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PubMedDate not supplied

Features of chronic inflammation at the gastric cardia and the relationship with Helicobacter pylori infection and oesophagitis.

BACKGROUND: The etiopathogenesis of chronic inflammation at the gastric cardia is still debated. It is suggested that carditis may be a finding of gastro-oesophageal reflux disease (GORD) or it may occur as a result of the gastritis caused by Helicobacter pylori (H. pylori) infection. AIM: To examine morphological features of carditis, as well as the associations of carditis with Helicobacter pylori gastritis and oesophagitis as a marker of gastro-oesophageal reflux disease. PATIENTS AND METHODS: Endoscopic biopsy specimens obtained systematically from oesophagus, cardia, corpus and antrum of 135 dyspeptic patients were retrospectively evaluated. In biopsies, we have searched for any correlations between clinical, endoscopic, and histological features. RESULTS: Carditis was detected in 123 (91.1%) of the cases. The mean age of the carditis group was 47.9 years and the male-to-female ratio was 1.08:1. The relation of carditis with age and sex was not significant (p = 0.19 and p = 0.24, respectively). All cases of the carditis group had concomitant chronic gastritis. In these cases, chronic inflammation, degree of neutrophil-mediated activity and H. pylori colonisation were significantly correlated in cardia, corpus and antrum (p < 0.001). Intestinal metaplasia was observed in 14 cases (11.3%) and, was associated with H. pylori colonisation (p < 0.001). Microscopic oesophagitis detected in 37.7% cases also showed correlation with reflux symptoms and endoscopic oesophagitis but not carditis. When all cases with carditis were evaluated for H. pylori infection and oesophagitis, which are presumed risk factors for carditis, H. pylori infection appeared to be an independent risk factor for carditis (p = 0.012), while oesophagitis did not. CONCLUSIONS: This study suggests that carditis is commonly found in patients presenting with dyspepsia and the histological features of carditis were similar to those seen in H. pylori gastritis in antrum and corpus. In addition, our data have also shown that carditis was significantly associated with H. pylori infection but not with symptoms or signs of GORD.

Adult↗
PubMed2003

Dietary intake of heterocyclic amines and cancers of the esophagus and gastric cardia.

The results of two epidemiological studies suggest that high intake of heterocyclic amines, which are formed on the surface of meats cooked at high temperatures, might be associated with increased risk of esophageal or cardia cancers. Our aim was to further investigate heterocyclic amine intake and risk of these cancers. We examined data from a nationwide, population-based, case-control study of risk factors for adenocarcinoma of the esophagus and gastric cardia and squamous cell carcinoma of the esophagus in Sweden, with 185, 258, and 165 cases, respectively, and 815 controls. Heterocyclic amine intake was estimated based on the frequency of consumption and degree of surface browning of commonly fried meats, and the consumption of pan juices. Statistically nonsignificant 50-70% higher risks of esophageal squamous cell carcinoma were observed among individuals in the highest quartile levels of 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline, 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline, and 2-amino-1methyl-6-phenylimidazo[4,5-b]pyridine relative to those in the lowest. Dose-risk trends were evident. Subjects reporting high intake of all three heterocyclic amines had an odds ratio of 2.4 (95% confidence interval, 1.2-4.8) relative to those with low intake of all three substances. In contrast, no association was found with risk of adenocarcinoma of the esophagus or gastric cardia. Heterocyclic amine intake might be associated with an increase in risk of squamous cell carcinoma of the esophagus. Given the dearth of epidemiological data regarding these cancers and the lack of established biological mechanisms, confirmatory data are needed.

Adenocarcinoma↗
PubMed2003

[Surgical approach for carcinoma in the gastric cardia].

