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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Resumé Par une analyse unit- et multifactorielle de 3926 cas de cancers gastriques recueillis entre 1981 et 1991, on a confirmé la valeur pronostique de plusieurs facteurs clinicopathologiques et on a évalué l'efficacité d'une immunothérapie postopératoire comportant de l'OK-432, du 5-FU et de la mitomycine dans le cancer gastrique du stade III. On a calculé les taux de survie à cinq ans pour chaque catégorie de facteur pronostique et par analyse unifactorielle, on a démontré une différence significative pour la plupart de ces facteurs tels que l'âge, la profondeur d'invasion, les métastases ganglionnaires, le site primitif de la tumeur, la différentiation histologique et l'aspect macroscopique. Il n'y avait pas, par contre, de différence significative en ce qui concerne le sexe. Par analyse multifactorielle, on a mis en évidence une différence significative concernant la profondeur d'invasion et les métastases ganglionnaires (p〈0.001), ainsi que l'aspect macroscopique, le site et la différentiation de la tumeur (p〈0.05). En ce qui concerne le traitement postopératoire, l'immunochimiochirurgic était plus effective chez les patients stade III (p〈0.05). En conclusion, le pronostic du cancer gastrique peut être évalué selon plusieurs facteurs indépendants et l'immunochimiochirugie peut être un traitement efficace en cas de cancer gastrique avancé.
    Abstract: Resumen Se realizó análisis uni y multivariable de 3926 pacientes seleccionados con cáncer gástrico tratados en el lapso de 1981 a 1991, con el fín de confírmar el valor de diversos factores clínicopatológicos de pronóstico y de evaluar la eficacia de la immunoquimitoterapia postoperatoria con OK-432, 5-FU y Mitomicina-C en el cáncer gástrico en estado III. Se determinaron las tasas de sobrevida a cinco años para cada categoría de las variables de pronóstico, y en el análisis univariable la mayoría de las mismas, incluyendo edad, profundidad de la invasión tumoral, metástasis ganglionares linfáticas, ubicación del tumor primario, diferenciación histológica y tipo macroscópico, excepto por el sexo, demostraron alguna significación estadística. El análisis multivariable verificó los factores pronósticos de significación. La profundidad de la invasión y las metástasis ganglionares aparecieron como los factores más poderosos (p〈0.01) y el tipo macroscópico, la ubicación y la differenciación histológica aparecieron como factores adicionales de significación (p〈0.05). En cuanto al tratamiento postoperatorio, la inmunoquimiocirugía fue más efectiva en los pacientes en estado III (p〈0.05). En conclusión, planteamos que es posible predecir el pronóstico en el cáncer gástrico con mayor precisión basándose en tales factores independientes de pronóstico y que la inmunoquimiocirugía puede ser un valioso método de tratamiento en el cáncer gástrico avanzado.
    Notes: Abstract Univariate and multivariate analyses of 3926 selected gastric cancer patients collected between 1981 and 1991 were made to confirm several clinicopathologic prognostic factors and to evaluate the effectiveness of postoperative immunochemotherapy with OK-432, 5-FU, and mitomycin C in stage III gastric cancer. Five-year survival rates for each category of prognostic variables were obtained; and in the univariate analysis, most of the factors (including age, depth of invasion, lymph node metastasis, location of primary tumor, histologic differentiation, and gross type except for sex) showed some significance. Multivariate analysis was conducted and verified significant prognostic factors. Depth of invasion and lymph node metastasis were found to be the most powerful factors (p〈0.001); gross type, location, and histologic differentiation were additional significant factors (p〈0.05). For postoperative treatment, immunochemosurgery was most effective in stage III patients (p〈0.05). In conclusion, we may predict a prognosis for gastric cancer more precisely on the basis of these independent prognostic factors, and immunochemosurgery may be a valuable means to treat advanced gastric cancer.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Liver failure due to ischemia-reperfusion injury, believed to be closely related to the generation of oxygen-free radicals, is a serious problem during liver surgery. Gabexate mesilate, a synthetic protease inhibitor, suppresses the extracellular release of oxygen-free radicals in the microvascular endothelium. To determine its effects on ischemia-reperfusion injury to the liver, we performed experiments with rats. We divided the animals into two ischemia-reperfusion groups: an experimental group, which underwent ischemic injury for 30 minutes, along with the infusion of gabexate mesilate, and a control group, which underwent injury only. Each group was then divided into four subgroups: ischemic injury only and 60-, 120-, and 180-minute reperfusion injury. The test parameters were tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) in serum and superoxide dismutase (SOD), catalase, and malondialdehyde (MDA) in liver and lung tissues. The experimental group had a significantly higher liver SOD and catalase levels and a significantly lower level of liver and lung MDA than the control groups. TNFα levels in the experimental groups were significantly lower during the early phase, but a comparison of IL-6 levels between the two groups yielded no differences. Levels of lung catalase and SOD were not significantly different between the two groups. We concluded that protease inhibitor suppressed liver ischemia-reperfusion injury, and that it was due to an increase of antioxidant or suppression of oxygen-free radicals. The roles of TNFα and IL-6 in liver reperfusion injury were not clear, though TNFα might have had an effect during the early phase. With liver ischemia-reperfusion injury, the mechanism of lung involvement might be different from that of liver involvement.
