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BACKGROUND: How systemic inflammation-based prognostic scores such as the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR) differ across populations of patients with colorectal cancer (CRC) remains unknown. The present study examined the mGPS and NLR in patients from United Kingdom (UK) and Japan. METHODS: Patients undergoing resection of TNM I-III CRC in two centres in the UK and Japan were included. Differences in clinicopathological characteristics and mGPS (0-CRP≤10 mg/L, 1-CRP>10 mg/L, 2-CRP>10 mg/L, albumin<35 g/L) and NLR (≤5/>5) were examined. RESULTS: Patients from UK (n = 581) were more likely to be female, high ASA and BMI, present as an emergency (all P < 0.01) and have higher T stage compared to those from Japan (n = 559). After controlling for differences in tumor and host characteristics, patients from Japan were less likely to be systemically inflamed (OR: mGPS: 0.37, 95%CI 0.27-0.50, P < 0.001; NLR: 0.53, 95%CI 0.35-0.79, P = 0.002). CONCLUSION: Systemic inflammatory responses differ between populations with colorectal cancer. Given their prognostic value, reporting of systemic inflammation-based scores should be incorporated into future studies reporting patient outcomes.
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Colectomía , Neoplasias Colorrectales/diagnóstico , Inflamación/patología , Estadificación de Neoplasias , Anciano , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Linfocitos/patología , Masculino , Neutrófilos/patología , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Reino Unido/epidemiologíaRESUMEN
AIM: Although it has been widely demonstrated that administration of Daikenchuto (DKT), a traditional Japanese herbal medicine, improves gastrointestinal (GI) motility in patients undergoing abdominal surgery, few studies have investigated the efficacy of perioperative DKT administration for relief of postoperative ileus (PI) in patients undergoing surgery for GI cancer. Therefore, the aim of this study was to investigate whether perioperative administration of DKT relieves PI in patients with GI cancer. PATIENTS AND METHODS: We performed a comprehensive electronic search of the literature (Cochrane Library, PubMed, the Web of Science and ICHUSHI) up to December 2016 to identify studies that had shown the efficacy of perioperative DKT administration for relief of PI in patients with GI cancer. To integrate the individual effect of DKT, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI), and heterogeneity was analyzed using I2 statistics. RESULTS: Seven studies involving a total of 1,134 patients who had undergone GI cancer surgery were included in this meta-analysis. Among 588 patients who received DKT perioperatively, 67 (11.4%) had PI, whereas among 546 patients who did not receive DKT perioperatively, 87 (15.9%) had PI. Perioperative administration of DKT significantly reduced the occurrence of PI (RR=0.58, 95% CI=0.35-0.97, p=0.04, I2=48%) in comparison to patients who did not receive DKT or received placebo. CONCLUSION: The result of this meta-analysis suggests that perioperative administration of DKT relieves PI in patients undergoing surgery for GI cancer.
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Gastrectomía/efectos adversos , Neoplasias Gastrointestinales/cirugía , Ileus/prevención & control , Fitoterapia , Extractos Vegetales/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Humanos , Ileus/etiología , Panax , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Zanthoxylum , ZingiberaceaeRESUMEN
α-taxilin is a binding partner of syntaxins, which are the central coordinators of membrane traffic. Expression of α-taxilin has been implicated in the development of human glioblastoma, hepatocellular carcinoma and renal cell carcinoma. In the present study, the clinical significance of α-taxilin expression in colorectal cancer (CRC) was investigated. A total of 20 cases of colorectal intramucosal adenocarcinoma (IMA) with adenoma were analyzed using immunohistochemical analysis. The results demonstrated that α-taxilin expression was significantly associated with Ki-67 indices in adenoma and IMA. The patients expressed equally high levels of α-taxilin in the upper third of the intramucosal glands. These results suggest that α-taxilin expression is significantly associated with the proliferative activity of CRC, but that its overexpression alone is not a biomarker of malignancy. Next, α-taxilin expression was investigated in 57 advanced CRCs and its association with prognosis was determined. Well-differentiated and/or moderately differentiated adenocarcinomas in the left-sided colon with anatomic stage II and/or III were analyzed. α-taxilin expression levels were high on the surface of nearly all tumors, but variable at the deep advancing edge. α-taxilin levels at the advancing edge were not significantly associated with local invasiveness or prognosis. In conclusion, α-taxilin is a cell proliferation marker in colorectal epithelial neoplasms but cannot be a marker of malignancy or prognosis of CRCs.
