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Evaluates the effects of the Magenstrasse and Mill (M&M) operation for obesity on plasma leptin levels and insulin resistance. Measurement of the plasma glucose, leptin and insulin levels of obese patients; Decrease of the body mass index after the M&M procedure; Association of the decrease of insulin resistance with the lower levels of plasma leptin.

Aims: The role of total parenteral nutrition (TPN) in patients undergoing surgery for upper GI cancer remains controversial: TPN is used routinely after oesophagogastric surgery in some centers whereas in others, nutrition is maintained by feeding jejunostomy or is simply not given at all. The aim of this study was to determine whether TPN was beneficial to patients who underwent resection for oesphago-gastric cancer. I Methods: 110 consecutive patients who underwent potentially curative resection (33 Ivor Lewis oesophagogastrectomy, 39 total gastrectomy and 38 subtotal gastrectomy) for oespohago-gastric cancer were allocated at random immediately after their operation to receive either TPN (minimum 7 days post op) or standard intravenous fluids. The groups were well matched for age, sex, and type of operation performed. Outcome measures included post-operative complications (chest infection, wound infection, anastomotic leak and line sepsis) and length of hospital stay. Statistical analysis was by Mann Whitney U test for non-parametric data. Results: See Table below. Conclusion: The findings of this study suggest that TPN does not confer any significant benefit to patients who undergo resection for oesophago-gastric cancer. It is debatable whether such patients require any form of nutritional support at all. [ABSTRACT FROM AUTHOR]

Evaluates the management of patients with esophageal cancer. Evaluation of the esophageal resections; Identification of increase in the subspecialization; Application of radiotherapy and chemotherapy; Improvement of patients in specialized units.

Aims: Prognostic factors that may be influenced by surgical therapeutic measures such as the extent of resection and lymphadenectomy are of particular interest in oesophageal cancer. The aim of the present study was to determine prognostic factors in patients with oesophageal cancer undergoing resection with special reference to lymph node metastasis. Methods: From January 1990 to December 1999, 204 patients with oesophageal cancer underwent resection. The ratio of adenocarcinomas to squamous cell carcinomas was 3.5:1. The majority (77%) of tumours were located in the lower third of the oesophagus. Both univariate and multivariate analysis of prognostic factors were performed. Results: The median age of patients was 66 years (range 29–89) with a male to female ratio of 2.5:1. The overall 5-year survival was 24.1%, with a median survival of 18.3 months. Univariate analysis identified the depth of tumour invasion, nodal involvement, presence of distant metastases, UICC stage, presence of residual tumour (R category), circumferential resection margin involvement, number of involved lymph nodes and ratio of involved lymph nodes to resected lymph nodes as significant (P < 0.05) factors in predicting overall survival. Multivariate analysis demonstrated R category (relative risk 3.4, P < 0.01) and lymph node ratio (relative risk 1.8, P < 0.02) as independent predictors of overall survival. Five-year survival was 37.7% for patients who underwent R0 resection and 0 for R[sup 2] resection. The 5-year survival rate of patients without lymph node metastasis was 49.4% compared with 11.4% for patients with nodal metastasis. The patients with less that 20% involved lymph nodes fared significantly better than patients with more than 20% involved nodes: 23.4% versus 7.2% 5-year survival; log rank test = 20.4, 2 d.f., P < 0.0001. Conclusions: Radical resection with extended lymphadenectomy may have a role in improving outcome in patients with oesophageal cancer. [ABSTRACT FROM AUTHOR]

Aims: The sharp increase in the incidence of oesophageal adenocarcinoma over a relatively short period of time indicates that environmental factors are involved in the aetiology and epidemiological data suggest that dietary antioxidants might have a protective effect against the development of the disease. The aim of this study was to measure tissue and plasma levels of vitamin C and ascorbic acid in patients with Barrett's oesophagus. Methods: Blood samples and endoscopic biopsies from squamous, Barrett's, and gastric mucosa were obtained from consecutive patients participating in a surveillance programme. Vitamin levels were measured by high performance liquid chromatography and mean values were compared by a two-tailed unpaired t-test. Results: Forty-two male and 15 female volunteers were recruited. Histology of the Barrett's epithelium revealed nine cases with gastric metaplasia, 45 with intestinal metaplasia and three with dysplasia. The mean values ± SD) of ascorbic acid in squamous, Barrett's and gastric mucosa were 111.1 (± 51.1), 86.9 (± 38) and 75.8 (± 35.8) µg g[sup -1], respectively. The difference between the mean values in squamous and Barrett's mucosa was statistically significant (P = 0.02). The difference between Barrett's and gastric mucosa was not significant. There was also a statistically significant difference between the mean plasma levels of ascorbic acid in male [mean = 7.51 (± 3.7) µg mL[sup -1]] and female [mean = 10.14 (± 4.2) µg mL[sup -1] patients (P = 0.04). A trend towards a decrease in the mean plasma levels of ascorbic acid was noted between patients with gastric metaplasia, intestinal metaplasia and dysplasia (10.57 versus 7.98 versus 4.56 µg mL[sup -1]) but this failed to reach statistical significance due to the small number of patients in each subgroup. Similar results were obtained for the tissue and plasma levels of vitamin C. Conclusions: These results suggest... [ABSTRACT FROM AUTHOR]