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PurposeRadiotherapy is a very effective adjuvant treatment for rectal cancer with little side effects. Its killing effect on tumor cells seems to be more profound than the effect on normal tissue. The molecular events caused by irradiation are mainly analyzed in in vitro and animal models; investigations on human material are rare. In the current study, we analyzed the effects of irradiation on gene expression in normal and tumor tissue of rectal cancer patients.Methods and materialsNormal and carcinoma tissue of patients from a randomized clinical trial of the benefits of preoperative radiotherapy were analyzed using the Affymetrix Human Cancer Gene Chip. Preoperative radiotherapy was given within 5 days prior to surgery. Results for normal tissue and tumor were compared to investigate the radiation-related differences between normal and tumor cells. We clustered the differentially expressed genes based on their functional annotation. Results were compared with immunohistochemical and literature data.ResultsThe majority of the investigated cancer-related genes remained unchanged by irradiation (92% in tumor tissue and 93% in normal tissue). The differentially expressed genes varied between tumor and normal tissue except for maspin and IL-8. Both in tumor and normal tissue, differentially expressed genes were present related to cell signaling and cycle control, apoptosis and cell survival and tissue response and repair. However, the spectrum of affected genes was totally different.ConclusionPre-existing differences in gene expression between normal tissue and tumor tissue might explain the differences in their responses to radiation. This change in response may explain the clinical beneficial effect of radiotherapy on tumor cells (low local recurrence rate) and the less severe effects on normal tissue (minor side effects).

Immunohistochemical detection of expression of the anti-apoptotic Bcl-2 protein is widely studied as a putative prognostic and predictive factor in various types of cancer. For that purpose, heating for 10 min by microwave (MW) up to 100o C in citrate buffer, pH 6.0, prior to immunostaining is often used to retrieve Bcl-2 antigens in archival formalin-fixed, paraffin-embedded tissue. We recently reported that Bcl-2 is not only a cytoplasmic protein, but that it is present also in interphase nuclei and that it strongly associates with mitotic chromosomes. Furthermore, we showed that binding of the monoclonal antibody (MAb) #124 with nuclear/chromosomal epitopes is diminished by formaldehyde-based fixatives and cannot be restored by MW treatment for 10 min. Here we report that prolonged MW heating or heating up to 130°C in a high pressure cooker (HPC), despite improved cytoplasmic immunostaining, fails to retrieve nuclear/chromosomal Bcl-2 epitopes recognized by the MAb #124 in human tissues. In contrast, these procedures can retrieve nuclear/chromosomal Bcl-2 epitopes detected by polyclonal #15616E antibodies in rat tissues. The specificity of these epitopes was confirmed by Western blot analysis of tissues treated by MW heating or HPC.

Observations support the theory that development of left‐ and right‐sided colorectal cancers may involve different mechanisms. This study investigated different genes involved in oncogenesis of colon and rectal cancers and analysed their prognostic value. The study group comprised 35 colon and 42 rectal cancers. Rectal cancer patients had been treated with standardized surgery performed by an experienced rectal cancer surgeon. Mutation analysis was performed for p53 in eight colon cancers and for APC and p53 in 22 rectal cancers. MLH1, MSH2, Bcl‐2, p53, E‐cadherin and β‐catenin were investigated by immunohistochemistry in all colorectal tumours. APC mutation analysis of the MCR showed truncating mutations in 18 of 22 rectal tumours (82%), but the presence of an APC mutation was not related to nuclear β‐catenin expression (p=0.75). Rectal cancers showed significantly more nuclear β‐catenin than colon cancers (65% versus 40%, p=0.04). p53 mutation analysis corresponded well with p53 immunohistochemistry (p<0.001). Rectal cancers showed significantly more immunohistochemical expression of p53 than colon cancers (64% versus 29%, p=0.003). In rectal cancers, a significant correlation was found between positive p53 expression and worse disease‐free survival (p=0.008), but not in colon cancers. Cox regression showed that p53‐expression (p=0.03) was an independent predictor for disease‐free survival in rectal cancers. This study concluded that rectal cancer may involve more nuclear β‐catenin in the APC/β‐catenin pathway than colon cancer and/or nuclear β‐catenin may have another role in rectal cancer independently of APC. The p53‐pathway seems to be more important in rectal cancer, in which it also has independent prognostic value. When prognostic markers are investigated in larger series, differences in biological behaviour between colon and rectal cancer should be considered. Copyright © 2001 John Wiley & Sons, Ltd.

