Delayed Surgery for Congenital Diaphragmatic Hernia

Infants with congenital diaphragmatic hernia (CDH) operated on at 12 hours of age have poor prognosis. Development of severe hypoxemia due to hypoplastic lung and pulmonary vascular constriction is the major prognostic factor. Infants who show reasonable gas exchange at first but develop severe hypoxemia a few hours following surgery (honeymoon period) may have benefited from delayed radical surgery. During the waiting period, the patient should be kept on a minimal handling and stabilizing protocol. In our institute, 24 CDH patients were treated from 1970 to 1995. These patients were divided into two groups : group I (n = 11) was the first stage (1970-1984), group II (n = 13) was the second stage (1985-1995). The total survival rate of these two groups did not improve. However our experience with the last six cases using this stabilizing protocol between 1989 and 1995 suggests that delayed repair surgery for CDH improved the survival rate. The survival rate changed from 33.3% in group I to 44.4% in group II. We report our cases, including clinical status, surgical findings and treatments

Prognostic Value of Circulating CA 19-9 in Colorectal Cancer Patients

Aims: We examined the preoperative serum levels of sialyl Lewisa (CA19-9) and carcinoembryonic antigen (CEA) in 262 colorectal cancer patients, in order to clarify whether or not the prognostic value of CA19-9 after curative surgery is superior to that of CEA. Patients and Methods: The patients were divided into two groups: low or high antigen groups (higher or lower than a selected diagnostic-based cut-off value). For evaluation of the prognostic value of CA19-9 and CEA, the disease-free interval was studied. Results: The disease-free interval of patients with a high serum levels of CA19-9 or CEA was significantly shorter than for those patients with a low serum level of the particular antigen (P<0.0001 and P=0.0009, respectively). The disease-free interval of patients with stage I/II tumors who had a high CA19-9 level was significantly shorter than in those patients with stage I/II tumors with low CA19-9 levels (P=0.0020). In contrast, the disease-free interval of patients with stage I/II tumors who had a low or high CEA level did not differ. Cox s regression analysis revealed that a high serum level of CA19-9 or CEA was an independent predictor for short disease-free interval after curative surgery, separate from stage (Hazard ratio=2.65 or 1.68, respectively, versus a low serum level of each respective antigen) . Conclusions: These data suggest that the preoperative serum level of CA19-9 was a stronger prognostic factor after curative surgery than CEA. Furthermore, in contrast to CEA, CA19-9 provides more prognostic information than that obtained by conventional staging methods in patients with stage I/II tumors

Biological Differences Between. Polypoid and Nonpolypoid Growth Types of Colorectal Cancer

Background- Two distinct morphologic types of colorectal cancer have been described in recent studies: polypoid growth type (PG-type) and nonpolypoid growth type (NPG-type). Materials and Methods- We investigated possible biological and clinical differences between 37 PG-type and 156 NPGtype cancers using both univariate and multivariate analyses (logistic and Cox regression models). Results- Unlike NPG-type cancers, PG-type cancers had a high proportion of well-differentiated adenocarcinoma cells, a high likelihood of being early colorectal cancers (carcinoma in situ and cancer invades submucosa), and a low frequency of lymph node metastasis. On average, such PG-type cancers also carried a better prognosis than NPG-type cancers (P=0.01). In particular, PG-type cancer patients with stage IV tumors had a better prognosis than NPG-type cancer patients (P=0.02). In fact, after performing a Cox regression analysis, we found that colorectal cancer growth type is an independent prognostic variable, separate from histologic type or stage. Conclusions- PG-type colorectal cancer is less aggressive and has a favorable prognosis compared to NPG-type cancer

Circulating Sialyl Lewisa, Sialyl LewisX, and Sialyl Tn Antigens in Patients with Diffuse Type of Gastric Cancer

The aim of this study was to clarify whether or not preoperative serum levels of sialyl Lewisa (CA19-9), sialyl LewisX (SLX), and sialyl Tn (STN) antigens are predictors for diffuse type gastric cancer. Eighty-two patients with diffuse type and 96 patients with intestinal type cancers were studied. Univariate logistic regression analysis showed that the following factors were significantly associated with diffuse type cancer: high levels of serum STN, young age (<62 years), female gender, tumor in the middle stomach, macroscopic type 3/type 4 cancer, presence of lymphatic invasion, peritoneal dissemination, stage III/IV, and non-curative resection. Multivariate analysis revealed that diffuse type cancer was independently related to young age (<62 years), female gender, tumor in the middle stomach, and macroscopic type 3/type 4 cancer. In conclusion, none of the preoperative serum levels of CA19-9, SLX, and STN were predictors for diffuse type cancer

Delayed Surgery for Congenital Diaphragmatic Hernia

Infants with congenital diaphragmatic hernia (CDH) operated on at 12 hours of age have poor prognosis. Development of severe hypoxemia due to hypoplastic lung and pulmonary vascular constriction is the major prognostic factor. Infants who show reasonable gas exchange at first but develop severe hypoxemia a few hours following surgery (honeymoon period) may have benefited from delayed radical surgery. During the waiting period, the patient should be kept on a minimal handling and stabilizing protocol. In our institute, 24 CDH patients were treated from 1970 to 1995. These patients were divided into two groups : group I (n = 11) was the first stage (1970-1984), group II (n = 13) was the second stage (1985-1995). The total survival rate of these two groups did not improve. However our experience with the last six cases using this stabilizing protocol between 1989 and 1995 suggests that delayed repair surgery for CDH improved the survival rate. The survival rate changed from 33.3% in group I to 44.4% in group II. We report our cases, including clinical status, surgical findings and treatments

Paratracheal Lymph Node Metastasis from Cancer of the Stomach

An unusual case of gastric cancer associated with a huge metastasis to the paratracheal lymph node is presented. The 57-year-old female patient with such a metastatic disease was managed by surgery and immunochemotherapy. Histologic examination of the stomach and involved lymph nodes showed a poorly differentiated adenocarcinoma