Predicting survival in locally advanced gastric cancer using prognostic factors - neoadjuvant rectal score and downstaging depth score.

BACKGROUND: Clinical prediction models are needed to accurately predict the prognosis of patients with gastric cancer who have received neoadjuvant therapy and to determine the best treatment strategies. The aim of this study is to determine the role of two prognostic factors, the neoadjuvant rectal (NAR) score and the downstaging depth score (DDS), in predicting survival in patients with gastric cancer who received neoadjuvant therapy and underwent curative gastrectomy. METHODS: We reviewed the medical records of 129 patients who had been diagnosed with primary gastric cancer and underwent radical gastrectomy after receiving neoadjuvant therapy. We calculated the NAR score and DDS values for each patient and conducted a survival analysis to assess the accuracy of these prognostic factors in predicting overall survival. RESULTS: The median overall survival time of the patients was found to be 29 months. Patients with low NAR scores and high DDS had significantly longer overall survival. Univariate analyses based on clinical and laboratory characteristics showed that gender, surgery type, resection type, neural invasion, grade, adjuvant radiotherapy, lymphocyte level, carcinoembryonic antigen (CEA) level, NAR score, and DDS were associated with survival. Moreover, multivariate analyses showed that lymphocyte level, DDS, and NAR score were independent prognostic factors. CONCLUSION: In summary, our research indicates that NAR score and DDS may serve as useful prognostic markers for predicting overall survival in patients with locally advanced gastric cancer who receive neoadjuvant chemotherapy followed by curative surgery. Patients with high DDS and low NAR scores were found to have better prognoses.

Pontocerebellar hypoplasia associated with nevoid hyperpigmentation and dysmorphic findings: a new subtype?

Pontocerebellar hypoplasia consists of a rare heterogeneous group of congenital neurodevelopmental disorders characterized by hypoplasia and atrophy of the cerebellar cortex, dentate and pontine nuclei, and inferior olives. Lineer nevoid hyperpigmentation is a rare skin condition characterized by whorls and streaks of hyperpigmented macules in a reticulate pattern along Blaschko's lines. Herein we present a three year-old male patient with pontocerebellar hypoplasia associated with nevoid hyperpigmentation on the upper part of the body. Besides he has some dysmorphic features including microcephaly, triangular chin, long philtrum, long hand fingers, flexion contracture in all of the distal phalanges of both hands, and strabismus.

Multiple relapses in extramedullary localization of acute lymphoblastic leukemia.

Extramedullary relapses of acute lymphoblastic leukemia in children and young adults are rare and in most cases are usually related to the central nervous system or testes. We describe a case of a 25-year-old man with an acute lymphoblastic leukemia with multiple extramedullary relapses in the testes, gallbladder, breast, parotid gland and eye at various times (Fig. 5, Ref. 21).

Bilateral breast cancer: a male patient.

Bilateral breast cancer represents less than 2% of male patients with breast cancer. A 63-year old male presented with a mass at right breast and modified radical mastectomy was performed. Pathology was reported as invasive ductal carcinoma. Radiotherapy and tamoxifen was administered following chemotherapy. At the 5th month, a mass was detected at left breast and modified radical mastectomy was performed. Chemotherapy was started postoperatively. BRCA1 and BRCA2 were reported negative. Although male breast cancer is rare, male patients with breast cancer may have cancer at the other breast (Fig. 1, Ref. 5).

Nodular fasciitis of the external auditory canal.

PROBLEM: Nodular fasciitis (NF) is a reactive myofibroblastic proliferation that may be misdiagnosed as a sarcoma because of its rapid growth, rich cellularity, and mitotic activity. NF is uncommon in the auricular region. We describe a case of nodular fasciitis of the external auditory canal in an 8-year-old male. METHODOLOGY: An excisional biopsy was performed, and the pathologic examination was consistent with nodular fasciitis; however, the lesion recurred within a month requiring that a total excision be done. RESULTS: The patient is without recurrence 7 months after the total excision. CONCLUSIONS: Because its histologic features closely mimick a malignant lesion, NF must be considered in the differential diagnosis of a mass originating from the external auditory canal to avoid overly aggressive and functionally debilitating treatment.

