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Aim: To evaluate the recurrence risk for Siewert type II esophagogastric junction carcinoma treated with curative resection., Patients and Methods: We retrospectively analyzed clinicopathological and recurrence-free survival (RFS) data of 52 patients after curative resection for Siewert type II carcinoma focusing on the role of lymph node metastasis around the greater curvature or parapyloric area., Results: Recurrence was observed in 21 (40%) patients; the median time-to-recurrence was 11 months (range=3-33 months). According to multivariate Cox proportional hazard regression analysis, involvement of nodes no. 4sa, 4sb, 4d, 5 and/or 6 (odds ratio (OR)=6.62; 95% confidence interval (CI)=1.27-41.1; p=0.04) and younger age (OR=2.10; 95% CI=1.25-3.82; p<0.01) were significant independent risk factors affecting RFS., Conclusion: Involvement of no. 4-6 nodes appears to predict recurrence of Siewert type II carcinoma treated with curative resection. Patients with this risk factor may benefit from effective use of perioperative chemotherapy., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

This retrospective study evaluated the efficiency of oxaliplatin-based (Oxa-based) adjuvant chemotherapy for colorectal cancer with perforation. The study included 38 patients who underwent surgery for perforation associated with StageII and III colorectal cancer between April 1998 and March 2013. Patients with operative mortality were excluded from the study. The numbers of patients with StageII and III disease were 26 and 12, respectively. Adjuvant chemotherapy was received by 16 patients (62%) in the Stage II group. Seven patients (54%) in the Stage III group received adjuvant chemotherapy, of which 6 received Oxa-based adjuvant chemotherapy. The median relative dose intensity(range)of oxaliplatin was 83.3 (28.8- 100)%. Grade 3 adverse events were reported in 2 cases. The 3-year overall survival rates in the StageII and III groups were 60% and 79%, respectively. There was no significant difference in overall survival between the groups (p=0.28). Patients who received adjuvant chemotherapy had a 2.3-fold greater 3-year overall survival rate than those who did not receive adjuvant chemotherapy (80% vs 35%, p=0.01). The 3-year overall survival rates were 100% in patients who received Oxabased adjuvant chemotherapy (n=6), and 76%in patients who received adjuvant chemotherapy without oxaliplatin (n=17), with no significant difference between the groups (p=0.24). The Oxa-based adjuvant chemotherapy was tolerated equally well in Stage II and III colorectal cancer patients with or without perforation. Further studies are needed to compare the effect of oxaliplatin with other adjuvant chemotherapies.

The aim of this study was to compare the results between lateral lymph node dissection (LLND) alone, and preoperative radiotherapy (preRT) followed by LLND, for the treatment of locally advanced rectal cancer. This study assessed 44 consecutive patients with lower rectal cancer (clinical Stages II and III) without lateral lymph node metastasis by preoperative imaging at two hospitals. Twenty-five patients at one hospital received preoperative short-course radiation therapy (total 25 Gy) followed by a curative LLND operation (preRT group), and 19 patients at another hospital underwent a curative operation by LLND alone (non-preRT group). The 5-year locoregional relapse-free survival, disease-free survival, and overall survival rates were not different between the preRT and non-preRT groups. Although three patients in each group had lateral lymph node metastases, none developed pelvic sidewall recurrence. This study suggests that preRT followed by curative surgery with LLND for lower rectal cancers without lateral lymph node metastasis before surgery would not improve survival and local control rates.

This retrospective study identified the optimal treatment strategy for patients with gastric cancer with positive peritoneal cytology. We analyzed clinicopathologic and survival data for 54 patients who had undergone gastrectomy and/or chemotherapy for treatment of gastric cancer with positive peritoneal cytology with (n = 40) or without (n = 14) metastatic disease. The median overall survival did not differ significantly between patients with gastric cancer with positive peritoneal cytology with and without metastatic disease (19 versus 13 months, respectively). Among 14 clinicopathologic variables, the lack of gastrectomy was the only significant independent unfavorable factor for survival (odds ratio, 1.64; 95% confidence interval, 1.04-2.57; P = 0.03). The median overall survival significantly differed among patients who had undergone gastrectomy plus chemotherapy, chemotherapy alone, and gastrectomy alone (25, 10, and 17 months, respectively; P < 0.01). Gastrectomy may be optimal for patients with (gastric cancer with positive peritoneal cytology), considering its favorable prognostic effect with respect to perioperative chemotherapy.