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It is well known that intersigmoid hernia (ISH) is a rare condition. Here we describe our experience of laparoscopic surgery for small-bowel obstruction (SBO) due to ISH after sufficient decompression involving long-tube insertion.A 45-year-old woman with no history of abdominal surgery visited our hospital with epigastric pain. She was diagnosed as having SBO and underwent long-tube insertion as conservative therapy. However, her symptoms did not improve. Gastrografin contrast enema via the long-tube demonstrated a beak sign in the lower left abdomen and CT showed incarcerated small bowel was successively covered by sigmoid mesocolon, suggesting that the SBO was due to ISH, and she underwent laparoscopic surgery after sufficient decompression of the dilated small bowel.Intraoperative examination demonstrated incarceration of a loop of the small bowel in the intersigmoid fossa without strangulation. Because the incarcerated portion of the small bowel was not necrotized, herniation repair was performed by removing the incarcerated small bowel from the intersigmoid fossa without closure of the hernia orifice.The postoperative course was uneventful, and the patient is now free of symptoms and recurrence 12 months after surgery. Laparoscopic surgery after sufficient decompression is a useful treatment for SBO due to ISH.
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We herein report five cases of ulcerative colitis-associated cancer/dysplasia. Although clinical remission had been achieved in all patients, mucosal inflammation had been resolved in only one patient. Thus, in order to prevent cancer from developing, appropriate medical therapy aiming not only to relieve the clinical symptoms, but also to suppress chronic inflammation appears to be necessary. Moreover, cancer occurred as early as 4 years after the diagnosis in one patient. In patients without complete resolution of mucosal inflammation, careful surveillance colonoscopy should be initiated in the early phase.
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Colitis Ulcerosa/complicaciones , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etiología , Adolescente , Adulto , Anciano , Colonoscopía , Neoplasias Colorrectales/patología , Femenino , Humanos , Hiperplasia , Inflamación , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: This study was designed to estimate the clinical significance of the C-reactive protein (CRP)/albumin ratio (CAR) for prediction of postoperative survival in patients with colorectal cancer (CRC). BACKGROUND: The Glasgow Prognostic Score (GPS), calculated from the serum levels of CRP and albumin, is well known to be a valuable inflammation-based prognostic system for several types of cancer. A recent study has demonstrated that the CAR is also useful for prediction of treatment outcome in patients with hepatocellular carcinoma. METHODS: Uni- and multivariate analyses using the Cox proportional hazards model were performed to detect the clinical characteristics that were most closely associated with overall survival (OS). All recommended cutoff values were defined using receiver operating characteristic curve analyses. Kaplan-Meier analysis was used to compare OS curves between the two groups. RESULTS: A total of 627 patients who had undergone elective CRC surgery were enrolled. Multivariate analysis using the results of univariate analyses demonstrated that CAR (>0.038/≤0.038) was associated with OS (hazard ratio 2.596; 95% confidence interval 1.603-4.204; P < 0.001) along with pathological differentiation (others/well or moderately), carcinoembryonic antigen level (>8.7/≤8.7, ng/ml), stage (III, IV/0, I, II), neutrophil to lymphocyte ratio (NLR) (>2.9/≤2.9), and GPS (2/0, 1). Kaplan-Meier analysis and log rank test demonstrated a significant difference in OS curves between patients with low CAR (≤0.038) and those with high CAR (>0.038; P < 0.001). CONCLUSIONS: CAR is as useful for predicting the postoperative survival of patients with CRC as previously reported inflammation-based prognostic systems, such as GPS and NLR.