Primary biliary cystadenocarcinoma mimicking a complicated hydatid cyst.

Cystadenocarcinoma of the liver is a rare neoplasm that originates from hepatobiliary epithelium. Primary location of this tumor is generally intrahepatic and most cases are in the right hepatic lobe. Herein we present a case of intrahepatic cystadenocarcinoma in a 53-year-old man who had been followed up for 8 years as hydatic cyst disease of the liver. He was admitted to our hospital with jaundice and loss of appetite. Ultrasound and computed tomography showed a cystic lesion that looked like type II cyst hidatic. Thereafter magnetic resonance imaging revealed a cystic lesion associated with biliary tree. On diagnostic laparotomy peritoneal infiltrations were observed and pathologic examination revealed a biliary cystadenocarcinoma and peritonitis carcinomatosa was diagnosed. Unfortunately correct diagnosis was extremely late and no curative management was possible.

Large retroperitoneal schwannoma mimicking ovarian carcinoma: case report and literature review.

UNLABELLED: In this article we present a case of retroperitoneal schwannoma localized in the pelvic cavity with complete cystic degeneration, mimicking ovarian carcinoma. CASE: A 25-year-old nulligravid woman was admitted to our gynecology out-patient clinic with the complaint of abdominal distension, right flank pain and pollakiuria. Sonographic study showed a cytic mass containing necrotic areas and filling the whole pelvic cavity. Computed tomography and colonography suggested the possible diagnosis of a right ovarian malign tumor. Laparotomy revealed a retroperitoneal cystic lesion. Microscopic examination of the pelvic mass confirmed the diagnosis of cystic degenerative schwannoma. After six months of initial surgery she is still alive without any evidence of disease. CONCLUSION: In the present case, it is emphasized that it is easy to make an error and misdiagnose a pelvic mass as an ovarian tumor when it is in fact a tumor from another origin. Additonally, clinicians should keep in mind that retroperitoneal schwannoma may mimic cystic ovarian carcinoma even in young women.

Alterations of thymic morphology and antioxidant biomarkers in 60-day-old male rats following exposure to a continuous 900 MHz electromagnetic field during adolescence.

We investigated changes in thymic tissue of male rats exposed to a 900 megahertz (MHz) electromagnetic field (EMF) on postnatal days 22-59. Three groups of six 21-day-old male Sprague-Dawley rats were allocated as: control (CG), sham (SG) and EMF (EMFG) groups. No procedure was performed on the CG rats. SG rats were placed in a Plexiglas cage for 1 h every day between postnatal days 22 and 59 without exposure to EMF. EMFG rats were placed in the same cage for the same periods as the SG rats and were exposed to 900 MHz EMF. Rats were sacrificed on postnatal day 60. Sections of thymus were stained for histological assessment. Oxidant/antioxidant parameters were investigated biochemically. Malondialdehyde (MDA) levels in EMFG increased compared to the other groups. Extravascular erythrocytes were observed in the medullary/corticomedullary regions in EMFG sections. We found that 900 MHz EMF applied for 1 h/day on postnatal days 22-59 can increase tissue MDA and histopathological changes in male rat thymic tissue.

Simple scoring system for prediction of mortality in Fournier's gangrene.

PURPOSE: To create new scoring system for prediction of hospital mortality for patients with Fournier's gangrene(FG). MATERIAL AND METHOD: In total, 84 patients with FG were enrolled into this study. The demographic and clinical characteristics of patients were analyzed retrospectively. RESULTS: The mortality rate was 11.9 %. On multivariate analyses, age >60 years, BUN >40 mg/dl, RDW >14.95 %, albumin level <20 mg/dl and presence of sepsis were significant and independent predictors of mortality. The predictive value of our score for mortality was 95.1 %. CONCLUSION: Our scoring system shows adequate discriminatory function for prediction of mortality in patients with FG. Further larger scale studies can improve the performance of our score.

