A retrospective study of 954 resectable gastric cancers in a single institute of Taiwan from 1971 to 1990 was performed to evaluate improvements in gastric cancer surgery. The patients were divided into four time periods representing an overall experience of progressive implementation of aggressive resection and increased extent of systematic lymph node dissection. The clinicopathologic data and survival rates were statistically compared and the significance of the extent of resection on survival analyzed. A significant increase in the proportion of upper one-third tumors (from 14.8% to 20.4%) and a decrease in the incidence of intestinal type (73.6% to 41.5%) was found within the overall period. The proportion of patients with early gastric cancer increased from 11.5% to 19.4%. Patients who underwent total gastrectomy and combined visceral resection increased from 13.7% to 27.4% and 19.8% to 41.1%, respectively. An increase of both total dissected lymph node number and the incidence of detected lymph node metastases in early gastric cancer were associated with more extensive lymphadenectomy. An improved 5-year survival rate following aggressive resection was found for all stages except stage IV and T4 lesions, and the surgical mortality decreased from 5.5% to 2.0%. Patients with earlier stage lesions benefited more from radical resection, especially those with stage II and T2 lesions. Systematic lymph node dissection increased the 5-year survival of patients by about 10% for stage III or T3 lesions but not for patients with stage IV or T4 lesions. Multivariate analysis confirmed the significance of the improved technique of lymphadenectomy on the prognosis of gastric cancer following resection in Taiwan.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

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Clinical use of tai chi in elderly populations.

Tai chi, a type of low-intensity exercise, has received growing attention in both eastern and western cultures, especially its use with the most rapidly increasing segment of the population-elders. Previous research findings further supported the idea that tai chi is appropriate for elderly populations and helps promote their well-being. In this article, the beneficial effects of tai chi for elders are summarized, resources to increase awareness about the exercise are provided, and ways to promote tai chi in elderly populations are suggested.

Aged↗

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Lymph node metastases in gastric cancer: significance of positive number.

To investigate the significance of the number of node metastases in gastric cancer and its relationship to traditional anatomical classification, 305 patients who underwent a radical gastrectomy and extended lymphadenectomy (R3/4) with curative intent were reviewed. Lymph node metastases was found in 191 (62.6%) patients. The incidence of lymph node metastases was closely related to the depth of cancer invasion as well as the extent of lymph node group involvement. The frequency of metastases in different lymph node locations was related to the location of the primary tumor. The 3-year survival rates for patients with node involvement and without were 42.1 and 92.3%, respectively. In node number analysis, the distribution of the N1 group and the N4 group involvement was rather characteristic and could be predicted from a node number < 4 or > 12. The predictability of N2 and N3 involvement from node numbers 4-8 and 9-12 was less satisfactory. On the whole, patients with a metastatic node number < 4 could be considered to be N1 and had a relative good prognosis. Patients with node number 4-10 could be considered as N2 and > 10 as an incurable disease with distant metastases. Both had a poor prognosis. The data suggest that lymph node number represents the biologic behavior of cancer instead of the anatomic consideration of conventional N stage. The number of metastatic lymph node number is a good prognostic indicator with similar predicting power as the conventional node stage.

Adult↗

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Energy substrate for liver regeneration after partial hepatectomy in rats: effects of glucose vs fat.

This study evaluated the effects of glucose or fat on liver regeneration after partial hepatectomy in rats. Partial hepatectomy with resection of the median and left lateral lobes (67.31%) was performed on three rat groups. Two groups were infused with high-glucose (HG) or high-fat (HF) solutions intravenously 2 days before surgery. The control (C) group was allowed to eat instead of receiving intravenous infusions. Another group with sham operation only was also allowed to eat. Rats were killed 6, 24, 48, or 72 hours after the operation. Remnant liver weight, DNA synthetic rate, DNA content, and mitotic index were chosen as comparing indicators. Blood glucose, serum free fatty acid (FFA), total ketone bodies, and ketone body ratio were measured. Transmission electron microscopy was also used to observe the remnant liver. The results showed that the HG rat group had a better regenerative condition than did the HF rat group (p less than .01). Glucose is the predominant energy substrate when enough is offered during the immediate posthepatectomy phase. FFA utilization occurred only very early after partial hepatectomy, and it was remarkable in the control group, moderate in the HF group, and low in the HG group. Shifting of the energy substrate to FFA occurred only when glucose was not available for utilization. The disappearance and reappearance of glycogen, and accumulation of fat in cytoplasm as shown by transmission electron microscope pictures support this conclusion.

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Preoperative evaluation of rectal carcinoma invasion using transrectal ultrasonography: preliminary experience of 30 patients.

Transrectal ultrasonography was used to examine and to preoperatively evaluate rectal carcinoma invasion in 30 patients. Satisfactory sonography pictures were obtained in 23 patients. Four stages of tumor invasion were identified in our study. The sensitivity of preoperative evaluation in this study was 91%. In order to verify the correspondence between the ultrasonographic findings and the actual histo-anatomic condition of rectum, 10 resected rectal specimens were studied by in vitro ultrasonography. We conclude that the appearance of the muscularis propria layer of rectum as a homogeneous hypoechogenic band can be stably defined with transrectal ultrasonography and is crucial for accurate evaluation of cancer invasion. Although lymph node enlargement was shown as hypoechogenic nodules on the sonographic pictures, the existence of cancer metastasis could not be differentiated in this study.

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Cancer of the stomach: a review of two hospitals in Korea and Japan.

Explore the source record for details and available documents.

Hospitals↗

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Fulminant hepatic failure in a renal transplant recipient with positive hepatitis B surface antigens: a case report of fibrosing cholestatic hepatitis.

This 28-year-old male, a hepatitis B virus (HBV) carrier, received cadaveric renal transplantation and was maintained on cyclosporin A and prednisolone. Jaundice occurred 8 months after the transplantation and he died 2 weeks later due to hepatic failure. The liver histologic findings were compatible with fibrosing cholestatic hepatitis (FCH), which is caused by HBV and has only been reported in liver allografts of orthotopic liver transplantations. This is the first case of FCH developing in a renal transplant recipient. The report illustrates that (1) FCH is also a unique histologic entity in renal transplantations; (2) FCH might occur in a liver chronically infected by HBV without co-existing hepatitis D virus; and (3) FCH can cause fulminant hepatic failure within one year after transplantation while the patient is still in an immunosuppressed state.

Adult↗

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Cytomegalovirus enteritis causing massive bleeding in a patient with AIDS.

An emergency operation was performed on a 58 year-old heterosexual male patient for massive lower gastrointestinal bleeding, which was caused by cytomegalovirus (CMV) related ulceration at the terminal ileum. Pre-operative endoscopic evaluation revealed multiple esophageal and gastric ulcerations in upper gastrointestinal tract and much fresh blood in distal colon. Angiography showed vascular tufts and extravasation of contrast medium in the cecal area. Angiodysplasia of cecum with massive bleeding was initially impressed. However, CMV enteritis was identified in the resected ileum, the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) was confirmed by subsequent serological tests. AIDS was unknown to treating physicians until diagnosed by pathological specimen. Massive lower gastrointestinal bleeding related to CMV ulceration in small bowel is rare, we report this unusual presentation and highlight the the suspicion of immunocompromised state of patients with unusual, multiple gastro-intestinal ulcers.

AIDS-Related Opportunistic Infections↗