Genitourinary symptoms and sexual function in women with primary ovarian insufficiency.

OBJECTIVE: There are limited studies on urogenital symptoms in women who experience menopause before the age of 40 years due to primary ovarian insufficiency (POI) or bilateral oophorectomy (surgical POI). This study aimed to compare the urogenital symptoms, including sexuality, of women with POI to those without the condition. METHODS: This cross-sectional study conducted was in seven Latin American countries, in which postmenopausal women (with POI and non-POI) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS) and the six-item Female Sexual Function Index (FSFI-6). The association of premature menopause with more urogenital symptoms and lower sexual function was evaluated with logistic regression analysis. RESULTS: Women with POI experience more urogenital symptoms (MRS urogenital score: 3.54 ± 3.16 vs. 3.15 ± 2.89, p < 0.05) and have lower sexual function (total FSFI-6 score: 13.71 ± 7.55 vs. 14.77 ± 7.57 p < 0.05) than women who experience menopause at a normal age range. There were no significant differences in symptoms when comparing women based on the type of POI (idiopathic or surgical). After adjusting for covariates, our logistic regression model determined that POI is associated with more urogenital symptoms (odds ratio [OR]: 1.38, 95% confidence interval [CI] 1.06-1.80) and lower sexual function (OR: 1.67, 95% CI 1.25-2.25). CONCLUSION: POI, whether idiopathic or secondary to bilateral oophorectomy, is associated with symptoms that affect vaginal and sexual health.

Meta-analysis of cardiovascular toxicity risks in cancer patients on selected targeted agents.

PURPOSE: The purpose was to estimate the risk and severity of cardiovascular toxicities associated with selected targeted agents. METHODS: We searched English-language literature for randomized clinical trials published between January 1, 2000 and November 30, 2013 of targeted cancer therapy drugs approved by the FDA by November 2010. One hundred ten studies were eligible. Using meta-analytic methods, we calculated the relative risks of several cardiovascular toxicities [congestive heart failure (CHF), decreased left ventricular ejection fraction (DLVEF), myocardial infarction (MI), arrhythmia, and hypertension (HTN)], adjusting for sample size using the inverse-variance technique. For each targeted agent and side effect, we calculated the number needed to harm. RESULTS: Regarding CHF, trastuzumab showed significantly greater risk of all-grade and high-grade CHF. There was significant increased risk of all-grade DLVEF with sorafenib, sunitinib, and trastuzumab and high-grade DLVEF with bevacizumab and trastuzumab. Sorafenib was associated with significant increased all-grade risk of MI based on one study. None was associated with high-grade risk of MI or increased risk of arrhythmia. Bevacizumab, sorafenib, and sunitinib had significant increased risk of all-grade and high-grade HTN. CONCLUSIONS: Several of the targeted agents were significantly associated with increased risk of specific cardiovascular toxicities, CHF, DLVEF, and HTN. Several had significant increased risk for high-grade cardiovascular toxicities (CHF, DLVEF, and HTN). Patients receiving such therapy should be closely monitored for these toxicities and early and aggressive treatment should occur. However, clinical experience has demonstrated that some of these toxicities may be reversible and due to secondary effects.

Obesity-dependent metabolic signatures associated with nonalcoholic fatty liver disease progression.

Our understanding of the mechanisms by which nonalcoholic fatty liver disease (NAFLD) progresses from simple steatosis to steatohepatitis (NASH) is still very limited. Despite the growing number of studies linking the disease with altered serum metabolite levels, an obstacle to the development of metabolome-based NAFLD predictors has been the lack of large cohort data from biopsy-proven patients matched for key metabolic features such as obesity. We studied 467 biopsied individuals with normal liver histology (n=90) or diagnosed with NAFLD (steatosis, n=246; NASH, n=131), randomly divided into estimation (80% of all patients) and validation (20% of all patients) groups. Qualitative determinations of 540 serum metabolite variables were performed using ultraperformance liquid chromatography coupled to mass spectrometry (UPLC-MS). The metabolic profile was dependent on patient body-mass index (BMI), suggesting that the NAFLD pathogenesis mechanism may be quite different depending on an individual's level of obesity. A BMI-stratified multivariate model based on the NAFLD serum metabolic profile was used to separate patients with and without NASH. The area under the receiver operating characteristic curve was 0.87 in the estimation and 0.85 in the validation group. The cutoff (0.54) corresponding to maximum average diagnostic accuracy (0.82) predicted NASH with a sensitivity of 0.71 and a specificity of 0.92 (negative/positive predictive values=0.82/0.84). The present data, indicating that a BMI-dependent serum metabolic profile may be able to reliably distinguish NASH from steatosis patients, have significant implications for the development of NASH biomarkers and potential novel targets for therapeutic intervention.

