Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer.

BACKGROUND AND STUDY AIMS: Colonoscopy has replaced barium enema as the primary method for direct diagnosis of colorectal cancer, but detection may fail, and the reasons for this are not completely understood. PATIENTS AND METHODS: In order to analyze the accuracy of colonoscopy for detecting invasive colorectal cancer, 7365 colonoscopic examinations were matched with the most accurate local government population-based cancer registry in Japan. RESULTS: In 15 colonoscopic examinations, patients were not diagnosed as having invasive colorectal cancer, but disease of this type was detected within 3 years of the examinations (false-negative examinations). During the same period, 233 colonoscopies were identified as true-positive examinations. The false-negative rate for detecting invasive colorectal cancer with colonoscopy was 6% at 3 years. The false-negative rate was significantly higher in individuals between 60 and 69 years of age and in invasive cancers located to the right of the splenic flexure. CONCLUSIONS: Colonoscopists should receive adequate training in achieving easy cecal intubation, detecting small or flat lesions, and carrying out adequate biopsies.

Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: The degree of accuracy of gastroscopy for the detection of gastric cancer is poorly understood. The aim of this retrospective study was to determine the accuracy of gastroscopy by using cancer registry records. PATIENTS AND METHODS: Gastroscopic examinations (n = 37094) conducted between 1984 and 1989 were studied by linking them with hospital-based and population-based (Fukui Prefecture, Japan) cancer registry records between 1984 and 1992. False-negative gastroscopies that had been carried out within the three years preceding the diagnosis of gastric cancer were identified. RESULTS: The numbers of true-positive, false-positive, and false-negative examinations carried out were 659, six and 155, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 81.0%, 100.0%, 99.1%, and 99.6%, respectively. The overall diagnostic accuracy of gastroscopy was 99.6%. There was little difference in sensitivity results between the patient groups with regard to reason for referral, type of endoscope used, experience of endoscopist, or location of gastric cancer. The percentage of tumours representing early gastric cancer, identified after false-negative gastroscopy, was lower for those situated in the cardia or gastric body than for those in the angular notch or the antrum. CONCLUSIONS: The accuracy of gastroscopy in the detection of gastric cancer is satisfactory, but false-negative results are sometimes obtained. We emphasize the importance of repeated endoscopic examination for the detection of gastric cancer.

[Relationship between participation in annual health examinations and mortality rate over a 5-year period].

A total of 34,000 adults in Fukui City who had participated in annual health examinations at least once between 1986 and 1988, were followed for a period of 5 years. The results were as follows; (1) The mortality rate during a 5 year period was significantly lower for participants in health examinations than in nonparticipants of the same age group. (2) Mortality was significantly related to obesity, systolic and diastolic blood pressure, glucosuria, proteinuria, occult blood in urine, GOT and cholesterol in man, in women obesity, systolic and diastolic blood pressure, glucosuria, proteinuria, GOT, GPT and cholesterol were related to mortality. (3) An increase in hazard ratio with increasing degree of thinness was suggested particularly in males. (4) Hazard ratios increased with decreasing cholesterol in both men and women combined. (5) Except for hypertension which increased risk for circulatory disease, none of the above data appeared to be related to specific causes of death.

[The volume and pH of gastric fluid in elective surgical patients after preoperative oral fluid intake].

The effect of preoperative oral fluid intake on the volume and pH of gastric fluid was examined in 45 elective surgical patients ranged in ages from 18 to 70 years. Two hours preoperatively they all received oral roxatidine 75 mg with 10 ml water, immediately followed by 150 ml oral water or 150 ml refreshing drink or no fluid as control. Just after the induction of anesthesia, a Salem-sump tube was put down to the stomach to collect gastric fluid in each patient. The volume and pH of gastric fluid taken were 10.9 +/- 7.9 ml, 16.3 +/- 2.3 in control group, 8.0 +/- 6.0 ml, 6.2 +/- 2.4 in the water group and 6.3 +/- 6.0 ml, 7.1 +/- 1.7 in the refreshing drink group. As there were no significant differences in gastric pH values in the three groups, the highest value was found in the refreshing drink group. No significant difference in VAS of hungry and thirsty feeling was found among the three groups. We conclude that preoperative oral water or refreshing drink with roxatidine 75 mg 2 hours before the start of anesthesia may not increase the risk of aspiration during the induction of anesthesia.

Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output?

In anesthetized patients, acute decreases in cardiac output (CO) are often reflected as decreases in end-tidal CO2 tension (PETCO2), but the quantitative relationship between the changes in CO and the changes in PETCO2 is uncertain. We hypothesize that a quantitative relationship can be demonstrated if timing of the measurements in each episode of hemodynamic perturbation is standardized. In 24 patients undergoing abdominal aortic aneurysm surgery with constant ventilation, we prospectively performed 33 measurements of CO, PETCO2, and CO2 elimination (VECO2) within 10 min of hemodynamic changes. The percent decrease in PETCO2 directly correlated with the percent decrease in CO (slope = 0.33, r2 = 0.82). Also, the percent decrease in VECO2 correlated with the percent decrease in CO similarly (slope = 0.28, r2 = 0.84). The changes in PETCO2 and VECO2 following hemodynamic perturbation were parallel. This finding suggests that decreases in PETCO2 quantitatively reflect the decreases in CO2 elimination.

[The effect of enflurane anesthesia on plasma superoxide dismutase (SOD)-like activity in elderly patients].

Plasma SOD-like activity during enflurane anesthesia was measured according to electron spin resonance in ten elderly patients over 66 years and in nine patients under 64 years. Anesthesia was induced with thiopental 4 mg.kg-1 and succinyl-choline 0.8-1.0 mg.kg-1 intravenously and was maintained with enflurane 1.0-2.0% in nitrous oxide and oxygen. They were ventilated manually throughout the surgery. The mean plasma SOD-like activity before anesthesia was lower in the elderly group compared with the control group. This decreased significantly in the elderly patients on the first and third day after surgery. There was no relationship between plasma SOD like activity and patient age. We conclude that increased superoxide anion production in the post-operative period may affect plasma SOD-like activity.

[Plasma alpha-human atrial natriuretic polypeptide levels during surgery for pheochromocytoma].

We measured plasma alpha-human atrial natriuretic polypeptide (alpha-hANP) and catecholamine concentrations during anesthesia and surgery for pheochromocytoma in five patients ranging in ages from 19 to 69. Plasma catecholamine concentrations and systemic blood pressure increased extremely during surgical manipulation of the tumor, while plasma alpha-hANP levels did not change even during surgical manipulation or after removal of the tumor as compared with preanesthetic values. Our findings suggest that plasma alpha-hANP levels were unchanged during anesthesia and surgery for human pheochromocytoma.

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--5. An anesthetic experience of a pediatric patient with severe epilepsy].

A 6-year-old girl with severe epilepsy received an orthopedic surgery of the right hand under new total intravenous anesthesia with droperidol, fentanyl and ketamine. For the induction of anesthesia, droperidol 0.25 mg.kg-1, fentanyl 5.0 micrograms.kg-1 and ketamine 2.0 mg.kg-1 was administered intravenously. She was intubated and ventilated manually throughout the operative procedure to maintain the end tidal CO2 between 4.5 and 5.5%. For the maintenance of anesthesia, ketamine was given continuously at a rate of 2.0 mg.kg-1.hr-1. Intraoperative muscle relaxation was obtained with vecuronium bromide. The patient recovered from anesthesia uneventfully. The total doses of droperidol, fentanyl, ketamine and vecuronium were 8.75 mg, 1.0 mg, 210 mg and 7.5 mg, respectively. Neither epileptic seizure, nor any other adverse effects with anesthetics was observed during and after anesthesia and surgery. We conclude that this method of anesthesia for epileptic patients may deserve further detailed study.