Does the stomach remain silent after neonatal loss of its original pacemaker?: gastric motility in long-term survivors of neonatal gastric rupture.
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Gastric peristaltic contractions are controlled by an intrinsic electrical pacemaker located in the mid-body along the greater curve. This study was undertaken to investigate gastric motility in long-term survivors of neonatal gastric rupture who were surgically deprived of their original pacemaker. Four patients, 1 boy and 3 girls, aged between 6 and 12 years were studied. Physiological activity of the gastric remnant was assessed in terms of electrical as well as peristaltic functions by means of electrogastrography and video-recorded barium swallow study. Electrical and mechanical pacing activities were classified into normogastria or dysrhythmia (brady- or tachygastria) according to their frequencies. In these patients, ectopic pacemakers were found to be arising just distal to the site of resection along the greater curve. Electrophysiologically, one patient was diagnosed as having normogastria, and other 3 patients were found to have dysrhythmia (2, bradygastria; 1, tachygastria) on the basis of electrogastrographic analyses. In two of three patients studied further by fluoroscopy, electrical activity agreed well with peristaltic activity. In one patient, however, electrical tachygastria was associated with peristaltic bradygastria. In conclusion, an ectopic pacemaker arises in the stomach that does not remain silent after neonatal surgical loss of its own pacemaker. Noninvasive electrogastrography seems useful in assessing electrical potentials generated by the ectopic pacemaker. (+info)
Prognostic factors in gastric stump carcinoma.
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OBJECTIVE: To compare prognostic results in patients with gastric stump cancer (GSC) versus those with primary gastric cancer (PGC). SUMMARY BACKGROUND DATA: Gastric stump carcinomas have often been described as having low resectability rates and a poor prognosis. METHODS: Results of surgical treatment of 50 patients with GSC were compared with that of 516 patients with PGC. RESULTS: The resectability rate was 94% for GSC patients and 96.5% for PGC patients, without significant differences in terms of postoperative complications, death rate, and median survival time (31.6 vs. 32.9 months). The multivariate analysis showed an independent prognostic effect for R0 resection, pT1 and pT2 category, and age older than 65 years. CONCLUSION: The prognosis after resection and adequate lymphadenectomy does not differ between patients with GSC and PGC. (+info)
Possible association of active gastritis, featuring accelerated cell turnover and p53 overexpression, with cancer development at anastomoses after gastrojejunostomy. Comparison with gastroduodenostomy.
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To cast light on tumorigenesis in the remnant stomach after distal gastrectomy for peptic ulcer or gastric cancer, 45 cases in gastroduodenostomy (Billroth I, 17 cases) and gastrojejunostomy (Billroth II, 28 cases) groups were compared for a series of parameters. Cancers in Billroth II were significantly more predominant in the anastomosis area and more frequently associated with Epstein-Barr virus infection. Active gastritis, accelerated epithelial cell turnover (as assessed by measurements of apoptosis and cell proliferation), DNA damage, and foveolar cell hyperplasia were all greater in anastomotic areas after Billroth II than in proximal areas after Billroth II or either area after Billroth I. K-ras mutations were rare, but Epstein-Barr virus infection in cancers was seen frequently in anastomosis cases. In conclusion, active gastritis, possibly induced by enterogastric reflux, is linked to tumorigenesis in anastomosis sites in Billroth II cases. (+info)
Clinical study on reservation of part of stomach for patients with cardiac cancer of the gastric stump.
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OBJECTIVE: To explore the clinical significance of the resection of the cardia and fundus for patients suffering from cardiac cancer of the gastric stump. METHODS: Twenty-five patients suffering from cardiac cancer with a mean period of 13 years and 3 months after subtotal gastrectomy were included in this study. Their average age was 59.1 years. Among them, 19 patients got exploratory thoracotomy. RESULTS: Of the 19 patients, 1 was inoperable, 1 underwent resection of the gastric stump and esophagojejunostomy because of his huge tumor, 17 underwent resection of the cardia and fundus of the gastric stump and accepted gastroesophagostomy (9 were subjected to tunnel gastroesophagostomy and 8 to end-to-end esophagogastrostomy). The largest tumor was 5 cm x 4 cm in size. Except for a death resulting from intestinal obstruction following operation, the others attained a good recovery. The longest period of survival was 4.5 years. CONCLUSIONS: Resection of the cardia and fundus and gastroesophagostomy can be carried out for patients suffering from cardiac cancer of the gastric stump. The method is in line with the principle of the conservation surgery. (+info)
Carcinogenic potential of duodenal reflux juice from patients with long-standing postgastrectomy.
