OBJECTIVETo investigate the impact of dissected lymph node number on the prognosis of patients with advanced cancer of cardia and stomach fundus.

METHODSClinical data of 236 patients with advanced cancer of cardia and stomach fundus undergone D(2) radical resection were reviewed retrospectively. Five-year survival rate and post-operative complication rate were followed up and their relationships with dissected lymph node number were analyzed respectively.

RESULTSThe 5-year survival rate of the entire cohort was 37.5%. Among those patients with the same stage, the more lymph nodes (LNs) resected, the better survival outcomes achieved(Log-rank trend test P=0.0013). A cut point analysis yielded the ability to detect the significant survival differences. The best long-term survival outcomes were observed with LN counts of more than 20 for stage II(P=0.0136), more than 25 for stage III(P<0.0001), more than 30 for stage IV(P=0.0002) or more than 15 for the entire cohort (P=0.0024), with greatest comparative discrepancies. The post-operative complication rate was 15.7% and was not significantly correlated with dissected lymph node number(P=0.101).

CONCLUSIONSThe prognosis of patients with advanced cancer of cardia and stomach fundus is associated with the number of resected LNs when D(2) lymphadenectomy is carried out. Suitable increment of dissected lymph node number would not increase the post-operative complication rate.

Adult ; Aged ; Cardia ; pathology ; Female ; Gastric Fundus ; pathology ; Humans ; Lymph Node Excision ; Lymph Nodes ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; surgery

OBJECTIVETo probe into the method for effectively increasing complete abortion rate of medicine-induced abortion and observe pathological changes.

METHODSTwo hundred cases were randomly divided into an observation group and a control group, 100 cases in each group. The observation group were treated by acupuncture at Hegu (LI 4), Sanyinjiao (SP 6), Neiguan (PC 6) and Kunlun (BL 60), and the control group were not treated by acupuncture. The abortion rate, bleeding condition, adverse reaction and pathological changes were observed in the two groups.

RESULTSThe complete abortion rate was 96.0% in the observation group, better than 88.0% in the control group (P < 0.05). There were significant differences between the two groups in bleeding time and pathological changes (P < 0.05).

CONCLUSIONAcupuncture can increase complete abortion rate of medicine-induced abortion, with shorter bleeding time and less residual villus.

Abortion, Induced ; Acupuncture Therapy ; Female ; Humans ; Pregnancy

OBJECTIVETo explore the molecular mechanism of dutasteride inhibiting fertility by studying its effects on the expressions of the epididymal epithelial junction proteins Claudin1 and β-catenin in rats.

METHODSSixteen 3-month-old SD male rats were equally divided into an experimental and a negative control group to be treated intragastrically with dutasteride at 40 mg/kg per day and the same dose of solvent, respectively, for 14 consecutive days. Then, the sperm motility and morphology of the rats were detected by computer-assisted sperm analysis, the serum levels of testosterone (T) and dihydrotestosterone (DHT) measured by ELISA, changes in the tight junction of epididymal cells observed under the transmission electron microscope, the protein and gene expressions of Claudin1 and β-catenin determined by RT-PCR and immunohistochemistry, and the conception rate of the mated female rats calculated.

RESULTSDutasteride significantly suppressed the serum DHT level, sperm motility, and fertility of the rats (P <0.05). Interspaces between epididymal epithelial cell tight junctions were observed, the volume of epididymal fluid obviously increased, and the expressions of Claudin1 and β-catenin gene and protein remarkably downregulated in the experimental rats (P <0.05).

CONCLUSIONDutasteride can significantly inhibit the fertility of male rats by reducing the serum DHT level, suppressing Claudin1 and β-catenin expressions, and damaging epididymal epithelial cell junctions.

Animals ; Azasteroids ; pharmacology ; Claudin-1 ; metabolism ; Dihydrotestosterone ; blood ; Dutasteride ; Epididymis ; drug effects ; metabolism ; Female ; Fertility ; drug effects ; Humans ; Intercellular Junctions ; drug effects ; Male ; Rats ; Rats, Sprague-Dawley ; Sperm Motility ; drug effects ; Testosterone ; blood ; Urological Agents ; pharmacology ; beta Catenin ; metabolism

OBJECTIVETo explore the pattern of solitary lymph node(LN) metastasis in gastric cancer and its prognosis.

METHODSThe clinical records of 83 patients with gastric cancer presenting solitary LN metastasis who underwent D2 radical resection from January 1995 to December 2003 were analyzed retrospectively. The precise stations of the metastasis of LN and their correlation with the location of primary tumor were studied. The 5-year survival rates were compared between patients with and without skipping LN metastasis. The prognostic factors were evaluated by using univariate and multivariate analyses.