OBJECTIVE: To explore the optimal surgical approach for carcinoma in the gastric cardia. METHODS: A total of 157 patients with carcinoma in the gastric cardia were assigned into 2 groups according to the surgical approaches adopted, namely transabdominal (57 patients) and transthoracic approaches (100 patients), and the therapeutic effects of the two approaches were compared. RESULTS: In the transabdominal group, the average volume of intraoperative blood transfusion was 164.91+/-36.83 ml, average operative time 219.04+/-10.72 min and average hospital stay 14.39+/-1.39 d, with an average number of 6.04+/-2.84 lymph nodes removed. In the transthoracic group, the 4 parameters were 575.50+/-40.12 ml, 286.40+/-7.94 min, 20.32+/-0.81 d, and 3.62+/-2.56 respectively. None of the cases developed pleural effusion in the former group, which had a tumor recurrence rate of 22.80% within the follow-up period for 3 to 60 months. In contrast, 15 cases had pleural effusion in the latter group with a tumor recurrence rate of 41.00%. There was a significant difference between the two groups in terms of the therapeutic effects. CONCLUSION: Transabdominal approach is the better alternative to transthoracic one for operation of carcinoma in the gastric cardia.

Adult↗
PubMed2004

[Strongly increasing incidence of adenocarcinoma of the esophagus and gastric cardia].

The objective of this retrospective study was to see whether there was an increasing incidence of adenocarcinoma of the oesophagus and gastric cardia in the Swedish population 1970-1997. If there was, could it be explained as a period or cohort phenomenon? The data were compared with the incidence of squamous cell carcinoma and gastric adenocarcinoma with the gastric cardia excluded. Age standardised incidence for each sex was calculated using the age distribution of the world population as a reference. For the combined group of adenocarcinoma in the oesophagus and gastric cardia incidence gradually increased during the study period. The median increase between adjacent five-year intervals was 14% in men and 20% in women. Previously described risk factors are gastro-oesophageal reflux, obesity and smoking. This study suggests that the increasing incidence also can be explained as a shift in classification from squamous cell carcinoma to adenocarcinoma after 1985.

Adenocarcinoma↗
PubMed2003

[Long-term therapeutic effects of total gastrectomy in cancer of the cardia and stomach fundus].

OBJECTIVE: To evaluate total gastrectomy for the treatment of cancer of the cardia and stomach fundus. METHODS: Five hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy (group TG); and 187, using proximal gastrectomy (group PG). The 5-year and 10-year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups. RESULTS: The 5-year and 10-year survival rates of group TG were 43.6% and 24.5%, of group PG were 33.9% and 14.1%, respectively, and the difference was statistically significant (chi(2) = 4.421, P < 0.05, chi(2) = 5.726, P < 0.05). The postoperative complication rate and mortality rate of group TG were 14.7% and 3.1%, of group PG were 10.2% and 2.1%, respectively, and the difference was not statistically significant (chi(2) = 1.796, P > 0.05, chi(2) = 0.082, P > 0.05). CONCLUSIONS: To improve long-term therapeutic effects, total gastrectomy should be recommended for stage III patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3.0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.

Adult↗
PubMedDate not supplied

Serrated adenomas of the cardia.

Adenomas of the stomach are histologically classified into tubular and villous adenomas, mixed (tubulovillous) and papillary phenotypes being also recognized. They are localized in the antrum and the body. In a previous work we reported a case of serrated adenoma of the cardia having, at the time of diagnosis, an invasive growth. In this communication we report five newly identified cases of serrated adenomas of the cardia. The five neoplasias were characterized by serrated indentations furnished with dysplastic epithelium. Five out of six serrated adenomas--including the previously reported case--had, in addition, an invasive or a suspected invasive carcinoma. The latter case had at the time of diagnosis lung and liver metastasis. Metastases were also demonstrated in two additional cases. In similarity with other adenoma phenotypes, serrated adenomas of the cardia have a propensity to evolve into invasive carcinoma, a phenomenon that appears to be size-dependent.

Adenoma↗
PubMedDate not supplied

Laparoendoscopic removal of a benign gastric stromal tumor at the cardia.