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Biomarcadores de Tumor/sangre , Proteína C-Reactiva/análisis , Neoplasias Colorrectales/mortalidad , Cirugía Colorrectal/mortalidad , Albúmina Sérica/análisis , Anciano , Antígeno Carcinoembrionario/metabolismo , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Linfocitos/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neutrófilos/patología , Pronóstico , Curva ROC , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The authors evaluated the usefulness of intraoperative photodynamic eye (PDE) observation in patients with nonocclusive mesenteric ischemia (NOMI). Between February 2012 and July 2013, 6 patients who had undergone emergency surgery for NOMI were enrolled. Intraoperative PDE observation was performed to decide the adequate length of bowel resection including all skipped dark spots, which could not be detected as ongoing mucosal ischemic changes under visible light observation. All ongoing mucosal ischemic changes were easily detected as dark spots using PDE observation in all 6 patients. The mean length of adequate ileal resection (92 ± 48 cm) was significantly longer than that of ischemic ileum (85 ± 50 cm) (mean ± SD) (P = 0.043). After resection of an adequate length of bowel, all the patients had a good course until discharge without incidents due to residual bowel ischemia, except for 1patient who died. PDE observation is useful for deciding the adequate length of bowel to resect, including ongoing mucosal ischemic changes that cannot be detected under visible light observation. In patients with NOMI, resection of an adequate length of bowel is necessary to prevent postoperative incidents due to residual bowel ischemia.
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Diagnóstico por Imagen/instrumentación , Isquemia Mesentérica/cirugía , Anciano , Anciano de 80 o más Años , Urgencias Médicas , Femenino , Fluorescencia , Colorantes Fluorescentes/administración & dosificación , Humanos , Verde de Indocianina/administración & dosificación , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The needleless closed system (NCS) has been disseminated in several clinical fields to prevent central venous catheter-related bloodstream infection (CVC-RBSI), in place of the conventional Luer cap system (LCS). The purpose of this study is to examine whether NCS is really superior to conventional LCS for prevention of CVC-RBSI. Between May 2002 and December 2008, 1767 patients received CVC in our department. The time interval from insertion to development of CVC-RBSI was compared retrospectively between selected patients who were treated using the conventional LCS (group 1, n = 89, before June 2006) and the NCS (group 2, n = 406, June 2006 and after). Kaplan-Meier analysis revealed no significant difference in the time interval from insertion to development of CVC-RBSI between the two groups. NCS does not reduce CVC-RBSI in adult colorectal cancer patients who undergo CVC insertion.
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Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales/efectos adversos , Infección Hospitalaria/prevención & control , Anciano , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Colorectal cancer is a frequently occurring cancer whose incidence has shown a marked increase in recent years. Additionally, an increase in right side colon in elderly patients has been identified. Therefore, a clinicopathological study was conducted in 49 patients with unresectable advanced colorectal carcinomas to elucidate the association of clinicopathological characteristics and K-ras mutation. Of the 49 patients included in this study, 24 were aged <60 years with a male/female (M/F) ratio of 16/8 and 25 patients were aged ≥60 years with a M/F ratio of 16/9. Of the patients aged ≥65 years, 15 patients were enrolled as controls and the M/F ratio was 9/6. Results revealed that with regard to the subsite of cancer, unresectable advanced colorectal carcinomas developed in the right-sided colon in 13 patients, left-sided colon in 19 patients and rectum in 17 patients. Right-sided colon carcinomas were commonly identified in the elderly patients aged ≥65 years, with a marked tendency in the female patients (P=0.024). Immunostaining was performed for the epidermal growth factor receptor (EGFR) antibody in 40 patients to determine whether the K-ras gene would yield positive results. The mutant K-ras gene was identified in 8 patients (20%) and the frequency was lower compared with that of the normal colorectal carcinomas. Anti-EGFR antibody (cetuximab) is considered to be a molecularly targeted agent for unresectable advanced colorectal carcinomas. The increase in incidence of right-sided colon carcinomas as well as the increase in the number of patients presenting with colorectal carcinomas means this issue should be addressed. Sessile serrated adenoma/polyp (SSA/P) with b-raf mutation and CIMP (CpG island methylator phenotype) abnormality as a precursor lesion of right-sided colon carcinoma is common and since cetuximab refractory wild-type K-ras/mutant b-raf colorectal carcinoma may increase in elderly patients and patients with right-sided colon carcinoma, a simultaneous examination for the K-ras and b-raf gene abnormalities for the treatment of colorectal cancer using anti-EGFR antibody (cetuximab) is crucial. In addition, the multidisciplinary assessments regarding the effect of such treatments is likely to be determined based on cumulative results, such as the duration of patient survival.
