Purpose
To define the median endometrial thickness (ET) in office gynecology is thought to be important for clinical practice. However, there are few reports about ET that have included the general ...female population on a large scale. The median ET was determined prospectively in premenopausal women who attended office gynecology for cervical cancer screening.
Methods
In total, 849 women were enrolled. The median ET was determined by using transvaginal ultrasound and the relationships between the ET and various clinical factors were analyzed.
Results
The participants' median age was 38.5 years. The median ET was 8.6 mm (90% and 95% quantiles: 13.8 and 15.8 mm). The ET was not related to their age, symptoms, obstetric history, geographical location, or risk factors for endometrial cancer. In the women with a menstrual cycle length of 28–30 days, the ET was 7 mm on days 1–6, but it increased from 5.4 mm immediately after menstruation (day 7 or 8) to 9.2 mm on days 13–14. Subsequently, the ET increased further to 11.1 mm on day 18.
Conclusion
In all the women, the upper limit of the ET was 13.8 mm and 15.8 mm in the 90% and 95% quantile, respectively, in office gynecology.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Reflux esophagitis and gastric tube ulcer sometimes cause severe clinical problems in patients undergoing esophagectomy with gastric tube reconstruction. We previously reported that acidity in the ...gastric tube was decreased for 1 year after esophagectomy, and that lower acidity levels were associated with Helicobacter pylori (H. pylori) infection. However, the long-term changes in gastric acidity remain unknown. We aimed to investigate the long-term changes in gastric acidity after surgery. Eighty-nine patients who underwent esophagectomy with gastric tube reconstruction for esophageal cancer were analyzed. They underwent 24-hour pH monitoring, serum gastrin measurement, and H. pylori infection examination before surgery, at 1 month, 1 year, and 2 years after surgery. The gastric acidity at 1 month and 1 year after surgery was significantly lower than that before surgery (p=0.003, p=0.003). However, there was no difference in gastric acidity before and 2 years after surgery. The gas tric acidity in H. pylori-infected patients was significantly lower in comparison to non-infected patients at each time point (p=0.0003, p<0.0001, p<0.0001, p<0.0001, respectively). In H. pylori-infected patients, gastric acid ity was decreased for 1 year after surgery, and recovered within 2 years after surgery. However, no significant differences were observed in the acidity levels of non-infected patients during the 2-year follow-up period. The serum gastrin level increased after esophagectomy. The acidity levels in the gastric tube recovered within 2 years after surgery. Periodic endoscopy examination is recommended for early detection of acid-related disease, such as reflux esophagitis or gastric tube ulcer, after esophagectomy with gastric tube reconstruction.
We examined incidence probabilities of cervical intraepithelial neoplasia 3 (CIN3) or more severe lesions (CIN3+) in 1,467 adult Japanese women with abnormal cytology in relation to seven common ...human papillomavirus (HPV) infections (16/18/31/33/35/52/58) between April 2000 and March 2008. Sixty‐seven patients with multiple HPV infection were excluded from the risk factor analysis. Incidence of CIN3+ in 1,400 patients including 68 with ASCUS, 969 with low grade squamous intraepithelial lesion (LSIL), 132 with HSIL without histology‐proven CIN2 (HSIL/CIN2(−)) and 231 with HSIL with histology‐proven CIN2 (HSIL/CIN2(+)) was investigated. In both high grade squamous intraepithelial lesion (HSIL)/CIN2(−) and HSIL/CIN2(+), HPV16/18/33 was associated with a significantly earlier and higher incidence of CIN3+ than HPV31/35/52/58 (p = 0.049 and p = 0.0060, respectively). This association was also observed in LSIL (p = 0.0002). The 1‐year cumulative incidence rate (CIR) of CIN3+ in HSIL/CIN2(−) and HSIL/CIN2(+) according to HPV genotypes (16/18/33 vs. 31/35/52/58) were 27.1% vs. 7.5% and 46.6% vs. 19.2%, respectively. In contrast, progression of HSIL/CIN2(+) to CIN3+ was infrequent when HPV DNA was undetected: 0% of 1‐year CIR and 8.1% of 5‐year CIR. All cervical cancer occurred in HSIL cases of seven high‐risk HPVs (11/198) but not in cases of other HPV or undetectable/negative‐HPV (0/165) (p = 0.0013). In conclusion, incidence of CIN3+ depends on HPV genotypes, severity of cytological abnormalities and histology of CIN2. HSIL/CIN2(+) associated with HPV16/18/33 may justify early therapeutic intervention, while HSIL/CIN2(−) harboring these HPV genotypes needs close observation to detect incidence of CIN3+. A therapeutic intervention is not indicated for CIN2 without HPV DNA.
What's new?