Abstract:  Purpose : The oxidant-antioxidant balance within tissues is thought to contribute to the development and progression of cancer. Previous investigations have indicated changes in this balance during the colorectal oncogenic process that merit further investigation. The aim of the present study was to evaluate whether the human colorectal cancer sequence is accompanied by changes in the protein and activity levels of the antioxidant enzymes manganese- and copper/zinc-superoxide dismutase (Mn-SOD and Cu/Zn-SOD). Patients and methods : SOD levels were assessed in colorectal adenomas, carcinomas, and liver metastases and were compared with those in the corresponding normal tissues (n=35 in each group). Mn- and Cu/Zn-SOD expression was first evaluated semiquantitatively by electrophoretic activity analysis, immunoblotting, and immunohistochemistry and was subsequently quantified by enzyme-linked immunosorbent assays (ELISAs) and spectrophotometric activity assays. Results : The semiquantitative analyses showed enhanced Mn-SOD levels, primarily localized in (neoplastic) epithelial cells, in carcinomas, and in liver metastases as compared with adenomas and normal mucosa, whereas no consistent pattern was observed for Cu/Zn-SOD. Normal liver tissue expressed the highest levels of both SODs. The quantitative SOD analyses confirmed these observations and revealed that carcinomas and liver metastases expressed 2–4 times more Mn-SOD protein and enzymatic activity (0.0005 < P ≤ 0.01) than did the normal mucosa. Adenomas expressed intermediate Mn-SOD levels, which increased significantly with the diameter and tended to increase with the grade of dysplasia and presence of a villous component. In contrast, adenomas, carcinomas, and the corresponding normal mucosa were found to have a similar Cu/Zn-SOD content, whereas liver metastases contained significantly (P < 0.02) more Cu/Zn-SOD as compared with these tissues. In addition, the Cu/Zn-SOD content was not related to any histopathological characteristic of the carcinomas or adenomas. Conclusions : Our study indicates that the development of neoplasia in the human colorectum is accompanied by major changes in the level and activity of Mn-SOD. This observation illustrates that Mn-SOD might have a functional role in human colorectal carcinogenesis.

Multivisceral resection has been accepted as treatment for patients with locally advanced colorectal cancer. Nodal status has recently been claimed to be the most important predictor of survival in patients with such disease, with no survival after 2 years for patients with lymph node metastasis. A retrospective analysis was carried out of the prognostic significance of different tumour characteristics, and whether a more limited palliative resection is warranted in patients with positive lymph nodes. Of 1346 patients with colorectal adenocarcinoma operated on between 1987 and 1991, all those with a tumour staged as T4N0M0or T4N1M0(94 patients) were selected. From the remainder, 195 patients with stage T3N0M0and T3N1M0lesions were randomly selected as a control group. Overall survival was assessed at the beginning of 1993. The most important predictors of survival were lymph node status and involvement of the resection margins of the tumour. Overall survival in patients with T4tumours who underwent radical resection was not significantly different from that in those with T3tumours, even in N1stages. Extended resection did not induce unacceptable morbidity or mortality. Surgery for locally advanced colorectal adenocarcinoma should result in tumour-free margins, and should therefore include multivisceral resection, even in patients with lymph node metastasis.

In Japan, R2lymph node dissection is standard practice for all curatively resected gastric cancer patients. From 1969 to 1984, data were collected prospectively to evaluate this procedure and to provide information for a more rational approach to node dissection for each individual case. A total of 3843 cases was included in this study and an evaluation was made of the prognostic variables and lymph node involvement at various locations. Using a computer program, it is possible to compile a group of treated patients, with prognostic variables exactly matching those of an individual patient. Analysis of this group can then give an indication of the extent of lymph node dissection required for an individual patient. This paper gives a demonstration of the structure of such a system by means of an example.