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BACKGROUND: The aim of this study was to estimate whether the Glasgow prognostic score (GPS) is useful for predicting the survival of patients after surgery for stage IV colorectal cancer (CRC). METHODS: The GPS was calculated on the basis of admission data as follows: patients with both an increased C-reactive protein (CRP) level (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a score of 2, and patients showing one or none of these abnormalities were allocated a score of 1 or 0, respectively. RESULTS: A total of 108 patients with stage IV CRC were enrolled. Although multivariate analyses showed that tumor pathology, subclass of stage IV CRC, and the GPS were associated with overall survival, the GPS could divide the patients into 3 independent groups showing significant differences in postoperative survival (P = .018). CONCLUSIONS: The GPS is not only one of the most significant clinical characteristics associated with the overall survival of patients with stage IV CRC, but also a useful indicator that is capable of dividing such patients into 3 independent groups before surgery.
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Proteína C-Reactiva/análisis , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Hipoalbuminemia/epidemiología , Anciano , Antígeno Carcinoembrionario/sangre , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Inflamación/sangre , Masculino , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Our aim was to examine whether systemic inflammatory response (SIR) is associated with perioperative central venous catheter-related bloodstream infection (CVC-RBSI) in patients undergoing surgery for colorectal cancer (CRC) with administration of parenteral nutrition (PN). Between May 2002 and August 2009, 310 patients undergoing CRC surgery were enrolled. A CVC was inserted in all patients for administration of PN. Among these patients, 117 developed fever, and blood cultures for diagnosis of CVC-RBSI were obtained from them. A final total of 22 patients were diagnosed as having CVC-RBSI. Univariate analysis was performed to evaluate the risk factors for CVC-RBSI using the clinical characteristics of the patients. The results of univariate analyses revealed that only the Glasgow Prognostic Score was an independent risk factor for CVC-RBSI (odds ratio 3.733; 95% confidence interval 1.416-9.844; p=0.008). The Glasgow Prognostic Score is associated with CVC-RBSI in patients undergoing CRC surgery with administration of PN.
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Infecciones Relacionadas con Catéteres/sangre , Cateterismo Venoso Central/efectos adversos , Neoplasias Colorrectales/microbiología , Neoplasias Colorrectales/terapia , Inflamación/patología , Nutrición Parenteral/efectos adversos , Sepsis/etiología , Anciano , Bacteriemia/etiología , Bacteriemia/patología , Infecciones Relacionadas con Catéteres/patología , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/cirugía , Femenino , Fungemia/etiología , Fungemia/patología , Humanos , Masculino , Periodo Perioperatorio , Pronóstico , Estudios Retrospectivos , Sepsis/patologíaRESUMEN
Uni- and multivariate analyses were performed in order to assess the most valuable clinical features that were associated with the overall survival of 169 patients who underwent surgery for stage IV colorectal cancer (CRC). Univariate analyses demonstrated that tumor pathology (other/tub1, 2), the proportion of neutrophils and lymphocytes, serum level of C-reactive protein and albumin, neutrophil to lymphocyte ratio, and intraoperative bleeding volume were associated with overall survival. Multivariate analysis using these seven selected features disclosed that only tumor pathology was associated with the overall survival (p<0.001). In addition, tumor pathology was able to divide not only the patients as a whole (p<0.001), but also both patients with stage IVa (p=0.007) and IVb (p=0.007), into two groups for overall survival, respectively. Tumor pathology is not only associated with the overall survival but is also able to divide both patients as a whole and those sub-classified by stage, into two independent groups before surgery.
