Duodenal ulcer pain - The role of acid and inflammation [2]

Gut356863-864GUTT

Persistent Elevation of C-Reactive Protein Following Esophagogastric Cancer Resection as a Predictor of Postoperative Surgical Site Infectious Complications

Infectious complications, particularly in the form of anastomotic leaks (ALs) or surgical site infections (SSIs), represent a serious morbidity after esophagogastric cancer resections. Therefore, early detection is of paramount importance. Although markers of the systemic inflammatory response, including C-reactive protein (CRP) and white cell count (WCC), have been used in this regard, their relative predictive value is unclear. The aim of the present study was to examine serial postoperative WCC, albumin, and CRP and their diagnostic accuracy in case of infectious complications. White cell count, albumin, and CRP were routinely measured postoperatively for 7 days in 136 consecutive patients who had undergone esophagogastric cancer resection. All postoperative complications were recorded. The diagnostic accuracy of the WCC, albumin, and CRP values were analyzed by receiver operating characteristics curve analysis with surgical site and remote infectious complications as outcome measures. Fifty-four (40%) patients developed infectious complications, and 17 of them developed an AL. CRP was significantly higher from postoperative day (POD) 3 onward in those patients who developed an AL. On POD 3, a threshold reading of 180 mg/l was associated with development of an AL, providing a sensitivity of 82% and a specificity of 63%. On POD 4, the same CRP threshold of 180 mg/l provided 71% sensitivity and 83% specificity. Postoperative CRP measurements on PODs 3 and 4 are clinically useful in predicting surgical site infectious complications, in particular an AL, after resection for esophagogastric cance

Comparison of the prognostic value of tumour- and patient-related factors in patients undergoing potentially curative resection of oesophageal cancer

<p>Background: Evidence is increasing that elevated systemic inflammation is associated with poor survival in patients with oesophageal carcinoma. However, it is not yet established if any specific component of systemic inflammatory response is a better predictor of cancer survival. The aim of the present study was to compare the predictive value of selected markers of systemic inflammation in patients who undergo surgical resection of oesophageal cancer.</p> <p>Methods: One hundred twelve patients who underwent potentially curative resection for oesophageal carcinoma, including type I and type II tumours of the gastro-oesophageal junction (Siewert and Stein in Dis Esophagus 9:173–182, 1996), between 1996 and 2008 were included in the study. Patients had laboratory measurement of white cells, neutrophils, lymphocytes, platelet counts, albumin, and C-reactive protein. Glasgow Prognostic Score (mGPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and metastatic lymph node ratio (LNR) were calculated.</p> <p>Results: On multivariate analysis, only the LNR (HR 2.87, 95% CI 1.99-4.15, p < 0.001) and the mGPS (HR 4.31, 95% CI 2.20-8.45, p < 0.001) were independently associated with cancer-specific survival in oesophageal cancer. An elevated mGPS was associated with high white cell count (p < 0.05) and poorer survival (p = 0.001).</p> <p>Conclusion: The present study indicates that the mGPS, an acute-phase protein-based prognostic score, better predicts cancer survival compared with the cellular components of systemic inflammation in patients with oesophageal carcinoma.</p&gt

A comparison of POSSUM and GPS models in the prediction of post-operative outcome in patients undergoing oesophago-gastric cancer resection

