Risk Factors for Metachronous Gastric Cancer in the Remnant Stomach After Early Cancer Surgery

Background  

Early gastric cancer patients have a good prognosis after radical resection. However, if the patients have a gastric remnant after the surgery, the risk of metachronous gastric cancer remains. The aim of this study was to clarify the risk factors for metachronous gastric cancer after partial gastrectomy for early gastric cancer.     

Study on the prostatic tissue levels of cefmenoxime (CMX)

The concentrations of Cefmenoxime (CMX) were examined in the serum and prostatic tissue of 25 patients with benign prostatic hypertrophy and of 1 patient with prostatic carcinoma. The CMX levels were measured at scheduled intervals after 2 g CMX administration by one hour drip infusion prior to prostatectomy. Pharmacokinetic analysis was performed based on the two compartment open model theory. 1) Maximum serum level of CMX was 124 micrograms/ml at the end of drip infusion and the biological half-life was 1.07 hrs. 2) CMX concentration in prostatic tissue reached a maximum level of 35.7 cg/g at 1.16 hrs after the start of CMX administration. Ratio of prostatic tissue to serum level in the area under curve (AUC) was 33% and biological half-life was 1.07 hrs. These results suggested that the CMX concentration in the prostatic tissue was higher than the MIC80 against pathogenic bacteria, particularly E.coli and Klebsiella sp. for a relatively long time. For this reason CMX is one of the more preferred drugs for treatment of chronic prostatitis and post-operative infection of prostate.     

Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection

Background

Laparoscopy-assisted gastrectomy (LAG) is becoming widely used for early gastric cancer. However, how the curability and long-term prognosis of LAG and open gastrectomy (OG) for early and advanced gastric cancer compare remains unclear. This study assessed short- and long-term outcomes after LAG with lymph node dissection in early and advanced gastric cancer.

Methods

A total of 332 patients who underwent LAG or OG for early and advanced gastric cancer from January 2001 through December 2010 were reviewed retrospectively. The mean operating time, estimated mean blood loss, number of dissected lymph nodes, and survival rates were compared between LAG and OG for early and advanced gastric cancer.

Results

Overall, 47.6% (158/332) of patients underwent LAG; D1, D1+ lymph node dissection was carried out in 77.2%, with D2 dissection in 22.8%. Only one patient required conversion to OG. Comparing LAG and OG with D1, D1+ lymph node dissection for early gastric cancer (EGC), mean operating time was significantly longer, estimated mean blood loss was significantly smaller, and the average number of retrieved lymph nodes was significantly greater with LAG. The rate of specific postoperative morbidity was 17.2% for LAG patients and 25.0% for OG patients, with no postoperative mortality. Survival and recurrence rates were not significantly different. Comparing LAG and OG with D2 lymph node dissection for advanced gastric cancer (AGC), mean operating time was significantly longer and estimated mean blood loss was significantly smaller with LAG, while the average number of retrieved lymph nodes, specific postoperative morbidity and mortality, and survival and recurrence rates were not significantly different.

Conclusions

LAG with D1, D1+ lymph node dissection for EGC is safe and equivalent to open gastrectomy in curability. Moreover, LAG with D2 lymph node dissection for AGC is comparable to OG with D2 lymph node dissection with regard to short- and long-term results.     

An I(2) cointegration model with piecewise linear trends

Summary This paper presents likelihood analysis of the I(2) cointegrated vector autoregression which allows for piecewise linear deterministic terms. Limiting behaviour of the maximum likelihood estimators are derived, which is used to further derive the limiting distribution of the likelihood ratio statistic for the cointegration ranks, extending Nielsen and Rahbek. The provided asymptotic theory extends also the results in Johansen et al. where asymptotic inference is discussed in detail for one of the cointegration parameters. An empirical analysis of US consumption, income and wealth, 1965–2008, is performed, emphasizing the importance of a change in nominal price trends after 1980.     

