Relationship between Barrett’s esophagus and colonic diseases: a role for colonoscopy in Barrett’s surveillance

Journal of Gastroenterology - Given that risk factors for Barrett’s carcinogenesis are predictive, appropriate management and surveillance of Barrett’s esophagus (BE) may be provided....     

Impact of mediastinal lymph node dissection on octogenarians with non-small cell lung cancer

Objective: Impacts of mediastinal lymph node dissection on a patient’s course after pulmonary resection is unclear in octogenarians with non-small cell lung cancer. Methods: Retrospectively identified subjects included 39 octogenarians and 1 nonagenarian, with grades according to the Charlson Comorbidity Index ranging from only 0 to 2. We performed mediastinal lymph node dissection in 19 patients (D group), and just lymph node sampling biopsy in the other 21 (S group). We compared clinicopathologic features and outcome after surgery between both groups. Results: Deterioration of performance status at the time of discharge, evident in 17 patients overall, was significantly more frequent in the D group. Postoperative complications occurred in 27 patients overall and there was no significant difference between the two groups. Survival rates in younger patients at 1, 3, and 5 years were 86, 59, and 49%, respectively; in octogenarians these were 83, 58, and 42% (no significant difference). Nor did survival differ significantly by surgical management of mediastinal lymph nodes; 1-, 3-, and 5-year survival rates were 94, 63, and 40%, respectively in the D group and 78, 66, and 43%, respectively in the S group. Conclusion: Octogenarians with non-small cell lung cancer should be treated by urgent pulmonary resection whenever possible. Since mediastinal lymph node dissection has little effect on long-term survival or the carried risk of worsening performance status at discharge, pulmonary resection without complete mediastinal lymph node dissection should be considered.     

Anesthetic considerations in 65 patients undergoing unilateral pneumonectomy: problems related to fluid therapy and hemodynamic control

Study ObjectiveTo examine perioperative management and complications in patients undergoing pneumonectomy.DesignObservational cohort study.SettingUniversity-affiliated city hospital.Measurements65 patients who underwent unilateral pneumonectomy for resection of lung cancer between March 1997 and October 2007 were included in this study. Patients who underwent pneumonectomy were then classified into two groups: Group C patients had signs of postoperative acute right heart failure, and Group N patients had no signs of postoperative acute right heart failure.Main ResultsIn the pneumonectomy patients, extubation did not occur in 8 patients (12%) and postoperative death occurred in 4 patients (6%), compared with no such occurrences among patients who underwent lobectomy. Perioperative respiratory function was significantly lower in Group C (P < 0.05) than Group N. Fluid infusion volume, fluid balance volume, intraoperative total fluid balance, urine output volume, blood loss volume, blood transfusion volume, times of administration of vasopressors intraoperatively, and number of patients requiring intraoperative administration of catecholamines were significantly greater in Group C (P < 0.05) than Group N.ConclusionsFluid infusion volume, fluid balance volume, intraoperative total balance, blood loss volume, and blood transfusion volume were important intraoperative risk factors in the development of postoperative right-sided heart failure.     

Clinical significance of new coagulation and fibrinolytic markers in ischemic stroke patients.

BACKGROUND AND PURPOSE: We investigated plasma levels of D-dimer products of crosslinked fibrin degradation products, thrombin-antithrombin III complex, and plasmin-alpha 2-antiplasmin complex for detecting coagulation system activation in ischemic stroke patients to determine the possible effect of age on these marker levels. METHODS: We measured plasma levels of these three markers in 54 acute ischemic stroke patients within 5 days of stroke onset, in 44 chronic ischemic stroke patients over 3 months from onset, and in 50 age-matched healthy subjects. We divided the stroke patients into two subgroups, those with visible occlusion and those with nonvisible occlusion having obstruction of the major cerebral artery. RESULTS: The plasma levels of these three markers were significantly (p less than 0.01) higher in the stroke patients than in controls. Significant differences did not exist at any level between the patients and controls in the younger-aged subjects (less than or equal to 64 years of age), but did exist in the older-aged subjects (greater than or equal to 75 years of age). An age-related increase of the marker levels was noted between stroke patients and controls. No significant difference in the three markers was found among any of the stroke patients. CONCLUSIONS: Increased levels of these markers in stroke patients seem to be related mostly to age.     

Heterogeneous distribution of acidic TA-4 in cervical squamous cell carcinoma: immunohistochemical demonstration with monoclonal antibodies

Tumor antigen TA-4 is divided into two subgroups; acidic and neutral TA-4. The tissue localizations of these TA-4 subgroups were examined by using monoclonal antibodies, i.e., Mab-21 which reacts with both acidic and neutral TA-4, and Mab-317 which is specific to acidic TA-4. Immunohistochemical staining with Mab-21 showed positive cells in most parts of the cancer nest and in the intermediate layer of the non-cancerous squamous epithelium of the uterine cervix, whereas positive staining with Mab-317 was observed only in the cells at the peripheral parts of the cancer nest adjacent to the surrounding stromal tissue. Thus, examination of the subgroups of TA-4 may be a useful aid for investigating the biologic behavior of squamous cells.     

Study on pruritus in hemodialysis patients and the antipruritic effect of neurotropin: plasma levels of C3a, C5a, bradykinin and lipid peroxides

The causes of pruritus in patients undergoing hemodialysis and the mechanism of the antipruritic effect of Neurotropin, an extract isolated from the inflamed dermis of rabbits inoculated with vaccinia virus and clinically used in Japan as an analgesic and antiallergic drug, were investigated by measuring the levels of C3a, C5a, bradykinin and lipid peroxides in venous blood collected before dialysis, and at 15 min and 4 hr after starting hemodialysis. C3a increased considerably in pruritic patients compared to non-pruritic patients at 15 min after starting hemodialysis. Neurotropin significantly suppressed the C3a level and improved the condition of pruritic patients. There was no significant difference in the level of bradykinin between pruritic patients and non-pruritic patients. Therefore, bradykinin was not thought to be related to the incidence of pruritus in such patients. A tendency towards lowering of the levels of lipid peroxides in the patients' plasma by Neurotropin was also observed. It seems possible that elevation of C3a may be one of the underlying causes for the appearance of pruritus, and that Neurotropin may exert its antipruritic effect through suppression of the activation of C3 in patients undergoing hemodialysis.     

Effect of alpha-glucosidase inhibitor on human pancreatic and salivary alpha-amylase

The mode of inhibition of a new complex oligosaccharide that inhibits the alpha-glucoside hydrolase activity of pancreatic and salivary alpha-amylase was studied. Kinetic analysis revealed a non-competitive type of inhibition with a Ki of 1.47 +/- 0.03 micrograms when tested against human pancreatic alpha-amylase and 3.89 +/- 0.08 micrograms against human salivary alpha-amylase. The inhibitory action of alpha-glucoside hydrolase inhibitor (alpha-GHI) on pancreatic amylase was observed over a wide range of pH (6.0--7.9), whereas the inhibition of salivary amylase was optimal at pH 6.5. Column chromatographic investigations suggested the possible formation of an enzyme-inhibitor complex because the mixture of alpha-GHI and pancreatic alpha-amylase was eluted as a single component through a Sephadex G200 column. However, this enzyme-inhibitor complex was easily separated into each component and the enzyme activity was fully recovered after electrophoresis.