The surgical treatment of gastric cancer: a retrospective study with special reference to total gastrectomy.

A retrospective study of 312 consecutive cases of gastric malignancy treated from 1974 to 1984 is presented. Eighteen patients (6%) had gastrointestinal lymphoma of the stomach. Among the remaining 294 cases with gastric carcinoma, 46 (16%) had carcinoma of the gastric stump after previous resection for peptic ulcer. Fifty-seven percent (167/294) had no distant metastases (MO). Early gastric carcinoma (pT1) occurred in 16 patients (5.8%), among whom four had distant metastases (pT1M1) and another two patients had regional lymph node metastases (pT1N1). Thirty-three percent of the patients had either no surgical treatment or an explorative laparotomy only, and 9% had a palliative bypass operation performed. A curative (48%) or palliative (10%) resection of the stomach was possible in 171/294 patients. Thus, the resectability rate was 58%. Total gastrectomy was performed in 108 cases with either curative (100) or palliative (eight) intention. The 30-day mortality was two and one patients, respectively (2.8%). Crude survival in the whole series was 16% and 11% at 5 and 10 years. After non-randomized curative total gastrectomy (100 cases) or gastric resection (40 cases) crude survival was 40% and 22% at 5 years, and 24% and 16% at 10 years, respectively (P greater than 0.05, n.s.). We found that total gastrectomy with extensive dissection and end-to-end esophago-jejunostomy by the EEA stapler can be performed with a low mortality rate (2% after curative operation) even in the upper age groups.

Detection and treatment of local recurrence.

The chance of a curative reoperation is better in patients with an asymptomatic recurrence than in those with a symptomatic one. Pelvic recurrences are often detected by thorough physical examination. In general, however, the sensitivity of the clinical examination is low, so that about 75% of the patients have symptomatic recurrence when it is detected clinically. Serial examinations of CEA, however, seem at present time to be the best indication of recurrence. Thus, elevated serum CEA concentration seems to predict cancer recurrence correctly in 80-90%.

Fecal incontinence. Diagnosis and treatment.

This is a survey of fecal incontinence. The etiology is multifactorial. It may develop after traumatic lesion of the anal sphincters, neurological disorders, rectal prolapse or idiopathic. The treatment may be conservative including diet, drugs and sphincter exercise or consisting of suture of the sphincter, post anal repair, free autogenous muscle transplantation. In some cases colostomy is the only way of choice.

Stereological analysis of human parietal cells before and 6 months after vagotomy.

Gastric biopsies from 10 patients were studied before proximal gastric vagotomy (PGV) and 6 months after the operation. The parietal cells were studied light microscopically and electron microscopically, using point-counting stereology. The volume fraction of the mucosa made up of parietal cells was significantly reduced (p less than 0.01) from 13.9% before PGV to 10.6% 6 months after PGV (median values). This reduction corresponded with a decrease of the median cell volume from 4698 microns3 before PGV to 3737 microns3 after the operation (p = 0.01). The ultrastructural composition of the parietal cells was virtually unchanged after the vagotomy, with the exception of a slight but significant reduction of the cell fraction occupied by mitochondria. The fractions of the parietal cell volume occupied by microvilli and tubulovesicular structures were significantly altered during stimulation with pentagastrin. These relative alterations were of the same magnitude before and after PGV.

Morphometric studies of human parietal cells before and 7 days after proximal gastric vagotomy.

In nine patients, acid titration tests and gastric biopsy specimens were studied before proximal gastric vagotomy (PGV) and 1 week after the operation. When postoperative biopsy specimens were compared with the preoperative ones, no change was found in the thickness of the mucosa. The volume fraction of the mucosa made up of parietal cells was significantly reduced (p less than 0.01) from 13.8% before PGV to 11.2% after PGV (median values). Both before and after the operation, stimulation with pentagastrin was followed by a significant increase in the relative volume of microvilli in parietal cells and a significant reduction of the relative volume of tubulovesicular structures. The magnitude of this ultrastructural response to pentagastrin was similar before and after PGV. The relative volume of lysosome-like structures was significantly increased in parietal cells postoperatively. With this exception, no significant alteration was found when comparing the ultrastructure before and 7 days after PGV.

Pharmacokinetics of metronidazole and its major metabolite after a high intravenous dose.

The pharmacokinetics of metronidazole (M) and hydroxy-metronidazole (OH-M) were determined in 8 healthy volunteers after a single dose of 1.5 g metronidazole given as an intravenous infusion during 50 min. High-pressure liquid chromatography was used for the assays. The serum concentration determined 1 h after the start of infusion was 40.21 +/- 6.54 mg/1. The peak concentrations of the metabolite were observed after 8-12 h. The serum concentrations of M and OH-M were detectable throughout the 48 h monitored. The serum half-life of M was 7.6 h and of OH-M 13.3 h. The terminal phase distribution volume was 43.2 lit and the total body clearance 4.0 lit./h. The prophylactic use of 1.5 g of metronidazole given as a single intravenous dose 1 h prior to surgery is supported by the pharmacokinetic assessments in this study.