Pasteurization of milk proteins promotes allergic sensitization by enhancing uptake through Peyer's patches.

BACKGROUND: The underlying mechanisms responsible for allergic sensitization to food proteins remain elusive. To investigate the intrinsic properties (as well as the effect of pasteurization) of the milk proteins alpha-lactalbumin, beta-lactoglobulin and casein that promote the induction of milk allergy. METHODS: Alteration of structure and immune-reactivity of native and pasteurized proteins was assessed by gel filtration and ELISA. Uptake of these proteins was compared in vitro and in vivo. The biological effect was assessed by orally sensitizing C3H/HeJ mice with milk proteins followed by a graded oral challenge. Required dose to induce anaphylaxis, symptoms and mean body temperature was recorded. Antigen-specific antibodies and cytokine production by splenocytes were analyzed. RESULTS: Soluble beta-lactoglobulin and alpha-lactalbumin but not insoluble casein were readily transcytosed through enterocytes in vitro and in vivo. Pasteurization caused aggregation of beta-lactoglobulin and alpha-lactalbumin inhibiting uptake by intestinal epithelial cells in vitro and in vivo. Furthermore, aggregation redirected uptake to Peyer's patches, which promoted significantly higher Th2-associated antibody and cytokine production in mice than their native counterparts. Despite this only the soluble forms of beta-lactoglobulin and alpha-lactalbumin elicited anaphylaxis (following priming) when allergens were administered orally. Aggregated beta-lactoglobulin and alpha-lactalbumin as well as casein required systemic administration to induce anaphylaxis. CONCLUSIONS: These results indicate that triggering of an anaphylactic response requires two phases (1) sensitization by aggregates through Peyer's patches and (2) efficient transfer of soluble protein across the epithelial barrier. As the majority of common food allergens tend to form aggregates, this may be of clinical importance.

Expression, purification, and co-crystallization of IRF-I bound to the interferon-beta element PRDI.

Interferon regulatory factor 1 (IRF-1) is an essential factor involved in the regulation of type I interferon (IFN) and IFN-inducible genes. The protein consists of 329 amino acids that are highly conserved from mouse to human. Similar to other transcription factors, the protein is modular in nature with a basic N-terminal region involved in DNA binding and an acidic C-terminal region required for activation. We report here the expression, purification and co-crystallization of the minimal N-terminal region of IRF-1 involved in DNA binding (amino acids 1-113) with a 13 bp DNA fragment from the IFN-beta promoter. The crystals diffract to at least 3.0 A in resolution and belong to space group R3 with unit cell parameters of a = b = 84.8 A, c = 203.7 A.

"No punch" technique of laparoscopic vertical banded gastroplasty for morbid obesity.

BACKGROUND: This report describes the technical details and an initial evaluation of laparoscopic vertical gastroplasty modified for morbid obesity. After a surgical experience in 150 patients with open vertical banded gastroplasty (Mason's procedure), it was decided to perform a modified banded vertical gastroplasty. MATERIALS AND METHODS: Six patients were treated by this laparoscopic approach in 1997-1998. All patients were women with a mean age of 28 years (range 20-46). The mean body weight was 128 kg (range 105-146), and the mean BMI was 42.7 kg/m2 (range 35.6-53.0). Four or five 10- or 12-mm trocars were used. For all the dissection we used atraumatic ultracision (harmonic scalpel). In this procedure the technique of laparoscopic gastroplasty is performed without a circular gastric window. During the operation, 3 omental openings were made and the vertical staple-line was constructed by using a 30-mm 3-row linear stapler twice, establishing the gastric pouch. The outflow stoma was reinforced by a Gore-Tex band and calibrated to have an internal diameter of 10-15 mm. The band was sutured to itself. RESULTS: There were no deaths or complications. Operating time was 200 min (150-240). The nasogastric tube was removed at 1-2 days. The postoperative course was characterized by normal respiratory function and minimal pain in all cases. Patients were discharged 5-6 days after operation. CONCLUSIONS: Our technique excluded the circular gastric window (i.e., "no-punch") technique in the development of an effective and simple laparoscopic procedure to treat morbid obesity.