OBJECTIVE: Gastrointestinal stromal tumors are the most common submucosal masses in the stomach and are mostly benign. Minimally invasive surgery is being increasingly used for their excision. Tumors close to the cardia often require a stapled resection of stomach. We report a technique for enucleating a 4-cm, well-circumscribed gastric submucosal tumor at the cardia, avoiding gastric transection. METHODS: A gastroscope was introduced to distend the stomach. A laparoscope was inserted through the umbilicus after pneumoperitoneum was created. Two 5-mm metal trocars were inserted into the stomach under vision. A 10-mm trocar was passed through the umbilical incision into the stomach for the camera. Dilute epinephrine was injected submucosally. The tumor was enucleated after incising the overlying mucosa. A gastroscope snare helped in grasping the tumor for retraction and final removal in a plastic bag. The submucosal defect and gastric port-site defects were sutured laparoscopically with Vicryl 3-0. RESULTS: Contrast studies showed no leakage. Final histology indicated a benign leiomyoma. The patient was discharged on the sixth day. No recurrence was noted at 6-month follow-up. CONCLUSION: Benign stromal tumors at the cardia can be safely enucleated by this method. This technique is cost-effective as it avoids expensive staplers or self-retaining gastric balloon ports.

Cardia↗
PubMed2006

[Fluorine-18 fluorodeoxyglucose-positron emission tomography imaging of carcinoma of cardia or fundus of stomach].

OBJECTIVE: To investigate the value of fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) in carcinoma of cardia or fundus of stomach. METHODS: From April 1999 to April 2005, 57 patients with carcinoma of cardia or fundus of stomach were imaged with FDG-PET. FDG-PET imaging were analyzed by visual method combined with semiquantitative analysis. The results were compared with pathological findings and follow-up results. RESULTS: In 29 untreated patients, 25 T(2) to T(4) tumors were all FDG avid and 4 T(1) cases showed nothing abnormal at the primary site. In 24 patients performed curative operation 40 resected enlarged lymph nodes beyond 1 cm were diagnosed correctly by FDG-PET. FDG-PET revealed distant metastases in 5 patients and corrected them from curative surgery candidates to late stage. In 28 treated patients FDG-PET confirmed 22 cases with recurrence or metastasis. CONCLUSIONS: FDG-PET has limited value in confirming T stage in carcinoma of cardia or fundus of stomach. It showed potential in N and M staging and predicting treatment response.

Adult↗
PubMedDate not supplied

Intraoperative frozen section margin evaluation in gastric cancer of the cardia surgery.

BACKGROUND/AIMS: The use of intraoperative frozen section to determine the extent of margin resection is a common practice. Our aim was to identify the value of intraoperative frozen section in margin evaluation and to investigate its indication for gastric cancer of the cardia. METHODOLOGY: Intraoperative frozen section examinations of the proximal margins of 66 patients with gastric adenocarcinoma of the cardia were reviewed. The frozen section results were compared with those of the permanent sections. Clinicopathological features that predict a positive frozen section margin were examined by univariate and multivariate analysis. RESULTS: The overall accuracy, sensitivity and specificity of an intraoperative frozen section, was 97%, 77.8%, and 100%, respectively. Infiltration on frozen section occurred in 10.7% (7/66) of the proximal margins, while in 28.6% (2/7) of the entire additional resection margins. The positive margins were associated with more advanced in depth of tumor invasion and disease stage. However, the depth of invasion was the only independent predictor for a positive frozen margin. CONCLUSIONS: Routine evaluation of the proximal resection margin by intraoperative frozen section does not appear to be necessary in gastric cancer surgery of the cardia. However, this technique is advisable for patients with T3 or T4 lesions.

Aged↗
PubMed1991

[The study of lymph nodes metastasis and staging of carcinoma of the gastric cardia by computer].

A total of 605 cases of the carcinoma of gastric cardia resected were analysed univariantly using program of analysis for risk states and survival analysis by life table method on IBM-PC computer. The significance of lymph nodes metastasis in different situations concerning prognosis was evaluated. Our results suggest that the lymph nodes with metastasis at the lower part of esophagus should be grouped as N 1 in the TNM staging system for carcinoma of the gastric cardia. We propose a new staging method, using number of lymph nodes metastasis and degree of tumorous infiltration to the adjacent organs as main indices, for the advanced carcinoma of the gastric cardia clinically and pathologically.

Cardia↗
PubMedDate not supplied

[The myoarchitectonics of the human gastric cardia].