Survey of <Emphasis Type="Italic">Ephedra </Emphasis>resources in the Northern Areas of Pakistan and their genetic diversity

More than 400 species of medicinal plants grow in the Northern Areas of Pakistan, including Ephedra plants. To investigate the wild Ephedra plant resources in the area, we surveyed the medicinal plants and collected 71 specimens from 18 collecting sites to analyze their genetic variation. The DNA sequences of the internal transcribed spacers 1 and 2 (ITS 1 and 2) of nuclear ribosomal DNA and a noncoding sequence of chloroplast DNA (trn L/F) were analyzed. This DNA data analysis and external morphological features were used to confirm the species of the specimens, and it was found that E. intermedia was the major species in the area and that E. gerardiana and E. przewalskii were present sporadically. Although it inhabits a relatively small area in comparison with the northwestern Chinese provinces, the DNA sequence of E. intermedia in the Northern Areas of Pakistan was significantly more heterogeneous than the same species grown in those neighboring regions. Most of the E. intermedia specimens contained more than 0.7% ephedrine alkaloids, fulfilling the requirement of the Japanese Pharmacopoeia; thus, the Ephedra plants in the area are a genetic and medicinal resource of great importance.     

Ageing of the vibratory tissue of human vocal folds

Sixty-four human larynges ranging in age between 70 and 104 years were investigated histologically. The results were incorporated into our previous data for younger age groups. Discussion was focused on the mucosa around the vocal fold edge. The following tendencies were observed with ageing: (1) the membranous vocal fold shortens in males; (2) the mucosa thickens in females; (3) the cover of the vocal fold thickens in females; (4) edema develops in the superficial layer of the lamina propria in both sexes; (5) the intermediate layer of the lamina propria thins and its contour becomes deteriorated in males; (6) elastic fibers in the intermediate layer become less dense and atrophy in males; (7) the deep layer of the lamina propria thickens in males; (8) collagenous fibers in the deep layer become denser and fibrotic in males. The degree of these geriatric changes vary from individual to individual.     

Stomal recurrence following total laryngectomy--a clinicopathological study

A clinicopathological study of 10 cases of stomal recurrence following total laryngectomy treated at Kurume University Hospital from 1971 to 1986 was completed. The results of this study are summarized as follows: 1) The frequency of stomal recurrence was 5.8%. 2) Of these 10 cases, 3 cases were supraglottic (3%), 5 cases were glottic (7%), and 2 cases were subglottic (29%) carcinomas. The incidence of stomal recurrence was higher in subglottic carcinomas. 3) Nine cases out of 10 extend to the subglottic region. 4) The incidence of stomal recurrence was higher in emergency tracheostomy case. 5) Average of period from total laryngectomy to stomal recurrence was 9.7 months. 6) It is suggested that the cause of stomal recurrence is metastasis to the paratracheal lymphnode. 7) In order to prevent stomal recurrence, it is important to dissect paratracheal soft tissues bilaterally in high risk cases. 8) With regard to treatment, it is better to remove surgically the tumor and paratracheal soft tissues as completely as possible and to do postoperative radiation.     

Histopathologic study of carcinoma of the hypopharynx: implications for conservation surgery

A total of 38 specimens obtained by laryngopharyngectomy were subjected to a whole organ section study. Of the 38, 31 were pyriform sinus (PS), three were postcricoid (PC), and four were posterior wall (PW) carcinomas. The results were as follows. 1) The thyroid cartilage was involved much more frequently than the other laryngeal cartilages. 2) Joint involvements were infrequent. 3) The interarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles frequently were invaded by PS carcinomas, whereas PC carcinomas frequently involved the interarytenoid and posterior cricoarytenoid muscles. 4) The recurrent laryngeal nerve (RLN) was involved in all PC T3 cases, but RLN involvement was rare in PS cases. 5) Involvements of the paraglottic space and periarytenoid region were closely related to fixation of the larynx on the affected side (hemilarynx) in PS carcinomas. 6) Neither hemilarynx fixation nor PS apex involvement was a reliable landmark for determining the exact extent of laryngeal involvement. 7) Conservation surgery could have been employed in 18 of the 38 cases.     

Vocal function following hemilaryngectomy

Vocal function following hemilaryngectomy was investigated in 54 cases in which a superiorly based sternohyoid muscle flap was used for glottic reconstruction. Four types of material were employed for covering the muscle flap: hypopharyngeal mucosa, lip mucosa, thyroid perichondrium, and island cervical skin flap. The vocal function varied greatly from individual to individual; however, the following tendencies were observed in many cases: 1) the glottis did not close completely; 2) supraglottic structures (false fold, arytenoid region, and epiglottis) were hyperfunctional and vibrated instead of or together with the unaffected vocal fold; 3) vibrations of the laryngeal structures were irregular; 4) maximum phonation time was short; 5) mean airflow rate was high; 6) fundamental frequency and intensity ranges of phonation were limited; 7) the voice was rough, breathy, and/or strained; and 8) cases with poor vocal function were most frequent in the skin flap group and least frequent in the lip mucosa group.