Antral Carcinoma Research Articles

Spectrum of Upper Gastrointestinal Endoscopy Findings in Patients with Dyspepsia

Introduction: This retrospective study was designed to see the endoscopic findings in patients with dyspepsia. Materials and Methods: This was a hospital-based retrospective observational study which included adult patients who underwent upper gastrointestinal endoscopy for dyspepsia from December 2020 to November 2022. Result: Total of 802 patients, male 405 (50.5%) and female 397 (49.5%), age ranging from 14 to 87 years (mean 42.2382 and SD 15.45) were included in this study. Most common abnormal endoscopic finding was non erosive antral gastritis seen in 341 patients (42.5%), followed by pangastritis in 63 (7.86%) and erosive antral gastritis in 52 (6.48%) patients, duodenal ulcer disease including active, with or without outlet obstruction and remission phase 127 (15.82%), gastric ulcer 34 (4.24%) and oesophageal varices 21 (2.62%). In addition, 24 (2.99%), seven (0.87%) and five (0.62%) patients had carcinoma stomach, carcinoma oesophagus and carcinoma duodenum respectively with higher incidence among elderly patients. While, duodenal malignancy and haital hernia were more common in elderly patients, erosive antral gastritis and pangastritis were more common at younger age groups. However, oesophageal varix, duodenal ulcer and antral carcinoma were more common among male patients. Conclusion: Gastritis was the most common endoscopic finding among dyspeptic patients. The incidence of upper GI malignancy was low, but comparatively higher in elderly patients. Medicine Today 2024, Vol.36 (2): 90-94

Novel parameter optimization lattice design for improving osseointegration in hypo-loading regions – A case study of maxillary tumor reconstruction implant

This study utilizes the Taguchi method and sub-model analysis technique to create a novel optimization lattice for the hypo-loading region. The lattice is designed to mimic the mechanical properties of bone and promote the growth of immature bone under appropriate loading to enhance the osseointegration capacity of implants. The Maxillary lattice implant (ML implant) was developed to address the case of Maxillary antral carcinoma. The implant's structural parameters, including Angle of rotation (A), Concave angle (B), Pillar diameter (C), and Fillet radius (D), were analyzed to design and optimize the Hypo-Loading lattice (HL lattice) with various structures. Through the analysis, the optimal structural parameters for the HL lattice were determined, resulting in the creation of the Optimal HL lattice with exceptional Elastic Admissible Strain (EAS), a comparable elastic modulus to bone, and outstanding mechanical robustness. This feature of the Optimal HL lattice improves the bionic performance.

A CLINICAL STUDY OF GASTRIC OUTLET OBSTRUCTION IN ADULTS

Introduction : Gastric Outlet Obstruction implies complete or incomplete obstruction of the distal stomach, pylorus or proximal duodenum[1]. This may occur as an obstructing mass lesion, external compression or as a result of obstruction from acute edema, chronic scarring and brosis or a combination of both[1,2].Gastric outlet obstruction is not a single entity; it is the clinical and pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying[3]. To Aims Of The Study : determine the relative incidence of benign and malignant gastric outlet obstruction.To study the modes of presentation of gastric outlet obstruction.To study the outcome of management of gastric outlet obstruction. The pat Materials And Methods : ients for this study have been selected from Kurnool medical college, KURNOOL from September 2020 to April 2022. In total, 50 in-patients of gastric outlet obstruction have been studied. An elaborate study of these cases with regard to the history, clinical features, routine and special investigations, pre-operative treatment, operative ndings, postoperative management and complications in post-operative period is done. Of the 50 cases of gastric Results : outlet obstruction 26 had carcinoma antrum, 23 had cicatrized duodenal ulcer and 1 had gastric outlet obstruction secondary to corrosive ingestion. The commonest causes of gastric outlet obstruction in adults are Conclusion : carcinoma stomach with antral growth producing gastric outlet obstruction (52%) and cicatrised duodenal ulcer (46%). Number of cases with cicatrised duodenal ulcer as the chief etiological factor for gastric outlet obstruction is diminishing and the number of cases of antral carcinoma of stomach as the cause of gastric outlet obstruction is increasing.

