Jorge Tolmos

Gastric adenocarcinoma in patients 40 years of age or younger

BACKGROUND Gastric adenocarcinoma is considered a disease of the middle aged and elderly and has been infrequently reported in patients under 40 years of age. The purpose of this study was to determine the proportion of young patients diagnosed with gastric adenocarcinoma and to compare the demographic, clinical and pathologic features of younger and older patients with gastric adenocarcinoma. METHODS A retrospective cohort study using tumor registry records of all patients with gastric adenocarcinoma diagnosed from 1982 through 1996 at a public teaching hospital. Demographic, clinical, and pathologic comparisons were made between patients younger than 41 years of age and race- and sex-matched older patients with gastric adenocarcinoma. RESULTS Thirty of 203 (15%) cases of gastric adenocarcinoma were diagnosed in patients less than 41 years (range 23 to 40). Male to female ratio was 1:1. Young patients were more likely to be black (33% versus 17%, P = 0.04) Both younger and older patients presented with advanced disease, with nearly half of each group having metastases. Twelve of 29 (41%) younger patients were operated on without a histologic diagnosis of gastric adenocarcinoma in contrast to only 1 older patient (P < 0.001). One of 30 (3%) young patients is alive 39 months following gastrectomy. Twenty patients died and the remaining 9 were lost to follow-up, all with known residual or recurrent disease. Six-month survival of young patients (23%) was less than older patients (42%) (P = 0.14). Young patients were more likely to have diffuse histology (80% versus 55%, P = 0.12). Overt infection with Helicobacter pylori was uncommon in both groups. CONCLUSIONS Young patients accounted for an unusually high proportion of patients with gastric adenocarcinoma diagnosed at our public teaching hospital. Young patients were significantly more likely to be black and less likely to have an accurate preoperative histologic diagnosis. Both young and older patients presented with advanced disease and had poor survival. Young patients were more likely to have diffuse histology and had poorer 6-month survival, suggesting a more aggressive variety of the disease in this group.

Keratinocyte growth factor promotes healing of left-sided colon anastomoses

BACKGROUND Inadequate healing and consequent leakage from bowel anastomoses are a significant cause of postoperative morbidity and mortality. Systemic application of keratinocyte growth factor (KGF) has been shown to promote mucosal healing in models of colitis in rats and mice. The aim of the present study was to evaluate the effect of systemic KGF administration on healing of colonic anastomoses in rats. METHODS Rats underwent laparotomy, division of the left colon, and sigmoido-sigmoidostomy. KGF (5 mg/kg) or vehicle were administered intraperitoneally in two groups (n = 30 per group) 12 hours prior to surgery, and then once daily until sacrifice (6 animals per group; 2, 4, 7, 12, and 21 days after surgery). Bursting pressure measurements, histologic evaluation, morphometric analysis, mucin and collagen staining, and hydroxyproline measurements of the anastomotic site were performed. RESULTS Administration of KGF significantly increased anastomotic bursting pressure on postoperative days 2, 4, and 7 by 34%, 49%, and 19%, respectively. Histology, mucin staining, and measurements of the colonic crypt depth showed markedly less extended inflammation with an increased acidic mucin content and a significantly thickened mucosal layer in the KGF treated group when compared with vehicle-treated animals. CONCLUSIONS KGF promotes healing of colonic anastomoses in rats during a 1-week postoperative period following large bowel surgery. KGF may be acting to accelerate host reparative processes as well as to enhance protection of the anastomotic wound bed by increased colonic epithelium proliferation, increased mucus production, and reduction of the inflammatory activity at the anastomotic site.

Keratinocyte Growth Factor Ameliorates Dextran Sodium Sulfate Colitis in Mice

Keratinocyte growth factor (KGF) is emerging asan important mediator of mucosal defense and repair inthe colon. The aim of the present study was to evaluateand further characterize the effects of exogenous KGF administration utilizing the dextran sodiumsulfate (DSS) model of colitis in mice. Colitis wasinduced via oral administration of DSS (5 g/100 ml) toBalb/c mice for eight days. Intraperitonealadministration of KGF (5 mg/kg, once daily) or vehicle (VEH)was initiated 1 hr prior to the induction of the colitis(N = 10, each group). Mucosal injury of the entire colonwas histologically assessed and graded. An approximately fourfold reduction in the cryptdamage score was noted in the KGF group when compared tocontrols (VEH) (2.8 ± 1.03 and 11.4 ±0.78, respectively). The significant reduction ofmucosal injury in KGF treated mice confirms that KGF isa key mediator maintaining the integrity of the colonicmucosa.

Tc-99m Sestamibi Scintimammography for the Evaluation of Breast Masses in Patients with Radiographically Dense Breasts.

Abstract: The objective of this study was to evaluate the usefulness of technetium‐99m sestamibi (MIBI) scintimammography for the diagnosis of breast cancer in patients with palpable breast masses that cannot be adequately evaluated by mammography due to the presence of radiographically dense breasts. At 5 minutes after intravenous injection of MIBI, scintimammograms were obtained in 80 patients who had grade 3 or 4 glandular density on mammograms and a palpable breast mass. Excisional biopsy or FNA biopsy was obtained in 68 lesions in 67 patients. Scintimammography (22 true positive, 4 false positive, 41 true negative, 1 false negative) resulted in a sensitivity of 95.6%, specificity 91.1%, positive predictive value 84.6%, and negative predictive value 97.6%. Mammography (19 true positive, 21 false positive, 24 true negative, 4 false negative) resulted in a sensitivity of 73.9%, specificity 53.3%, positive predictive value 44.7%, and negative predictive value 80%. MIBI scintimammography has a higher sensitivity and specificity than mammography in patients with radiographically dense breasts. It is useful as an adjunct to mammography in those patients with radiographically dense breasts for the characterization of palpable masses. Although sensitivity of mammography in this cohort was high, its specificity was significantly lower than scintimammography. If validated in prospective studies it could provide a safe way of avoiding a breast biopsy in patients with benign findings on clinical exam, mammography, and needle aspiration cytology.

Keratinozyten-Wachstumsfaktor verbessert signifikant die Heilung von linksseitigen Kolonanastomosen

Die Anastomoseninsuffizienz ist ein wesentlicher Faktor fur Morbiditat und Mortalitat bei kolorektaler Chirurgie [1]. Die klinisch relevante Rate von Anastomoseninsuffizienzen reicht von 3,4 [1] bis hin zu 8 Prozent [2] und mindestens ein Drittel der Mortalitat bei kolorektaler Chirurgie ist auf diese schwerwiegende Komplikation zuruckzufuhren [1,2].