Liver transplantation in a case of steatohepatitis and subacute hepatic failure after biliopancreatic diversion for morbid obesity.

BACKGROUND: Biliopancreatic diversion (BPD) was designed to avoid the serious complications of jejunoileal bypass (steatohepatitis and hepatic failure). Although this is today considered a safe and effective procedure, a few reports of patients who developed steatohepatitis and subsequently died in hepatic failure exist. METHODS: We report a morbidity obese patient who developed subacute hepatitis resulting in hepatic failure 1 year after BPD. RESULTS: Because of irreversible liver failure the decision to perform a liver transplantation was made. The patient underwent emergency liver transplant and lengthening of the common limb. The course of liver transplantation and the patient's recovery were uneventful. CONCLUSION: Severe liver disease may rarely follow BPD. Liver transplantation and lengthening of the common bowel may be performed to treat these patients.

Variables affecting BMI evolution at 2 and 5 years after vertical banded gastroplasty.

BACKGROUND: Vertical banded gastroplasty (VBG) has been found to result in significant reduction in body mass index (BMI) during the first postoperative year. We investigated the impact of some intrinsic and extrinsic factors on long-term BMI evolution in morbidly obese patients who underwent VBG, with the aim of establishing a long-term weight-loss prognosis. METHODS: 67 consecutive morbidly obese patients who underwent VBG were followed for 2 years; of these, 34 were followed 3 more years, for a total follow-up of 5 years. BMI was monitored and correlated with demographic (preoperative BMI, obese relatives, age and gender) and lifestyle variables (physical activity, habitual dietary transgression and occupational status). RESULTS: Global BMI fell from 47.5 at the time of the intervention to 32.1 when patients were examined 12 months after surgery. From the second year, an upward trend was observed, and at 5 years, mean BMI was above 35, considered in the high-risk range. Modifiable variables affecting lifestyle have shown significantly favorable effects on BMI evolution. Among intrinsic variables, BMI before surgery and obese parents also affect long-term evolution. CONCLUSION: Different variables should be considered in order to establish a long-term weight-loss prognosis for each patient, thus making it possible to act more specifically on modifiable variables.

Application of the POSSUM system in bariatric surgery.

BACKGROUND: The POSSUM system has been devised for physiologic and operative scoring. The scoring system produced assessment for morbidity and mortality rates, which did not significantly differ from observed rates. The authors have applied this system to bariatric surgery. PATIENTS AND METHODS: 20 patients were scored by the POSSUM system. All underwent elective bariatric surgery during 1997. All patients were scored at the time of surgery with the physiologic score (FIS) and at discharge with the operative severity score (IQ). The FIS score included age; cardiac signs; chest radiograph; respiratory history; blood pressure; pulse; Glasgow coma score; determinations of hemoglobin, leukocyte, urea, sodium, and potassium levels; and electrocardiogram. The IQ score included multiple procedures, total blood loss, peritoneal soiling, presence of malignancy, and mode of surgery. RESULTS: The mean POSSUM score was 23.9. The mean FIS was 13.95 (12-22), and the mean IQ was 9.4 (7-16). The distribution of patients was performed for BMI. The group with BMI 35-45 (n = 4 patients) had a mean POSSUM score of 22.75, a mean FIS of 13.75, and a mean IQ of 9.0. The group with BMI >45 (n = 16 patients) had a mean POSSUM score of 24.18, a mean FIS of 14.62, and a mean IQ of 9.5. The morbidities were gastric fistula with peritonitis and deep venous thrombosis. The two complications had similar POSSUM scores with different BMIs. No mortality was observed. CONCLUSIONS: According to this experience, the POSSUM scoring system appears to provide an indicator of minor risk of morbidity and mortality in bariatric surgery with vertical banded gastroplasty.