The aim of this study was to evaluate clinicopathological variables, including the granulocyte-to-lymphocyte ratio(G/L ratio), as prognostic factors for Stage IV gastric cancer patients. A total of 70 patients treated for Stage IV gastric cancer were enrolled in this study. Univariate analysis indicated that age ≥70 years, performance status >2, resection not being performed, chemotherapy not being administered, high C-reactive protein(CRP)levels, and carbohydrate antigen 19-9 levels were significantly associated with poor survival. Multivariate analysis of these factors identified resection not being performed, chemotherapy not being administered, and high CRP levels as independent unfavorable factors of survival. Although the G/L ratio was not a prognostic factor for Stage IV gastric cancer patients in this study, further studies with greater number of patients are required to determine whether the G/L ratio is a significant biomarker associated with survival.

The aim of this study was to evaluate the clinical significance of the granulocyte-to-lymphocyte(G/L)ratio as a prognostic predictor in patients with Stage IV colorectal cancer. A total of 83 patients who underwent oxaliplatin-based chemotherapy for Stage IV colorectal cancer were enrolled in the study. Univariate analysis indicated that the G/L ratio; number of involved organs(more than one organ); performance status ≥1; noncurability; and levels of hemoglobin, C-reactive protein, albumin, alkaline phosphatase, carbohydrate antigen 19-9, and lactate dehydrogenase before chemotherapy were significant prognostic factors. Noncurability was identified to be an independent, unfavorable factor for survival on multivariate analysis. When patients were divided into 2 groups according to the G/L ratio(the median was considered the cut-off value), the median survival time of patients with a high G/L ratio(≥3.0)was significantly worse than that of patients with a low G/L ratio(<3.0; 16.1 months vs 25.4 months, p=0.03). Further studies with more patients are required to examine whether the G/L ratio is a convenient biomarker affecting survival in patients with Stage IV colorectal cancer.

We report a case of malignant melanoma of unknown primary origin presenting metastasis in various organs as well as intraluminal gallbladder bleeding due to gallbladder metastasis. A 58-year-old woman was diagnosed with stage IV metastatic malignant melanoma. Because she exhibited acute cholecystitis and hemobilia due to malignant melanoma of the gallbladder, laparoscopic cholecystectomy was performed to relieve the symptoms. The resected gallbladder specimen showed a pedunculated black mass indicating malignant melanoma. Pathologic examination and immunohistochemical analysis revealed malignant melanoma of the gallbladder. Only a few cases of gallbladder malignant melanoma presenting hemobilia have been reported; here we present our case, including the experience of multidisciplinary treatment.

Myeloid-derived suppressor cells (MDSC) are one of the major cell populations responsible for regulating immune responses. These cells have been reported to accumulate in the blood, lymph nodes, and tumor sites in most patients during tumor progression and in chronic infection. They are also reported to potently suppress T-cell functions. We studied MDSC in the peripheral blood mononuclear cells(PBMC)by flow cytometry using blood samples from 29 patients with breast cancer, and from 11 healthy donors. The cell level was significantly high for patients compared to the 11 healthy donors (5. 68±6. 09% vs. 0. 91±0. 54%). MDSC was significantly higher in all of the breast cancer patients (5. 68±6. 09%), preoperative patients (5. 79±4. 92%) and recurrent disease patients (5. 59±7. 28%), compared to healthy donors, but not for postoperative patients (1. 50±0. 95%). Thus, MDSC was elevated in patients with breast cancer, but decreased to the range of healthy individuals after the removal of the tumor mass. However, MDSC increased again with recurrence. We also report that in 2 cases, MDSC in the peripheral blood and pleural effusion of patients with metastatic breast cancer decreased after chemotherapy with gemcitabine.

A 39-year-old man with psoriasis vulgaris who complained of severe anemia was examined and diagnosed with advanced gastric cancer (UM, Type 3, cT3 cN2 cH0 cP0 cM0, cStage III B). He was treated with S-1/CDDP as neoadjuvant chemotherapy. S-1 (120mg/day) was administered orally for 14 days, followed by 7 drug-free days as a course, and CDDP (100mg/ body) was administered by intravenous drip on day 8. After the third course, a significant tumor reduction was obtained. Total gastrectomy and lymph node dissection (D2) were performed. The histological diagnosis revealed a complete disappearance of cancer cells in the stomach and all of the lymph nodes. He has been doing well without any recurrence for 9 months since the start of treatment.

A 76-year-old woman was scheduled to undergo distal gastrectomy and cholecystectomy. She had no history of illnesses including hypertension. During the induction of anesthesia, she developed hypertension just after intravenous administration of fentanyl 200 microg. The marked hypertension lasted for 30 min without any complaints and neurological symptoms, and gradually became normalized. We started the induction of anesthesia again without using fentanyl. For the maintenance of anesthesia, sevoflurane, nitrous oxide, and epidural anesthesia with intermittent administration of 0.75% ropivacaine were used. The operation was finished successfully without any complications. We consider intravenous small dose of fentanyl could be a cause of unexpected marked hypertension in this elderly patient.

