Endoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergone gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically broken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal infiltration. Endoscopy used for histological evaluation frequently revealed the protruded type to be whole layer and had a highly accurate diagnosis rate (94%); it revealed the histology of the other four types to be primarily superficial. Extent of cancer invasion was underestimated in giant-rugae tumors (40%), as endoscopy could barely detect the small nest of esophageal infiltrations. Lugol staining was useful in preventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen section taken from the proximal edge of resected specimen.

Adenocarcinoma↗

PubMedDate not supplied

A case for multisite studies in critical care.

Studies in critical care settings are essential to improve critical care practice. Critical care research conducted at a single site may be limited with respect to sample size leading to large type II error, diminished statistical power, decreased generalizability, and inconclusive results. Multiple-site studies are more likely to change nursing practice in critical care. They allow for larger sample size, broader sampling, faster accrual rates, and meaningful subgroup analyses. Successful multisite research requires more thorough planning, and deliberate steps are required to ensure its feasibility and acceptability. Multisite research protocols can be challenging regarding communication, reliability, and data integrity. However, defining and addressing these challenges and selecting subjects and settings appropriately can lead to results that are more generalizable and relevant to practice.

Clinical Protocols↗

PubMedDate not supplied

Differential diagnosis of solitary pulmonary nodules with positron emission tomography using [11C]L-methionine.

Two patients with solitary pulmonary nodules, 1.5-2.0 cm in diameter, were studied by positron emission tomography using [11C-Methyl]L-methionine (11C-Met). Case 1 showed high accumulation of 11C-Met in the tumor, and a tumor/muscle ratio of 6.0 suggesting malignancy. Tissue obtained by biopsy revealed a squamous cell carcinoma. Case 2 showed nonspecific isotope accumulation in the tumor, and a tumor/muscle ratio of 1.2 suggesting a benign lesion. Lung biopsy demonstrated granuloma. Positron emission tomography with 11C-Met seems to be useful for the differential diagnosis of solitary lung nodules.

Aged↗

PubMedDate not supplied

Tracheobronchial mucociliary clearance and alveolar epithelial permeability measured by PET with 18FDG powder.

Tracheobronchial mucociliary clearance and alveolar permeability were measured with positron emission tomography using a water-soluble dry aerosol, sodium-N-acetyl-neuraminate tagged with 2-deoxy-2-[18F]fluoro-D-glucose (18FDG powder). Five normal volunteers inhaled 1.5-2.0 mCi of FDG powder by a single deep breath. The distribution of radioactivity, measured by scanning during a period of 120 min, showed that the 18FDG powder deposition progressed from the central airways to the peripheral alveolar areas. In the tracheobronchial system the radioactivity decreased to 24% of the initial deposition at 60 min. In the peripheral alveolar area, where absorption into blood or lymphatic flow crossing the epithelial layer represents a unique mechanism of clearance for water-soluble 18FDG powder, alveolar radioactivity decreased slowly to approximately 70% of the initial deposition at 60 min after inhalation. Positron emission tomography using 18FDG powder provides a regional evaluation of both mucociliary transport in the tracheobronchial system and epithelial permeability in the alveolar area.

Absorption↗

PubMedDate not supplied

Imaging of breast cancer with [18F]fluorodeoxyglucose and positron emission tomography.

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Adult↗