Calcium level may be a predictive factor for pseudocyst formation after acute pancreatitis.

Pancreatic pseudocysts (PPs) are defined as fluid collections more than 4 weeks old that are surrounded by a nonepithelial wall of fibrous or granulation tissue. Many risk factors have been associated with pseudocyst development but predictive factors remain to be explored. The aim of this study was to investigate the clinical, and biochemical parameters that may predict the development of a PPs after an attack of acute pancreatitis (AP). The medical charts of 102 patients diagnosed with AP were enrolled into the study. Demographic, clinical and laboratory details were recorded at admission and at the 48(th) hour. There were several risk factors on admission and at the 48(th) hour that was predictive of PP formation when evaluated by univariate analysis such as: Alanine aminotransferase level at 48 hrs, calcium level at admission, base excess at 48 hrs, calcium level at 48 hrs, and albumin level at 48 hrs. In multivariate analysis, low calcium level at admission was the only variable that was shown to predict formation of PPs. Lower serum calcium level may be a predictive factor for the development of PPs after AP attack. We advise that patients with calcium levels below 8 mg/dl, after AP should be followed more closely.

Can prenatal exposure to a 900 MHz electromagnetic field affect the morphology of the spleen and thymus, and alter biomarkers of oxidative damage in 21-day-old male rats?

We investigated the effects of a 900 Megahertz (MHz) electromagnetic field (EMF), applied during the prenatal period, on the spleen and thymus of 21-day-old male rat pups. Pregnant Sprague-Dawley rats were divided into control and EMF groups. We applied 900 MHz EMF for 1 h/day to the EMF group of pregnant rats. Newborn male rat pups were removed from their mothers and sacrificed on postnatal day 21. Spleen and thymus tissues were excised and examined. Compared to the control group, thymus tissue malondialdehyde levels were significantly higher in the group exposed to EMF, while glutathione levels were significantly decreased. Increased malondialdehyde and glutathione levels were observed in splenic tissue of rats exposed to EMF, while a significant decrease occurred in superoxide dismutase values compared to controls. Transmission electron microscopy showed pathological changes in cell morphology in the thymic and splenic tissues of newborn rats exposed to EMF. Exposure to 900 MHz EMF during the prenatal period can cause pathological and biochemical changes that may compromise the development of the male rat thymus and spleen.

Philadelphia negative, Bcr-Abl positive chronic myeloid leukemia associated with pure red cell aplasia.

Pure red cell aplasia (PRCA) is a rare disorder which is associated with thymoma, viral infections and autoimmune diseases. A few cases of PRCA during the clinical course of CML have been reported and these usually terminate in blastic crisis and death, suggesting a poor prognosis. However, only one case of Philedelphia chromosome negative, Bcr-Abl positive CML associated with PRCA has been reported. Here, we present a second case report of a Philedelphia negative, Bcr-Abl positive CML associated with PRCA who was unresponsive to all the chemotherapeutic regimens. We conclude that the present case supports the idea that the development of PRCA in the course of CML may be a bad prognostic sign.

Changes in portal blood flow following acute exercise in liver transplant recipients.

