been described in japanese populations. These convulsions are not related to clinical signs of dehydration or electrolyte disorder. This entity was called CwG,benign Convulsions with mild Gastroenteritis. We report th...been described in japanese populations. These convulsions are not related to clinical signs of dehydration or electrolyte disorder. This entity was called CwG,benign Convulsions with mild Gastroenteritis. We report the case of a 19 month-old japanese boy who presented with a CwG. We described the characteristic clinical features of this entity and we reviewed the cases reported in literature. The evolution of the CwG is always simple without relapse or side effects. Better understanding will help pediatricians make more accurate diagnosis and avoid treatment even though initial signs might be severe.展开更多
Background: Although an association between benign digestive diseases and smoking or drinking habits was reported, consistent results have not been obtained either in European,American or Japanese populations. Methods...Background: Although an association between benign digestive diseases and smoking or drinking habits was reported, consistent results have not been obtained either in European,American or Japanese populations. Methods: Smoking and alcohol habits as risk factors for the incidence of gastric ulcer, duodenal ulcer, chronic liver disease and cirrhosis as well as cholelithiasis were examined using the longitudinal data of the Adult Health Study collected biennially between 1958 and 1998. During 1958- 1998, 1,093 gastric ulcers, 437 duodenal ulcers, 2,054 chronic liver diseases and cirrhoses, and 1,136 cholelithiasis cases were newly detected based on medical history, fluoroscopy or endoscopy and ultrasonography. Smoking and drinking histories were obtained from five and three questionnaires, respectively, administered during different periods. The relative risks (RRs) for ever smoked to never smoked and that for ever drank to never drank were estimated after adjustment for city, sex, age, birth cohort, calendar time and radiation dose. Results: The analysis showed a positive association of smoking with gastric ulcer (RR: 2.03, 95% CI: 1.71- 2.41), duodenal ulcer (RR: 1.31, 95% CI: 0.99- 1.72), chronic liver disease and cirrhosis (RR: 1.23, 95% CI: 1.08- 1.39) and cholelithiasis (RR: 1.19, 95% CI: 1.02- 1.40), and a positive association of drinking with chronic liver disease and cirrhosis (RR: 1.10, 95% CI: 0.99- 1.23). Conclusions: The peptic ulcer, chronic liver disease and cholelithiasis incidence increased significantly with smoking, and the chronic liver disease incidence increased significantly with drinking simultaneously in a prospective study of a Japanese population.展开更多
Background. We assessed the characteristics of symptomatic gastroesophageal reflux disease (sGERD), defined as the presence of symptoms, but no endoscopic findings of reflux esophagitis, in Japanese. Methods. Sixty- t...Background. We assessed the characteristics of symptomatic gastroesophageal reflux disease (sGERD), defined as the presence of symptoms, but no endoscopic findings of reflux esophagitis, in Japanese. Methods. Sixty- three patients were diagnosed with sGERD, and underwent 24- h esophagogastric pH monitoring (32 men; mean age, 50.5 years). Patients were classified into the following three groups: reflux group (group R), minor reflux group (group MR), and a no- reflux group (group N) by the percentage of time at pH below 4 (group R, 4.0% or more; group MR, 2.0% - 3.9% ;groupN, 0- 1.9% ). Hiatal hernia was assessed based on the Anatomy- Function- Pathology (AFP) classification, and the shape of the cardia was assessed based on valve factors (V0- V3). Results. There were 13 patients (21% ) in group R, 17 (27% ) in group MR, and 33 (52% ) in group N.Hiatal hernia was present in 11 patients (85% ) in group R, 14 (82% ) in group MR, and 22 (67% ) in group N. Patients grouped according to presence of V2/V3 (chalasia) accounted for 100% of those in group R, 71% of those in group MR and 70% of those in group N. Hiatal hernia was present in 10 (91% ), 10 (83% ), and 6 patients (86% ) who had 50 or more episodes of esophageal acid reflux per day in group R, group MR, and group N, respectively. Conclusions. Reflux (percentage of time below pH 4, 4% ) was seen in only about 20% of the patients with sGERD, and this percentage of patients with reflux was lower compared to the data reported from the United States and Europe. The percentage of patients who had a hiatal hernia or chalasia was high in all these groups, and this seemed to be a characteristic cause of sGERD in Japanese.展开更多
