RESUMEN
OBJECTIVE: Several adjuvant therapy concepts have been developed to improve the treatment of gastric cancer patients. Dealing with intraperitoneal chemotherapy, it seems to be useful to determine suitable prognostic factors for the occurrence of peritoneal carcinosis, as it is possible to select patients who may profit from this therapy. METHODS: Between June 1975 and December 1999 resection of gastric cancer was performed in 575 patients. From 1 January 1986 clinical data were recorded prospectively, before that time, retrospectively. The complete data concerning preoperative diagnosis, operation, histology, postoperative course and survival time were documented in an Excel file for statistical analysis. Multivariate analysis was performed using the chi-squared logistic regression test. RESULTS: Significant correlation was found between the occurrence of peritoneal dissemination and tumour stage pT3, pN2, G3, cancer of the whole stomach and cancer at the anastomotic site after partial gastric resection. Lauren classification, signet-ring cell cancer, liver metastasis and tumour localisation in the distal or proximal stomach showed no significant correlation to peritoneal carcinosis in the multivariate analysis. However, only one-third of patients with liver metastasis had simultaneous peritoneal dissemination. CONCLUSION: The results show a clinical correlation of tumour localisation, infiltration of the serosa, lymph node metastasis and grading with peritoneal dissemination. The present data serve as a basis for further histochemical and molecular biological investigations e.g. of the expression of adhesion molecules to determine the risk of peritoneal tumour dissemination after gastric cancer.
Asunto(s)
Neoplasias Peritoneales/secundario , Neoplasias Gástricas/cirugía , Adulto , Anciano , Quimioterapia Adyuvante , Terapia Combinada , Femenino , Gastrectomía , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Estudios Prospectivos , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Tasa de SupervivenciaRESUMEN
In contrast to childhood intussusception, the clinical signs of intussusception in adults are nonspecific. Generally organic alterations of the small bowel cause intussusception in adults. In this case report on a retrograde jejunojejunal intussusception in a 61-year-old male, following removal of an intraoperatively placed intestinal tube for ileus therapy, the clinical symptoms, diagnostic methods and therapy for intussusception are described. Sonography is not only the diagnostic tool of choice in children, but also led to the correct diagnosis in this case. In contrast to childhood intussusception, operative treatment is preferred in adults.
Asunto(s)
Obstrucción Intestinal/cirugía , Intubación Gastrointestinal , Intususcepción/etiología , Enfermedades del Yeyuno/etiología , Complicaciones Posoperatorias/etiología , Adulto , Humanos , Intususcepción/cirugía , Enfermedades del Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Reoperación , Adherencias TisularesRESUMEN
In 10 patients with gastroesophageal reflux disease, defective lower esophageal sphincter and normal motility pH and impedance were measured parallel over 24 hours. All patients had a reflux score > 40 with a total of 736 reflux episodes registered by the pH metry of which 724 (sensitivity: 98.9%) were recognized by impedancemetry and with additional 292 reflux phases registered at a stomach pH > 4 by the impedancemetry of which none was recognized by the pH metry as a reflux of pH > 7. With the multiple impedancemetry a reliable recognition of gastroesophageal reflux is possible, independently of the pH and this makes it possible to recognize gastroesophageal reflux also at a non acid milieu of the stomach, e.g. under acid suppression medication or after stomach resection.