Prognostic impact of D2-plus lymphadenectomy and optimal extent of lymphadenectomy in advanced gastric antral carcinoma: Propensity score matching analysis.

ObjectiveTo investigate the prognostic impact of D2-plus lymphadenectomy including the posterior (No. 8p, No. 12b/p, No. 13, and No. 14v), and para-aortic (No. 16a2, and No. 16b1) lymph nodes (LNs) in subtotal gastrectomy for advanced gastric antral carcinoma.MethodsA total of 203 patients with advanced gastric cancer (GC) located in the antrum, who underwent R0 gastrectomy with D2 or D2-plus lymphadenectomy between January 2003 and December 2011 were enrolled. Propensity score matching was used to reduce the strength of the confounding factors to accurately evaluate prognoses. The therapeutic value index (TVI) was calculate to evaluate the survival benefit of dissecting each LN station.ResultsOf 102 patients with D2-plus lymphadenectomy, 21 (20.59%) were pathologically identified as having LN metastases beyond the extent of D2 lymphadenectomy. After matching, the overall survival (OS) was significantly better in the D2-plus than the D2 group (P=0.030). In the multivariate survival analysis, D2-plus lymphadenectomy (hazard ratio, 0.516; P=0.006) was confirmed to significantly improve the survival rate. In the logistic regression analysis, pN stage [odds ratio (OR), 2.533; 95% confidence interval (95% CI), 1.368−4.691; P=0.003] and extent of LNs metastasis (OR, 5.965; 95% CI, 1.335−26.650; P=0.019) were identified as independent risk factors for LN metastases beyond the extent of D2 lymphadenectomy. The TVI of patient with metastasis to LNs station was 7.1 (No. 8p), 5.7 (No. 12p), 5.1 (No. 13), and 7.1 (both No. 16a2 and No. 16b1), respectively.ConclusionsD2-plus lymphadenectomy may improve the prognoses of some patients with advanced GC located in the antrum, especially for No. 8p, No. 12b, No. 13, and No. 16.

Gastric outlet obstruction, a clinical study in tertiary care hospital South India

Background: Gastric Outlet Obstruction implies complete or incomplete obstruction of the distal stomach, pylorus or proximal duodenum. Gastric outlet obstruction is not a single entity; it is the clinical and pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying. Now in the era of H2 blockers and proton pump inhibitors, incidence of duodenal ulcer producing gastric outlet obstruction has been decreasing as symptomatic ulcer begin to respond to medical treatment, and at the same time the incidence of antral carcinoma of stomach producing gastric outlet obstruction has comparatively increased, which may be due to increased early diagnosis of the condition with the help of flexible fibre optic endoscope.Methods: An elaborate study of these cases with regard to the history, clinical features, routine and special investigations, pre-operative treatment, operative findings, post-operative management and complications in post-operative period is done.Results: Of the 50 cases of gastric outlet obstruction 26 had carcinoma antrum (52%), 23 had cicatrized duodenal ulcer (46%) and 1 had gastric outlet obstruction secondary to corrosive ingestion. The age incidence of the patients in this study ranged from 22 – 84 years with a mean of 53.62 years. In case of obstruction secondary to duodenal ulcer the maximum age incidence is between 31-40 years. The maximum age incidence of gastric outlet obstruction due to carcinoma antrum is 61-70 years.In this series, 42 patients (84%) were males and 8 patients (16%) were female. Male to female ratio (M:F) is 5.25:1. M: F ratio in cicatrized duodenal ulcer is 10.5:1 and in carcinoma antrum is 3.33:1. 52% of the patients were manual labourers who gave a history of irregular diet habits. 68% of patients had history of smoking and 66% had history of alcohol intake. Post – prandial vomiting and epigastria pain are the main symptoms (96%) in this series. Other symptoms included anorexia (84%), weight loss (72%), post prandial Epigastric fullness (68%), haematemesis (24%), melena (64%) and constipation (48%). Pallor was present in 56% and dehydration in 62%. Blood group ‘O’ was common in cicatrized duodenal ulcer patients (52.18%) whereas blood group ‘A’ was common in malignant cases (50%).Conclusions: Number of cases with cicatrized duodenal ulcer as the chief etiological factor for gastric outlet obstruction is diminishing and the number of cases of antral carcinoma of stomach as the cause of gastric outlet obstruction is increasing. Upper Gastro intestinal endoscopy should be mandatory in all suspected cases of gastric outlet obstruction. It can diagnose the cause of obstruction very effectively than any other investigative modality. Effective treatment in carcinoma stomach depends on early diagnosis.