HPV causes a precancerous condition called cervical intraepithelial neoplasia, or CIN. Women with CIN could be on a path to cancer, but accurate assessment of the stage of CIN is important for knowing whether to treat it. Low grade CIN is unlikely to become cancer, and need not be treated, but high grade CIN is harder to assess by cytology alone. Could HPV genotyping help with that assessment? The authors examined HPV genotypes in 1400 Japanese women with abnormal cytology and found that HPV genotyping can predict the risk of more severe lesions developing in women with abnormal cervical cytology and CIN.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Cervical cancer screening has been shifting from primary cytology to primary HPV testing worldwide as primary HPV testing is more sensitive than primary cytology. To the best of our knowledge, the ...current study is the first in Japan to examine the feasibility of primary HPV testing. One of the disadvantages of this shift is that hrHPV-/??LSIL/CIN2+ (high-risk HPV negative cancers or pre-cancerous lesions with abnormal cytology results) can be missed. The objectives of the present study are to clarify in detail CIN2+ missed by this shift and to evaluate the feasibility of primary HPV testing in Japan. Data from 115,273 women who underwent co-testing with cytology and HPV testing in cancer screening were used in the current study. The cases with hrHPV-/??LSIL ('hrHPV-/??L-SIL' include CIN2-, in contrast, 'hrHPV-/??L-SIL/CIN2+' doesn't include CIN2-) were analysed in detail. Women with hrHPV-/??LSIL comprised 0.3% of the total. The prevalence of CIN2, CIN3, SCC or cervical adenocarcinomas in the lesions with HPV-/??LSIL was 0.03% in the cancer screening group. Only one case of 14 cervical adenocarcinomas in ??LSIL was hrHPV-. The prevalence of cancer missed by the shift in patients >50 years of age was significantly higher compared with patients younger than 49 years. In conclusion, the prevalence of CIN2+, which might be missed by the shift from primary cytology to primary HPV testing, was remarkably low in this Japanese cancer screening. The data indicated that primary HPV testing, which was more sensitive for CIN2+ than primary cytology, was a feasible method that can be used in Japan. In particular, primary HPV testing should be introduced for women <50 years old. Key words: uterine cervical cancer, cancer screening, cytology, primary HPV testing, HPV negative cancers
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The aim of the present retrospective study was to investigate the predictability of dual-energy computed tomography (DECT) for pararectal lymph node (PRLN) metastasis and lateral pelvic lymph node ...(LPLN) metastasis in rectal cancer (RC). The present study involved 44 patients with RC who were examined by DECT and then underwent surgery between May 2015 and September 2017. LPLN dissection was performed in 24 patients. The normalized iodine concentration (nIC), the ratio of iodine concentration in the lymph node (LN) to that in the common iliac artery on DECT, of the largest PRLN and LPLN was calculated, and the association between LN metastasis and nIC was analyzed. The median nIC value for PRLNs was significantly lower in PRLN metastasis-positive cases compared with PRLN metastasis-negative cases in the arterial phase 0.18 vs. 0.25; P=0.01; cut-off, 0.24; area under the curve (AUC), 0.733 and portal phase (0.47 vs. 0.61; P=0.03; cut-off, 0.59; AUC, 0.701). A significant difference was not identified between the median maximum short axis diameter of PRLNs in PRLN metastasis-positive and metastasis-negative cases (7.6 vs. 6.4 mm; P=0.33). The nIC for LPLNs was not significantly different between LPLN metastasis-positive and metastasis-negative cases in the arterial phase (0.15 vs. 0.21; P=0.19); but was significantly lower in LPLN metastasis-positive cases compared with LPLN metastasis-negative cases in the portal phase (0.29 vs. 0.56; P=0.04; cut-off, 0.29; AUC, 0.877). The maximum short axis diameter of LPLNs was significantly larger in metastasis-positive cases compared with LPLN metastasis-negative cases (9.1 vs. 4.8 mm; P=0.03; cut-off, 7.0 mm; AUC, 0.912). In conclusion, the nIC was identified to be significantly lower in metastasis-positive cases, which may be useful for the prediction of PRLN and LPLN metastases. A combination of size-based diagnosis and DECT may increase the accuracy of preoperative diagnosis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
A 54-year-old man was admitted at our hospital with a complaint of sudden anterior chest pain. At 1 year previously he had undergone right transthoracic esophagectomy for cancer followed by ...reconstruction using a gastric tube through a posterior mediastinal route. Upper gastrointestinal endoscopy confirmed a gastropericardial fistula. He was therefore given emergency intensive proton pump inhibitor together with gastric tube decompression using a nasogastric tube. Transabdominal pericardial drainage was surgically performed through a retrosternal space at 4 days after the onset. On the 22nd day after the drainage operation, upper gastrointestinal endoscopy showed healing of the gastropericardial fistula, and he was discharged on the 38th postoperative day. A gastropericardial fistula in the gastric tube following esophagectomy for cancer could be treated with less-invasive procedures including surgical pericardial drainage. Our procedure may be recommended as initial emergency treatment before more invasive procedures such as gastric tube resection and muscle flap plombage.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
27.