• The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in 169 patients surgically treated for nodular thyroid disease. Patients were divided into three groups with high, moderate, or low suspicion of malignant neoplasms on clinical grounds without previous knowledge of cytologic or histologic results. Histologic examination revealed an overall malignant neoplasm rate of 23%; the rate was 71%, 14%, and 11%for the groups with high, moderate, and low suspicion, respectively. The FNAB diagnostic interpretations of malignant and uncertain were considered positive. Overall sensitivity, specificity, and accuracy for FNAB were 92%, 71%, and 75%, respectively. Sensitivity in the high-, moderate-, and low-suspicion groups was 95%, 89%, and 88%, respectively; specificity was 88%, 72%, and 67%, respectively; and accuracy was 93%, 75%, and 69%, respectively. In our opinion, all patients in the group with high clinical suspicion need surgical treatment whatever the FNAB result; those with lower degrees of clinical suspicion should also undergo surgery.(Arch Intern Med. 1990;150:113-116)

As a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed (p<0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male-female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5-year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach. Whether this approach (i.e., extended lymph node dissection) actually improves survival or merely improves classification, is currently the subject of a prospective randomized trial in The Netherlands.

Apoptosis (programmed cell death) can be difficult to detect in routine histological sections. Since extensive DNA fragmentation is an important characteristic of this process, visualization of DNA breaks could greatly facilitate the identification of apoptotic cells. We describe a new staining method for formalin-fixed, paraffin-embedded tissue sections that involves an in situ end-labeling (ISEL) procedure. After protease treatment to permeate the tissue sections, biotinylated nucleotides are in situ incorporated into DNA breaks by polymerase and subsequently stained with DAB via peroxidase-conjugated avidin. Staining of cells with the morphological characteristics of apoptosis was demonstrated in tissues known to exhibit programmed cell death, i.e., prostate and uterus after castration, tumors, lymph node follicles, and embryos. Apoptotic cells could be discriminated morphologically from areas of labeled necrotic cells, in which DNA degradation also occurs. Because apoptosis is relatively easily recognized in H&E-stained sections of involuting prostates of castrated rats, we used this model system to validate the ISEL method for the quantification of apoptotic cells. A high correlation was found between the fractions of ISEL-labeled cells and the fractions of apoptotic cells that were morphologically determined in adjacent sections. We conclude that ISEL is a useful technique for quantification of apoptosis in paraffin sections, especially for those tissues in which morphological determination is difficult. Furthermore, this new staining method enables the use of automated image cytometry for evaluating apoptosis.

The only currently available, potentially curative treatment of hepatic metastasis is resection. With a reported 5-year survival rate of 30% this has become an accepted treatment for this condition. An overview of clinical experience in prevention, early diagnosis, and selection criteria for and treatment of patients with liver metastasis in The Netherlands is given. Results indicate a slow but steady improvement in understanding the disease, with benefit for the patient.

The controversy over the value of extended lymph node dissection for treatment of gastric cancer is fiercely debated. Whereas Japanese surgeons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe that their results only reflect differences in the prevalence of prognostic factors, inconsistencies between Japanese and Western staging systems, and the phenomenon of “stage migration,” which occurs with extensive resection. Two small randomized prospective trials from Hong Kong and Cape Town showed a tendency toward high morbidity with extensive lymph node dissection but no survival benefit. In contrast, the recently completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The long-term results of the still ongoing randomized MRC and Dutch trials are therefore eagerly awaited. La controverse concernant le curage ganglionnaire étendu dans le traitement du cancer gastrique est vivement débattue. Alors que les chirurgiens japonais clament que la survie est améliorée justement à cause de l'étendue de la résection (dite D2), beaucoup d'experts de l'Occident croient que cette apparente supériorité reflète seulement la différence dans la prévalence des facteurs pronostiques, les différences des systèmes de classification entre l'Occident et l'Orient ainsi que le phénomène de «migration de stade» qui est une conséquence des résections étendues. Deux essais randomisés provenant de Hong Kong et du Cap ont démonté une tendance vers une morbidité élevée en cas de dissection plus poussée mais sans supériorité de survie. En contraste, l'étude prospective allemande nommée «German Gastric Carinoma Study» a démontré une nette amélioration de survie par la résection D2 pour les tumeurs de stade II et IIIa sans augmentation de la morbidité ou de la mortalité périopératoires. Les résultats à long terme d'autres essais randomisés, toujours en cours, des groupes MRC et Hollandais, sont attendus avec impatience. La controversia sobre el valor de la disección ganglionar radical en el tratamiento del cáncer gástrico es motivo de fiero debate. En tanto que los cirujanos japoneses proclaman que sus mejores tasas de sobrevida se deben a la resección radical (resección D-2), muchas autoridades de Occidente creen que ello sólo refleja diferencias en la prevalencia de factores de pronóstico, inconsistencias entre los sistemas de estadificación del Japón y de Occidente y el fenómeno de la “migración del estadío” que se observa con las resecciones más extensas. Dos pequeños ensayos clínicos prospectivos y randomizados provenientes de Hong Kong y de la Ciudad del Cabo han demostrado una tendencia hacia una más alta morbilidad con la disección radical y ningún beneficio en cuanto a sobrevida. En contraste, el reciente Estudio Prospectivo Alemán sobre cáncer gástrico demostró clara ventaja con la resección D-2 para los estados II y IIIa sin incremento de la morbilidad y la mortalidad perioperatorias. Los resultados a largo plazo del estudio randomizado MRC y del estudio holandés, que están en progreso, son esperados con gran expectativa.

