Sentinel lymph node mapping with technetium-99m colloidal rhenium sulfide in patients with gastric carcinoma.

BACKGROUND: The objective of this study was to determine, with the use of technetium-99m colloidal rhenium sulfide, whether the concept of sentinel lymph nodes (SLNs) is applicable to gastric cancers. METHODS: Fifty-nine gastric cancer patients underwent radical gastrectomy and SLN mapping with an intraoperative hand-held gamma probe. After surgery, each transected lymph node was measured for radioisotope (RI) activities by a well-type scintillation counter. RESULTS: SLNs were detectable in 57 (96%) of 59 patients. The sensitivity, specificity, and diagnostic accuracy were calculated to be 83.3%, 100%, and 92.9%, respectively. Sensitivity was 100% in the T1 group, 91.6% in the T2 group, and 62.5% in the T3 group. When RI activities were measured with a well-type scintillation counter, every metastatic non-SLN was found to be situated in the same lymphatic basin as the SLNs. CONCLUSION: The SLN concept is applicable to patients with early gastric cancer (T1). SLN mapping is suitable for identifying the lymphatic basin in cases of gastric cancer.

Laparoscopy-assisted gastrectomy for early gastric cancer in young and elderly patients.

Open gastric surgery in elderly patients is associated with higher morbidity and mortality rates than those reported among younger individuals. Therefore, minimally invasive surgery may have a larger impact on the elderly compared to the younger age group. The objective of this study was to evaluate the experience of laparoscopy-assisted distal gastrectomy (LADG) in patients with early gastric cancer and compare the results in patients 70 years of age and older to those in patients younger than 70 years of age. From January 1998 to October 2004, a total of 103 patients underwent LADG. Of these patients, 30 who were older than 70 years were compared with 73 who were younger. Preoperative co-morbidity, operative results, postoperative outcomes, and survival were analyzed. Furthermore, as a standard control of this study, we reviewed 54 distal gastrectomy cases with open surgery (open distal gastrectomy; ODG) in the same term with the same background factors, categorized into elder (n = 16) and younger (n = 38). The mean age of the elderly patients was 75 years in the LADG group. A significantly higher proportion of elderly patients had concurrent diseases in both groups. Blood loss was significantly less in the elderly than in younger patients undergoing LADG, and it was less in the LADG group than in the ODG group. The overall 5-year survival rates in the LADG group were not significantly different between elderly and younger patients. Laparoscopy-assisted distal gastrectomy is a safe and effective treatment for early gastric cancer in the elderly. Therefore, chronological age alone should not be considered a contraindication in selecting patients for LADG.

Expression of p53 in esophageal carcinoma with multiple areas unstained by iodine.

BACKGROUND/AIMS: Esophageal squamous cell carcinoma is occasionally associated with multiple areas in the surrounding mucosa unstained with iodine. METHODOLOGY: We examined 21 male patients with superficial esophageal carcinoma. Group 1 consisted of 4 cases of superficial esophageal carcinoma associated with multiple lesions that did not stain with iodine. Group 2 comprised 17 cases of a solitary tumor without major additional lesions in the mucosa. We assessed the correlation between clinicopathological factors, a history of tobacco and alcohol consumption, and p53 expression in the two groups. RESULTS: We found four cases (group 1) of superficial esophageal squamous cell carcinoma where there were a total of 10 satellite tumors in addition to the main tumor. These patients tended to have a higher daily consumption of tobacco and alcohol than those in group 2. Moreover in all these group 1 cases there was intraepithelial spread of the tumors and p53 overexpression in all of the main and additional tumors. CONCLUSIONS: We have found that higher tobacco and alcohol consumption are closely related to multiple lesions unstained by iodine and abnormal expression of the p53 gene.

Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years' experience.