Association between polymorphisms in the CYP1A1, CYP2E1 and GSTM1 genes, and smoking, alcohol and upper digestive tract carcinomas in a high-incidence area of northern China.

Metabolic gene variants, smoking, and alcohol consumption are important upper digestive tract cancer (UDTC) risk factors. However, the gene-gene and gene-environment interactions remain unclear. A case-control study in a high incidence area for upper digestive tract cancer was conducted in China. DNA was extracted from buffy coat samples for PCR or PCR-restriction fragment length polymorphism. Smoking and alcohol drinking status was determined by questionnaires. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the associations. After adjusting for confounding factors, smoking increased esophageal cancer (EC), gastric cardia cancer (GCC) and gastric antral carcinoma (GAC) risk by 3.594, 4.658, and 3.999-fold, respectively. Alcohol consumption increased EC, GCC and GAC risk by 1.953, 2.442 and 1.765-fold, respectively. The cytochrome P4501A1 (CYP1A1) rs4646903 T>C polymorphism increased GCC risk, the cytochrome P4502E1 (CYP2E1) rs2031920 C>T polymorphism increased EC risk, while the GSTM1 null genotype decreased EC risk. An association existed between the following: CYP1A1 rs4646903 and smoking in EC, GCC and GAC; CYP1A1 rs4646903 and alcohol consumption in EC and GCC; CYP2E1 rs2031920 and smoking in EC, GCC and GAC and CYP2E1 rs2031920 and alcohol consumption in EC and GCC. No association was observed between CYP1A1 and CYP2E1. The glutathione S-transferase mu 1 (GSTM1) null genotype decreased EC risk (OR=0.510). Smoking/drinking are upper digestive tract cancer risk factors. The CYP1A1 rs4646903 and CYP2E1 rs2031920 polymorphisms were risk factors of GCC or EC, and the GSTM1 null genotype may serve a protective role against EC. The results of the present study indicated that gene-environment interactions increase the risk of UDTC.

The Role of the General Dental Practitioner in the Detection of Squamous Cell Carcinoma of the Maxillary Antrum

Antral squamous cell carcinoma (SCC) is a relatively uncommon head and neck malignancy. Fewer than 400 cases are reported annually in the UK. As it is uncommon and often shows slow progression, it can be misdiagnosed in the early stages. This report describes a case involving a 52-year-old patient who presented at the emergency department of a district hospital complaining of facial swelling and recent dental issues. Further investigation revealed the presence of a mass in the right maxillary antrum, subsequently confirmed as SCC on histology. Significant pathology may be the underlying cause of symptoms which appear trivial. Persistent symptoms in the absence of a reasonable cause should raise suspicion. CPD/Clinical Relevance: A general dental practitioner is likely to be the initial point of contact of patients with maxillary antrum malignancies of the maxillary sinus; identification of suspicious signs and symptoms can help in early detection and treatment.

An observational study on benign/malignant gastric outlet obstruction in tertiary care centre of RIMS, Ranchi, India

Background: Gastric outlet obstruction is a group of clinico-patho physiological consequence of mechanical impediment of gastric emptying. Clinical entities that can result in gastric outlet obstruction are categorized into two well-defined groups of causes - benign and malignant. The proximal stomach is now the most common site for gastric carcinoma in the west but in Japan and developing countries like India the distal gastric cancer (antrum 13% and pylorus 7%) still predominates. Diagnosis of gastric outlet obstruction depends on different clinical features and certain investigations. The definitive treatment involves surgical relief of the gastric outlet obstruction. The correct surgical procedure to be adopted is planned according to the cause of obstruction and condition of the patients. This is an observational study aimed for characterization of gastric outlet obstruction in terms of benign and malignant and their relation to its causes, sites and other related factors in tertiary care centre (RIMS).Methods: This is an observational study comprises on 50 patients of gastric outlet obstruction admitted in the Department of Surgery R.I.M.S., Ranchi. The provisional diagnosis was based on detailed clinical history, thorough physical examinations, and some radiological investigations.Results: Majority of the patients of gastric outlet obstruction were malignant lesions of stomach and very few are benign. Antral carcinoma of stomach was found to be the commonest etiology of gastric outlet obstruction followed by pyloric stenosis secondary to acid peptic disorders. Most of the patient was in the age group of 40 to 60 years of age, males were affected more than Females.Conclusions: Gastric outlet obstruction in adults, a surgical problem of either sex, results commonly due to antral carcinoma or pyloric stenosis secondary to acid peptic disorder.

