Combined Gastrectomy with Adjacent Organs in T4 Gastric Cancer : Therapeutic Results and Indication

The postoperative morbidity, mortality and survival of 244 T4 gastric cancer patients were examined to assess the therapeutic results and to clarify the indication for combined gastrectomy with adjacent (T4) organs. A total of 190 combined and 54 simple gastrectomies were performed during the 25-year period between 1969 and 1994. Fourteen (7.4%) and 7 (13.0%) patients died of the complications after combined and simple gastrectomies respectively. No statistical significant difference was found in the mortality rates between the gastrectomies. The histological examination of 190 resected specimens by the combined gastrectomy with T4 organs revealed that gastric resections with conclusive curability A, B and C were performed in 33 (17.4%), 84 (44.2%) and 73 (38.4%) cases respectively. Significant differences (P < 0.01) among 3 survival curves of the patients with curability A, B and C were found, and the 5-year survival rates were 65.5%, 35.4% and 9.2% respectively. The survival curve of 176 patients with combined gastrectomy was significantly (P < 0.01) higher than that of 47 patients with simple gastrectomy, and the 5-year survival rates were 31.3% and 4.3%. However, the survival curve and the 5-year survival rate of the patients with simple gastrectomy were not statistically different from those of the patients with curability C. These results suggest that combined gastrectomy with T4 organs in T4 gastric cancer may be indicated for the patients with surgical curability B, but not surgical curability C

Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI

Solitary Ulcer Syndrome of the Rectum in an Aged Patient Treated With Sigmoidostomy

A rare patient with solitary ulcer syndrome of the rectum was reported. A 78-year-old male with a habit of strong straining on defecation noticed anal bleeding of 2 weeks' duration and consulted us. Preoperative examinations revealed one bleeding ulcer with raised margin at the anterior wall of the. Rectum. The ulcer was pathologically diagnosed as solitary ulcer syndrome of the rectum from its characteristic findings of the biopsy-specimens. Sigmoidostomy was done, because the conservative treatment had no effect on the symptoms and signs and the patient remained in a poor general condition. Since the bleeding stopped completely 2 weeks after surgery and the ulcer became scar phase, sigmoidostoma was closed 4 weeks later. Thereafter, the recurrence was not found 34 months after operation. The pathogenesis as well as surgical treatments for this rare syndrome are discussed, because the considerable uncertainty has yet remained