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Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Análisis de Supervivencia , Anciano , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Masculino , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
BACKGROUND: Although carcinoembryonic antigen (CEA) is a valuable indicator for estimating the progression of colorectal cancer (CRC), some patients with advanced CRC show no elevation of the CEA level. On the other hand, inflammation-based prognosis, assessed by the Glasgow Prognostic Score (GPS), has been established as one of the important prognostic factors of survival after surgery for several types of cancer. We estimated the postoperative survival of CRC patients with a normal preoperative serum level of CEA on the basis of the GPS. METHODS: Among 491 patients who had undergone elective CRC surgery, 271 with a normal preoperative serum CEA level (≤5.0 ng/ml) were enrolled. Uni- and multivariate analyses were performed to evaluate the relationship to overall survival. Kaplan-Meier analysis and log rank test were used to compare the survival curves between patients with GPS 0 (group A), and 1 or 2 (group B). RESULTS: Univariate analyses using clinical characteristics revealed that lymphatic invasion, lymph node metastasis, platelet count, the serum levels of CEA and C-reactive protein, tumor, node, metastasis staging system (stage 0, I, II/III, IV), and the GPS (0/1, 2) were associated with overall survival. Among these characteristics, multivariate analysis demonstrated that the GPS and platelet count were associated with overall survival. Kaplan-Meier analysis and log rank test demonstrated a significant difference in overall survival between groups A and B (P < 0.001). CONCLUSIONS: Even if CRC patients have a normal preoperative serum level of CEA before surgery, the GPS is able to predict their postoperative survival.
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Biomarcadores de Tumor/sangre , Proteína C-Reactiva/metabolismo , Antígeno Carcinoembrionario/sangre , Carcinoma/sangre , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Hipoalbuminemia/sangre , Adenocarcinoma/sangre , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Carcinoma/secundario , Carcinoma/cirugía , Neoplasias Colorrectales/cirugía , Intervalos de Confianza , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Oportunidad Relativa , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Albúmina Sérica/metabolismoRESUMEN
OBJECTIVE: To evaluate the influence of preoperative thrombocytosis on survival after surgery in patients with colorectal cancer (CRC). METHODS: Four hundred fifty-three patients who had undergone CRC surgery were retrospectively identified from institutional database. On the basis of receiver operating characteristic (ROC) curve analysis, they were classified into two groups: group A, with a preoperative platelet count of ≤300 (×10(9) /L), and Group B, with a preoperative platelet count of >300 (×10(9) /L). Uni- and multivariate analyses were performed to evaluate the relationship to overall survival. Kaplan-Meier analysis and log rank test were used to compare the survival curves between groups A and B. RESULTS: There was a significant difference in overall survival between the two groups (P = 0.007). Multivariate analysis of selected preoperative clinicolaboratory characteristics showed that overall survival was associated with the platelet count (Group A/B) (odds ratio, 1.642; 95% CI, 1.025-2.629; P = 0.039) as well as the number of tumors (1/≥2), and the serum levels of C-reactive protein (CRP) and carcinoembryonic antigen (CEA). CONCLUSION: Preoperative thrombocytosis is associated with survival after surgery in CRC patients, and is able to divide such patients into two independent groups before surgery.