RESULTSAmong the 83 patients with pathologically proven solitary LN metastasis, 64 cases (77%) presented with the perigastric nodes metastasis (N1 area), and 19 cases (23%) in N2 area without N1 involvement (skipping LN metastasis). For tumors in the upper and middle third stomach, the No. 3 station was the most common first metastasized LN station (40% and 42%, respectively). While for tumors in the lower third stomach, the No.6 station was the mostly affected LN (33%). Of the patients, 77 cases were followed up for 5-14 years, the median survival time was 77.0 months, and the overall 5-year survival rate was 63%. The 5-year survival rates of the patients with and without skipping LN metastasis was 52% and 67% respectively, there was no significant difference between the two groups (P>0.05). The serosal invasion and pathological types were influencing factors of the 5-year survival rate on univariate analysis. But with multivariate analysis, only the serosal invasion was an independent factor affecting the survival.

CONCLUSIONSPerigastric nodes are the most common first sites of tumor metastasis, making them the main targets of operative sentinel lymphatic mapping procedures. The patients with serosal invasion have poorer prognosis.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo investigate the impact of solitary lymph node (LN) metastasis on the prognosis of gastric cancer.

METHODSClinical data of 280 patients with gastric cancer who underwent D(2) radical resection from January 1995 to December 2003 were analyzed retrospectively. Among them, solitary LN metastasis was proven pathologically in 83 cases(solitary LN metastasis group), while node-negative metastasis proven in 197 cases (node-negative group). The 5-year survival rate was compared between two groups and between patients with and without skipping LN metastasis. The prognostic factors were evaluated by uncaria and multivaria analyses.

RESULTSThe 5-year survival rates in the solitary LN metastasis group and the node-negative group were 62.3% and 83.5% respectively with significant difference (P<0.05). The solitary LN metastasis was one of the independent prognostic factors. Logistic regression revealed that the invasion depth was an independent covariate for solitary LN metastasis. The proportion of skip metastasis was 22.9% in gastric cancer patients with solitary LN metastasis. The 5-year survival rates of the patients with and without skipping LN metastasis were 50.0% and 66.1% respectively, which was not significantly different (P>0.05).

CONCLUSIONSThe prognosis of patients with solitary LN metastasis is significantly poorer than those without lymph node metastasis. Due to the high incidence of skip LN metastasis in gastric cancer, D(2) radical resection should be performed to ensure oncological clearance.

Aged ; Factor Analysis, Statistical ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

OBJECTIVETo compare the number of retrieved lymph nodes (LN) between laparoscopic resection and conventional open resection for early distal gastric cancer with meta-analysis.

METHODSOriginal articles published from January 2000 to December 2008 were searched in the MEDLINE, EMBASE and Cochrane Controlled Trials Register. According to the criterion, 14 articles were identified which compared the number of retrieved lymph nodes between laparoscopic resection and conventional open resection for early distal gastric cancer. Data were extracted from these trials by 3 reviewers independently and analyzed by Rev Man 5.0 software.

RESULTSA total of 1454 patients with early gastric cancer were enrolled, including 815 patients in the laparoscopic group and 630 patients in the conventional group. The mean number of dissected lymph nodes per patient was 3.26 less in the laparoscopic group as compared to the conventional group (WMD -3.26,95% CI -6.24~-0.27,P=0.03). The differences were not statistically significant in the articles published during 2005-2008 years (WMD -2.84, 95% CI -6.79~1.11, P=0.16), in D(1)(+)alpha/beta lymph node dissection (WMD -2.80, 95% CI -7.57~1.97, P=0.25), and in retrospective non-randomized trials (WMD -2.89, 95% CI -6.48~0.70,P=0.11).

CONCLUSIONWith the improvement in surgical skills, laparoscopic surgery and open surgery do not differ significantly in the number of retrieved lymph nodes for early distal gastric cancer with D(1)(+)alpha/beta lymph node dissection.

Gastrectomy ; Humans ; Laparoscopy ; Laparotomy ; Lymph Node Excision ; Lymph Nodes ; pathology ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo investigate the long-term correlation between the number of resected lymph nodes (LNs) and the prognosis of patients with node-negative gastric cancer.

METHODSFrom January 1995 to December 2004, 221 patients with gastric cancer underwent D2 radical resection and were proved with no nodal involvement. The clinical records of the patients were analyzed retrospectively. The relationships of the dissected LNs number to 5-year survival rate and post-operative complication rate were analyzed respectively.

RESULTSThe overall 5-year survival rate of this group was 83.5%. The total number of dissected LNs was one independent prognostic factors in this group. Among patients with the same depth of tumor invasion, the more the number of dissected LNs, the better the survival would be (P < 0.05). The patients had better long-term survival outcomes with dissected LNs counts of more than 15 for cases with pT1-2 tumor, and more than 20 for cases with pT3 tumor. The post-operative complication rate was 10.8% and it was not significantly correlated with the number of dissected lymph nodes (P > 0.05).

CONCLUSIONSThe number of dissected LNs is an independent prognostic predicting factor for lymph node-negative gastric cancer. Sufficient dissection of LNs is recommended to improve the patients' long-term survival. Suitable increment of dissected LNs count would not increase the post-operative complication rate.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo investigate the prognostic factors of surgical treatment for the cancer of stomach fundus and cardia with invasion to body and tail of the pancreas.