The phenomenon of experimental lymphatic invasion and metastasis has been reviewed. The invasion of lymphatics must be dependent on the same factors as are involved in neoplastic invasion in generalcell motility, lack of adhesiveness, release of lytic enzymes, increase in cell population and tissue pressure and active migration of cells.

As a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed(p<0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male-female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5-year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach. Whether this approach (i.e., extended lymph node dissection) actually improves survival or merely improves classification, is currently the subject of a prospective randomized trial in The Netherlands. Comme les Japonais ont rapporté une survie augmentée lorsqu'une gastrectomie avec lymphadénectomie étendue a été pratiquée pour cancer gastrique, nous avons entrepris cette étude pour évaluer les facteurs qui pourraient influencer ces résultats. Pour ce faire, 1085 patients du Centre National du Cancer du Japon ont été stratifiés et regroupés selon trois classifications bien connues: la classification TNM ancienne et nouvelle (4è édition) et la classification de la Société de Recherche Japonaise pour l'Etude du cancer gastrique (JRSGC). Aucune différence n'a été retrouvée dans la survie des trois classifications, exception faite pour les cancers stade II, pour lesquels les classifications TNM et JRSGC différaient significativement (p<0.05). Dans une deuxième analyse, l'incidence des facteurs pronostiques les plus importants du cancer avancé a été comparé entre trois centres, le Centre National du Cancer à Tokio (NCC), l'Hôpital Universitaire d'Erlangen (UHE) en RFA, et l'Hôpital Universitaire de Maastricht aux Pays Bas (UHM). Les patients japonais étaient plus jeunes de trois et huit ans, respectivement, par rapport aux patients Allemands et Hollandais et avaient une proportion plus élevée de cancers avancés (T4). Le rapport mâle/femelle, l'histologie et le degré d'invasion lymphatique étaient, par contre, comparables dans les trois groupes. De cette étude, on pouvait s'attendre à des plus mauvais rapport mâle/femelle, l'histologie et le degré d'invasion lymphatique étaient, par contre, comparables dans les trois groupes. De cette étude, on pouvait s'attendre à des plus mauvais résultats chez les patients Japonais. Cependant le taux de survie à 5 ans chez les Japonais était largment supérieur (57%) comparé à ceux de l'UHE (34%) et de l'UHM (31%). La différence de survie entre les classifications TNM et JRSGC, chez les patients stade II, n'est pas suffisante pour expliquer cette différence. Ceci semble souligner la valeur de l'attitude thérapeutique (lymphadénectomie étendue) des Japonais. Pour déterminer si cette attitude améliore réellement le pronostic de ces patients, on a entrepris un essai randomisé, prospectif aux Pays Bas. Como consecuencia de los reportes japoneses sobre mejorar sobrevida de los pacientes con cáncer gástrico luego de extensa disección ganglionar, se emprendió un estudio con el objeto de evaluar los factores que pueden tener influencia sobre tales resultados. La influencia de la estadificación fue valorada mediante la estratificación de 1.085 pacienes del Centro Nacional de Cáncer del Japón y su agrupación de acuerdo a los 3 sistemas más utilizados: el sistema TNM antiguo y el nuevo de la Unión Internacional contra el Cáncer (4aedición) y el sistema de la Sociedad Japonesa de Investigación Sobre Cáncer Gástrico. No se encontró diferencia en la sobrevida entre los estados de los tres sistemas, excepto por el estado II, donde el nuevo sistema TNM y el de la Sociedad Japonesa difirieron (p<0.005). En un segundo análisis se comparó la incidencia de los factores de pronóstico de mayor importancia del cáncer gástrico avanzado en la siguientes tres instituciones: el Centro Nacional de Cáncer de Tokio, Japón (CNC), el Hospital Universitario de Erlangen, Alemania (HUE) y el Hospital Universitario de Maastricht, Holanda (HUM). Los pacientes japoneses aparecieron en promedio 3 años más jóvenes que los alemanes y 8 años más jovenes que los holandeses, y exhibieron una más alta proporción de carcinoms avanzados (T4). La distribución por sexos, la histología y la invasión ganglionar se mnifestarn similares en los tres grupos. Según estos datos, se podría esperar un cierto peor grado de pronóstico en los pacientes japoneses con cáncer avanzado. Sin embargo, las tasas de sobrevida a 5 años demostraron una marcada ventaja en los pacientes japoneses: 57% (CNC) vs 34% (HUE) y 31% (HUM). La diferencia de sobrevida para los pacientes en estado II entre el nuevo sistema TNM y el sistema de la Sociedad Japonesa de estadificación no es suficiente para explicar tal superioridad. Esto resalta la importancia del aproche japonés. En cuanto a si este aproche, o sea la disección ganglionar extensa, realmente mejora la sobrevida o simplemente mejora la clasificación, es motivo de un ensayo prospectivo y aleatorizado actualmente en progreso en Holanda.

