Recurring gastrointestinal stromal tumor with splenic metastasis

Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 × 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist

Acute Appendicitis in Henoch-Schönlein Purpura : A Case Report

Common complications of Henoch-Schönlein purpura (HSP) that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Acute appendicitis is rarely seen as a complication of HSP. A seven-year-old boy was admitted for arthralgia, abdominal pain, hematochezia, melena, and purpuric rash on the lower extremities. On admission day abdominal ultrasonography was normal, but on day 5, he became pyrexial and developed right iliac fossa pain and tenderness with guarding. Ultrasonography showed distended appendix surrounded by hyperechoic inflamed fat. On exploration an acutely inflamed, necrotic appendix was removed and grossly there was an appendiceal perforation in the appendiceal tip. Microscopically some of the small blood vessels in the submucosa showed fibrinoid necrosis with neutrophilic infiltrations. The authors report the case of a child who developed acute perforative appendicitis requiring appendectomy while on treatment for HSP

Adverse prognostic impact of splenectomy on survival in gastric carcinoma patients: Regression and propensity score matching analysis of 1074 patients.

BACKGROUNDS:Patients with proximal gastric carcinoma undergo total gastrectomy with concomitant splenectomy to ensure the complete removal of splenic hilar lymph nodes. However, the impact of splenectomy on survival remains uncertain. This study aimed to investigate the impact of splenectomy on survival among patients with gastric carcinoma. METHODS:Of 1074 patients who underwent total gastrectomy for proximal gastric carcinoma between 2006 and 2014, 229 patients underwent concomitant splenectomy or pancreaticosplenectomy during surgery. We investigated the prognostic impact of splenectomy using a regression and propensity score matched model. RESULTS:The splenectomy and non-splenectomy groups differed in many baseline characteristics, including tumor stage, and had respective crude 5-year survival rates of 55% and 81% (p <0.001). In a multivariate analysis adjusted for TNM stage and other prognostic factors, splenectomy was an independent poor prognostic factor for overall survival (hazard ratio [HR] = 1.67, 95% confidence interval [CI] = 1.11-2.51) and disease-free survival (HR = 1.61, 95% CI = 1.24-2.10). A survival evaluation stratified by TNM stage showed that splenectomy adversely affected survival among patients with stage III, but not stage I, II, and IV disease. In the propensity score-matched sample, splenectomy group also showed significantly worse overall survival (5-year, 65% vs. 79%, p = 0.010) and disease-free survival (5-year, 55% vs. 72%, p = 0.025) and was an independent poor prognostic factor in a multivariate analysis adjusting TNM stage and other prognostic factors. CONCLUSIONS:Splenectomy adversely affects survival, particularly among patients with stage III gastric carcinoma, and should be avoided unless there is direct invasion to the splenic hilum

Multicenter Phase 2 Study about the Safety of No Antimicrobial Prophylaxis Use in Low-Risk Patients Undergoing Laparoscopic Distal Gastrectomy for Gastric Carcinoma (KSWEET-01 Study)

Background. Recent studies have shown a lower risk of surgical site infections (SSI) after laparoscopic distal gastrectomy compared to open surgery. This is a phase 2 study aiming to determine the incidence of SSI after laparoscopic distal gastrectomy without using antimicrobial prophylaxis (AMP). Methods. cT1N0 gastric cancers that were subject to laparoscopic distal gastrectomy were enrolled. Based on the unacceptable SSI incidence of ≥12.5% and the target SSI incidence of ≤5%, 105 patients were enrolled with an α of 0.05 and a power of 80% (ClinicalTrials.gov, NCT02200315). Results. In intention-to-treat analysis, patients did not reach the target SSI rate (12.4%, 95% confidence  interval=6.8%–19.8%). Of patients, 44 patients had a protocol violation, such as extended lymph node dissection (LND) or inappropriate nonpharmacological SSI prevention measures. Per-protocol analysis excluding these patients (n=61) showed a SSI rate of 4.9%, which was within the target SSI range. Multivariate analysis revealed that extracorporeal anastomosis and extended LND were independent risk factors for SSI. Conclusions. This study failed to reach the target SSI rate without using AMP. However, per-protocol analysis suggests that no AMP might be feasible when limited LND and adequate SSI prevention measures were performed

Prognosis of Gastric Carcinoma Invading the Mesocolon

The prognosis is poor when gastric carcinoma invades adjacent organs. We evaluated the outcome indicators in gastric carcinoma patients with mesocolon invasion. METHODS: We reviewed the hospital records of 169 gastric carcinoma patients with mesocolon invasion seen between 1986 and 2000 at Chonnam National University Hospital. RESULTS: The curative resection rate in gastric carcinoma patients with mesocolon invasion was 29.6% (50/169). Using Cox's proportional hazards regression model, curability was the only independent, statistically significant prognostic parameter (risk ratio, 1.48; 95% confidence interval, 0.90–2.46; p < 0.05). The 5-year survival rate was higher for patients who underwent curative resection (15.5%) than for those who underwent non-curative resection (2.6%; p < 0.001). The 5-year survival rate was higher for patients who underwent resection (7.3%) than for those who did not (bypass and exploration groups, 5.1% and 0%, respectively; p < 0.001). CONCLUSION: The results showed improved survival of gastric carcinoma patients with mesocolon invasion who underwent curative resection compared to those who did not. Improving the prognosis for patients with mesocolon invasion requires curative resection

Generation of motor neurons requires spatiotemporal coordination between retinoic acid and Mib-mediated Notch signaling

Mind bomb (Mib) is an E3 ubiquitin ligase that activates the Notch signaling pathway. A previous study demonstrated that the generation of late-born GABAergic neurons may be regulated by the interplay between Mib and retinoic acid (RA). However, the relationship between Mib function and the retinoid pathway during the generation of late-born motor neurons remains unclear. We investigated the differentiation of neural progenitors into motor neurons by inhibition of Notch signaling and administration of RA to Tg[hsp70-Mib:EGFP] embryos. The number of motor neurons in the ventral spinal cord increased or decreased depending on the temporal inhibition of Mib-mediated Notch signaling. Inhibition of the retinoid pathway by citral treatment had a synergistic effect with overexpression of Mib:EGFP on the generation of ectopic motor neurons. Additionally, the proteolytic fragment of Mib was detected in differentiated P19 cells following treatment with RA. Our observations imply that the function of Mib may be attenuated by the retinoid pathway, and that Mib-mediated Notch signaling and the retinoid pathway play critical roles in the spatiotemporal differentiation of motor neurons