BACKGROUND: Laparoscopic assisted gastrectomy is being reported increasingly as the treatment of choice for early gastric cancer. However, no reports concerning the prognosis of patients who have undergone laparoscopic assisted distal gastrectomy (LADG) for early gastric cancer or data comparing the results to those obtained after open gastric surgery are yet available. METHODS: A retrospective study was performed comparing laparoscopic assisted and open distal gastrectomies for early gastric cancer. Eighty-nine patients who underwent LADG were compared to 60 who underwent conventional open distal gastrectomy (DG) in terms of pathologic findings, operative outcome, complications, and survival. RESULTS: There were no significant differences between LADG and DG in operation time (209 vs 200 minutes), complication rate (9% vs 18%), and 5-year survival rate (98% vs 95%). There were differences between LADG and DG with regard to blood loss (237 vs 412 mL), number of lymph nodes (19 vs 25), postoperative stay (17 vs 25 days), and the duration of epidural analgesia (2 vs 4 days) ( P < .05 each). CONCLUSIONS: For properly selected patients, LADG can be a curative and minimally invasive treatment for early gastric cancer.

Helicobacter pylori infection in hemodialysis patients.

BACKGROUND/AIMS: Studies on the relationship between high serum urea nitrogen, creatinine and Helicobacter pylori infection in hemodialysis patients still give conflicting results. In the present study we investigated the prevalence of Helicobacter pylori positivity in patients with hemodialysis [HD(+)] and without hemodialysis [HD(-)] and assessed the relationship between clinical factors, serum urea nitrogen, creatinine levels and Helicobacter pylori prevalence in these patients. METHODOLOGY: 117 patients with dyspeptic complaints were included in the study. They consisted of 36 HD(+) patients (31%) and 81 HD(-) patients (69%). Endoscopy was performed and gastric antral biopsies were obtained for immunohistochemical analysis for Helicobacter pylori in all patients. RESULTS: Helicobacter pylori was positive in 53(45%) of 117 patients [Hp(+)]. In univariate analysis Hp(+) patients received hemodialysis therapy significantly less often (P = 0.002) and had lower serum urea nitrogen (P = 0.0008) and creatinine (P = 0.003) levels than Hp(-) patients. There was no significant difference in age, gender, endoscopic findings or comorbid conditions (hypertension or diabetes mellitus) between these groups. Multivariate logistic regression analysis revealed that only the serum urea nitrogen level was significantly associated with Helicobacter pylori prevalence (P = 0.008). CONCLUSIONS: These results indicate that high serum urea nitrogen seems to correlate with a low prevalence of Helicobacter pylori infection and hemodialysis patients with high serum urea nitrogen may be protected against Helicobacter pylori infection.

Predictive value of uric acid in gastric mucosal damage in hemodialysis patients.

BACKGROUND/AIMS: Uric acid, which has an antioxidant effect, is present at very high serum levels in hemodialysis patients, but its effect has not yet been clarified. In this study we investigated whether or not serum uric acid levels could be associated with gastric mucosal damage in hemodialysis patients. METHODOLOGY: We performed endoscopy in 53 patients who were on dialysis for more than two months and determined the relationship between serum uric acid levels, clinical features and gastric mucosal damage. RESULTS: Of 53 patients, gastroduodenal ulcer was found in 13 patients (Ulcer group), gastritis lesions in 25 patients (Gastritis group) and no pathological findings in 15 patients (Normal group). Serum uric acid levels before the dialytic session were remarkably higher in the Ulcer group than in the Normal (P < 0.01) or Gastritis group (P < 0.05). There was also a significant difference between the Gastritis and Normal groups in the serum uric acid levels (P < 0.05). Alcohol intake and noncompliance resulted in a significant increase in both gastric mucosal damage (P = 0.009 and P = 0.010) and serum uric acid levels (P < 0.05 and P < 0.01). Serum uric acid levels were markedly decreased after treatment with a proton pump inhibitor or H2 blocker. CONCLUSIONS: In hemodialysis patients alcohol intake and noncompliance contribute to the increase in serum uric acid levels and gastric mucosal damage, and serum uric acid levels have predictive values in gastric mucosal damage.