The effect of perioperative blood transfusion on the survival rate of patients with gastric cancer was studied. One thousand patients with primary gastric cancer, who had curative surgery performed at the National Cancer Center Hospital in Japan from 1976 to 1981, were studied retrospectively. Overall comparison of transfused (n=371) versus nontransfused (n=629) patients by log rank analysis revealed a statistically significant adverse influence of blood transfusion on survival (p=0.0001). Fifty-seven percent of transfused as compared to 80.8% of nontransfused patients survived for 5 years or more; however, after stratifying patients into stages and applying proportional regression analyses, blood transfusion did not appear to have any effect on prognosis: relative risk ratio, 1.16;p=0.28. Similarly, comparison of patients transfused with more than 600 cc of blood and those transfused with 600 cc of blood or less revealed no statistical difference in survival time.

The effect of perioperative blood transfusion on the survival rate of patients with gastric cancer was studied. One thousand patients with primary gastric cancer, who had curative surgery performed at the National Cancer Center Hospital in Japan from 1976 to 1981, were studied retrospectively. Overall comparison of transfused (n=371) versus nontransfused (n=629) patients by log rank analysis revealed a statistically significant adverse influence of blood transfusion on survival (p=0.0001). Fifty-seven percent of transfused as compared to 80.8% of nontransfused patients survived for 5 years or more; however, after stratifying patients into stages and applying proportional regression analyses, blood transfusion did not appear to have any effect on prognosis: relative risk ratio, 1.16;p=0.28. Similarly, comparison of patients transfused with more than 600 cc of blood and those transfused with 600 cc of blood or less revealed no statistical difference in survival time. It is postulated that the possible adverse influence of blood transfusion on the survival of patients with gastric cancer is linked to other prognostic features rather than to the immunologic sequelae of the transfusion itself. L'effet des transfusions sanguines periopératoires sur la survie des patients ayant un cancer gastrique a été étudié. Mille patients ayant un cancer primitif de l'estomac, ayant subi une résection à visée curative entre 1976 et 1981 au Centre Hospitalier National du Cancer au Japon ont été étudiés rétrospectivement. L'analyse selon la méthode du log rank a montré que la survie des patients ayant eu des transfusions (n=371) était nettement moins bonne que celle des patients qui n'en avaient pas reçues (n=629) (p=0.0001). Parmi les patients ayant reçu des transfusions, la survie à 5 ans était de 57% comparé a 80.8% quand les patients n'en avaient pas reçu (p=0.0001). Après stratification et en appliquant une analyse de régression proportionnelle, la transfusion sanguine ne paraît pas influencer le pronostic. Le rapport de risque relatif était de 1.16 avecp= 0.28. De même, la survie entre les patients ayant eu plus ou moins de 600 ml de sang en transfusion ne différait pas. On postule que les effets nocifs éventuels des transfusions sur la survie des patients ayant un cancer gastrique sont liés à des facteurs pronostiques autres que la conséquence immunologique des transfusions en elles-mêmes. Se estudió el efecto de la transfusión perioperatoria de sangre sobre la tasa de supervivencia en pacientes con cáncer gástrico. Mil pacientes con cáncer gástrico primario que recibieron cirugía curativa en el Hospital Centra Nacional de Cáncer de Japón entre 1976 y 1981 fueron estudiados en forma retrospectiva. La comparación global de los pacientes transfundidos (n= 371) versus los no transfundidos (n=629) reveló una influencia significativamente adversa de la transfusión sanguínea sobre la supervivencia (p=0.0001). Cincuenta y siete por ciento de los pacientes transfundidos y 80.8% de los no transfundidos sobrevivieron 5 años o más; sin embargo, después de estratificar los pacientes según estadio y aplicando análisis proporcional de regresión, la transfusión sanguínea no pareció tener efecto alguno sobre el pronóstico: relación de riesgo relativo, 1.16;p= 0.28. Así mismo, la comparación de los pacientes transfundidos con más de 600 cc de sangre y de los transfundidos con 600 cc o menos de 600 cc no reveló una diferencia estadística en el tiempo de sobrevida. La conclusión es que la administración de sangre homóloga parece no tener influencia sobre la supervivencia a 5 años de pacientes sometidos a cirugía curativa para carcinoma gástrico. Se postula que el posible efecto adverso de la transfusión sanguínea sobre la sobrevida de pacientes con cáncer gástrico está ligada a otros factores de pronóstico más que a las secuelas inmunológicas de la transfusión misma.