The aim of this study was to investigate the impact of acute exercise on portal blood flow in liver transplant recipients compared to healthy subjects since it is known that transplantation produces a denervated liver and intrahepatic vascular tube. Twelve liver transplantation recipients and 12 age-gender-matched subjects were included in the study. All patients were at least 6 months posttransplant and in stable condition with normal liver biochemistry values. Measurements of portal vein blood flow were performed before starting exercise and immediately after its completion. The exercise program consisted of 40 minutes of treadmill running or walking with at least 20 minutes at 75% of maximal heart rate. The portal vein flow in the controls decreased by 74% after 40 minutes of exercise (absolute flow, 730 +/- 160 to 190 +/- 35 mL x min). Among the liver transplant group, following exercise the portal vein cross-sectional area also decreased to a lesser degree. However, statistical significance was only reached for blood flow. In this group the absolute flow was 940 +/- 165 mL x min at rest and 460 +/- 135 mL x min at 40 minutes (P <.01 by ANOVA). This flow pattern was more resistant to exercise, thereby protecting the liver from an exercise-induced low-flow state. Exercise and physical conditioning should be recommended without hesitation for liver transplant recipients.

Technical implications of living donor liver transplantation: a single-center experience.

Liver transplantation for end-stage liver disease is the treatment of choice in current surgical practice. However, the shortage of cadaveric organs has limited this treatment option for many years. Living donor liver transplantation (LDLT) may be an option to overcome the organ shortage. In the present series we report a single-center experience with 39 LDLT performed from March 2000 to June 2003. The main indications for LDLT was hepatitis B cirrhosis (11 patients). The recipient hepatectomy was performed with caval preservation. The hepatic vein anastomosis was performed either to recipient hepatic vein or inferior vena cava. The portal vein anastomosis was performed either to the recipient's main or right portal branch. Biliary diversion was performed to the recipient biliary ducts if possible, otherwise to a jejunal loop in Roux-en-Y fashion. The survival rate at the end of one year was 71%. The leading cause of mortality was sepsis in five patients. Biliary complications developed in 20% of the recipients. All bile leaks were from the Roux-en-Y hepaticojejunostomy. Hepatic artery thrombosis was diagnosed in four patients by loss of hepatic blood flow on Doppler ultrasound. LDLT is a major surgical option for end-stage liver disease, particularly for countries with low rates of organ donation. However, there are technical challenges to be overcome such as small vessels from segmental grafts and multiple small bile ducts.

Could the use of interposition grafts for arterial reconstruction be avoided by more caudate graft placement in living donor liver transplantation?

One of the major challenges in living donor liver transplantation (LDLT) is short and small vessels (particularly the hepatic artery), particularly in segmental liver grafts from living donors. In the present study we report an alternative surgical technique that avoids interpositional vessel grafts or tension on the connection by anastomizing the allograft hepatic vein to the recipient inferior vena cava in a more caudate location. From March 2000 to January 2003, 28 patients (11 women/17 men) underwent 28 LDLT. Until June 2001, the preferred technique for hepatic vein anastomosis was end-to-end anastomosis between the allograft hepatic vein and the recipient hepatic vein (HV-HV) (n = 10). Thereafter an end-to-side anastomosis was performed between allograft hepatic vein and recipient inferior vena cava (HV-IVC) (n = 18). The level of venotomy on the recipient vena cava was decided according to the pre-anastomotic placement of the allograft in the recipient hepatectomy site with sufficient width to have an hepatic artery anastomosis without tension or need for an interposition graft during hepatic artery and portal vein anastomoses. Except the right lobe allograft with anterior and posterior portal branches, all portal and hepatic artery anastomoses were constructed without an interposition graft or tension in the HV-IVC group. Only one hepatic artery thrombosis developed in the HV-IVC group. As a result, this technique may avoid both hepatic artery thrombosis and the use of interposition grafts in living donor liver transplantation.

Coeliac artery aneurysm: aorto-hepatic artery reconstruction.

Aneurysms of the coeliac axis are rare. Up to 1997, 137 cases had been reported. Here we present a coeliac aneurysm which involved the origin of the splenic, left gastric, and common hepatic arteries. After making a midline incision, infra-diaphragmatic control of the aorta was obtained. The aorta was clamped for 25 minutes to resect the aneurysm. The defect at the origin of the coeliac axis was closed with 1.5 cm PTFE patch. The distal segments of the splenic and left gastric arteries were ligated. A 6-mm ringed PTFE graft was interposed between the infra-renal aorta and the proper hepatic artery. The control arteriogram showed a good arterial flow. The patient recovered uneventfully after surgery with normalisation of hepatic function.

