ABSTRACT
Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer.
Subject(s)
Esophageal Neoplasms/mortality , Esophagectomy/mortality , Hospital Mortality , Lung Diseases/epidemiology , Postoperative Complications/epidemiology , Radioactive Fallout/adverse effects , Surgical Wound Infection/epidemiology , Aged , Anastomotic Leak/epidemiology , Case-Control Studies , Esophageal Neoplasms/surgery , Female , Humans , Japan , Male , Middle Aged , Multivariate Analysis , Nuclear Weapons , Risk Factors , SurvivorsABSTRACT
AIM: This study aimed to evaluate the effect of oral beraprost sodium, a prostaglandin I2 analogue, on symptoms of intermittent claudication in patients with arteriosclerosis obliterans. The research design consisted of a before and after treatment study without comparison groups. The subjects comprised arteriosclerosis obliterans patients who experienced intermittent claudication. Furthermore, this study aimed to assess the mechanism of action of beraprost sodium via blood sampling and measurements of flow-mediated vasodilatation before and after treatment. METHODS: The study was performed prospectively in 7 patients with arteriosclerosis obliterans. Beraprost sodium (40 microg) was orally administered to 7 patients at study entry, followed by administration of 120 microg/day for 12 weeks. Blood sampling and measurements of flow-mediated vasodilatation were performed before and after treatment at study entry, 4 weeks, and 12 weeks after treatment. Treadmill exercise tests were performed three times at study entry, 4 weeks, and 12 weeks after treatment. The ankle-brachial index (ABI) was measured at rest and after exercise. RESULTS: Pain-free walking distances increased by 138% at 12 weeks after treatment. Maximum walking distances increased by 133%. The ABI was significantly increased at 4 weeks and 12 weeks after treatment at rest. Endothelin-1 levels tended to be decreased at 1 h after administration of 40 microg beraprost sodium. N(G),N(G)-dimethyl-L-arginine, nitrate ions, and flow-mediated vasodilatation. CONCLUSION: Beraprost sodium tended to decrease endothelin-1 levels and improved symptoms of intermittent claudication in patients with arteriosclerosis obliterans.
Subject(s)
Arteriosclerosis Obliterans/drug therapy , Epoprostenol/analogs & derivatives , Intermittent Claudication/drug therapy , Platelet Aggregation Inhibitors/administration & dosage , Vasodilator Agents/administration & dosage , Administration, Oral , Aged , Ankle Brachial Index , Arginine/analogs & derivatives , Arginine/blood , Arteriosclerosis Obliterans/blood , Arteriosclerosis Obliterans/complications , Arteriosclerosis Obliterans/physiopathology , Biomarkers/blood , Endothelin-1/blood , Epoprostenol/administration & dosage , Exercise Test , Exercise Tolerance/drug effects , Humans , Intermittent Claudication/blood , Intermittent Claudication/etiology , Intermittent Claudication/physiopathology , Prospective Studies , Time Factors , Treatment Outcome , Vasodilation/drug effects , WalkingABSTRACT
This is a report of a case with both peritoneal tuberculosis and gastric cancer. Physicians should have a high index of suspicion of peritoneal tuberculosis if the patient is febrile with a past history of tuberculosis.
Este es el reporte de un caso con tuberculosis peritoneal y cáncer gástrico a la vez. Los médicos debáan tener un alto índice de sospecha de tuberculosis peritoneal si se trata de un paciente febril con antecedentes de tuberculosis.
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/complications , Stomach Neoplasms/complications , Peritonitis, Tuberculous/complications , Adenocarcinoma/surgery , Adenocarcinoma/diagnosis , Antitubercular Agents/therapeutic use , Diagnosis, Differential , Gastrectomy , Neoplasm Invasiveness , Stomach Neoplasms/surgery , Stomach Neoplasms/diagnosis , Peritonitis, Tuberculous/drug therapyABSTRACT
This is a report of a case with both peritoneal tuberculosis and gastric cancer. Physicians should have a high index of suspicion of peritoneal tuberculosis if the patient is febrile with a past history of tuberculosis.
