ABSTRACT
Multiple drug resistance is one of the problems associated with the treatment of urinary tract infection. Urine bacterial culture confirmed extended-spectrum beta lactamase (ESBL)-producing Escherichia coli in 56 patients in the Department of Urology, Hokkaido Social Welfare Association Furano Hospital. The mean age of the patients was 83 years, and the male-to-female ratio was 1:2. The source of infection was cystitis in 51 patients and pyelonephritis in 5 patients. The most common underlying disease was neurogenic bladder in 42 patients, and a urinary tract catheter had been placed in 33 patients. Before the detection of ESBL-producing E. coli, common bacteria included E. coli, Enterococcus, and Pseudomonas. ESBL-producing E. coli were sensitive to the following antibiotics: carbapenem; cephamycin; aminoglycoside; and synthesized penicillin. ESBL-producing E. coli are resistant to multiple drugs. The use of urinary tract catheterization and antibiotics for asymptomatic urinary tract infection should be kept to a minimum.
Subject(s)
Cystitis/microbiology , Escherichia coli Infections , Escherichia coli/drug effects , Escherichia coli/enzymology , Pyelonephritis/microbiology , beta-Lactamases/biosynthesis , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Cross Infection/prevention & control , Drug Resistance, Multiple, Bacterial , Female , Humans , Male , Middle Aged , Urinary Bladder, Neurogenic , Urinary Catheterization/adverse effectsABSTRACT
BACKGROUND/AIMS: More than 20% of patients with advanced gastric cancer show paraaortic lymph node metastasis. However, whether extensive paraaortic lymphadenectomy is beneficial remains controversial. We performed a prospective study of paraaortic lymphadenectomy for patients with advanced gastric cancer. METHODOLOGY: From January 1991 to March 2004, 244 consecutive patients with advanced gastric cancer underwent gastrectomy with paraaortic lymphadenectomy with curative intent. The patients were divided into 3 groups according to the period: Group 1 (1991-1995), Group 2 (1996-1999), and Group 3 (2000-2004). RESULTS: Overall mortality rate was 2.4%, and it fell rapidly from 7.1% in Group 1 to 0% in Group 3. Postoperative complications occurred in 35.6%. High age and postoperative complications were significant predictive factors for operative death. Preoperative comorbidity, positive distal margin, and pancreatectomy were significant predictive factors of postoperative complications. Depth of cancer invasion was correlated with paraaortic node metastasis. Ten patients with paraaortic node metastases survived for more than 5 years. Operative curability and postoperative complications were significant prognostic factors for patients who underwent this procedure. CONCLUSIONS: Paraaortic lymph node dissection for gastric cancer should be performed in patients with tumors deeper than the serosa. Pancreatectomy should be avoided, with careful management required in cases of unavoidable pancreatectomy.
Subject(s)
Aorta , Lymph Node Excision , Lymphatic Metastasis , Stomach Neoplasms/pathology , Aged , Female , Humans , Male , Middle Aged , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Survival Rate , Treatment OutcomeABSTRACT
We performed radio-frequency ablation (RFA) therapy combined with intra-arterial chemotherapy for a 71-year old female gastric cancer patient with liver metastasis. She underwent total gastrectomy due to advanced gastric cancer in July of 1996. Because CT scans revealed multiple liver tumors with her, she also underwent intra-arterial chemotherapy comprising of 5-fluorouracil, cis-platinum and Leucovorin. Although her liver tumors decreased in size and number, after 9 months, we had to remove the catheter because of hepatic artery obstruction. Immediately after the removal, 5 hepatic metastases appeared, which were 3.5 cm in maximum diameter. After RFA therapy, CT scans revealed homogenously attenuated lesions. Liver biopsy demonstrated a complete coagulation necrosis. She is currently alive going into 19 months after liver metastasis and 7 months after RFA.
Subject(s)
Adenocarcinoma/secondary , Adenocarcinoma/therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Catheter Ablation , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Stomach Neoplasms/pathology , Adenocarcinoma/pathology , Aged , Cisplatin/administration & dosage , Female , Fluorouracil/administration & dosage , Gastrectomy , Humans , Infusions, Intra-Arterial , Leucovorin/administration & dosage , Liver Neoplasms/pathology , Male , Middle AgedABSTRACT
Due to the contradictory roles that thymidine phosphorylase (TP) plays in both tumor aggressiveness and fluoropyrimidine activation, its impact on drug responses has yet to be clearly established. Therefore, the present study was performed to clarify the effects of TP levels on the prognosis of gastric cancer patients treated postoperatively with different fluoropyrimidines. A total of 52 gastric cancer patients who underwent gastrectomy from January 1997 to March 1998 were enrolled in the present study. The TP levels in the specimens were assayed by enzyme-linked immunosorbent assay (ELISA). Survival was significantly poorer for the 27 patients with high normal tissue TP activity than for the 25 with low normal tissue TP activity. Normal tissue TP level showed different effects on survival according to the chemotherapy regimen used. While the survival rate was significantly poorer in patients with high normal TP level than in those with low normal TP in the 5-FU group, the rate was almost the same in the 5'-DFUR group. Cox's proportional hazard model revealed that tumor TP was an independent prognostic factor in gastric cancer patients. Since activating and catabolizing enzymes for fluoropyrimidines differ from each other, alterations in gene expression of these enzymes should be useful predictive factors.