A clinical study of gastric outlet obstruction

Background:From the standpoint of pathology, the term pyloric stenosis is usually inaccurate at least in adult patients, since the site of obstruction is rarely situated at the pylorus itself but, is more often placed immediately proximal to the spinchter where the diagnosis of carcinoma is most probable or more distally in the duodenal bulb where the cause is almost invariably a duodenal ulcer. The aim was to study infantile hypertrophic pyloric stenosis, benign peptic ulcer and gastric carcinoma and evaluation of electrolyte abnormalities in gastric outlet obstruction, to study various modalities of treatment and to assess pertaining to recovery from paralytic ileus. Methods: This was a clinical observational study comprising of 40 cases of gastric outlet obstruction. The patients for this study have been selected from Prathima Institute of Medical Sciences, Karimnagar, Telangana, India from December 2013- November 2015. The cases were selected who were willing to undergo surgery.Results:Congenital hypertrophic pyloric stenosis (CHPS) is more common among first born male infants. Parental consanguinity is associated with increased incidence of congenital hypertrophic pyloric stenosis. CHPS is common in the age group of first 3-6 weeks of life (average 4 weeks). Males are more commonly affected with gastric outlet obstructions in adults. Cicatrized duodenal ulcer is more common in the age group of 30-40 years, while carcinoma stomach is more common in age group of 50-60 years. Vomiting and visible gastric peristalsis are the most common and constant symptom and sign of gastric outlet obstruction, more so in cases of cicatrized duodenal ulcers.Conclusions:Ramstedt’s pyloromyotomy is the gold standard treatment for CHPS. Patients with gastric outlet obstruction due to cicatrized duodenal ulcer require truncal vagotomy with posterior gastrojejunostomy. Vagotomy is optional in view of better response with drugs for APD. Antral carcinoma cases require curative or palliative surgery depending on the stage of the disease.

Trends in gastric cancer incidence: a period and birth cohort analysis in a well-defined French population.

The incidence of gastric cancer has declined over the past decades. Little is known about trends by site and histological subtype. The aim of this study was to analyze changes in gastric cancer incidence patterns in a French well-defined population. Data on patients with an epithelial gastric cancer diagnosed between 1982 and 2011 were collected by the population-based digestive cancer registry of Burgundy (n = 4694). Time trends in gastric cancer incidence by period of diagnosis and birth cohort were analyzed by sex, subsite, and histological type. There was a decrease in incidence rates for antral carcinomas (-2.6 % per year in males, -2.5 % per year in females; p < 0.001) and corpus carcinomas (-3.3 % and -3.2 %, respectively; p < 0.001). Annual percentage changes were not significant for fundus carcinomas in both sexes and cardia carcinoma in females, although they increased in males (+1.0 % per year; p < 0.02).When comparing the 1900 cohort and the 1950 cohort, there was a five- to sevenfold decrease in the cumulative risk at 0-79 years for corpus and antral carcinomas in both sexes and a threefold decrease for fundus carcinomas. There were minor variations for cardia carcinomas. There was a decrease of incidence both by period of diagnosis and by birth cohort for adenocarcinoma and colloid carcinoma. It was more marked for undifferentiated carcinoma. The variation for signet-ring carcinoma was minor. Temporal variations in incidence rates of gastric cancer differed according to subsite and histology, suggesting different etiological factors. Available analytical studies provide an explanation for the reported trends by subsite.