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Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Trombocitosis/complicaciones , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/sangre , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Curva ROC , Estudios Retrospectivos , Tasa de Supervivencia , Trombocitosis/mortalidad , Trombocitosis/patología , Resultado del TratamientoRESUMEN
Few studies have examined the relationship between systemic inflammatory response (SIR) and distant metastasis in patients with T3 colorectal cancer (T3 CRC). Uni- and multivariate analyses were performed in order to evaluate the influence of SIR on distant metastasis in patients with T3 CRC using collected clinical data. Between January 2000 and August 2009, 335 patients with pathologically diagnosed T3CRC were enrolled. Univariate analysis revealed that tumor differentiation, lymphatic invasion, venous invasion, lymph node metastasis, serum carcinoembryonic antigen (CEA) level, carbohydrate antigen 19-9 (CA 19-9) level, C-reactive protein (CRP) level and the Glasgow Prognostic Score (GPS) were associated with distant metastasis. Multivariate analysis using these selected characteristics disclosed that the CRP level was associated with distant metastasis of T3 CRC, as well as with lymph node metastasis, and CEA and CA19-9 levels. The level of CRP is one of the important clinical characteristics associated with distant metastasis of T3 CRC.
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Proteína C-Reactiva/metabolismo , Neoplasias Colorrectales/patología , Metástasis de la Neoplasia , Anciano , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND/AIMS: To demonstrate the usefulness of a fluorescence imager (photodynamic eye; PDE) for observation of lymph flow in lower rectal cancer (LRC). METHODOLOGY: Between October 2006 and January 2010, PDE observations were performed in 14 patients with LRC. After induction of general anesthesia, a total of 2mL of indocyanine green (ICG) (2.5mg/mL) was injected into the submucosal layer on the dentate line or the anal margin of the LRC. RESULTS: Preoperative PDE observation was able to demonstrate several lymph flows running to the bilateral inguinal areas from the perianal area immediately after ICG injection in 13 of the patients (92.9%). Although these flows were pooled in the bilateral inguinal areas, there was no pooling of such lymph flows in the perianal area. Intraoperative PDE observation was able to demonstrate not only mesenteric lymph nodes in all patients but also bilateral lateral lymph nodes in 13 patients (92.9%). Although 6 patients had undergone sphincter-preserving surgery (SPS), no local recurrence was observed in such patients during the observation period. CONCLUSIONS: PDE is able to visualize three sets of regional lymph nodes in patients with LRC, suggesting that it would be useful for determining the effectiveness of SPS for such patients.
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Colorantes Fluorescentes , Verde de Indocianina , Ganglios Linfáticos/diagnóstico por imagen , Neoplasias del Recto/patología , Biopsia del Ganglio Linfático Centinela , Anciano , Femenino , Fluorescencia , Humanos , Conducto Inguinal , Ganglios Linfáticos/patología , Masculino , Mesenterio , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Neoplasias del Recto/cirugíaRESUMEN
OBJECTIVE: Serrated adenocarcinoma (SAC), proposed as a new pathologic type, arises predominantly in the right side of the colon and has a poorer prognosis than conventional colorectal carcinoma. The prognosis of colorectal carcinoma is variable in Dukes' B, so the aim of this study was to determine whether or not SAC has a poor prognosis in Dukes' B. METHODS: The study group comprised 64 patients who underwent surgery for colorectal carcinoma. We undertook a statistical analysis of the association of SAC and non-SAC with sex, age, histologic type, depth of tumor, location of tumor, venous invasion and lymphatic invasion. RESULTS: SACs were encountered in 17.5% of cases (n = 11). SAC had a less favorable 5-year survival than non-SAC (p = 0.0396 log-rank, Kaplan-Meier). The factors that achieved statistical significance in the univariate analysis were subsequently included in a multivariate analysis and we found that SAC was an independent factor (p = 0.027). CONCLUSIONS: SAC has a poor prognosis and is not affected by other factors confirming that SAC is an independently less favorable prognostic factor.
