The Effect of Preoperative Oral Application of Bovine Colostrum on Endotoxemia and TNF-alpha in Abdominal Surgery

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.

Analysis of Prognostic Factors in Gastric Cancer Patients Treated with Total Gastrectomies

The prognoses for the gastric cancer patients treated with total gastrectomies are known to be unsatisfactory due to the low survival rates, the high frequency of postoperative mortality or morbidity, and long-term complications such as nutritional deficiency. The authors evaluated the 5-year survival rates and analyzed the prognostic factors in 557 patients with gastric cancer who underwent total gastrectomies during the period between Jan. 1987 and Dec. 1993. The overall 5-year survival rate was 49.7%, and the survival rates according to the stage were stage Ia, 92.0%; Ib, 85.5%; II 64.1%; IIIa 55.0%; IIIb 26.5%; and stage IV, 6.3%. Postoperative mortality rate was 1.1%. By using univariate analysis to evaluate the prognostic factors, factors such as age, depth of invasion, extent of lymph node metastasis (according to the Japanese rule), number of involved nodes, lymph node ratio, distant metastasis (peritoneal and/or hepatic), size of the tumor, gross type, histological type, the surgical curability and the TNM stage were found to be related with the survival of the patients. In a multivariate analysis using 11 variables, the TNM stage was the single most significant prognostic factor. Besides the TNM, depth of invasion (ratio of risk (R.R)=1.50), extent of lymph node metastasis (R.R=1.83), number of involved nodes (R.R=1.64), lymph node ratio (R.R=1.91), and peritoneal metastasis (R.R=3.11) were found to be independent prognostic factors influencing survival. It was thought that the radicality of surgery could be reflected in the number of removed nodes per specimen. In this study, the average number of removed nodes was 42.3 per case. Hence, it may be said that adequate lymphadenectomy was performed for almost all the grossly curable cancers. The 5-year survival rate in stage IV patients with tertiary node (N3) metastasis and no peritoneal or hepatic metastasis was 16.8%; in patients with peritoneal or hepatic metastasis, the survival rate was 0%. There was a significant survival difference between these two groups (p<0.05). This result suggests that the tertiary node metastasis is a potentially curable factor, and that it should be classified differently in the current TNM system. In conclusion, the overall survival rates in the patients treated with total gastrectomies were favorable compared with the results in other reports. Depth of invasion, extent of lymph node metastasis, number of involved nodes, lymph node ratio were important prognostic factors for survival after a total gastrectomy. The current TNM staging system appears to be a reasonable one, except that the probable curability of tertiary node metastasis may need to be taken into consideration.

Controlled Gastrostomy & Omental Patch for a Aifficult Case in Peptic Ulcer Perforation: A case report

If peptic ulcer perforates in the presence of shock or concurrent medical disease or delay of operation, the postoperative morbidity and mortality are high. Years ago most discussion was on whether urgent definite surgery was the most effect therapy, nowadays there is a tendency to less invasive measures in risk situation. Although the simple closure or omental patching has its weak point of high frequency of symptomatic relapse, it is a simple and safe method with the advantage of having a low complication rate than other definite operations. So many surgeons frequently use this simple method in high risk situation. But in the rare instance of large perforation of prepyloric ulcer, this simple closure method is not safe to apply. The authors experienced an unusual case of large prepyloric ulcer perforation in an 80 year old female who had undergone a previous operation(choledocho-duodenostomy). Moreover she had suffered from several concurrent medical diseases and the operation was delayed. We succeeded in repairing the perforation using controlled gastrostomy and omental patching method, and present this case with a review of the literature.

Clinicopathologic Characteristica of the Mucinous Gastric Adenocarcinoma

There has been a considerable controversy on the prognosis of the mucinous gastric adenocarcinoma(MGC). In this study we analyzed the clinicopathologic differences between MGC and non-mucinous gastric carcinoma(NMGC). In addition, the relationship between mucin content and other clinicopathologic variables, including prognosis in MGC was examined. We reviewed 2118 patients with pathologically confirmed gastric cancer who had underwent gastrectomy at the department of surgery of Yonsei University College of Medicine, during the period between Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric cancer with extracellular mucin(MGC) and 1988 patients had gastric carcinoma without extracellular mucin(NMGC). We studied the MGC patients into two groups according to mucin content: mucin content involving over 50% of the tumor(dominant type, n=94) and mucin content involving less than 50% of the tumor area(partial type, n=36). The results are as follows: The MGC was more common in male then NMGC. The size of tumor in MGC was larger than that of NMGC. The patients with MGC had higher incidence of Borrmann type IV, more frequent serosal invasion, lymph nodes metastasis and peritoneal metastasis than the patients with NMGC. The patients with MGC had more advanced stage at the time of diagnosis and worse overall 5-year survival rate than the patients with NMGC. But the 5-year survival rate according to the stage of MGC was similar to that of NMGC. There were no significant differences between the mucin content and other pathologic variables including prognosis. So we suggested that MGC has worse prognosis than NMGC and it is reasonable to consider the carcinoma with mucin content involving less than 50% of the tumor area as MGC.