EXAMINATION OF EAR, NOSE &amp; THROAT IS MANDATORY IN A CASE OF PROPTOSIS

Aim : To report an interesting case of Proptosis wherein clinical diagnosis can be made without even doing imaging of Orbit. Materials and Methods: A case of proptosis presented at Gandhi Hospital department of Ophthalmology after thoroughly examining we came to the clinical conclusion of Maxillary Antral Carcinoma or Fungal granuloma of Maxillary sinus involving orbit and oral cavity. Results & Discussion: Proptosis is not only caused by ocular or orbital conditions but also by diseases of para nasal air sinuses. Conclusion: Clinical diagnosis can be arrived at by examining a case of proptosis which should include examination of Ear, Nose and Throat of the patient. Key words: Proptosis, ENT exam, Maxillary antral carcinoma.

Primary antral carcinoma managed by en-bloc radical maxillectomy with orbital exenteration

The prognosis of maxillary sinus carcinomas is not very promising. Maxillary sinus carcinomas are usually diagnosed at advanced stages and the proximity of important organs such as the eyes and cranial nerves makes complete surgical resection difficult. We here present a case that presented late with squamous cell carcinoma and was treated by radiotherapy (RT) followed by radical maxillectomy with en-bloc orbital exenteration. Patients who undergo RT followed by en-bloc radical maxillectomy with orbital exenteration as salvage, in these cases may have promising results. We had raised forehead fascio cutaneous flap and translocated it deep to the upper eyelid to bridge the cutaneous defect. Forehead defect was covered with split-thickness skin taken from left thigh. No microvascular surgery was done, but cosmetic results were comparable. In rural setups of developing countries where facilities for microvascular surgery are lacking flap translocation may have a positive outcome.

X-ray and CT presentation of advanced gastric carcinomas of different locations

We presented the X-ray and CT findings characteristic for gastric cancers of different localizations (localized in different parts of the stomach). Particularly, esophagogastric junction (EGJ) carcinomas and antral carcinomas are singled out, as two localizations of gastric cancer that we usually meet in everyday clinical and radiological practice, and which have completely different radiological presentation. Advanced carcinomas of esophago-gastric junction, whose incidence is on the rise, usually affect the distal segment of the esophagus, cardia, and proximal part of the stomach, in different proportions. Siewert's, and the Japanese classification of these tumors are listed. Due to the involvement of the distal esophagus, scanning region, besides the abdomen, should be expanded to the chest. Advanced cancer of the antral part of the stomach is presented by the X-ray as a fungating, infiltrative, or combined form, often capturing the entire wall circumference. Possible infiltration of the left liver, the body and neck of the pancreas, colon and anterior abdominal wall should be estimated by CT.

Clinical changing trend in gastric cancer: a review on 437 patients

Objective To study the clinical changing trend in gastric cancer. Methods 437 cases of gastric cancers diagnosed by gastroscopy and pathology during the period from January 1975 to December 2004 were selected. The patients were divided into three groups according to the diagnosis time. Group Ⅰ comprised 66 patients from 1975 through 1984,group Ⅱ consisted of 198 patients from 1985 through 1994,and group m included 173 patients from 1995 through 2004. Statistical comparison analysis was performed according to the gastroscopically detected rate, sex ratio, locational distributions, histological type of gastric cancer. Results The gastrocopically detected rate of gastric cancer was 4.5 % in group Ⅰ ,2.6% in group Ⅱ ,and 1.7 % in group Ⅲ ,respectively, P 〈 0. 005. There was no change in the male：female ratio among three groups. There was an increase in the proportion of cardia carcinoma in group m （26 % ） compared with group Ⅰ （13.6 % ） and group Ⅱ （21.7 % ）, with a corresponding decrease in the proportion of antral carcinoma in group m （30.1% ） compared with gorup Ⅰ（43.9 % ） and group Ⅱ（30.3%）,the proportion of well and moderate adenocarcinoma in group Ⅰ,Ⅱ andⅢ was 36.4% ,30.3% and 30.6 %, respectively（ P 〉 0.05）. While poor adenocarcinoma in the three groups was 45.5 % ,54 % and 50.9 %, respectively（ P 〉0.05）. Whereas the incidence rates of undifferentiated carcinomas and of other histological types remained quite stable. Conclusions The gastroscopically deteceted rate of gastric cancer decrease in this period. The male：female ratio doesn＇t change significantly. There is a trend in location of gastric cancer towards proximal stomach. The proportions of well-moderate adenocarcinoma and undifferentiated cancer decrease with an increase in the proportion of poor differentiated adenocarcinoma. But there is no significant difference among them, especially in recent twenty years. Key words: gastric cancer; Changing trend