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Adenocarcinoma/patología , Neoplasias Colorrectales/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de SupervivenciaRESUMEN
BACKGROUND/AIMS: To evaluate alterations of serum trace element (TE) levels in critically ill patients receiving parenteral nutrition (PN) including the recommended doses of TEs. METHODOLOGY: Measurements of serum levels of TEs such as zinc, iron, copper, manganese and iodine were performed on the day before, and two and four weeks after, administration of PN. RESULTS: Forty-six patients who received PN from October 2007 to August 2009, were enrolled. All patients received 100µmol (6.5mg) zinc, 35µmol (2mg) iron, 5µmol (0.3mg) copper, 1µmol (0.05mg) manganese and 1µmol (0.13mg) iodine as the recommended daily doses. There were no significant differences in the serum levels of iron, copper and manganese among the three measurement points. On the other hand, there were significant differences in the serum levels of zinc (p<0.001), triiodothyronine (T3) (p=0.010) and unbound T3 (p=0.006) among the three points, but not for thyroxine (T4) and unbound T4. CONCLUSIONS: The recommended doses of TEs are justified for critically ill patients in terms of constant serum levels, except for zinc and iodine.
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Enfermedad Crítica , Nutrición Parenteral , Oligoelementos/sangre , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no ParamétricasRESUMEN
BACKGROUND/AIMS: To compare the time interval from insertion until development of central venous catheter related bloodstream infection (CVC-RBSI) between patients who received non-routine dressing change group (Group 1) and patients who received routine dressing change group (Group 2). METHODOLOGY: Between March 2006 and July 2008, patients who underwent CVC were randomly divided into Groups 1 and 2. Comparative study between the two groups was performed by reference to the incidences of CVC-RBSI from the prospectively obtained database. RESULTS: One hundred-eighty nine patients underwent 530 CVC insertions. Group 1 had 254 CVCs and Group 2 had 276 CVCs. There were no significant inter-group differences in patient background factors, except for gender. In addition, Group 1 had a shorter duration of catheter insertion than Group 2. Nevertheless, Group 1 had not only a significantly shorter period from insertion until the development of CVC-RBSI but also a higher frequency of fever than Group 2. CONCLUSIONS: The results of our comparison between non-routine dressing change group and routine dressing change group indicate that routine dressing change can reduce the incidence of CVC-RBSI in patients undergoing CVC insertions.
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Bacteriemia/prevención & control , Vendajes , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Anciano , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: The internal jugular vein (IJV) is one of the recommended sites for safe insertion of a central venous catheter (CVC). Although CVC insertion via the IJV has a lower risk of severe complications such as pneumothorax and arterial bleeding than insertion via the subclavian vein, few reports have provided concrete evidence for the safety of a right-sided approach. PURPOSE: To examine whether a right-sided approach, rather than a left-sided one is superior for CVC insertion via the IJV. METHODS: A retrospective study was performed to compare the right IJV with the left in terms of characteristics such as vertical and horizontal diameters, depth from the skin, and the relationship between the IJV and the common carotid artery (CCA) using the same computed tomography axial slice. RESULTS: From April 2006 to September 2008, 100 patients (50 male and 50 female) who underwent CVC insertion via the IJV before surgery for colorectal cancer were enrolled. Vertical and horizontal diameters of the right IJV were significantly larger than those of the left IJV [right: left (cm), 1.51 +/- 0.41 vs 1.13 +/- 0.34, p <.0001, 1.54 +/- 0.36 vs 1.08 +/- 0.33, p <.0001], respectively. The right IJV runs more superficially than the left IJV [right: left (cm), 1.74 +/- 0.60 vs 1.87 +/- 0.56, p <.0001]. CONCLUSIONS: Because the right IJV has a much wider diameter and runs more superficially than the left IJV, a right-sided approach is more acceptable than a left-sided one for CVC insertion via the IJV.