Background: Eradication of Helicobacter pylori has become a common treatment for several diseases. There is an increase in antibiotic-resistant strains, which causes the failure of eradication. The aim of this study w...Background: Eradication of Helicobacter pylori has become a common treatment for several diseases. There is an increase in antibiotic-resistant strains, which causes the failure of eradication. The aim of this study was to investigate the usefulness of metronidazole for the treatment of H. pylori infection in patients who failed eradication therapy. Methods: Seventy H. pylori positive patients who had failed eradication treatment with first-line triple therapy, which consisted of a proton pump inhibitor, amoxicillin, and clarithromycin, were enrolled into the study. Before the second-line therapy, patients underwent endoscopy to obtain H. pylori strains to test susceptibility to antibiotics. Lansoprazole (30mg b.d.), amoxicillin (750mg b.d.), and metronidazole (250mg b.d.) were administered for 1 week, and the result was tested by 13C-UBT. Results: H. pylori was isolated from 62 patients, and 52 of them (83.9%) were clarithromycin resistant. There was no amoxicillin-or metronidazole-resistant strain. No major adverse effects were seen, and all the patients completed the 1-week regimen. The eradication rates of lansoprazole-amoxicillin-metronidazole were 96.2%(51/53; 95%CI, 87.0%-99.5%) using both intention-to-treat analysis and per protocol analysis. Conclusions: Lansoprazole-amoxicillin-metronidazole triple therapy is an effective and promising second-line H. pylori eradication therapy in a north Japanese population, which has a low frequency of metronidazole resistance.展开更多
Background: Interleukin-1β(IL-1β) gene polymorphisms are related to hypochlorhydria and increase the risk of gastric cancer in the presence of Helicobacter pylori infection. However, little information is available ...Background: Interleukin-1β(IL-1β) gene polymorphisms are related to hypochlorhydria and increase the risk of gastric cancer in the presence of Helicobacter pylori infection. However, little information is available about the genetic risk factors of reflux esophagitis. In this study we investigated its association with the IL-1β.polymorphisms. Methods: We examined 48 patients with reflux esophagitis and 96 control subjects, 89 with gastric cancer. IL-1β-511C/T genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: The frequency of IL-1β-51 1T alleles was significantly higher in reflux esophagitis patients (57.3%) than in controls (41.1%) (P = 0.0215, χ2 = 5.289). The frequency of IL-1β-511T/T genotypes was also significantly higher in reflux esophagitis patients (31.3%) than in controls (15.6%). The odds ratio and the 95%confidence interval were 4.000 and 1.393-11.486, respectively. The frequency of IL-1β-511T/T genotypes was significantly higher in reflux esophagitis patients (31.3%) than in gastric cancer patients (21.4%). The odds ratio and the 95%confidence interval were 2.961 and 1.054-8.316, respectively. Conclusions: IL-1β-511T was associated with reflux esophagitis having hyperacidity. Differences of genetic background regarding gastric acid secretion may exist between Japanese and Caucasians.展开更多
Objective. The frequency of gastroesophageal reflux disease (GERD) has not been fully investigated in the Asian population. The aim of this study was to investigate the prevalence of GERD, endoscopy-negative GERD (NER...Objective. The frequency of gastroesophageal reflux disease (GERD) has not been fully investigated in the Asian population. The aim of this study was to investigate the prevalence of GERD, endoscopy-negative GERD (NERD), and erosive GERD in Japan, and the factors influencing disease prevalence. Material and methods. A total of 2760 subjects (mean age 50.4 years, range 24- 84 years) were prospectively enrolled in this multicenter study. GERD symptoms were assessed with the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and upper gastrointestinal endoscopy was performed on all study participants. Results. A total of 495 (17.9% ) individuals were diagnosed with GERD by the presence of erosive esophagitis at endoscopy and/or by the presence of GERD symptoms. Erosive esophagitis was diagnosed endoscopically in 195 (7.1% ), and symptomatic GERD was diagnosed in 351 (12.7% ) based on a QUEST score of over 6. Of these 351 subjects, 300 (10.9% ) were considered to have NERD. Male gender, hiatal hernia, and mild gastric mucosal atrophy were significant positive predictive factors of erosive esophagitis by multiple regression analysis. Hiatal hernia was the only significant predictor of GERD symptoms. Traditional Japanese foods, such as sweet cakes and rice cake, frequently exacerbated GERD symptoms. Conclusions. The prevalence of GERD in the Japanese was 17.9% and the prevalence rates of NERD and erosive esophagitis were 10.9% and 8.6% , respectively. The majority of symptomatic patients did not have endoscopically proven esophagitis. Hiatal hernia is the only important predictor of the presence of GERD symptoms.展开更多
