Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma.

BACKGROUND/AIMS: Although the incidence of primary gastric carcinoma is decreasing, the majority of patients in Western countries are still diagnosed with advanced tumor stages. In many cases surgical therapy can be performed only by multivisceral resections including the pancreas. METHODS: Between April 1986 and April 1997, thirty-three patients with primary gastric carcinoma underwent gastric resection and segmental/total pancreatectomy at our institution (21 males, 12 females; median age 57 years). The operative and pathologic findings and clinical course in these patients were analyzed retrospectively. RESULTS: In all patients total gastrectomy with D2 lymphadenectomy was performed. In 26 patients (79%) the pancreatic tail was also resected. Other resections included the pancreatic head in 5 patients (15%) and the whole pancreas in 2 cases (6%). Radical (R0) resections were possible in 73% of all cases (n = 24). 22 patients (67%) had stage-IV disease due to liver/peritoneal metastases (n = 11) or to extensive lymph node metastases (N3, n = 11). Histology showed a predominance of the diffuse type according to Laurén (n = 16, 49%). Intraoperatively suspected tumor infiltration of the pancreas was confirmed by histology only in 39% (n = 13) of the examined resection specimens. Postoperative morbidity was 36% (n = 12) and mortality was 9% (n = 3). Five patients developed pancreatitis or peripancreatic abscess, 2 with a lethal outcome. Overall the median survival was 13 months. Following R0 resection median survival was 17 months. If the pancreas was microscopically not infiltrated, median survival was 23 months. CONCLUSION: Pancreatic invasion in patients with gastric carcinoma is often associated with positive lymph nodes and liver metastases or peritoneal carcinomatosis. Intraoperatively, true pancreas invasion is difficult to differentiate from inflammatory reactions. Postoperative morbidity and mortality are increased by pancreatic resection, mainly due to pancreatitis or peripancreatic abscess. Curative (R0) resection improves prognosis and even long-term survival can be achieved in selected individual cases. Palliative resections can be performed for local complications like bleeding or obstruction refractory to other therapies.

Rapid detection of enterohemorrhagic Escherichia coli by real-time PCR with fluorescent hybridization probes.

In this report, we present a PCR protocol for rapid identification of enterohemorrhagic Escherichia coli on a LightCycler instrument. In a multiplex assay, the genes encoding Shiga toxin 1 and Shiga toxin 2 are detected in a single reaction capillary. A complete analysis of up to 32 samples takes about 45 min.

[Estrogen feedback tests in women with laryngeal carcinomas]. / Ostrogenfeedback-Tests bei Frauen mit Larynxkarzinomen.

BACKGROUND: The high incidence ratio males to females is the reason for considering a hormonal dependency of these tumours for many years. The low incidence of laryngeal cancer in women has generally been suggested as being due to "oestrogen defense". Although we do have some circumstantial evidence in the meantime, no final evidence on this topic is available so far. METHODS: The oestrogen feedback effect could be another more objective parameter to bring more light to the research of this question. As one of the regulation mechanisms of the hypothalamic-pituitary-adrenal axis the oestrogen feedback mechanism represents the regulation of LH and FSH production in the pituitary gland by peripheral oestrogens. The mechanism is known to exist lifelong under normal conditions. Whereas the positive oestrogen feedback is typical for women, a negative response pattern is mostly found in men. The positive response pattern is characterised by increasing LH values, higher than the starting level, on the 3 th and 4 th day after intravenious application of oestrogens. RESULTS: The results of the present investigation show some difference. 5 of 6 examined women with laryngeal cancer were found to have a clearly negative oestrogen feedback, whereas 4 of 5 healthy women had a positive oestrogen feedback effect. 5 healthy men showed the typical negative effect for men. CONCLUSION: We may assume a narrow relationship between the male regulation type and the occurrence of laryngeal cancer in women, if further trials including more patients are able to reproduce these results.