Technical alternatives in laparoscopic distal gastric bypass for morbid obesity in a porcine model.

BACKGROUND: Laparoscopic gastric bypass and vertical banded gastroplasty are two procedures used in the treatment of morbid obesity. The authors describe alternative techniques of laparoscopic distal gastric bypass as a modification of the Scopinaro procedure, which were used experimentally in a porcine model. METHODS: Five pigs were used. The laparoscopic procedure was performed with the pigs under general anesthesia after pneumoperitoneum had been achieved. Five or six trocars were used. One port was converted from 12 to 33 mm, and all the other ports were 10-11 mm. The initial surgical technique was similar to that used by others for laparoscopic gastrectomy, except that atraumatic ultracision was used for all the dissection. The stomach was stapled with a linear cutter stapler (Endopath, 31 mm) to create a 50-ml pouch. The ileum was divided with a linear cutter-stapler (Endopath, 31 mm) or ultracision cautery. A long length of ileum was positioned between the stomach pouch and the jejunoileostomy. Only 50-70 cm of terminal ileum was preserved as a common channel. In three animals, the circular stapler (ILS, 21 mm) was used to produce an end-to-side anastomosis. In one animal, two purse-string sutures were handsewn in the ileum and jejunum stumps, and in another two animals, two endoloops were used for the anvil. In two animals, the linear stapler was used to form a side-to-side pouch stomach-ileum and jejunoileostomy anastomosis. In other animals, the two types of anastomosis have been combined. All animals were killed after surgery so that the anastomoses could be evaluated for size and integrity. RESULTS: In all animals, with the circular and linear stapler, both 21 and 13-15 mm anastomoses were intact. CONCLUSION: Distal gastric bypass is feasible laparoscopically, with intact anastomoses.

Tuberculosis meningitis in a patient with acute myelogenous leukemia.

We present a case of tuberculous meningitis in a patient with acute myelogenous leukemia. The patient was in complete remission; he had persistent lymphopenia and CD4+ T lymphocytopenia. Diagnosis was complicated by the chronic and subacute nature of symptoms; some originally thought to be secondary to depression and chemotherapy related toxicity. Treatment was further complicated by the unusual phenomenon of paradoxical progression of disease while on appropriate therapy. This case illustrates the importance of consideration of mycobacteriosis in the differential diagnosis of chronic unexplained fever complicating treatment for acute leukemia. The natural history and essential aspects of diagnosis and treatment of CNS tuberculosis are reviewed. The clinical significance of unexplained CD4+ T lymphocytopenia and chronic lymphopenia in patients with leukemia is also discussed.

Identifying risk factors for imminent death in cancer patients with acute dyspnea.

A substantial proportion of cancer patients presenting to an emergency center (EC) or clinic with acute dyspnea survives fewer than 2 weeks. If these patients could be identified at the time of admission, physicians and patients would have additional information on which to base decisions to continue therapy to extend life or to refocus treatment efforts on palliation and/or hospice care alone. The purpose of this study was to identify risk factors for imminent death (survival

Causes and management of superior vena cava syndrome.

Superior vena cava syndrome is today primarily a disease associated with malignancy. Thrombosis of the superior vena cava associated with the use of intravascular devices or extraluminal obstruction from malignancy is now recognized as an important pathophysiologic process in the syndrome. Irradiation has long been the mainstay of treatment. Newer treatments include more effective chemotherapy for certain cancers such as lymphoma and small-cell carcinoma, fibrinolytics to treat thrombosis, and interventional radiologic techniques. Expandable metallic stents have been shown to improve the quality of life for patients who, in the past, quickly succumbed to the disease process. Current management stresses the importance of accurate diagnosis of the underlying etiology before treatment. Only under extreme emergent conditions such as laryngeal or cerebral edema should irradiation proceed without a diagnosis. Future studies should address the role of anticoagulant therapy and the timing of interventional techniques in relation to radiation or chemotherapy.

NCCN Practice Guidelines for Cancer-Related Fatigue.