Gastric tube ulcer after esophagectomy Mori, Naoki; Fujita, Hiromasa; Tanaka, Toshiaki ...
Esophagus : official journal of the Japan Esophageal Society,
01/2015, Volume:
12, Issue:
1
Journal Article
Peer reviewed
Background
An ulcer occasionally develops in the gastric tube as an esophageal substitute after esophagectomy. The aim of the present study was to investigate the risk factors for a gastric tube ...ulcer.
Methods
We reviewed the medical records of all 826 patients who underwent esophageal reconstruction using a gastric tube following esophagectomy, in Kurume University Hospital between 1985 and 2010. Potential risk factors for a gastric tube ulcer were investigated by comparing the clinical characteristics between patients with a gastric tube ulcer and those without, using a multivariate logistic regression model.
Results
Among the 826 patients, 30 patients (3.6 %) developed a gastric tube ulcer. In 19 cases without any signs or symptoms, the ulcer was found using upper endoscopy. In the other 11 patients, there were symptoms including hematemesis, chest pain, and/or abdominal pain. In 3 cases, the patient developed a severe complication from the ulceration such as perforation. Of these 3 cases, one patient died of massive bleeding from the left brachiocephalic vein. The multivariate analysis revealed that (1) a past history of a peptic ulcer, and (2) the period of treatment (meaning the more recent period after the introduction of systematic prevention and treatment for a gastric tube ulcer) were the only two risk factors for a gastric tube ulcer (
p
< 0.0001, and
p
= 0.033, respectively).
Conclusions
Systematic prevention and treatment for a gastric tube ulcer including follow-up endoscopy, proton pump inhibitors administration according to 24-h pH monitoring, eradication of
H. pylori,
and others may decrease the incidence of a gastric tube ulcer. In particular, for patients with a past history of a peptic ulcer, the subcutaneous route of esophageal reconstruction is recommended to prevent fatal complications.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The aim of this study was to investigate the relation between hospital volume and clinical surgical outcome for 10 cardiac, lung, and esophageal surgical procedures.
The Committee for Scientific ...Affairs of the Japanese Association for Thoracic Surgery collected the pooled data on cardiac, lung, and esophageal surgical procedures between 2000 and 2004 from the annual reports. The relation between operative mortality (30-day or in-hospital mortality) and hospital volume was analyzed using a logistic regression model. The surgical procedures studied were surgery for acquired cardiac diseases coronary artery bypass grafting (CABG), valve procedures, acute type A dissection surgery, total CABG (elective + emergency), elective CABG, emergency CABG, single-valve surgery, acute type A dissection surgery, open heart surgery for the newborn, open heart surgery for the infants, lung cancer surgery, and esophageal cancer surgery. The data used in this study were not risk-adjusted.
The data on the relation between hospital volume and operative mortality generally tended to show an inverse correlation for all 10 cardiac, lung, and esophageal surgical procedures; that is, the higher was the volume the lower was the mortality. However, wide variations in operative mortality were noted among the very-low-volume hospital groups.
An inverse correlation was noted between hospital volume and operative mortality in the present study, although wide variations in clinical outcome were noted among the very low-volume hospitals. Further analysis is warranted using risk-adjusted data.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This study aimed to investigate the correlation between the average iodine density (AID) detected by dual-energy computed tomography (DE-CT) and the maximum standardized uptake value (SUVmax) yielded ...by 18F fluorodeoxyglucose positron emission tomography (18F-FDG PET) for non–small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). Seventy-four patients with medically inoperable NSCLC who underwent both DE-CT and 18F-FDG PET/CT before SBRT (50‒60 Gy in 5‒6 fractions) were followed up after a median interval of 24.5 months. Kaplan–Meier analysis was used to determine associations between local control (LC) and variables, including AID, SUVmax, tumor size, histology, and prescribed dose. The median AID and SUVmax were 18.64 (range, 1.18–45.31) (100 µg/cm3) and 3.2 (range, 0.7–17.6), respectively. No correlation was observed between AID and SUVmax. Two-year LC rates were 96.2% vs 75.0% (P = 0.039) and 72.0% vs 96.2% (P = 0.002) for patients classified according to high vs low AID or SUVmax, respectively. Two-year LC rates for patients with adenocarcinoma vs squamous cell carcinoma vs unknown cancer were 96.4% vs 67.1% vs 92.9% (P = 0.008), respectively. Multivariate analysis identified SUVmax as a significant predictor of LC. The 2-year LC rate was only 48.5% in the subgroup of lower AID and higher SUVmax vs >90% (range, 94.4–100%) in other subgroups (P = 0.000). Despite the short follow-up period, a reduction in AID and subsequent increase in SUVmax correlated significantly with local failure in SBRT-treated NSCLC patients. Further studies involving larger populations and longer follow-up periods are needed to confirm these results.
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