric myoelectric activity and emptying.
BACKGROUND/AIMS: Twenty patients with histologically confirmed pancreatic carcinoma without any endoscopic evidence of gastroduodenal obstruction were included in the study. The aim was to determine changes in gastric myoelectric activity and liquid/solid gastric emptying induced by pancreatic tumor. METHODOLOGY: According to TNM/UICC classification patients were divided into two groups A (T2) and B (T3) due to extent of tumor invasion (mainly to retroperitoneum space). In all patients electrogastrography, solid and liquid gastric emptying tests were performed. RESULTS: In the majority of patients of groups A and B the most commonly reported complaints included upper abdominal pain (60% vs. 80%) and icterus (80% vs. 60%). Dyspeptic symptoms were observed in 40% patients of group A and 90% in group B. In group electrogastrography recordings showed dysrhythmia patterns, mostly bradygastria, in 50% of group A patients and in 80% of group B. Liquid/solid gastric emptying were delayed in 20/40% of group A patients and 50/80% of group B. Disorders of gastric myoelectric activity and emptying correlated with tumor stage and location across analyzed groups but not with histology and hyperbilirubinemia levels. CONCLUSIONS: It was observed that solid gastric emptying is affected earlier compared to liquid gastric emptying. Delayed gastric emptying may be attributed to gastric dysrhythmia and/or abdominal pain but not mechanical effects of tumor growth that occur during the course of disease.
Adenocarcinoma↗
Outcome of gastric cancer surgery in elderly patients.
BACKGROUND/AIMS: The aim of the study was to review cases of gastric cancers in elderly adults (70 years of age and older), and compare demographic, clinical, pathologic features and outcomes of surgical treatment with younger patients (below 70 years of age). METHODOLOGY: The analysis included 3431 patients treated for gastric cancer between 1977 and 1998 at eight university surgical centers cooperating for the Polish Gastric Cancer Study Group (PGCSG). Patients were analyzed retrospectively according to data obtained from standardized forms and divided into two groups: group I--patients 70 years of age and over, group II--younger patients. RESULTS: There were no significant differences between these two groups in clinical symptoms at the time of diagnosis and tumor advancement. The incidence of the intestinal type according to Lauren (55.9% vs. 43.9%;p<0.05) and distally-located cancers (40.8% vs. 31.3%; p<0.05) was higher in group I. Total gastrectomies and extended lymph node dissection were performed more often in younger patients. There were no significant differences in postoperative complications between both groups, except the higher incidence of abdominal abscesses in the younger group. The overall 5-year survival was 24% and 35% for group I and II, respectively (p<0.05), and increased to 35% and 53% after radical resections, respectively. However, there were no statistically significant differences in stage-specific survival between both groups. CONCLUSIONS: Surgical resection is the method of choice in the treatment of gastric cancer. Age of the patients is not a contraindication to surgical treatment of gastric cancer.
Adenocarcinoma↗
Gastric acid, gastrin and pancreatic polypeptide responses to modified sham feeding in duodenal ulcer patients before and after highly selective or truncal vagotomy.
Gastric acid secretion, as well as gastrin and pancreatic peptide release into the bloodstream before and after TV or HSV were observed in 28 patients following modified sham feeding (MSF) and pentagastrin tests. Prior to surgery the majority of patients showed stimulation of gastric acid secretion and hormone release into the bloodstream as the result of the employed tests. The MSF-induced acid output (SAO) and pentagastrin-induced acid output (PAOpg) values were mainly observed immediately following the stimulus. In the majority of patients MSF triggered an increase in blood gastrin and PP concentrations. Nevertheless, the peak concentration values for the two hormones occurred at different time intervals following the stimulus. For gastrin the peak values appeared later than SAO, whereas for PP they occurred either in the course of or immediately after MSF. Irrespectively of, the type of surgical procedure used and the completeness of vagotomy, the values of BAO, PAO, SAO and PAOpg were significantly lower following the procedure. Blood hormone concentration, however, showed greater variations. The test stimulated gastrin release showed the peak values were greater after, than prior to, the surgery, whereas PP release was markedly inhibited. No correlation was found between gastric acid secretion, blood serum gastrin and PP levels.
Adolescent↗
Free amino acids in basal and vagally stimulated gastric secretion.
The concentrations of the individual free amino acids were determined in one hour fraction of basal secretion and peak hydrogen ion secretion following stimulation with 2-deoxy-D-glucose (2-DG) (group I) or insulin (group II). Group I consisted of 9 patients with duodenal ulcer having hypersecretion of gastric acid as determined by histamine test; 7 patients with duodenal ulcer who underwent truncal vagotomy and had insulin test performed two weeks after the operation formed group II. The total concentration of free amino acids was similar in basal and in stimulated gastric juice in both groups. Also the concentrations of the individual amino acids did not change significantly after stimulation. There was, however, a significant increase following stimulation in the output of amino acids both in group I and in group II. This increase was parallel to that in the volume of gastric juice, which suggests that a definite amount of free amino acids is always present in the gastric juice, and that the secretion of these acids is not under vagal control.
Amino Acids↗
Postoperative immunochemotherapy (BCG + 5-FU) in advanced gastric cancer.
Three hundred and twenty-two patients with locally advanced (stages III and IVA) and disseminated (stage IVB) gastric cancer were included in a randomized trial to assess the effect of immunochemotherapy (BCG and 5-fluorouracil,5-FU). The survival of patients receiving chemoimmunotherapy was compared to chemotherapy (5-FU) or no further treatment (control) groups. Patients with stage III underwent radical surgery (subtotal or total resection), stage IVA palliative resection, while explorative laparotomy or bypass was performed in stage IVB. Patients with stage III and IVA receiving immunochemotherapy had significantly (p less than 0.05) prolonged survival in comparison to chemotherapy or control groups. Prolongation of survival was more pronounced in patients with diffuse type carcinoma than in patients with intestinal type of tumour according to Lauren's classification. The survival of patients receiving chemotherapy was somewhat shorter than that of the control group, but the differences were not statistically significant. There was no effect of either immunochemotherapy or chemotherapy in patients with stage IVB. No serious side effects of immunochemotherapy were noted. These results indicate that immunochemotherapy may be a safe form of adjuvant treatment in patients with operable gastric cancer.
Adult↗
[Effectiveness of ultrasonographically guided fine-needle biopsy in the diagnosis of abdominal tumors].
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Biopsy, Needle↗
[Clinico-control studies of the role of nutrition in the development of stomach cancer].
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Aged↗
[Apropos of the reversibility of the hepatic insufficiency in obstructive jaundice].
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Adult↗
[Morphological evaluation of gastric mucosa in the light of endoscopic mass screening].
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Adult↗