The effect of octreotid on bacterial translocation from the gut. An experimental study.

Octreotid (OC) is a somatostatin (ST) analog which is being increasingly used during the management of various gastrointestinal disorders. This study was undertaken to assess the probable effects of OC on intraintestinal microflora and bacterial translocation. To our knowledge, no previous work has addressed this issue. Ten rats forming the study group were injected 20 micrograms/kg of OC subcutaneously for seven days. A control group (n = 10) received an equal volume of isotonic saline for seven days. All animals were sacrificed on the eighth day and tissue cultures were obtained from the mesenteric lymph nodes, liver, and spleen. Cultures were also made from the caecal content and a piece of terminal ileum was removed for histopathological examination. For statistical analysis, Mann Whitney-U, and Fisher's exact tests were used. Caecal bacterial content, and bacterial translocation were found to be significantly increased in the study group in comparison to the control group (p < 0.05). Among the study group, there was also a statistically significant increase in the caecal bacterial content in rats with evidence of bacterial translocation (p < 0.05). Histopathological evaluation drew a great deal of attention to submucosal edema present in the study group. OC significantly increases bacterial overgrowth, and translocation in rats. Studies on humans are needed to demonstrate similar clinical effects of OC.

Liver transplantation for HBV-related disease under immunosuppression with tacrolimus: an experience with 78 consecutive cases.

Hepatitis B viral liver disease (HBVLD) is a major worldwide health problem. It is estimated over 300 million people have had hepatitis B virus infection and that one-third of these have chronic HBVLD. Little effective therapy exists for HBVLD even though high dose interferon (IFN) has been advocated. For those who either are untreated or do not respond to IFN, HBVLD is steadily progressive and orthotopic liver transplantation (OLTx) is the only available therapy. Until quite recently, all OLTx recipients received cyclosporine (CyA) and prednisone. The consequence of OLTx for HBV disease in individuals immunosuppressed with tacrolimus has not previously been reported. A total of 78 consecutive patients with HBV-related liver diseases who were transplanted between January 1, 1990, and December 31, 1991, and treated with tacrolimus were studied. The clinical records of these patients were reviewed retrospectively. HBV disease recurrence was documented with serologic and histologic methods. As of April 1, 1993, 57 of 78 (73%) of the patients were still alive. Thirty-one of the alive patients have documented HBV recurrence. Eighteen of these 31 patients, however, have normal liver function. With a median follow-up of 24 months, 8 patients (10.9%) have died of recurrent HBVLD. Seven of 8 patients, who preoperatively were HBeAg+, developed recurrence and 4 of these patients have already died of recurrence. Patients who were HBsAg+ rarely recurred (1 of 16 patients). The use of HBIG did not prevent recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of adjunctive parathyroid hormone injection on bisphosphonate-related osteonecrosis of the jaws: an animal study.

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is a serious and challenging complication of chronic BP uptake in patients with osteoporosis who require management of skeletal-related events. The efficiency of adjunctive parathyroid hormone (PTH) injection was evaluated after chronic BP administration that was followed by tooth extraction. BRONJ was not observed in any of the subjects in the control groups, while BRONJ was observed in 66% and 22% of the subjects in the tooth extraction group and the tooth extraction with PTH injection group, respectively. In addition the presence and severity of inflammation was lower in the PTH injected group than in the tooth extraction group, but the difference was not statistically significant (P>0.01). In conclusion, the administration of 30µg/kg/day PTH during a period of 8 weeks had positive effects on the resolution of BRONJ, but further studies are required to verify the effectiveness of PTH in the treatment of BRONJ.