Asunto(s)
Impedancia Eléctrica , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/diagnóstico , Monitoreo Fisiológico , Humanos , Concentración de Iones de Hidrógeno , Manometría , Peristaltismo , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por ComputadorRESUMEN
One hundred and sixty-one consecutive patients (144 male, 57 +/- 9 years) with stable coronary artery disease underwent nuclear imaging for assessment of myocardial viability using Tc-99m sestamibi single-photon emission computed tomography (SPECT) and F-18 fluoro-deoxy-glucose (FDG) positron emission tomography (PET). 88% had a history of chronic myocardial infarction and all had angiographically proven regional wall motion (RWM) abnormalities in the distribution territory of a stenosed or occluded coronary artery. Patients were followed for 29 +/- 6 (22-44) months with 84/161 patients (52%) receiving elective revascularization by either bypass surgery or angioplasty. 61/84 patients underwent follow-up angiography after 5 +/- 2 months for quantitative assessment of RWM changes using serial analysis with the centerline method in 45 pts with technically suitable paired angiograms. Myocardial regions were classified according to semiquantitative analysis of regional sestamibi and FDG uptake as either normal, regions with evidence for maintained viability but no mismatch ("mild match"), regions with a perfusion/metabolism "mismatch," or scar. RWM improved in "mismatch" regions from -2.2 +/- 1.0 SD to -1.0 +/- 1.4 SD (p < 0.01) compared to the mean of a normal reference population. In contrast, in regions with a "mild match" or those classified as scar, RWM analysis revealed no functional changes at follow-up. For the assessment of clinical outcome, patients were divided into three groups depending on the result of viability imaging. Those with predominantly scar tissue in the target region for viability assessment (group A, n = 90), those with a "mild match" (B, n = 26), and group C (n = 45) consisting of patients with a "mismatch" pattern. Subsequent treatment was not blinded to nuclear imaging results and revascularization was performed in 30% of group A (group A2), 81% of group B, and 80% of group C, while the other patients were treated medically only. Cardiac events during follow-up were defined as cardiac death, myocardial infarction, unstable angina with subsequent revascularization, cardiac transplantation, and survived resuscitation without evidence for myocardial infarction. Group C demonstrated a significant reduction of cardiac events from 22% to 0% following revascularization, whereas in group A coronary revascularization did not influence the frequency of events. Subjective assessment of angina pectoris and heart failure symptoms revealed more patients with improvement following revascularization as compared to those treated medically. Thus, combined nuclear imaging using sestamibi SPECT and FDG PET with quantitative tracer uptake analysis allows detection of absent or preserved myocardial viability in regions with reduced perfusion and function with prognostic implication for regional myocardial functional outcome as well as for identification of patients who benefit most from coronary revascularization.
Asunto(s)
Glucemia/metabolismo , Puente de Arteria Coronaria , Contracción Miocárdica/fisiología , Infarto del Miocardio/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada de Emisión , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/fisiopatología , Angina de Pecho/cirugía , Desoxiglucosa/análogos & derivados , Metabolismo Energético/fisiología , Femenino , Fluorodesoxiglucosa F18 , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/cirugía , Miocardio/metabolismo , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Tecnecio Tc 99m Sestamibi , Resultado del TratamientoRESUMEN
145 patients with such kind of surgical infection have been taken to clarify the cause of it. Aerobic agents were the cause in 16.6% and anaerobic nonclostridial agents--in 33.1% of all cases. The mixed flora was the cause in 44.1%. The most important place among anaerobic nonclostridial infections belongs to bacteroids (38.3%), peptostreptococcus (27.3%) and the peptococcus (17.2%). One must use wide-spectrum antibiotic for a treatment of a such kind of infection tiel the usults of microbiological test are known and only then one can use group-specific antibiotics.
Asunto(s)
Bacterias Anaerobias , Infecciones Bacterianas/diagnóstico , Infección de Heridas/diagnóstico , Bacterias Aerobias/aislamiento & purificación , Bacterias Anaerobias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/cirugía , Terapia Combinada , Medios de Cultivo , Humanos , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/microbiología , Infección de Heridas/cirugíaRESUMEN
In this article, the diagnosis and treatment of gastroesophageal reflux (GER), esophageal primary dysmotilities, and esophageal infections were reviewed. Important systemic diseases, including endocrine, neurologic, and collagen vascular types, that affect the esophagus were discussed. Finally, theoretical mechanisms of aspiration and possible reflex bronchoconstriction secondary to GER have been reviewed. What is needed are further controlled studies of medications to treat GER, achalasia, and diffuse esophageal spasm (DES) with side effects safe enough, and efficacy strong enough, to permit patient acceptance and FDA approval for esophageal purposes.
Asunto(s)
Trastornos de Deglución , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/tratamiento farmacológico , Acalasia del Esófago/diagnóstico , Acalasia del Esófago/tratamiento farmacológico , Espasmo Esofágico Difuso/diagnóstico , Espasmo Esofágico Difuso/tratamiento farmacológico , Esofagitis/diagnóstico , Esofagitis/tratamiento farmacológico , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/tratamiento farmacológico , HumanosRESUMEN
Gastrointestinal (GI) abnormalities are frequent in patients with Down's syndrome. In a 12-year retrospective review, we identified 187 patients with Down's syndrome admitted to the Columbia-Presbyterian Medical Center. Twenty-seven had major GI disorders, the most common being duodenal stenosis (DS, nine), gastroesophageal reflux (GER, five), imperforate anus (five), and Hirschsprung's disease (four). The mortality for the whole group was 11% (20 patients). The mortality in the small group of patients with duodenal stenosis was particularly high (five out of nine, or 56%). Associated congenital heart disease, especially endocardial cushion defects, and the frequent occurrence of pneumonia contributed to this high mortality rate.