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AIM: To determine whether study on the carcinogenic potential of reflux juice from patients with remote gastrectomy could clarify the inherent relationship between duodenal reflux and gastric stump cancer. METHODS: A total of 37 reflux juice samples (13 Billroth I, 24 Billroth II) were employed in the present study. A two-stage transformation assay using BALB/c 3T3 cells was carried out to test the initiating or promoting activity of these samples. RESULTS: Two of 18 (11.1%) reflux samples exerted initiating activities, whereas 9/19 (47.4%) samples enhanced the MNNG-initiating cell transformation, suggesting the duodenal reflux juice might more frequently possess the tumor-promoter activity (P = 0.029). In addition, there was no difference in initiating activities of the samples irrespective of surgical procedures (P = 0.488), while Billroth II samples exhibited stronger tumor-promoter activity than Billroth I samples (P = 0.027). Furthermore, the promoter activities were well correlated with the histological changes of the stomas (r(s) = 0.625, P = 0.004), but neither their cytotoxicities nor initiating activities had this correlation (Probabilities were 0.523 and 0.085, respectively). CONCLUSION: The duodenal reflux juice from patients with remote postgastrectomy did have carcinogenic potential, and suggested that tumor-promoting activity should principally account for the high incidence of gastric cancer in gastrectomy patients. In contrast, it is difficult to explain the high stump-cancer incidence with the N-nitroso compounds theory-a popular theory for the intact stomach carcinogenesis, and it seemed to be justified to focus chemo-prevention of this cancer on the tumor-promoting potential of reflux juice. (+info)
Helicobacter pylori may survive ampicillin treatment in the remnant stomach.
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Helicobacter pylori (H. pylori) is a Gram-negative curved rod-like or spiral bacterium that chronically infects the human gastric mucosa, and is a major risk factor for gastritis, gastric and duodenal ulcer and adenocarcinoma of the stomach. After partial gastrectomy, some patients may have persistent H. pylori infection for five years or more. In this study, we detected three bacteria, i.e., Klebsiella pneumoniae, Enterobacter aerogenes, and Escherichia coli, in the gastric juice of patients with a remnant stomach. Some of these bacteria produced beta-lactamase. These findings are potentially important since such bacteria could provide H. pylori with the chance to acquire drug resistance and to transfer drug resistance genes. This could be one reason why H. pylori is difficult to eradicate in the remnant stomach. (+info)
Epstein-Barr virus in gastric carcinomas and gastric stump carcinomas: a late event in gastric carcinogenesis.
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BACKGROUND: To determine at what stage during gastric carcinogenesis Epstein-Barr virus (EBV) enters the gastric epithelial cells, the presence of EBV was investigated in two pathogenetically related but distinct forms of adenocarcinoma of the stomach-gastric carcinoma of the intact stomach (GCIS) and gastric stump carcinoma (GSC)-and their presumed precursor lesions. PATIENTS AND METHODS: Eleven patients with EBV positive GCIS and eight patients with EBV positive GSC, demonstrated by the highly sensitive EBV encoded RNA 1/2 (EBER1/2) RNA in situ hybridisation (RISH) technique, were studied. Paraffin wax embedded tissue available from preoperative gastric biopsies and tumour adjacent tissue from the resection specimens containing normal gastric mucosa, inflamed gastric mucosa, and preneoplastic lesions (intestinal metaplasia and dysplasia) was investigated by EBER1/2 RISH, in addition to EBV nuclear antigen 1 (EBNA-1) and latent membrane protein 1 (LMP-1) immunohistochemistry (IHC). RESULTS: In both GCIS and GSC and their precursor lesions EBER1/2 transcripts were restricted to the carcinoma cells. In addition, positivity of EBNA-1 IHC was also restricted to the tumour cells. IHC for LMP-1 was negative in all cases tested. CONCLUSIONS: The absence of EBER1/2 transcripts in preneoplastic gastric lesions (intestinal metaplasia and dysplasia) and their presence in two distinct types of gastric carcinoma strongly suggest that EBV can only infect neoplastic gastric cells and thus is a late event in gastric carcinogenesis. (+info)
Surgical management of gastric stump cancer: a report of 37 cases.
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OBJECTIVE: To observe the clinicopathological characteristics of gastric stump cancer (GSC) and evaluate the benefits of radical surgery of GSC. METHODS: The clinicopathological characteristics and postoperative survival time of 37 GSC patients who underwent surgery were investigated retrospectively. The survival time was compared according to the type of surgical operation (radical resection vs palliative operation). Twenty-one cases that received radical resection were analyzed based on the pTMN stage. Survival curves were traced by using Kaplan-Meier methods. RESULTS: Most GSC (32/37) was detected in patients who had received Billroth II reconstruction after partial gastrectomy for benign gastric disease. The lesser curvature side and the suture line of anastomosis were the most frequent sites where GSC occurred (27/37). Differentiated adenocarcinoma was the dominant histopathological type (24/37). The postoperative 5-year survival rate of early stage GSC patients (n=9) was significantly higher than advanced stage GSC (n=12) (55.6% vs 16.5%, xL2=11.48, P<0.01). Five-year survival rate of 21 GSC patients with radical resection were 75% (3/4) for stage I, 60% (3/5) for stage II, 14.2% (1/7) for stage III, and 0% (0/5) for stage IV respectively. The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative operation (43.0 m vs 13.0 m, x L2=36.31, P<0.01), the median survival time of stage IV patients with radical resection was 23.8 months. CONCLUSIONS: Without remote metastasis, radical resection for GSC is possible, and is an effective way to improve the prognosis of GSC. Even in stage IV GSC, radical resection can still prolong the survival time. It is necessary for the patients with benign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth II reconstruction procedure at 15-20 years. (+info)