We experienced one-lung anesthesia using Fogarty catheter as a selective bronchial blocker in two infants. First case was a one-year and ten month-old female who underwent partial resection of the right middle lobe for her giant lung cyst under general anesthesia. Second case was an eight-month-old male who underwent thoracoscopic resection of his left mediastinal tumor under general anesthesia. One-lung anesthesia was successfully established with Fogarty catheters for both cases. Size of the catheter and its balloon was decided beforehand by measuring the diameter and length of the trachea and both bronchi based on the image obtained from computerized tomography (CT) in both cases. Therefore, surgical field was well visible during operation. There was no accidental episode in perioperative period. Bronchoscopy with ultra-thin fiberscope and X-ray fluoroscopy is useful to decide the position of Fogarty catheter and its balloon. Our means is recommendable for maintenance of one-lung anesthesia in infant.

A 64-year-old male with tracheal stenosis by thyroid cancer was scheduled for the emergency management of airway maintenance and total thyroidectomy. Dyspnea and orthopnea appeared suddenly on the admission for operation. Cervical CT and bronchial fiberscope examination revealed the trachea oppressed at the frontal neck by thyroid tumor. The trachea diameter was nearly 5 mm at the narrowest part. Therefore it seemed to be of high risk of perform tracheal intubation and tracheostomy. Extracorporeal circulation was adopted for the respiratory management at anesthesia induction. At first, the femoral artery and vein were cannulated with local anesthesia for cardiopulmonary bypass (CPB). After confirming CPB pump working, intravenous anesthetic agents were infused. Thyroid tumor was partially resected and tracheostomy was done under CPB. After the tracheostomy, a spiral tracheal tube was inserted. Anesthesia was maintained with sevoflurane and managed with controlled ventilation. Thereafter operation and anesthesia were uneventful. After the operation, pleural bloody effusion was noticed. Blood in effusion seemed to be due to the heparinization in extracorporeal circulation. We conclude that anesthetic management with extracorporeal circulation is one of useful methods for managing severe tracheal stenosis.

A 66-year-old male with colon cancer was scheduled for left hemicolectomy. He had a past history of respiratory failure due to chronic obstructive pulmonary disease (COPD). Anesthesia method chosen was general anesthesia with sevo-flurane combined with epidural anesthesia. Respiration was managed with assisted ventilation using laryngeal mask airway and muscle relaxation was obtained with suxamethonium chloride given intermittently. After the operation, he did not seem to have COPD because of the relation between arterial PCO2 and bicarbonate in the perioperative period. Therefore, after obtaining informed consent from this patient, we determined the relation between arterial and spinal fluid acid-base balance under acetazolamide administration. He was more sensitive to central respiratory response because his respiration increased following the decrease of spinal fluid bicarbonate. We further examined and diagnosed him as Eaton-Lambert syndrome by evoked electromyography and by Ca2+ channel antibody.

This study investigated the changes in anesthetic requirement caused by administration of two different concentrations (0.1 microM and 1. 0 microM/h) of dopamine into the rat striatum. During the measurement of minimum alveolar concentration (MAC), each dopamine solution was continuously injected directly into rat striatum by microdialysis technique. During perfusion of the lower dose, MAC did not change. During the higher dose of dopamine, MAC decreased by approximately 30%., (Copyright 1999 Elsevier Science B.V.)

We experienced the anesthetic management of a 47-year-old woman with insulinoma. Removal of the tumor was performed under propofol, nitrous oxide, and epidural anesthesia. We tried the continuous infusion of glucose to maintain normal blood glucose level and to avoid intraoperative hypoglycemic event. The blood glucose and immunoreactive insulin (IRI) level were measured intermittently. After the removal of the insulinoma, the IRI level decreased rapidly to the normal range. In this case, neither hyperglycemic nor hypoglycemic episode was observed. The perioperative course was uneventful. Propofol has not been shown to significantly affect the release of insulin and glucose regulation. This case suggests that under the condition of continuous glucose infusion and blood glucose monitoring, propofol is an useful anesthetic agent for a patient with insulinoma.

In order to clarify the relationship between selected oral environmental factors and caries type in infants, we analyzed three parameters, salivary pH, salivary buffer capacity, and Cariostat, and tested their association with caries type. As a result, we obtained a significant relationship between the caries type and salivary buffer capacity, and also between the caries type and the Cariostat. The severity of caries increased with an increase in caries activity level measured by Cariostat, while it decreased with an increase in salivary buffer capacity (p less than 0.05). The occurrence rates of severe caries types were high under the condition of both low salivary buffer capacity and high acid productivity of dental plaque.