MDM2 Promoter Polymorphism Is Associated With Both an Increased Susceptibility to Gastric Carcinoma and Poor Prognosis

Recently, a single-nucleotide polymorphism in the MDM2 promoter (SNP309) has been found to lower the age of onset of tumors and increase the occurrence of multiple primary tumors in Li-Fraumeni syndrome, and accelerate the development of sporadic adult soft tissue sarcoma. The aim of this study was to determine whether SNP309 is associated with susceptibility to gastric carcinoma and its prognosis. In a case-control study including 438 controls and 410 patients with sporadic gastric carcinoma, MDM2 SNP309 was genotyped. Serum pepsinogens (PGs) I and II were measured in 438 control subjects and 253 cases selected from 410 patients. Tumor tissue was immunostained with p53 and examined for mutations in exons 5 to 8 of p53 using polymerase chain reaction-based single strand conformational polymorphism analysis and direct sequencing. The risk of overall gastric carcinoma for SNP309 (G/G) was significantly increased when compared with T carriers (P = .039), especially carcinomas with extragastric tumors (P = .005), carcinoma with severe atrophic gastritis positive for PG assay (PG I level < 70 ng/mL and PG I/II < 3.0; P = .005), antral carcinoma (P = .020), intestinal-type carcinoma (P = .023), p53-immunopositive carcinoma (P = .007), and carcinoma with p53 mutations (P = .007). No significant difference in age at diagnosis was observed among genotypes. SNP309 (G/G) was an independent marker of poor overall survival in advanced carcinoma (hazard ratio, 3.16; 95% CI, 1.22 to 8.20; P = .018). This study provides evidence supporting the association of SNP309 with gastric carcinogenesis via p53 tumor suppressor pathway, extragastric tumorigenesis, and poor prognosis.

Helicobacter felis Eradication Restores Normal Architecture and Inhibits Gastric Cancer Progression in C57BL/6 Mice

The impact of Helicobacter eradication therapy on the progression or regression of gastric lesions is poorly defined. This study examined the effects of eradication therapy on inflammation, atrophy, metaplasia, dysplasia, and cancer progression. C57BL/6 mice were infected with Helicobacter felis and received bacterial eradication therapy after 2, 6, or 12 months of infection. The gastric mucosa was examined at early, mid, and late intervals after eradication and graded for histology, expression pattern of alpha-catenin and beta-catenin, and IQGAP1. Eradication of Helicobacter infection after 2 or 6 months of infection led to a regression of inflammation, restoration of parietal cell mass, and reestablishment of normal architecture. Progression to adenocarcinoma was prevented. Bacterial eradication at 1 year was associated with the reappearance of parietal cells, partial regression of inflammation, and restoration of architecture. Hyperplasia scores significantly improved, and dysplasia did not progress. Infected mice developed antral adenocarcinoma and gastric outlet obstruction by 24 months. Only 30% of the mice receiving bacterial eradication therapy at 12 months developed antral carcinoma. Bacterial eradication at any time during the first year of infection prevented death due to gastric outlet obstruction. The expression pattern of alpha-catenin, beta-catenin, and IQGAP1 varied with cell type and paralleled histologic changes. Inflammation, metaplasia, and dysplasia are reversible with early eradication therapy; progression of dysplasia was arrested with eradication therapy given as late as 1 year and prevented gastric cancer-related deaths.

En bloc resection of the primary tumour and cervical lymph nodes through the parapharyngeal space in patients with squamous cell carcinoma of the maxilla: a preliminary study

We retrospectively studied 72 patients with maxillary carcinoma (48 of the gingiva, 22 of the antrum, and one each of the hard palate and maxillary bone). The 5-year survival was 73% for those with gingival carcinoma, and 45% for those with antral carcinoma. Nine patients died of local recurrence, three of cervical metastases, six of distant metastases, and five died of metastases in lateral retropharyngeal nodes despite successful control of local and regional disease. We have recently done en bloc resections of the maxilla and cervical lymph nodes through the parapharyngeal space for patients with posteriorly invasive maxillary cancer accompanied by lymph node metastases in the upper jugular region.