Anatomical investigations of the muscular layer of the cardia in corpses of adults (30-70 years of age) have shown the presence in the cardia of a 25-35 mm long sphincter disposed at an angle to the horizontal plane. Its formation proceeds with the participation of both the esophageal musculature (circular layer) and gastric musculature (gastro-esophageal fibers of the oblique muscular layer). As a whole, myo-architectonics of the cardia is dependent on the character of interrelation of the muscular layers of the esophagus and stomach which is responsible for the opening and closure of the gastro-esophageal junction.

Adult↗
PubMed1991

Rising incidence of adenocarcinoma of the esophagus and gastric cardia.

Analyses of cancer incidence data from nine areas of the United States revealed steadily rising rates from 1976 to 1987 of adenocarcinomas of the esophagus and gastric cardia. The increases among men in this period ranged from 4% to 10% per year, and thus exceeded those of any other type of cancer. In contrast, there were relatively stable trends for squamous cell carcinoma of the esophagus and slight declines for adenocarcinoma of more distal portions of the stomach. Adenocarcinomas of the esophagus and gastric cardia disproportionately affected white men and rarely occurred among women. By the mid-1980s, among white men, adenocarcinomas accounted for about one third of all esophageal cancers, while cardia cancers accounted for about one half of all stomach cancers with specified subsites. The rising incidence rates and similar demographic patterns point to the need for investigation into the causes of these poorly understood cancers.

Adenocarcinoma↗
PubMed1990

[Factors influencing survival after resection of cancer of the cardia. Comparison of total esophagogastrectomy and upper pole esophagogastrectomy].

Total oesophagogastrectomy (TOG) is the best surgical technique for carcinoma of the cardia. However, oesophagogastric anastomosis is easier in upper pole oesophagogastrectomy (UPOG). This is a retrospective study excluding post-operative deaths and palliative surgery. We studied the factors affecting the survival and then compared TOG (n = 15) and UPOG (n = 26) in carcinomas of the cardia. Bad prognosis was related to several factors: poorly differentiated adenocarcinomas, tumor size, lymph node involvement and residual tumor at the resection margins. The survival rate of resected carcinomas of the cardia was 22 +/- 13%. No difference was noted between extended and limited resections. 5-year survival after UPOG was 20 + 18% and after TOG 11% (0-30) (p = 0.21). In stage 1B, 5-year survival after UPOG 11% and TOG was 50% (19-81) and 33% (0-82) (p = 0.54). In stages II and III A, 3-year survival after UPOG and TOG was 7% (0-20) and 0% (p = 0.16). For a given tumor size, 5-year survival is the same whatever the technique.

Adenocarcinoma↗
PubMed1989

[State of the valvular function of the cardia in patients with duodenal ulcer before and after vagotomy and methods of its correction].

The authors studied the valvular function of the cardia in 714 patients who were kept under regular medical observation and in 138 patients who had been operated on for duodenal ulcer. Changes were found in the cardia of 9.4% of patients who underwent regular medical examination and in 17% of these subjected to operation. The valvular function of the cardia was impaired after vagotomy in all cases. Fundoesophagocrurorhaphy is the best method for correction of cardiac dysfunction.

Cardia↗
PubMed1987

[Risk factors for morbidity and mortality in resection of cancer of the cardia].

