Beyond the obvious step of limiting use of non-steroidal anti-inflammatory drugs (NSAIDs), the treatment of ulcers induced by NSAIDs remains controversial. We evaluated the efficacy of the proton-pump inhibitor lansoprazole on NSAID-induced ulcers. Ulcers were endoscopically diagnosed in 47 NSAID users. These patients received 30 mg/day lansoprazole, orally, for 6 or 8 weeks (6 weeks for duodenal ulcers and 8 weeks for other ulcers). Ulcer healing was assessed using an established classification system. The presence of immunoglobulin G antibody against Helicobacter pylori was also evaluated. The antibody was present in the sera of 51% of patients (24/47). Most of the ulcers reached scarring stages S1 (healing) or S2 (good healing), and the S2 healing rate was 35%. Two H. pylori seropositive patients did not reach these stages; their ulcers were improved by H. pylori eradication therapy, followed, in one case, by medication with misoprostol. Lansoprazole seemed to be useful for most patients with NSAID-induced ulcers, but a few needed additional treatments.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMedDate not supplied

Factors influencing survival in 33 patients undergoing resection of hepatic metastases from colorectal cancer.

BACKGROUND/AIMS: To determine the factors influencing the prognosis of patients undergoing resection of hepatic metastases from colorectal cancer. METHODOLOGY: Between December 1981 and March 1998, 33 patients underwent potentially curative hepatic resection for metastatic colorectal cancer at the Kiryu Kousei General Hospital. We retrospectively examined 15 factors, including 3 clinical factors, 5 primary tumor characteristics and 7 metastatic tumor characteristics. Survival rates were estimated by the Kaplan-Meier method, and the weighting of each factor was compared by the log-rank test. We used univariate and multivariate analyses to assess any associations between the factors and mortality. RESULTS: The 30-day operative mortality was 0%. The 5-yr survival rate of the 33 patients was 43%. A significant survival advantage was noted in patients with 1 or 2 metastatic lesions (25/33, 76%), patients who underwent systematic anatomical resection (14/33, 42%) and male patients (16/33, 48%), compared with patients with 3 or more lesions (50% and 17%, P = 0.021), patients who underwent non-systematic resection (67% and 23%, P = 0.005) and female patients (65% and 20%, P = 0.011), respectively. No statistical influence on survival was found in the multivariate analysis of these 3 factors. Recurrence was identified in 24 patients (73%) and 19 of them died of recurrent cancer. CONCLUSIONS: Surgical resection of hepatic metastases from colorectal cancer is safe and potentially curative in appropriately selected patients.

Aged↗

PubMedDate not supplied

Resection of liver metastasis from gastric adenocarcinoma.

BACKGROUND/AIMS: To determine the factors influencing the prognosis of patients undergoing resection of liver metastases from gastric adenocarcinoma. METHODOLOGY: Over a 10-year period, at Kiryu Kousei General Hospital, 12 patients underwent potentially curative hepatectomy for metastatic adenocarcinoma of gastric origin. Two patients were excluded from this study, one because of postoperative death and one due to insufficient follow-up. We retrospectively examined the following factors: including TNM classification of the primary tumor, disease-free interval between gastric and hepatic resection, number and maximum diameter of the metastases, histological differentiation of the metastases, and the presence of lymphocyte aggregation enclosing the metastatic lesions. Survival rates were estimated by the Kaplan-Meier method and the weighting of each factor was compared by the log-rank test. RESULTS: The overall 5-year survival rate of the 10 patients was 10%. The median survival time after hepatectomy was 16.3 months, ranging from 3.1 to 245.7 months. Eight patients died of recurrent cancer and 1 died of unrelated septic shock with no evidence of cancer recurrence. Only one patient was alive without recurrence at the time of maximum follow-up. A significant survival advantage was noted in patients with disease-free interval > or = 1 year, and those with metastatic tumors < 5 cm in maximum diameter and/or enclosed by the aggregated lymphocytes, when compared with patients with disease-free interval < 1 year and those with metastatic tumors > or = 5 cm and/or directly infiltrated hepatic parenchyma. CONCLUSIONS: It was suggested that hepatectomy should be attempted in patients where the disease-free interval was > or = 1 year and with metastatic nodules < 5 cm. Lymphocyte aggregation around the metastatic tumor is a good prognostic sign for long-term survival.

Adenocarcinoma↗

PubMedDate not supplied

Resection of liver metastasis after a pancreatoduodenectomy for pancreatic cancer: a case report.

A case of resected liver metastasis from pancreatic cancer, in a 69-year-old woman who obtained a relatively long survival, is presented. Primary pancreatic cancer was found in a patient presenting with obstructive jaundice and a loss of appetite. A pylorus-preserving pancreatoduodenectomy was carried out on December 2, 1996. Eleven months later, a 1.5-cm mass was found in the right posterior segment of the liver. Although the tumor size had increased to 2.5 cm 5 months later, no other metastases were observed. Therefore, the right posterior segment of the liver was resected. Eleven months after the second operation, recurrence was found in the cut surface of the liver and the left caudate lobe. She died on May 1, 1999. This case demonstrated a relatively favorable prognosis in comparison to other common type of liver metastasis from pancreatic cancer. This study discusses the peculiarities of this case and emphasizes the necessity to carefully select the patients before attempting to resect the liver metastasis from pancreatic cancer.

Adenocarcinoma↗

PubMedDate not supplied

Recurrent bleeding from a duodenal diverticulum 8 years after endoscopic treatment: case report and review of the literature.

A 70-year-old woman presented with a 2-day history of tarry stool. She had a history of hemorrhage from a duodenal diverticulum of the 2nd portion 8 years previously that had been managed successfully by endoscopic hemostasis. Initial gastrointestinal endoscopy revealed ulceration of the diverticulum with no active bleeding; nevertheless the ulceration was presumed to be the source of the tarry stool. Despite medical treatment, bleeding started again, but endoscopic ethanol injection achieved hemostasis. When bleeding started yet again 8 days after the endoscopic therapy, the patient underwent diverticulectomy. Although duodenal diverticula are frequently found in the adult gastrointestinal tract, they rarely show hemorrhage. Recently, there has been controversy about whether bleeding diverticula should be managed surgically or endoscopically. We describe for the first time a rare case of recurrent hemorrhage of a duodenal diverticulum after an 8-year interval; the case was treated by surgical diverticulectomy as a definitive therapy for the recurrent bleeding ulcer. We also present a review of the literature.

Aged↗