Effects of erythromycin and metoclopramide on surgical patients with acute gastroparesis

We explored the effect of intravenous erythromycin and metoclopramide on gastric emptying in patients with acute gastroparesis who had undergone Billroth 1 resection (BI) for gastric antral carcinoma or had acute pancreatitis (AP). We studied 15 patients with acute gastroparesis (8 with AP, 7 following BI), who received intravenous metoclopramide (0.2mg/kg) B.I.D. for 4 consecutive days. After 24hr, the patients who did not respond to metoclopramide were given intravenous erythromycin (3mg/kg) B.I.D. for 4 consecutive days. All patients underwent scintigraphic assessment of gastric, emptying (GE) before and after metoclopramide as well as after erythromycin using a 99mTc-sulfur colloid radio-labeled non nutrient liquid meal. Gastric half-emptying time (T1/2), residual percentage at 2 hr (RP), symptoms score (SS) as well as amount of nasogastric output (NGO) were adopted. GE in 4 patients with AP after metodopramide was more rapid (T1/2 93.2 +/-45.7rain vs 132 5 +A47.6min, and RP 64.6+/-27.5% vs 87.1 +/-11.6%, p 0.05). These 11 patients were given intravenous erythromycin. GE markedly accelerated and the amount of gastric output and SS significantly reduced compared to before erythromycin, in 4 patients with AP (T1/2 47.8 + A2 6rain vs 135 8 + / 1 4 1 min, RP 28.8 +/-4.1% vs 93.3 + A 4.5%, NGO 312 5 +/-62.9ml vs 1040.0+/-177.2ml, and SS 3 .8+/-1 .7 vs 6 .2+A2.0, p<0.O1), in patients with BI (T]/2 61 +/-21.7rain vs 106.0 +A18.7min, RP 50.0 +/-15.6% vs 865 +/-4. 1%, NGO 4333 +/]81.7ml vs 932.0 +/-70.5 ml, and SS 4 0 +/-1.5 vs 6.4 +/1.7, p < 0 01). One patient with BI discontinued erythromycin due to vomiting, 2 patients with BI did not respond to erythromycin. These three patients were treated with intravenous fluids only until symptoms resolved on 16th, 20th and 13th days respectively. Both erythromycin and metoclopramide significantly enhance GE in many patients with AP induced acute gastroparesis, and improves patient symptoms. Erythromycin was effective in the majority of patients with acute gastroparesis following B1 for antral cancer, but metoclopramide was not. We suggested that acute gastroparesis following BI resection and AP might be attnhuted to different mechanisms. Acute gastroparesis following BI resection may be a selflimiting disorder.

Maxillary antral carcinoma. A five year Study at the Lagos University teaching hospital (LUTH) Nigeria

Maxillary antral carcinoma. A five year Study at the Lagos University teaching hospital (LUTH) Nigeria

Transpyloric spread of gastric tumors: comparison of adenocarcinoma and lymphoma.

Our objective was to determine the relative frequency of transpyloric tumor spread in gastric antral carcinoma and lymphoma. We reviewed the medical records of 127 cases of pathologically proven gastric malignant tumors, including 102 carcinomas and 25 lymphomas, over a 10-year period. The antrum had carcinoma in 64 cases and lymphoma in 15. We reviewed upper gastrointestinal barium studies and correlated the findings of transpyloric tumor extension with the results of surgery, pathology, and endoscopy. Tumor extension into the duodenal bulb occurred in 16 (25%) of 64 patients with carcinoma and in six (40%) of 15 patients with lymphoma of the gastric antrum. Transpyloric spread of antral carcinoma as revealed by barium study was much more common in our series than has been stated in the literature. Duodenal invasion of an antral carcinoma is not rare. Because of the higher incidence of carcinoma, transpyloric spread of gastric tumor as revealed by barium studied should not by itself suggest the diagnosis of lymphoma.