Prognosis of early esophageal cancer. Comparison between adeno- and squamous cell carcinoma.

Background: The purpose of this study was to compare the prognosis of patients with T1 squamous cell carcinoma (SCC) with those with T1 adenocarcinoma of the esophagus and to explain prognostic differences by an analysis of clinicopathologic characteristics.

Methods: Seventy-seven patients with early esophageal cancer who underwent esophagectomy and lymphadenectomy from 1982 to 1993 were included in the study. Clinical and histopathologic characteristics, patterns of lymph node metastasis, results of surgery, and long term prognosis of 47 patients with SCC were compared with 30 patients with adenocarcinoma; a multivariate analysis of various prognostic factors was performed.

Problem of proximal third gastric carcinoma.

The prevalence of proximal third gastric carcinoma increases rapidly in the Western world. An analysis of prognostic factors indicates that the poor prognosis usually associated with these tumors is due at least in part to late presentation and advanced tumor stages. The current TNM classification usually understages these tumors because it does not take the partly retroperitoneal location of the proximal stomach into account.

Preoperative staging of gastric cancer as precondition for multimodal treatment.

Preoperative staging of gastric cancer plays a crucial role every multimodal treatment protocol. At present, staging intends to be far more than evaluation of the depth of tumor infiltration into the organ wall, that is, T stage, nodular status (N category), and the presence of distant metastases (M stage) according to UICC criteria. In modern surgical oncology it includes more often the evaluation of prognostic factors such as the RAS-protein, p53 tumor suppressor gene, growth factor receptors, cell adhesion molecules, proteolytic factors, and proliferation-associated antigens.

Staging concepts for gastrointestinal malignancies: the importance of preoperative locoregional T- and N-staging.

Preoperative locoregional staging of gastrointestinal tumors is of special significance for evaluation of resectability that means complete tumor removal without residual tumor (R0-resection). This is especially important within a multimodal therapeutic concept including neoadjuvant therapy of nonresectable tumors. In esophageal cancer above the bifurcation, tumors that are staged T3 or T4 should have neoadjuvant radiochemotherapy in order to achieve a down-staging and increase the chance for a complete tumor resection.

Three-dimensional pressure image and muscular structure of the human lower esophageal sphincter.

Background: The structural equivalent to the manometric high pressure zone separating the stomach from the esophagus is still a matter of dispute. We compared the three-dimensional (3D) manometric pressure image with muscular thickness and architecture at the human gastroesophageal junction.

Methods: Three-dimensional manometric images were obtained in 25 volunteers by using a stepwise pullback technique of a catheter with eight radially oriented pressure transducers.

[Ambulatory surgery--definition, socioeconomic and legal aspects].

One of the most important intentions of GSG 1992 is the favourization of traditional ambulatory surgery by legislative measures. However in general surgery a much higher potential for a significant reduction in cases of classical hospitalization and thus concomitant substantial financial savings lies in short-stay eg. one-day/one-night procedures.

Preoperative chemotherapy for unresectable gastric cancer.

Even with extended surgery, including systematic lymphadenectomy of the lymph node compartment II, only half of the patients with locally advanced gastric cancer (LAGC), which comprises stages IIIA, IIIB, and IV, undergo a macroscopic and microscopic tumor-free resection (i.e., R0 resection, according to UICC 1987/AICC 1988).

Multimodal treatment for squamous cell esophageal cancer.

Preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx/CTx) in patients with squamous cell esophageal carcinoma has recently received increasing attention. Although several prospective randomized trials could not show any benefit of neoadjuvant therapy in patients with potentially resectable tumors, preoperative CTx and combination RTx/CTx appear to increase the resection rate, the rate of complete tumor resection, and survival time in patients with locally advanced tumors. Most available studies show that a survival benefit from multimodal therapy can be expected primarily in patients who have a complete histopathologic response to preoperative treatment (i.

Staging gastrointestinal cancer as a precondition for multimodal treatment.

Staging gastrointestinal cancer is useful only if it has an impact on treatment. When applying modern multimodal therapies (i.e.

Peptide YY inhibits exocrine pancreatic secretion in isolated perfused rat pancreas by Y1 receptors.

