Gastric carcinoma: review of the results of treatment in a community teaching hospital

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to provide data on long term results of gastric cancer surgery and in particular the D1 gastric resection.</p> <p>Methods</p> <p>In the period 1992-2004, 235 male and female patients with a median age of 69 and 70 years respectively, were included with a stage I through IV gastric carcinoma, of which 37% was stage IV disease. Whenever possible a gastric resection was performed. In case of obstructive tumour growth palliation was provided by means of a gastro-enterostomy.</p> <p>Results</p> <p>Gastrectomy with curative intent was achieved in 50%, palliative resection in 22%, palliative surgery (gastro-enterostomy) in 10% and in 18% irresectability led to surgical exploration only. Patients in the curative intent group demonstrated a 47% survival after 5 years and up to 34% after 10 years. However metastases where seen in 32% of the patients after gastrectomy with curative intent. After palliative resection one year survival was 57%, whereas 19% survived more than 3 years. Overall postoperative morbidity and mortality rates were 40% and 13% respectively.</p> <p>Conclusion</p> <p>Long term survival after surgery for gastric cancer is poor and is improved by early detection and radical resection. However, palliative resection showed improved survival compared to gastro-enterostomy alone or no resection at all which may be an effect of adjuvant therapy.</p

Advances in short bowel syndrome: an updated review

Short bowel syndrome (SBS) continues to be an important clinical problem due to its high mortality and morbidity as well as its devastating socioeconomic effects. The past 3 years have witnessed many advances in the investigation of this condition, with the aim of elucidating the cellular and molecular mechanisms of intestinal adaptation. Such information may provide opportunities to exploit various factors that act as growth agents for the remaining bowel mucosa and may suggest new therapeutic strategies to maintain gut integrity, eliminate dependence on total parenteral nutrition, and avoid the need for intestinal transplantation. This review summarizes current research on SBS over the last few years.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47168/1/383_2005_Article_1500.pd

Fecal Lactoferrin: Reliable Biomarker for Intestinal Inflammation in Pediatric IBD

Background. Optimal management of pediatric patients with inflammatory bowel disease (IBD) requires early diagnosis. Aim of the study is to compare fecal lactoferrin (FL) as biomarker of intestinal inflammation to CRP in pediatric patients with new-onset IBD. Methods. FL was measured by ELISA in stool specimens collected prior to endoscopy for IBD (IBD-SCAN; TechLab, Blacksburg; normal < 7.3 µg/g feces). CRP was detected in serum (normal < 5 mg/L). Three patient groups were determined: n=21 (mean age 13.2) with Crohn’s disease (CD), n=15 (mean age 10.9) with ulcerative colitis (UC), and n=20 (mean age 11.9) in whom IBD was ruled out. In CD patients the endoscopic severity score SES-CD was correlated with the FL levels. Results. (Mean ± SEM). CRP levels were 27.18 ± 4.2 for CD-cases, 20.8 ± 9.5 for UC, and 0.24 ± 0.06 for non-IBD patients. FL levels were 313.6 ± 46.4 in CD, 370.7 ± 46.9 in UC, and 1.3 ± 0.5 in non-IBD patients. Sensitivity of CRP to detect IBD was 75% with specificity of 100%, positive predictive value of 100%, and negative predictive value of 69%. Sensitivity of FL was 100% with specificity of 95%, positive predictive value of 97.3%, and negative predictive value of 100%. In CD, FL levels correlated positively (R2=0.42) with disease severity as judged by the SES-CD. Conclusions. Elevated FL corresponds to intestinal inflammation, even in patients with normal CRP. With high probability, normal FL excludes intestinal inflammation

Genetic difference in HLA-DR phenotypes between coeliac disease and transitory gluten intolerance.

Genetic differences in HLA phenotypes were studied in coeliac disease to investigate why some patients do not react with mucosal damage after gluten challenge. Forty five children with coeliac disease and 16 with transitory gluten intolerance were typed; 76 subjects served as controls. HLA phenotypes in children with coeliac disease had significantly higher proportions of DR3/X and DR5/7 than controls (48.8% v 11.8% and 26.7% v 5.3%). Children with transitory gluten intolerance had lower DR3/X (43.8%) than children with coeliac disease and there were no DR5/7 phenotypes. Further analysis of similarly well defined cases might show whether genetic differences in the DR3/X and DR5/7 phenotypes can serve as a marker for the permanence of gluten intolerance