Background: After a myocardial infarction, a higher prevalence of coronary vasospastic response has been reported in the Japanese population than in the Caucasian population. Beta-blockers may exacerbate coronary vaso...Background: After a myocardial infarction, a higher prevalence of coronary vasospastic response has been reported in the Japanese population than in the Caucasian population. Beta-blockers may exacerbate coronary vasospasm. However, beta-blockers are given to Japanese patients after an acute myocardial infarction, though the mortality benefit is unknown. Thus, we investigated the mortality benefit of beta-blockers given to Japanese patients after an acute myocardial infarction. Methods: We prospectively studied consecutive patients with a first myocardial infarction admitted to the coronary care unit of Kansai Medical University Hospital, Osaka, Japan from May 1994 through the end of 2001. Patients who died during hospitalization or who were referred for coronary artery bypass graft surgery were excluded. The association of beta-blocker use with mortality after discharge was assessed by a proportional hazards regression analysis. Results: There were 546 patients and 400(73.3% ) patients were treated with beta-blockers at the time of discharge from hospital. During a mean followup of 2 years, 46(8.4% ) patients died. Beta-blocker therapy was associated with a reduced mortality after adjustment for age, gender, Q wave myocardial infarction, reperfusion therapy during acute phase, Killip functional class, serum creatinine level, cardiovascular risk factors, and medications(hazard ratio=0.51, 95% confidence interval=0.27 to 0.95). Conclusions: Contrary to the concern that beta-blocker therapy might induce coronary vasospasm and reduce survival, beta-blocker therapy improved survival after discharge in Japanese patients with a first myocardial infarction.展开更多
We investigated a Japanese family with generalized dystonia attributed to striatal degeneration, which occurred in childhood, and late-onset optic neuropathy. We determined the entire nucleotide sequence of mitochondr...We investigated a Japanese family with generalized dystonia attributed to striatal degeneration, which occurred in childhood, and late-onset optic neuropathy. We determined the entire nucleotide sequence of mitochondrial DNA (mtDNA) from the proband and compared our findings with the 2001 Revised Cambridge Reference Sequence. The mtDNA of the proband showed a total of 42 nucleotide changes. We identified two A3203G and G14459A mutations, which were completely absent in a population of 200 healthy Japanese, by estimating the frequency of each nucleotide change. The nucleotide G14459A mutation occurs in NADH dehydrogenase subunit 6, and has been suggested previously as the disease-causing mutation in Hispanic, African-American and Caucasian families of Leber’ s hereditary optic neuropathy (LHON) and/or dystonia. The significance of the A3203G mutation remains unknown. To our knowledge, this is the first case of LHON with dystonia that revealed a mtDNA mutation in a Japanese family.展开更多
Background: The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cance...Background: The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cancer in the population is decreasing. The optimal treatment for these patients remains a challenge to th e surgeon. The aim of this retrospective analysis was to describe the results of gastrectomy and EMR for early gastric cancer in elderly patients (80 years of a ge and over). Methods: This is a retrospective review of 93 elderly patients who had undergone gastrectomy or EMR at the National Cancer Center Hospital for ear ly gastric cancer. EMR was performed aiming en bloc local resection with a clear curative margin (R0). The clinicopathologic characteristics, comorbidity, posto perative mortality, and outcome were recorded. Results: Gastrectomy was performe d in 44 patients (surgery group) and EMR in 49 patients (EMR group). There were significant differences in mean tumor size (p < 0.05), histologic type (p < 0.05 ), and depth of tumor invasion (p < 0.05) between the two groups. There was no s ignificant difference in comorbidity between the two groups. No operative death was reported in either group. In the EMR group, 7 patients were reported to have recurrence of local disease and two patients died of advanced disease. There we re no significant differences in the overall 3-year survival rate or the 5-yea r survival rate between the surgery group and EMR group (73.5%vs. 82.5%and 55. 0%vs. 62.5%, respectively). Conclusions: EMR (R0) resection was performed safe ly in the elderly, and the overall results were excellent, the same as the resul ts with gastrectomy. Gastrectomy can still be performed if EMR is unsuccessful.展开更多
颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)是指颈椎椎管内椎体后方的后纵韧带逐渐发生骨化,并由此引发椎管狭窄以及脊髓、神经根受压等损害,其病因尚待明确。该疾病患者在临床上有脊髓损害及神经根刺...颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)是指颈椎椎管内椎体后方的后纵韧带逐渐发生骨化,并由此引发椎管狭窄以及脊髓、神经根受压等损害,其病因尚待明确。该疾病患者在临床上有脊髓损害及神经根刺激等症状。1960年,日本学者Tsukimoto根据尸检结果对此进行了描述。1964年,Terayama将其正式命名为"颈椎后纵韧带骨化症"。由于该疾病起病隐匿、进展缓慢,治疗措施及手术时机的选择一直颇具争议。因此,本刊特邀请了多位在该领域内颇具治疗及研究经验的专家共同探讨这一问题。专家们从各自经验出发,通过多个角度探讨了手术时机、手术方案的选择等问题。希望各位同道阅读之后能加以参考,并结合自身的经验提出自己的见解,以期共同提高。展开更多
文摘been described in japanese populations. These convulsions are not related to clinical signs of dehydration or electrolyte disorder. This entity was called CwG,benign Convulsions with mild Gastroenteritis. We report the case of a 19 month-old japanese boy who presented with a CwG. We described the characteristic clinical features of this entity and we reviewed the cases reported in literature. The evolution of the CwG is always simple without relapse or side effects. Better understanding will help pediatricians make more accurate diagnosis and avoid treatment even though initial signs might be severe.
文摘Background: Although an association between benign digestive diseases and smoking or drinking habits was reported, consistent results have not been obtained either in European,American or Japanese populations. Methods: Smoking and alcohol habits as risk factors for the incidence of gastric ulcer, duodenal ulcer, chronic liver disease and cirrhosis as well as cholelithiasis were examined using the longitudinal data of the Adult Health Study collected biennially between 1958 and 1998. During 1958- 1998, 1,093 gastric ulcers, 437 duodenal ulcers, 2,054 chronic liver diseases and cirrhoses, and 1,136 cholelithiasis cases were newly detected based on medical history, fluoroscopy or endoscopy and ultrasonography. Smoking and drinking histories were obtained from five and three questionnaires, respectively, administered during different periods. The relative risks (RRs) for ever smoked to never smoked and that for ever drank to never drank were estimated after adjustment for city, sex, age, birth cohort, calendar time and radiation dose. Results: The analysis showed a positive association of smoking with gastric ulcer (RR: 2.03, 95% CI: 1.71- 2.41), duodenal ulcer (RR: 1.31, 95% CI: 0.99- 1.72), chronic liver disease and cirrhosis (RR: 1.23, 95% CI: 1.08- 1.39) and cholelithiasis (RR: 1.19, 95% CI: 1.02- 1.40), and a positive association of drinking with chronic liver disease and cirrhosis (RR: 1.10, 95% CI: 0.99- 1.23). Conclusions: The peptic ulcer, chronic liver disease and cholelithiasis incidence increased significantly with smoking, and the chronic liver disease incidence increased significantly with drinking simultaneously in a prospective study of a Japanese population.
文摘Background. We assessed the characteristics of symptomatic gastroesophageal reflux disease (sGERD), defined as the presence of symptoms, but no endoscopic findings of reflux esophagitis, in Japanese. Methods. Sixty- three patients were diagnosed with sGERD, and underwent 24- h esophagogastric pH monitoring (32 men; mean age, 50.5 years). Patients were classified into the following three groups: reflux group (group R), minor reflux group (group MR), and a no- reflux group (group N) by the percentage of time at pH below 4 (group R, 4.0% or more; group MR, 2.0% - 3.9% ;groupN, 0- 1.9% ). Hiatal hernia was assessed based on the Anatomy- Function- Pathology (AFP) classification, and the shape of the cardia was assessed based on valve factors (V0- V3). Results. There were 13 patients (21% ) in group R, 17 (27% ) in group MR, and 33 (52% ) in group N.Hiatal hernia was present in 11 patients (85% ) in group R, 14 (82% ) in group MR, and 22 (67% ) in group N. Patients grouped according to presence of V2/V3 (chalasia) accounted for 100% of those in group R, 71% of those in group MR and 70% of those in group N. Hiatal hernia was present in 10 (91% ), 10 (83% ), and 6 patients (86% ) who had 50 or more episodes of esophageal acid reflux per day in group R, group MR, and group N, respectively. Conclusions. Reflux (percentage of time below pH 4, 4% ) was seen in only about 20% of the patients with sGERD, and this percentage of patients with reflux was lower compared to the data reported from the United States and Europe. The percentage of patients who had a hiatal hernia or chalasia was high in all these groups, and this seemed to be a characteristic cause of sGERD in Japanese.
