Long-term survival is improved by an extended lymph node dissection in potentially curable gastric cancer

BACKGROUND/AIMS: This study was planned to investigate the therapeutic value of performing an extended lymphadenectomy in potentially curable gastric cancer. METHODOLOGY: A prospective gastric cancer database was used. In total 114 gastric cancer patients (85 male, 29 female) who underwent a gastrectomy for curative intent from 1992 through 1999 were included to this study. Morbidity and mortality, survival rates and factors affecting survival were evaluated. RESULTS: Sixty-six (58%) patients had limited (D1) and 48 (42%) patients had extended (D2) gastric resections. The operative mortality rates were 12% and 8% and the postoperative complication rates were 33% and 25% in the D1 and D2 lymphadenectomy patients, respectively. The mean follow-up period was 34 (range: 8-94) months. The overall mean survival was 32 months (25 months in D1 group, 46 months in D2 group) (P < 0.05). The duration of symptoms, the presence of postoperative complications, the extent of lymphadenectomy, the operative curability and the site of the tumor were all found to be independent prognostic factors based on a multivariate analysis. CONCLUSIONS: This study demonstrates that an extended lymph node dissection improves long-term survival without increasing postoperative morbidity and mortality in patients with potentially curable gastric cancer.     

Automatic retinal oximetry

PURPOSE: To measure hemoglobin oxygen saturation (SO(2)) in retinal vessels and to test the reproducibility and sensitivity of an automatic spectrophotometric oximeter. METHODS: Specialized software automatically identifies the retinal blood vessels on fundus images, which are obtained with four different wavelengths of light. The software calculates optical density ratios (ODRs) for each vessel. The reproducibility was evaluated by analyzing five repeated measurements of the same vessels. A linear relationship between SO(2) and ODR was assumed and a linear model derived. After calibration, reproducibility and sensitivity were calculated in terms of SO(2). Systemic hyperoxia (n = 16) was induced in healthy volunteers by changing the O(2) concentration in inhaled air from 21% to 100%. RESULTS: The automatic software enhanced reproducibility, and the mean SD for repeated measurements was 3.7% for arterioles and 5.3% venules, in terms of percentage of SO(2) (five repeats, 10 individuals). The model derived for calibration was SO(2) = 125 - 142 . ODR. The arterial SO(2) measured 96% +/- 9% (mean +/- SD) during normoxia and 101% +/- 8% during hyperoxia (n = 16). The difference between normoxia and hyperoxia was significant (P = 0.0027, paired t-test). Corresponding numbers for venules were 55% +/- 14% and 78% +/- 15% (P < 0.0001). SO(2) is displayed as a pseudocolor map drawn on fundus images. CONCLUSIONS: The retinal oximeter is reliable, easy to use, and sensitive to changes in SO(2) when concentration of O(2) in inhaled air is changed.     

Bacterial meningitis: diagnosis and initial antibiotic therapy

Despite advances in antibiotic treatment, bacterial meningitis remains a significant cause of mortality and morbidity among children. In population-based studies in the United States, the incidence of bacterial meningitis is estimated to be 4.6 to 10 per 100,000 population per year. Every year more than two thousand deaths due to bacterial meningitis are reported in the United States, most of these in previously healthy children. This article reviews diagnosis and management of this puzzling disease entity.     

The relationship between circulating catecholamines and ST waveform in the fetal lamb electrocardiogram during hypoxia

Previous studies from this laboratory have shown that changes in the ST waveform in the fetal electrocardiogram are a sign of fetal asphyxia. In the present study, seven chronically instrumented fetal lambs between 117 and 143 days' gestation were studied during 16 one-hour periods of maternally induced hypoxia. The aim was to test the hypothesis of a relationship between the concentration of circulating catecholamines and T-wave amplitude. The response to hypoxia was aged-dependent. Fetuses below 126 days of gestation did not react with electrocardiographic changes and output of epinephrine unless acidosis occurred. In more mature fetuses, hypoxia per se would induce a surge of epinephrine and changes in the ST waveform. Overall there was a strong correlation between the T/QRS ratio and the level of circulating epinephrine. During normoxia, epinephrine was undetectable (less than 0.1 nmol/L) in most fetuses; norepinephrine showed an increase at term. The analysis showed one fetus with chronic changes in the ST waveform (T/QRS ratio greater than 0.30) related to a marked increase in the plasma level of epinephrine in spite of normal blood gas values. These findings complement previous results in the acute and chronically instrumented fetal lamb and suggest that changes in the ST waveform expressed as T/QRS ratio identify a change to anaerobic myocardial metabolism mediated by beta-adrenergic stimulation.     

Response of Antioxidant System of Tilapia (Oreochromis niloticus) Following Exposure to Chromium and Copper in Differing Hardness

Tilapias (Oreochromis niloticus) were exposed to copper or chromium in soft water (SW) (~80 mg CaCO₃/L, conductivity 1.77 mS/cm) or hard water (HW) (~320 mg CaCO₃/L, conductivity 5.80 mS/cm) using 2 exposure protocols (20 μM for 48 h and 10 μM for 144 h). Following the exposures, antioxidant enzyme activities [superoxide dismutase (SOD); catalase (CAT); glutathione peroxidase; glutathione reductase; and glutathione S-transferase (GST)] and glutathione (GSH) levels were measured in the liver of fish. SOD and CAT activities of control fish kept in SW were significantly lower than control fish kept in HW. However, the other antioxidant indices (glutathione metabolism) of both control fish were unaffected from water hardness. Acute metal exposures did not alter the glutathione metabolism, whereas SOD activity in SW and CAT activity in both waters changed significantly. In subchronic duration, Cu exposure caused significant decreases in measured parameters, except for GST activity and GSH level. Similarly, GST activity and GSH level were unaffected from Cr exposure. This study showed that SOD and CAT were the most sensitive antioxidant indices, and that glutathione metabolism, in general, was not altered following metal exposures in different waters.     

The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population

Vitamin D deficiency is commonly found in the elderly and is associated with osteoporosis and hip fractures. In this study, Vitamin D status of 138 female and 87 male subjects living in old age homes (OAH) and 171 female and 24 male subjects living in own homes (OH) from Central Anatolia were assessed. A questionnaire was applied to collect information about wearing features and degree of sunlight exposure and benefiting from ultraviolet index calculated (BFUI). We have found Vitamin D deficiency in 33.4% among our subjects. Also, 40.1% of subjects living in OAH (54.1% of females and 18.4% of males) and 24.4% of subjects living in OH (27.9% of females and 4.2% of males) were Vitamin D deficient. Vitamin D deficiency was significantly higher in subjects living in OAH than subjects living in OH (P = 0.001) and also higher in females than males (40.7% versus 15.3%, P < 0.001). Subjects with Vitamin D deficiency were older (P < 0.001), BFUI was lower (P < 0.001) and parathyroid hormone (PTH) was higher (P < 0.001) than those having normal level of 25(OH)D. There was a significant negative correlation between 25(OH)D levels and age (P < 0.001, r = -0.248) PTH and 25(OH)D (P = 0.004, r = -0.340), and positive correlation between 25(OH)D and BFUI (P < 0.001, r = 0.340). Vitamin D deficiency is very common in Turkish elderly subjects especially living in OAH and there is a significant low exposure to sunlight among them. Simply by asking clothing habits and exposure to sunlight, we can able to identify risk of Vitamin D insufficiency in elderly subjects.