These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue, using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for the five primary factors known to be associated with fatigue: pain, emotional distress, sleep disturbance, anemia, and hypothyroidism. If any of these conditions are present, it should be treated according to practice guidelines, and the patient's fatigue should be reevaluated regularly. If none of the primary factors is present or the fatigue is unresolved, a more comprehensive assessment is indicated--with referral to other care providers as appropriate. The comprehensive assessment should include a thorough review of systems, review of medications, assessment of comorbidities, nutritional/metabolic evaluation, and assessment of activity level. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, restorative therapies to decrease cognitive alterations and improve mood state, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs such as antidepressants for depression or erythropoietin for anemia. A few clinical reports of the use of corticosteroids and psychostimulants suggest the need for further research on these agents as a potential treatment modalities in managing fatigue. Basic to these interventions, the effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly and systematically and incorporates education and counseling regarding strategies for coping with fatigue (Johnson, 1999), as well as using institutional fatigue management experts for referral of patients with unresolved fatigue.

Hypertensive crisis.

Hypertensive crisis is an acute emergency requiring aggressive management. Its incidence has decreased in recent years but still is prevalent in the medical community. From review of past and present treatment regimens, the following recommendations can be considered. (1) In the treatment of malignant hypertension with associated CHF, sodium nitroprusside is still an excellent agent. It has a rapid onset of action and blood pressure can be easily titrated. Nitroglycerin is also another agent that can be used in this situation. (2) In the treatment of malignant hypertension with associated aortic dissection, trimethophan camsylate is the preferred agent. An alternative choice is the combination of nitroprusside and labetalol. (3) In the treatment of malignant hypertension with associated myocardial ischemia, an excellent choice is nitroglycerin. Labetalol also should be considered in this situation. (4) In the treatment of hypertension during pregnancy, hydralazine is still a good choice. Labetalol has also been shown to be efficacious. (5) In the treatment of malignant hypertension with associated cerebral ischemia, the following drugs should be considered: nitroprusside, nitroglycerin, and labetalol. The most important attribute of these agents is that they are nonsedating and rapid in onset. (6) In the treatment of postoperative hypertension the choices best suited are labetalol, enalapril, nitroprusside, and nitroglycerin. These agents are rapid in onset and all can be administered intravenously.

Severity of illness, outcomes, and resource use in elderly cancer patients with deep venous thrombosis.

Low-molecular-weight heparins provide new options for outpatient management of deep venous thrombosis. Because elderly patients with cancer are at increased risk of developing deep venous thrombosis, outpatient therapy for treatment of deep venous thrombosis may be important in this population. We compared the severity of illness, outcomes, and cost of deep venous thrombosis in elderly patients with cancer to those seen in younger patients with cancer. We examined all 766 episodes of deep venous thrombosis treated at the University of Texas M.D. Anderson Cancer Center between January 1, 1994 and December 31, 1996. Severity of illness level and predicted risks of mortality and readmission were obtained from a commercially available disease staging system (Inforum System). Observed outcomes and cost were based on data collected from the 766 episodes of deep venous thrombosis at our institution. One hundred nineteen (16%) episodes of deep venous thrombosis occurred in patients 70 years of age or older. The severity of illness scale (1-5, least-most severe) were identical (3.7) in the 3 groups studied (< 70 years, 70-79, years and > or = 80 years). The predicted risk of death during hospitalization (6%, 9%, 8%, respectively, by group, P = 0.12) and readmission in 30 days (5%, 4%, 3%, respectively, P = 0.04) were similar among the groups. The observed death rates during hospitalization were 5%, 6%, and 6%, respectively (P = 0.91), and the rates of hospitalization for deep venous thrombosis recurrence were 22%, 16%, and 28%, respectively (P = 0.27). The similarities in outcomes and resource use between elderly and younger patients suggest that elderly patients with cancer are not at greater risk of serious clinical outcomes or a prolonged clinical course. There is significant potential for outpatient management of these patients.

Enhanced anticaries efficacy of a 0.243% sodium fluoride/10% xylitol/silica dentifrice: 3-year clinical results.

