AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retr...AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatme...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatment </span><span style="font-family:Verdana;">of colon cancer are easily confounded by the modern adjuvant and</span><span style="font-family:Verdana;"> neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% </span><span style="font-family:Verdana;">of the patients, the cause of death was other than colorectal cancer recur</span><span style="font-family:Verdana;">rence. </span><span style="font-family:Verdana;">The adjusted Cox regression model showed that higher age (1.04 (95% CI:</span><span style="font-family:Verdana;"> 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;</span><span style="font-family:Verdana;">1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative</span><span style="font-family:Verdana;"> blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged sur展开更多
A 51-year old female with a history of multiple sclerosis presented to the emergency department with hypotension and fatigue. She was found to be in cardiogenic shock. Her initial EKG was concerning for STEMI and her ...A 51-year old female with a history of multiple sclerosis presented to the emergency department with hypotension and fatigue. She was found to be in cardiogenic shock. Her initial EKG was concerning for STEMI and her troponin was positive. She was eventually diagnosed with spontaneous coronary artery dissection. This case report discusses her presentation, management, and clinical course. We emphasize the need for emergency medicine physicians to be concerned for SCAD, especially in women with a history of fibromuscular dysplasia, connective tissue disorders, or peri-partum status.展开更多
文摘AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatment </span><span style="font-family:Verdana;">of colon cancer are easily confounded by the modern adjuvant and</span><span style="font-family:Verdana;"> neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% </span><span style="font-family:Verdana;">of the patients, the cause of death was other than colorectal cancer recur</span><span style="font-family:Verdana;">rence. </span><span style="font-family:Verdana;">The adjusted Cox regression model showed that higher age (1.04 (95% CI:</span><span style="font-family:Verdana;"> 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;</span><span style="font-family:Verdana;">1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative</span><span style="font-family:Verdana;"> blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged sur
文摘A 51-year old female with a history of multiple sclerosis presented to the emergency department with hypotension and fatigue. She was found to be in cardiogenic shock. Her initial EKG was concerning for STEMI and her troponin was positive. She was eventually diagnosed with spontaneous coronary artery dissection. This case report discusses her presentation, management, and clinical course. We emphasize the need for emergency medicine physicians to be concerned for SCAD, especially in women with a history of fibromuscular dysplasia, connective tissue disorders, or peri-partum status.