Operations were performed on 166 patients for adenocarcinoma of the cardia, between 1970 and 1986, with resections being applied to 102 of them (6.1 per cent), including 87 curative approaches with complete removal of tumours and no macroscopic evidence of metastases. Total gastrectomy with oesophagectomy was performed on 36 patients and proximal oesophagogastrectomy on 66, in 43 of these via left thoracic incision. Regional lymph nodes were free of tumour in 29 patients (28 per cent). The other approaches to proximal resection were thoracoabdominal in eight cases, abdominal in 13, and transmediastinal in two. Leakage of oesophageal anastomosis occurred in 19 cases and was followed by septicaemia and death in 13. Overall mortality during hospitalisation amounted to 22.5 per cent, including two patients who died on the 30th postoperative day as a result of dehiscence and septicaemia. Mortality figures were 17 per cent following total gastrectomy and 19 per cent in the wake of proximal gastrectomy by thoracic incision. Mortality amounted to 48 per cent in the 23 cases on which abdominal, thoraco-abdominal, and transmediastinal operations had been performed. Multiple logistic regression was used to determine age, ECG, spread of lymph nodes, and surgical techniques as potential risk factors. Emphasis in the context of surgical techniques was laid on proximal versus total gastrectomy, incision on both sides of the diaphragm, palliative resection, and anastomotic suturing (using one-layer or two-layer techniques or mechanical staples). Tumour spread to lymph nodes and proximal resection were the only independent variables associated with dehiscence. Electrocardiogram (ECG), lymph node involvement, and palliative resection proved to be of relevance to prognostication of lethality. No statistical correlations were found to exist between lethality, on the one hand, and surgical approach, age of patient, incision on either side of the diaphragm or suturing, on the other. The conclusion was drawn that in cases of cardia carcinoma total gastrectomy does not aggravate the risk of lethality, as compared to cardia resection.

Adenocarcinoma↗
PubMed1985

[Microscopic derivative spectrum measurement of DNA in nuclei of cancer and precancer cells in carcinoma of gastric cardia].

For comparative study, microscopic derivative spectrophotometry was used to determine the distribution of DNA concentration in nuclei of normal epithelial cells, precancer and exfoliative cancer cells in gastric cardia. By this technic, the relative DNA contents (arbitrary units) can be measured and the first microscopic derivative spectrum of several selected areas in the cellular nucleus can be recorded. The specimens of measurement were: 50 normal epithelial cells, 125 precancer (42 markedly dysplastic cells and 83 suspicious cancer cells) and 111 cancer cells of gastric cardia from 25 patients. The present study showed that, in general, the peak values and differences between the peak values of cancer cells as assayed by the first microscopic derivative spectrum were significantly greater than those of the precancer cells. But 9.6% of those values of the precancer cells were still similar to those of cancer cells. When these conditions were compared by using the biopsy material from the same patient, it was found that these cells were derived from patients with carcinoma of gastric cardia. Thus it is believed that biochemical changes of cells as measured by microscopic derivative spectrophotometry are more sensitive and objective than those by morphology. It would seem that microscopic derivative spectrophotometry would be, at least, a supplementary means of differentiating the cancer cells from the precancer ones.

Adenocarcinoma↗
PubMed1977

Surgical treatment of carcinoma of the oesophagus and cardia.

A clinical series of 216 patients with carcinoma of the oesophagus or cardia, who underwent surgical resection of the oesophagus, is presented. There were 104 patients with oesophageal carcinoma and 112 patients with carcinoma of the cardia. Histologically, there were 102 squamous cell carcinomas, 98 adenocarcinomas, 11 anaplastic carcinomas and 7 non-differentiated carcinomas. Oesophago-gastrotomy was the procedure mostly used; colon interposition was done in only 13 cases. The hospital mortality was 21%. The 5-year survival rate for the whole series after oesophageal resection was 23%. The duration of symptoms, location of the tumour, age and sex of the patients, pre- or postoperative radiotherapy and the histological type of the tumour had only a minor bearing on survival. The two most important prognostic factors were the spread of the tumour at time of operation and a preceding lye stricture. The 5-year survival rate was 34% for the patients with a local tumour at operation and 44% for those in whom the carcinoma developed at the site of a previous lye stricture. The variance of the results in the literature is discussed. Surgical approach to the carcinoma of the oesophagus and cardia is recommended in all the cases in which the patient and tumour seem to be eligible for resection.

Adult↗
PubMed1978

[Diagnosis and surgical treatment of functional disorders of the cardia in duodenal ulcer].

The article deals with the problem of the functional status of the cardia in duodenal ulcer. The cardial function was studied in 27 patients with complicated duodenal ulcer. The results make it possible to judge about the degree of manifestation of cardia insufficiency. While tackling the problem of a character of surgical intervention upon the duodenal ulcer cases it is necessary, in author's opinion, to take into consideration the results of the functional examination of the cardia.

Adult↗