文摘Background: Eradication of Helicobacter pylori has become a common treatment for several diseases. There is an increase in antibiotic-resistant strains, which causes the failure of eradication. The aim of this study was to investigate the usefulness of metronidazole for the treatment of H. pylori infection in patients who failed eradication therapy. Methods: Seventy H. pylori positive patients who had failed eradication treatment with first-line triple therapy, which consisted of a proton pump inhibitor, amoxicillin, and clarithromycin, were enrolled into the study. Before the second-line therapy, patients underwent endoscopy to obtain H. pylori strains to test susceptibility to antibiotics. Lansoprazole (30mg b.d.), amoxicillin (750mg b.d.), and metronidazole (250mg b.d.) were administered for 1 week, and the result was tested by 13C-UBT. Results: H. pylori was isolated from 62 patients, and 52 of them (83.9%) were clarithromycin resistant. There was no amoxicillin-or metronidazole-resistant strain. No major adverse effects were seen, and all the patients completed the 1-week regimen. The eradication rates of lansoprazole-amoxicillin-metronidazole were 96.2%(51/53; 95%CI, 87.0%-99.5%) using both intention-to-treat analysis and per protocol analysis. Conclusions: Lansoprazole-amoxicillin-metronidazole triple therapy is an effective and promising second-line H. pylori eradication therapy in a north Japanese population, which has a low frequency of metronidazole resistance.
文摘Background: Interleukin-1β(IL-1β) gene polymorphisms are related to hypochlorhydria and increase the risk of gastric cancer in the presence of Helicobacter pylori infection. However, little information is available about the genetic risk factors of reflux esophagitis. In this study we investigated its association with the IL-1β.polymorphisms. Methods: We examined 48 patients with reflux esophagitis and 96 control subjects, 89 with gastric cancer. IL-1β-511C/T genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: The frequency of IL-1β-51 1T alleles was significantly higher in reflux esophagitis patients (57.3%) than in controls (41.1%) (P = 0.0215, χ2 = 5.289). The frequency of IL-1β-511T/T genotypes was also significantly higher in reflux esophagitis patients (31.3%) than in controls (15.6%). The odds ratio and the 95%confidence interval were 4.000 and 1.393-11.486, respectively. The frequency of IL-1β-511T/T genotypes was significantly higher in reflux esophagitis patients (31.3%) than in gastric cancer patients (21.4%). The odds ratio and the 95%confidence interval were 2.961 and 1.054-8.316, respectively. Conclusions: IL-1β-511T was associated with reflux esophagitis having hyperacidity. Differences of genetic background regarding gastric acid secretion may exist between Japanese and Caucasians.
文摘Objective. The frequency of gastroesophageal reflux disease (GERD) has not been fully investigated in the Asian population. The aim of this study was to investigate the prevalence of GERD, endoscopy-negative GERD (NERD), and erosive GERD in Japan, and the factors influencing disease prevalence. Material and methods. A total of 2760 subjects (mean age 50.4 years, range 24- 84 years) were prospectively enrolled in this multicenter study. GERD symptoms were assessed with the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and upper gastrointestinal endoscopy was performed on all study participants. Results. A total of 495 (17.9% ) individuals were diagnosed with GERD by the presence of erosive esophagitis at endoscopy and/or by the presence of GERD symptoms. Erosive esophagitis was diagnosed endoscopically in 195 (7.1% ), and symptomatic GERD was diagnosed in 351 (12.7% ) based on a QUEST score of over 6. Of these 351 subjects, 300 (10.9% ) were considered to have NERD. Male gender, hiatal hernia, and mild gastric mucosal atrophy were significant positive predictive factors of erosive esophagitis by multiple regression analysis. Hiatal hernia was the only significant predictor of GERD symptoms. Traditional Japanese foods, such as sweet cakes and rice cake, frequently exacerbated GERD symptoms. Conclusions. The prevalence of GERD in the Japanese was 17.9% and the prevalence rates of NERD and erosive esophagitis were 10.9% and 8.6% , respectively. The majority of symptomatic patients did not have endoscopically proven esophagitis. Hiatal hernia is the only important predictor of the presence of GERD symptoms.