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  • 3
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Positron emission tomography (PET) is an imaging method that employs radionuclide and tomography techniques. PET has high sensitivity for detecting breast cancer, both the primary tumor and axillary node metastasis. From June 1995 to November 1996 a total of 27 patients underwent breast operations based on PET results at Seoul National University Hospital. Whole-body PET images were obtained beginning 60 minutes after injection of 370 MBq (10 mCi) 18F-fluorodeoxyglucose. Regional scans were also obtained with transmission images. We compared the PET results with those from the physical examination and mammography. All cases were histologically confirmed. The diagnostic accuracy of PET was excellent for the primary tumor mass (97%) compared with that of the physical examination (78%) and mammography (67%). For axillary lymph node metastasis, PET had outstanding detection accuracy (96%) compared with the physical examination and mammography (74% and 60%, respectively). Whole-body PET scans made it possible to see all of the metastatic lesions at a glance in cases of metastatic or recurrent breast cancer. There was a probable correlation between the standard uptake value (SUV) and the number of axillary lymph node metastases, but in this study statistical significance was not proved because of the small number of cases. PET also could detect breast cancer in paraffin-augmented breasts. We concluded that PET is a highly sensitive, accurate diagnostic tool for breast cancer and that SUV, after more studies, could be used as an important prognostic factor.
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  • 4
    ISSN: 1573-7217
    Keywords: breast cancer ; heterogeneity ; lymph nodes ; ploidy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Human breast carcinoma is biologically heterogeneous, and its clinical course may vary from one which is indolent to one which rapidly progresses. Although it is the metastasis rather than the primary tumor that ultimately overwhelms the patients, studies concerning the DNA pattern have focused on the primary tumors. This study was undertaken to identify heterogeneities between primary tumors and metastases, and to evaluate the prognostic significance of the ploidy pattern and the S-phase fraction (SPF) of metastatic nodes in axillary node positive patients. Seventy-four frozen specimens of the primary and corresponding metastatic nodes from 37 patients have been analyzed by flow cytometry and the SPF calculated. The results of ploidy pattern analysis in primaries revealed 25 diploidy (67.6%) and 12 aneuploidy (32.4%), while those in metastasis showed 17 diploidy (46.0%) and 20 aneuploidy (54.0%). The aneuploidy group in metastatic nodes had the poorer histological grade (85.0% vs. 15.0%, p = 0.02), and more mean metastatic nodes (5.75 ± 2.10 vs. 3.05 ± 1.56, p = 0.018), and more frequent lymphatic vessel invasion (65.0% vs. 11.8%, p = 0.031) than its counterpart. Decreased expression of ER (70.6% vs. 25.0% p = 0.006) and increased expression of c-erbB2 (65.0% vs. 23.5%, p = 0.012) were observed in the aneuploidy of metastatic nodes. The group with higher SPF in metastatic nodes had more metastatic nodes (5.47 ± 2.31 vs. 4.00 ± 1.78, p = 0.042), and the higher incidence of lymphatic vessel invasion (57.9% vs. 22.2%, p = 0.027), and poor histological grade (71.4% vs. 37.5%, p = 0.039). In conclusion, the cell populations in metastatic nodes revealed DNA pattern which differed from that of primary tumors. The ploidy pattern and SPF in metastatic nodes might be considered as discriminate measure for risk factors in breast cancer patients with positive axillary node.
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