Background. There is some evidence that a patient's pre-operative condition influences short-term and long-term post-operative outcomes. The aim of the present study is to compare the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and modified Glasgow prognostic score (mGPS) models in the prediction of post-operative outcome, both short term and long term, in patients undergoing resection of oesophago-gastric cancer. Patients and Methods. Patients who underwent curative resection for oesophago-gastric cancer from January 2005 to May 2009 and who had data to score the POSSUM, P-POSSUM, O-POSSUM and mGPS models were included in the study. Observed morbidity and mortality rates were compared with predicted outcome in different risk groups. Both short-term outcome and long-term survival were recorded. Results. Observed morbidity was 49%, whereas POSSUM predicted post-operative morbidity in 60%, giving an overall standardised morbidity ratio of 0.82. Only male sex [hazard ratio (HR) 3.61, 95% confidence interval (CI) 1.38-9.46, P = 0.009] and POSSUM physiology score (HR 2.13, 95% CI 1.11-4.08, P = 0.023) were independently associated with post-operative morbidity. The post-operative mortality rates predicted by POSSUM, P-POSSUM and O-POSSUM were 16.5, 5.8 and 9.9%, respectively, giving a standardised mortality ratio of 0.25, 0.71 and 0.42. Only mGPS (HR 1.96, 95% CI 1.09-3.54, P = 0.025) and tumour-node-metastasis (TNM) stage (HR 2.21, 95% CI 1.44-3.38, P < 0.001) were independently associated with cancer-specific survival. Conclusions. The POSSUM physiology score was useful in predicting post-operative morbidity, and the mGPS was useful in predicting cancer-specific survival, in patients undergoing surgery for oesophago-gastric cancer

A phase II study of epirubicin, cisplatin and raltitrexed combination chemotherapy (ECT) in patients with advanced oesophageal and gastric adenocarcinoma

Background: The aim of this study was to evaluate the efficacy of the combination of epirubicin, cisplatin and ralitrexed (Tomudex), ECT, in patients with advanced oesophageal or gastric adenocarcinoma. Efficacy was assessed primarily as response rate and secondarily in terms of toxicity, time to progression and survival. Patients and methods: Twenty-one patients with histologically and/or cytologically proven unresectable (7) or metastatic (14) gastro-oesophageal adenocarcinoma, who had bi-dimensionally measurable disease, with ECOG performance status less than or equal to2, with adequate haematological, hepatic and renal function received first-line chemotherapy with epirubicin (50 mg/m(2)), cisplatin (60 mg/m(2)) and Tomudex (2.5 mg/m(2)), ECT, at three-weekly intervals. Treatment consisted of three cycles of chemotherapy, with a further three cycles if there was disease response or stabilisation. Results: ECT is an active regimen in the treatment of advanced gastro-oesophageal adenocarcinoma with an overall intention-to-treat response rate of 29% (95% confidence intervals (CI): 11%-52%). In addition, 4 (19%) patients had stable disease. Median time to progression was 19 weeks (95% CI: 7-31 weeks). Median overall survival was 18 weeks (95% CI: 11-24 weeks). Seventeen patients failed to complete the six cycles of treatment due to disease progression (5), toxicity (3), non-toxic death (1 pulmonary embolism, 1 cardiac), severe allergy to epirubicin (1), patient decision (1) and five patients after the study was discontinued early due to toxicity. There were three toxic deaths: two due to sepsis complicating neutropaenia and one due to cardiorespiratory failure following drug induced enteritis. Nine patients experienced grade 3 or 4 neutropaenia, two patients experienced grade 3 or 4 nausea and vomiting and one patient had grade 4 diarrhoea. Conclusions: The combination of epirubicin, cisplatin and tomudex is active against advanced gastro-oesophageal adenocarcinoma but the toxicity suggests that further evaluation in a randomised comparison to ECF is not appropriate

The role of low fat diets in the management of gall-bladder disease

Full text of this article is not available in the UHRAThis paper presents the results obtained from 87 questionnaires completed by dietitians about the dietary management of gall-biadder disease. Of the patients referred to the dietitians, 86% were referred by surgeons. Of the dietitians that responded 77% thought that there was a role for low fat diets in the management of these patients; 92% would advise a low fat diet to help avoid pain, and 11% would advise a low fat diet to patients with gall-bladder disease who did not have pain, steatorrhoea or obesity. The paper reviews the available evidence concerning the effect of dietary fat on the gall-bladder; it is concluded that, at present, there is little data to support the therapeutic use of a low fat diet for individuals with gall-stones.Peer reviewe