METHODSA total of 135 patients with cancer of stomach fundus and cardia invading body and tail of the pancreas undergone surgical treatment were enrolled in this study. Twenty of them underwent laparotomy, while 115 underwent gastrectomy with pancreaticosplenectomy, even combined with the resection of other organs for macroscopic invasion to adjacent organs during surgery. The 3-,5-year survival rates, morbidity of postoperative complications and mortality were followed up. The prognostic factors were evaluated by univariate and multivariate analyses.

RESULTSThe median survival time of the patients undergone laparotomy was 4.7 months, of patients treated by gastrectomy combined with pancreaticosplenectomy was 30.5 months,and the difference was significant (chi(2)=403.8, P<0.01). The cumulative 3- and 5-year survival rates of the patients treated by gastrectomy combined with pancreaticosplenectomy were 48.3% and 26.6% respectively. Univariate analysis revealed that significant differences in prognosis of 115 patients undergone combined resection were demonstrated for the following factors: maximal dimension of tumor, macroscopic type, extent of lymph node metastasis according to the Japanese classification, No.10 or No.11 lymph node metastasis,curability and number of invaded organs.And histological depth of invasion, extent of lymph node metastasis according to the Japanese classification, number of invaded organs and curability were significant prognostic factors, examined as variables by multivariate analysis (Cox's proportional hazard model, forward stepwise selection LR method). The postoperative complication rate and mortality of 135 patients were 20.0% and 3.5% respectively.

CONCLUSIONSFor cancer located in stomach fundus and cardia with limited invasion to distal pancreas, gastrectomy combined with pancreaticosplenectomy should be performed to improve long-term outcomes. Best long-term survival outcomes would be attained if there are no lymph node metastases, or no incurable factors, or no other organ invasions.

Adult ; Aged ; Cardia ; pathology ; surgery ; Female ; Follow-Up Studies ; Gastric Fundus ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreas ; surgery ; Prognosis ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVETo analyze the efficacy and influence of D2 radical resection combined with splenectomy in T3 cancer of upper stomach.

METHODSFrom January 1980 to June 2002, 613 patients with T3 cancer of upper stomach received D2 radical resection. Of these cases, 102 underwent simultaneous splenectomy (splenectomy group), while 511 did not (spleen-preserved group). The metastatic rate of lymph nodes in splenic hilum and along the splenic artery (No. 10, No. 11), 5-year survival rates, recurrence rate, the postoperative complication rate and mortality rate were followed up and compared in the two groups.

RESULTSThe metastasis rate of No. 10 was 23.5% for splenectomy group and 14.9% for spleen-preserved group (P < 0.05). No significant difference was found in No. 11 metastasis between the two groups. The 5-year survival rate of splenectomy group was 39.8%, and was 32.3% in spleen-preserved group (P > 0.05). The recurrence rate of splenectomy group was 55.9%, and was 60.3% in spleen-preserved group (P > 0.05). In the splenectomy group, the 5-year survival rates were similar between patients with and without No. 10 metastasis (P > 0.05). The postoperative complication rate and mortality rate of the splenectomy group were 19.6% and 4.9%, and were 13.7% and 3.1% in the spleen-preserved group, respectively; and no significant difference was found between the two groups (P > 0.05).

CONCLUSIONSD2 radical excision combined splenectomy should be recommended for stage T3 cancer of upper stomach when suspected with No. 10, No. 11 lymph nodes metastasis. Simultaneous splenectomy would not increase the postoperative complication rate and mortality rate.

Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Lymph Node Excision ; Male ; Prognosis ; Splenectomy ; Stomach Neoplasms ; pathology ; surgery ; Survival Analysis ; Treatment Outcome

OBJECTIVETo investigate the diagnosis and treatment of ovotesticular disorders of sex development (DSD) in children.

METHODSWe reviewed the clinical data of 9 cases of ovotesticular DSD admitted in our department from 1988 to 2007.

RESULTSThe patients ranged in age from 9 months to 9 years, 7 raised as males and 2 as females. As for the karyotype, 4 cases were 46,XX, 2 were 46,XX/46,XY, 1 was 46,XY, and the other 2 had no karyotype data. All of them presented with obscure external genitalia: perineal or penoscrotal hypospadias with or without cryptorchidism in males and hypertrophy of the clitoris in females. They were diagnosed with ovotesticular DSD by gonad biopsy and underwent genitoplasty.

CONCLUSIONThe gender assignment of the ovotesticular DSD patient was chiefly based on the development of external genitalia, dominant gonad, karyotype and the parent's will. Laparoscopic technology is recommended in gonad biopsy and orchiopexy during the treatment of ovotesticular DSD.

Child ; Child, Preschool ; Disorders of Sex Development ; diagnosis ; surgery ; Female ; Humans ; Infant ; Laparoscopy ; Male ; Retrospective Studies ; Sexual Development