PURPOSE: To evaluate the efficacy of a sodium fluoride (NaF)/silica/xylitol dentifrice compared with that of a positive control NaF/silica dentifrice on caries increments in school children over a 3-year period in an area without an optimal level of fluoride in the drinking water (mean level <0.1 ppm). MATERIALS AND METHODS: A 3-year, double-blind clinical caries study was conducted in 2,630 children initially aged 8-10 years at 17 schools in the San Jose, Costa Rica metropolitan area. Clinical dental examinations were performed at participating schools utilizing portable dental equipment. Caries evaluations employed conventional tactile/visual methodology consisting of artificial light, dental mirrors and single-edge #23 explorers. Children accepted into the study were stratified by age and sex into two balanced groups within each school, and randomly assigned to use either a positive control dentifrice containing 0.243% NaF/silica or a test dentifrice containing 0.234% NaF/silica/10% xylitol. Children were instructed to brush with the assigned dentifrice twice daily. Caries evaluations were conducted at baseline, 2 years, and 3 years. RESULTS: After 3 years, subjects using the 0.234% NaF/silica/10% xylitol dentifrice had statistically significantly reduced decayed/filled surfaces (DFS; -12.3% reduction; P < or = 0.001) and decayed/filled buccal and lingual surfaces (DFS-BL; -10.5% reduction; P < or = 0/01).

Assessment of post-splenectomy residual splenic function. Splenic autotransplants.

Splenectomy increases the risk of fulminant sepsis. The present study assesses residual splenic function in patients splenectomized due to traumatic rupture of the spleen; and six cases with splenic autotransplants. Splenic tissue was observed in only 48% of the splenectomized patients and 100% of the autotransplant cases. The two most reliable analytical parameters to assess the presence of functional splenic tissue, were the absence of Howell-Jolly bodies and normal IgM blood levels. In cases where total splenectomy is indicated, it has proved useful to perform autotransplantation of splenic tissue at omentum major level.

[Extrahepatic biliary lesions in abdominal traumatism]. / Lesiones biliares extrahepáticas en el traumatismo abdominal.

The extrahepatic biliary tree traumatisms are rare and hard to diagnose; 15 of 864 patients with surgery treatment for abdominal trauma for over 19 years (1974-1992) were studied retrospectively. Twelve blunt abdominal traumas (9 traffic accident and 3 falls down) and 3 open traumas (stabbing in two and gunshot wounds in one case). Eleven had gallbladder injury, two gallbladder and biliary duct and two exclusively biliary duct. Only one case was an isolated lesion, in the rest of cases, intra or extra abdominal lesions, occasionally both, were seen. The diagnostic method, associated lesions, morbi-mortality are reviewed. Surgical treatment was cholecystectomy for gallbladder injury and direct suture with T-tube (Kehr) for biliary duct injury.

[Surgery of early gastric cancer. Twenty-five year experience]. / Cirugía del cáncer gástrico precoz. Experiencia en 25 años.

AIM: To study the influence of the depth of parietal invasion (mucosal-submucosal), the presence or absence of ganglionic invasion and type of gastrectomy performed (subtotal or total) on survival in patients with early gastric cancer. STUDY DESIGN: Longitudinal study. PATIENTS: A clinical-pathologic study of 101 patients who underwent surgery for early gastric cancer was performed. Probability of survival was estimated using the Kaplan-Meier and logrank tests and multivariate analysis was performed using the Cox test. RESULTS: Mucosal involvement was found in 46 patients (45.5%) and submucosal involvement in 55 patients (54.5%). The presence of ganglionic metastases was greater in tumors reaching the submucosa (14 [25.5%]) than in those limited to the mucosa (4 [8.7%]). Partial gastrectomy was performed according to tumor location in 84 patients (83.2%), total gastrectomy was performed in 16 patients (15.8%) and 1 wedge resection was performed. The mean postoperative follow-up was 84.04 55.89 months (range: 2-264). Comparison of survival in patients with tumors limited to the mucosal or submucosal layers revealed a p-value of 0.06 (NS). Comparison of survival in patients with metastases and in those without metastases revealed a p-value of < 0.0001. Comparison of survival between patients who underwent total gastrectomy and those who underwent partial gastrectomy showed a p-value of 0.38 (NS). Postoperative mortality was nil. Overall survival at 5 years was 79.24% and at 10 years was 68.14%. Multivariate analysis revealed that ganglionic involvement and depth of parietal invasion influenced survival. CONCLUSIONS: Survival is influenced by ganglionic involvement but not by submucosal invasion. Partial gastrectomy may be an appropriate procedure since survival is similar to that associated with total gastrectomy.