A retrospective study was performed on gastric cancer patients admitted to the Cancer Institute Hospital, Tokyo, during the periods 1961–65 (n= 1181) and 1980–84 (n= 1473). The aim of the study was to see whether changes had occurred in gastric cancer patients over the years with respect to histology and tumour localization and, if so, how they compared with reports from the West. The proportion of proximally localized primary tumour increased from 17 to 27 per cent (P= 0·008), and signet-ring cell carcinoma increased from 2 to 22 per cent (P<0·001). These changes were not relative with regard to the declining incidence of intestinal tumours, but absolute. Patients with proximally localized tumours were generally in a more advanced stage of disease than those with distally localized tumours, and thus had poorer survival rates. However, after stratifying into stages, the difference in survival disappeared. The survival rate of patients with signet-ring cell carcinoma was not significantly different from that of patients with other gastric tumours (P>0·05). The discrepancy between the survival rates of Japanese and western gastric cancer patients is attributed by some authors to tumour-related factors. However, we believe that the similar trends found with regard to tumour localization and histology point towards comparable tumour behaviour in the two different geographical areas.

The poor prognosis of patients with gastric cancer with free abdominal tumour cells on cytological examination has been described in Japan. In a randomized trial in the Netherlands comparing D1and D2lymphadenectomy for gastric cancer, patients were subjected to cytological examination of abdominal washings on an optional basis; findings were of no consequence for scheduled treatment. Cytology results in 535 patients were obtained, in 457 (85·4 per cent) after curative resection and in 78 (14·6 per cent) after palliative operation. There was a clear association of positive cytology results with serosal invasion (12 per cent positive cytology) and lymph node infiltration (7·5 per cent positive cytology). Survival of those with positive cytology results was significantly lower than that of those with negative findings, irrespective of the procedure employed (curative or palliative). Cytological examination of abdominal washings increases the accuracy of staging and improves the selection of patients suitable for curative or palliative resection.

L’administration entérale des médicaments par sonde est une problématique quotidienne dans un service d’ORL où la majorité des patients sont dans ce cas. Les infirmier(e)s sont amenées à écraser à l’aide d’un mortier et d’un pilon de nombreux comprimés en un minimum de temps, les exposants ainsi à l’inhalation des poudres et à la survenue de troubles musculo-squelettiques. Le risque de contamination croisée est aussi présent lorsque le matériel n’est pas ou mal nettoyé entre chaque administration. Face à ce constat, nous avons testé un nouveau dispositif facilitant l’écrasement des comprimés. L’objectif de ce travail a été d’en évaluer la satisfaction et l’intérêt des infirmiers en conditions réelles d’utilisation.