文摘Background: After a myocardial infarction, a higher prevalence of coronary vasospastic response has been reported in the Japanese population than in the Caucasian population. Beta-blockers may exacerbate coronary vasospasm. However, beta-blockers are given to Japanese patients after an acute myocardial infarction, though the mortality benefit is unknown. Thus, we investigated the mortality benefit of beta-blockers given to Japanese patients after an acute myocardial infarction. Methods: We prospectively studied consecutive patients with a first myocardial infarction admitted to the coronary care unit of Kansai Medical University Hospital, Osaka, Japan from May 1994 through the end of 2001. Patients who died during hospitalization or who were referred for coronary artery bypass graft surgery were excluded. The association of beta-blocker use with mortality after discharge was assessed by a proportional hazards regression analysis. Results: There were 546 patients and 400(73.3% ) patients were treated with beta-blockers at the time of discharge from hospital. During a mean followup of 2 years, 46(8.4% ) patients died. Beta-blocker therapy was associated with a reduced mortality after adjustment for age, gender, Q wave myocardial infarction, reperfusion therapy during acute phase, Killip functional class, serum creatinine level, cardiovascular risk factors, and medications(hazard ratio=0.51, 95% confidence interval=0.27 to 0.95). Conclusions: Contrary to the concern that beta-blocker therapy might induce coronary vasospasm and reduce survival, beta-blocker therapy improved survival after discharge in Japanese patients with a first myocardial infarction.
文摘We investigated a Japanese family with generalized dystonia attributed to striatal degeneration, which occurred in childhood, and late-onset optic neuropathy. We determined the entire nucleotide sequence of mitochondrial DNA (mtDNA) from the proband and compared our findings with the 2001 Revised Cambridge Reference Sequence. The mtDNA of the proband showed a total of 42 nucleotide changes. We identified two A3203G and G14459A mutations, which were completely absent in a population of 200 healthy Japanese, by estimating the frequency of each nucleotide change. The nucleotide G14459A mutation occurs in NADH dehydrogenase subunit 6, and has been suggested previously as the disease-causing mutation in Hispanic, African-American and Caucasian families of Leber’ s hereditary optic neuropathy (LHON) and/or dystonia. The significance of the A3203G mutation remains unknown. To our knowledge, this is the first case of LHON with dystonia that revealed a mtDNA mutation in a Japanese family.
文摘Background: The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cancer in the population is decreasing. The optimal treatment for these patients remains a challenge to th e surgeon. The aim of this retrospective analysis was to describe the results of gastrectomy and EMR for early gastric cancer in elderly patients (80 years of a ge and over). Methods: This is a retrospective review of 93 elderly patients who had undergone gastrectomy or EMR at the National Cancer Center Hospital for ear ly gastric cancer. EMR was performed aiming en bloc local resection with a clear curative margin (R0). The clinicopathologic characteristics, comorbidity, posto perative mortality, and outcome were recorded. Results: Gastrectomy was performe d in 44 patients (surgery group) and EMR in 49 patients (EMR group). There were significant differences in mean tumor size (p < 0.05), histologic type (p < 0.05 ), and depth of tumor invasion (p < 0.05) between the two groups. There was no s ignificant difference in comorbidity between the two groups. No operative death was reported in either group. In the EMR group, 7 patients were reported to have recurrence of local disease and two patients died of advanced disease. There we re no significant differences in the overall 3-year survival rate or the 5-yea r survival rate between the surgery group and EMR group (73.5%vs. 82.5%and 55. 0%vs. 62.5%, respectively). Conclusions: EMR (R0) resection was performed safe ly in the elderly, and the overall results were excellent, the same as the resul ts with gastrectomy. Gastrectomy can still be performed if EMR is unsuccessful.
文摘颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)是指颈椎椎管内椎体后方的后纵韧带逐渐发生骨化,并由此引发椎管狭窄以及脊髓、神经根受压等损害,其病因尚待明确。该疾病患者在临床上有脊髓损害及神经根刺激等症状。1960年,日本学者Tsukimoto根据尸检结果对此进行了描述。1964年,Terayama将其正式命名为"颈椎后纵韧带骨化症"。由于该疾病起病隐匿、进展缓慢,治疗措施及手术时机的选择一直颇具争议。因此,本刊特邀请了多位在该领域内颇具治疗及研究经验的专家共同探讨这一问题。专家们从各自经验出发,通过多个角度探讨了手术时机、手术方案的选择等问题。希望各位同道阅读之后能加以参考,并结合自身的经验提出自己的见解,以期共同提高。