Peptide YY (PYY) inhibits exocrine pancreatic secretion in several species. Two receptors, Y1 and Y2, are known to mediate PYY actions. While PYY 1-36 binds equally to both receptor subtypes, a second endogenous form of PYY, PYY 3-36, selectively activates Y2 receptors.

Surgical therapy for gastric cancer.

The aim of any surgical approach to gastric carcinoma should be a complete resection with no residual tumor left behind, that is, a R0-resection according to the UICC. Complete tumor resection in this respect refers to the primary tumor as well as the lymphatic drainage and requires an adequate safety margin. The indications for surgical therapy of gastric cancer and the choice of procedure should consequently be guided by the tumor stage.

[Immunosuppression and infection].

The course of prolonged sepsis is characterized by an initial activation of the immune system followed by the transition into a state of immunosuppression. Accordingly, a series of immunosuppressive substances can be detected in the serum of septic patients. On the cellular level many important functions of the unspecific as well as the specific defense systems of the organism are inhibited.

Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection.

Constipation and incontinence are frequent complications of rectal prolapse. Surgery should not only aim to correct prolapse but also improve bowel and sphincter function. From 1986-1991 42 patients with procidentia were treated by rectopexy and sigmoid resection.

Carcinoma of the gastric cardia.

The general term "carcinoma of the gastric cardia" includes three different types of adenocarcinomas. Carcinoma of the distal oesophagus (Type I), true carcinoma of the cardia (Type II) and subcardial gastric carcinoma (Type III). The preoperative classification of these carcinomas of the gastro-oesophageal junction is primarily based on radiologic and endoscopic examination.

Reoperations after failed antireflux procedures.

With the advent of laparoscopic surgery, the number of anti-reflux procedures performed has virtually exploded in some centers. Persistent, recurrent or new symptoms after an antireflux procedure are therefore likely to become a more common problem in the near future. Recurrent reflux is usually due to a breakdown of the repair and can frequently be treated medically or by a repeat antireflux procedure.

Serum levels of end products of nitric oxide synthesis correlate positively with tumor necrosis factor alpha and negatively with body temperature in patients with postoperative abdominal sepsis.

Nitric oxide (NO) has been implicated as the principal mediator of the catecholamine resistant vasodilation in septic shock. In this pilot study, we wanted to know if the serum values of nitrite/nitrate (NO2/NO3), the stable endproducts of NO biosynthesis, are elevated in patients with septic shock. Furthermore, we investigated whether there is a correlation between NO2/NO3 serum levels and tumor necrosis factor alpha or interleukin 6.

[Bile duct lesions in laparoscopic cholecystectomy].

Laparoscopic cholecystectomy is both resulting in a slightly higher incidence of biliary lesions and a change of prevalence of the type of lesions. Damage to the biliary system occurs in 4 different types: The most severe case is the lesion with a structural defect of the hepatic or common bile duct with (IVa) or without (IVb) vascular injury. Tangential lesions without structural loss of the duct should be denominated as type III (IIIa with additional lesion to the vessels, type IIIb without).

E-cadherin gene mutations provide clues to diffuse type gastric carcinomas.

The calcium-dependent homophilic cell adhesion molecule and candidate suppressor gene, E (epithelial)-cadherin, plays a major role in the organization and integrity of most epithelial tissues. Diffusely growing gastric carcinomas show markedly reduced homophilic cell-to-cell interactions. We speculated that mutations in the E-cadherin gene may be responsible for the scattered phenotype of this type of carcinoma.

Prognostic impact of urokinase-type plasminogen activator and its inhibitor PAI-1 in completely resected gastric cancer.

The prognostic impact of the proteolytic factors urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI-1) was evaluated in 76 completely resected gastric cancer patients enrolled in a prospective study. All patients underwent macroscopically and microscopically residual tumor-free resection (category R0, Union International Contre Cancer, 1987). uPA and PAI-1 levels were quantified in detergent-extracted (Triton X-100) specimens of primary gastric tumors by enzyme-linked immunosorbent assays.

Staging of squamous esophageal cancer: accuracy and value.

Endoscopic ultrasonography (EUS) and computed tomography (CT) should be used as complementary methods for TNM staging of esophageal cancer. EUS is the most accurate modality for staging primary tumor and mediastinal lymph node metastases. CT should be used to detect infiltration of other mediastinal organs and distant metastases.