Analysis of clinicopathologic characteristics of gastric cancer in patients ≤40 and ≥40 years of age.

Objectives: Gastric cancer (GC) in young patients is a troubling clinical problem. The aim of this study was to analyze whether patients ≤40 years of age with GC differ from patients (age >40 years) in terms of clinicopathological and selected genetic factors.Materials and methods: Between 1984 and 2011, data were collected for 840 GC patients diagnosed and treated for GC at the Department of Gastroenterology at Pomeranian Medical University. The following clinicopathological features were compared between two age groups: sex, symptom duration, family history of cancer, tumor site, stage (early vs. advanced), blood group, histology, Helicobacter pylori infection and BRCA2 C572T silent mutation status.Results: A total of 65 (7.7%) patients were age 40 years or younger. GC was predominant in women in the younger group (p < .001). Patients (≤40 years) more frequently reported a positive family history of cancer (p = .01) and a diffuse tumor type was more common in this group (p < .001). The two age groups did not differ significantly regarding symptom duration, tumor location or stage, H. pylori infection, blood group, or BRCA2 C572T silent mutation status. A comparison of male and female patients aged 40 years or less did not reveal sex-based differences in any analyzed features.Conclusion: Patients ≤40 years of age with GC differ from patient >40 years of age in having a predominance of women, diffuse tumor type, and positive family history of cancer. These results offer openings for further investigation of the relevance of these differences.

[Endoscopic ultrasound guided biliary drainage--case report]. / Drenaz dróg zólciowych pod kontrola endosonografii--opis przypadku.

Endoscopic biliary drainage (EBD) performed via retrograde cholangiopancreatography (ERCP) is a widely accepted method of treatment of obstructive jaundice. However, in some patients (around 15% of cases) due to various reasons proper cannulation of the biliary tract cannot be achieved, and these individuals are most commonly qualified for transcutaneous drainage or surgical intervention. Unfortunately, both of these procedures are accompanied with high rate of complications. In this paper we report a case of a patient suffering from non-operative, rarely occurring tumor of the papilla of Vater (rhabdomyosarcoma), who was treated with novel endoscopic procedure for obstructive jaundice. This patient presented indications for biliary drainage, however, the endoscopic intervention using classical retrograde access was technically impossible. Endoscopic ultrasonography-guided needle puncture was performed to visualize from the duodenal bulb the bile duct, that was amputated in its distal parts by the tumor mass. A guidewire was inserted through the needle, dilated, prosthesis was successfully inserted and normal gall flow was achieved. Authors have not observed any complications after this intervention. To our best knowledge, we are the first who performed such endoscopic procedure in Poland.

[Type 1 diabetes as a mask of a neuroendocrine tumour of pancreas]. / Cukrzyca typu 1 jako maska neuroendokrynnego guza trzustki.

Neuroendocrine tumours of pancreas originating from pancreatic islet cells are uncommon neoplasms with clinical manifestation depending on a type of hormone secreted. Diabetes as a clinical sign of such a tumour has been reported many times and is not an uncommon finding but it is generally mild and makes only a part ofa whole pattern of symptoms. We report on a case of a malignant neuroendocrine pancreatic tumour in 19 years old patient, where diabetes, with a clinical course typical for type 1 diabetes, was the first and the main symptom of the disease.

EcoRI polymorphism of the L-myc gene in gastric cancer patients.

BACKGROUND AND AIMS: L-myc is a nuclear oncogene, which is activated late in cancerogenesis. It has been documented that the EcoRI polymorphism of the L-myc gene is related to an individual's susceptibility to malignancy. Some studies have suggested that the presence of the S allele in patients with cancer is associated with a higher risk of metastases. Despite many studies, it is unclear whether this occurs in gastric cancer. The aim of our study was to determine whether the L-myc polymorphism is associated with susceptibility to gastric cancer in the Caucasian population and to evaluate the presence of the S allele in gastric cancer patients with respect to cancer histology, stage and site, and the patients' age and gender. PATIENTS AND METHODS: We studied 100 gastric cancer patients and 65 healthy unrelated individuals. Restriction fragment-length polymorphism of the L-myc gene was examined by polymerase chain reaction amplification of genomic DNA followed by EcoRI digestion. RESULTS: There were no significant differences in genotype distribution between the cancer group (genotypes: SS 24.6%; LS 58.5%; LL 16.9%) and the control group (genotypes: SS 24%; LS 47%; LL 29%). Significant correlation between S-allele presence and regional nodal metastasis was found (P < 0.025). No correlation with other clinicopathological features was observed. No relation between L-myc polymorphism and susceptibility to gastric cancer was found. CONCLUSIONS: Our study suggests that L-myc polymorphism can be a predisposing factor in the development of nodal metastases in stomach cancer patients.