Asunto(s)
Anomalías del Sistema Digestivo , Síndrome de Down/complicaciones , Adolescente , Canal Anal/anomalías , Obstrucción Duodenal/complicaciones , Esófago/anomalías , Femenino , Humanos , Lactante , Masculino , Estenosis Pilórica/complicaciones , Estudios RetrospectivosRESUMEN
Disorders of swallowing in a given patient can result from abnormalities of dentition, the oral cavity (mouth and pharynx), the cricopharyngeal muscle, esophageal skeletal (proximal) or smooth (distal) muscle, the lower esophageal sphincter, and the stomach. Recent advances include refinements in esophageal manometric techniques with reclassification of motility disorders; newer drugs to treat gastroesophageal reflux; recognition of more frequent infections of the esophagus in immunosuppressed patients; and adaptation of the use of medications such as nitrates and calcium-channel blockers, which were previously primarily cardiotonic, for investigative treatment of esophageal motility abnormalities.
Asunto(s)
Trastornos de Deglución/terapia , Terapia Combinada , Trastornos de Deglución/etiología , Acalasia del Esófago/terapia , Esofagitis/terapia , Esofagitis Péptica/terapia , Reflujo Gastroesofágico/terapia , HumanosRESUMEN
Abnormalities in esophageal function were identified in seven children with Down's syndrome. Three had recurrent episodes of pneumonia from gastroesophageal reflux; two of these and one other patient had esophageal strictures. Two patients with Down's syndrome revealed no evidence of gastroesophageal reflux but did show significant abnormalities in esophageal peristalsis. These data would suggest that ambulatory children with Down's syndrome may be at risk of developing serious sequellae of gastroesophageal reflux. The spectrum of data of these seven patients is discussed, and pertinent prior reports from the literature are reviewed.
Asunto(s)
Síndrome de Down/complicaciones , Enfermedades del Esófago/etiología , Adolescente , Niño , Preescolar , Femenino , Reflujo Gastroesofágico/etiología , Humanos , Masculino , Neumonía/etiologíaAsunto(s)
Esófago , Cuerpos Extraños/etiología , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fístula Traqueoesofágica/etiologíaRESUMEN
The course of patients with stricture of the esophagus is variable. Operation is effective, but preoperative trials of dilatation are often inadequate. We reviewed the records of 84 patients with esophageal stricture of various causes of assess efficacy of operative and nonoperative management. Sixty-five percent of patients were successfully treated with serial bouginage alone and 35% required operation, with an overall mean follow-up of 59.6 months. Sixty-eight percent of 37 patients with reflux-induced stricture were successfully treated with bouginage, whereas 32% required operation. Eighty-five percent of patients with stricture from nasogastric tubes of esophageal surgery wre successfully treated with dilatation, but 67% of those with corrosive stricture needed operation. Although surgical therapy is effective and generally safe on the management of esophageal stricture, we estimate that two-thirds of patients with stricture can be treated satisfactorily with nonoperative dilatation. Bouginage should be tried as the initial therapy in patients with reflux-induced, postoperative, or tube-related stricture of the esophagus.
Asunto(s)
Estenosis Esofágica/terapia , Adolescente , Adulto , Anciano , Niño , Preescolar , Dilatación , Estenosis Esofágica/etiología , Estenosis Esofágica/cirugía , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The symptoms of pancreatic cancer are nonspecific and are common in the elderly, who are at risk for pancreatic cancer. Ultrasound is an economic means for screening such individuals. This report describes a prospective study of the efficacy of ultrasound in 83 patients with symptoms of pancreatic cancer. Scanning techniques, which resulted in visualization of the head, neck, and body of the pancreas in 90% of the patients scanned, are reviewed. A sensitivity of 94% and a specificity of 99% were achieved. Small defects in the parenchyma may be seen with ultrasound before there are any changes in the size or contour of the organ.