[Nutritional status of patients in hospitals in Poland. I. Screening of adult patients]. / Stan odzywienia pacjentów w szpitalach w Polsce. I. Ocena przesiewowa pacjentów doroslych.

The aim of the study was a screening assessment of the nutritional status of patients admitted to hospitals and discharged from hospitals. The study was carried out in 4 university hospitals, 4 woivodeship hospitals and 4 district hospitals. In randomly selected 3310 patients (every 10th patient admitted to hospital) anthropometric parameters were assessed: body height, body mass, body mass index (BMI), waist-hip ratio (WHR), arm circumference, blood morphological and biochemical parameters were determined (erythrocyte, white blood cell and lymphocyte count in blood, albumin and haemoglobin concentration in serum). The mean values of the assessed parameters in the whole studied population of patients admitted to various types of hospitals were not different from the normative values for adults, however, a gradual decrease of the values of certain parameters in the over 70 years age group was observed. Although, the mean values of the studied parameters of the nutritional status were within the accepted normal range, 10.43% of the studied patients had BMI below 20 kg/m2, and 20.7% of the patients the serum albumin level was below 3.5 g/dl on admission, which could suggest protein-energy malnutrition. In a yet higher proportion of patients (21%) lymphocyte count was below 1500/mm3. During hospital stay tendency became even more pronounced. On discharge from hospital the proportion of patients with BMI below 20 kg/m2 rose to 11.21%, and with serum albumin level below 3.5 g/dl rose to 28.6%. Only the proportion of patients with low lymphocyte count remained unchanged during hospital stay and was 21.1% on discharge. In the studied population 42.29% of the patients reported receiving of additional food beyond hospital diet.

[Nutritional status of patients in hospitals in Poland. More thorough assessment of nutritional status of adult patients]. / Stan odzywienia pacjentów w szpitalach w Polsce. II. Poglebiona ocena stanu odzywienia pacjentów doroslych.

The purpose of the study was a more thorough assessment of the nutrition state of patients admitted to hospitals in Poland. The study was carried out in four hospitals at teaching centre level, in four hospitals at province level, and in four county hospitals. The patients for the study were selected randomly from 3310 adult patients (every 10th patient admitted to these hospitals). For the study 210 patients (122 women and 88 men) were qualified. Their mean age was 54 +/- 16 years (range 15-82 years). The patients were subjected to various biochemical tests including determination of antioxidant vitamins (vitamins A, E and C), vitamin B12, folic acid, ferritin, and homocysteine and blood lipids. Vitamin deficiency accepted as vitamin malnutrition was found in the case of vitamin C in 51.8% of the patients, folic acid in 32%, vitamin E in 10%, vitamin B12 in 6.8%, vitamin A in 1.4%. Vitamin deficiency was equally frequent in patients with malnutrition, overweight or with obesity. Lipid profile disturbances were found in 51% and high homocysteine level in 63% of the studied patients.

Synchronous and metachronous neoplasms in gastric cancer patients: a 23-year study.

AIM: To determine the prevalence and characteristics of additional primary malignancies in gastric cancer (GC) patients. METHODS: GC patients (862 total; 570 men, 292 women; mean age 59.8 ± 12.8 years) diagnosed at the Department of Gastroenterology at Pomeranian Medical University over a period of 23 years were included in this retrospective analysis of a prospectively maintained database. Mean follow-up time was 31.3 ± 38.6 mo (range 1-241 mo). The following clinicopathological features of patients with synchronous tumors were compared to those with metachronous tumors: age, sex, symptom duration, family history of cancer, tumor site, stage (early vs advanced), histology, and blood group. GC patients with and without a second tumor were compared in terms of the same clinicopathological features. RESULTS: Of 862 GC patients, 58 (6.7%) developed a total of 62 multiple primary tumors, of which 39 (63%) were metachronous and 23 (37%) synchronous. Four (6.9%) of the 58 multiple GC patients developed two or more neoplasms. The predominant tumor type of the secondary neoplasms was colorectal (n = 17), followed by lung (n = 9), breast (n = 8), and prostate (n = 7). Age was the only clinicopathological feature that differed between GC patients with synchronous vs metachronous malignancies; GC patients with synchronous neoplasms were older than those with metachronous neoplasms (68.0 ± 10.3 years vs 59.9 ± 11.1 years, respectively, P = 0.008). Comparisons between patients with and without a second primary cancer revealed that the only statistically significant differences were in age and blood group. The mean age of the patients with multiple GC was higher than that of those without a second primary tumor (63.4 ± 11.4 years vs 59.5 ± 13.0 years, respectively, P = 0.026). GC patients with a second primary tumor were more commonly blood group O than those without (56.2% vs 31.6%, respectively, P = 0.002). CONCLUSION: GC patients may develop other primary cancers; appropriate preoperative and postoperative diagnostic modalities are thus required, particularly if patients are older and blood group O.