Long-term intermittent venous access was established in 77 children by means of a central venous catheter (CVC) with a subcutaneous injection port (Port-A-Cath; PAC). Seventy of these children were included in this follow-up study. Sixty-three were treated for different malignant diseases, five for cystic fibrosis, one for severe hemophilia and one for central nervous system disease with seizures as the main problem. As of April, 1992, PACs had been in place for 3/12 to 8 3/12 years (cumulative 175 5/12 years) with 2,206 entries into the system. The PACs were used for blood sampling and administration of chemotherapy, antibiotics, fluids, total parenteral nutrition (TPN) and blood products. Portal infection was observed in four patients of which two patients had their PAC removed. Catheter dislocation was observed in two and catheter breakage in one. Portal occlusion, extravasation, thrombosis leading to removal of the PAC or other technical or psychological complications were not observed. The children continued normal activities, and the easy venous access decreased emotional stress during treatment. Local doctors were trained to use PACs, through which they administered maintenance chemotherapy. We conclude that long-time use of PACs in children is safe and has many advantages compared to traditional CVCs in use. Strict indications, meticulous implantation techniques and adequate handling are, however, mandatory.
Summary A twelve year series of 375 patients with gastric carcinoma has been studied. Patients were divided into TNM Groups. Tumours were classified as intestinal-type and diffuse. The patients with TI -3NOMO diffuse tumour were ten years younger than the patients with TI -3NOMO intestinal-type tumour. The mean age increased from Ti through T2 to those with T3 tumour. The age differences between the T-stages were the same in both groups, which indicate that once started, the diffuse and the intestinal-type tumours infiltrate the gastric wall at about the same rate. Among the patients with intestinal-type tumour, those with lymph node or distant metastases were three to seven years younger than the patients without metastases. On the other hand, the patients with diffuse tumour and metastases were as many years older than the patients without metastases. Apparently, tumour spread is age dependent and different between the two types of gastric carcinoma. The ill repute of the diffuse gastric carcinoma may therefore be explained by the advanced stage of that tumour at the time of treatment as compared to the intestinal-type tumour. The diffuse tumour seems to be clinically more silent and to give symptoms at a later stage than the intestinal-type tumour.Twenty-five years ago Pekka Lauren published his paper on the classification of gastric carcinoma into two main histopathological types, the intestinal-type and the diffuse (Lauren, 1965). Lauren's classification is now widely accepted and numerous reports have described significant differences between the two types of gastric carcinoma.The discrimination between the two types of tumour is particularly important for the clinical management of patients with gastric carcinoma. The diffuse carcinoma tends to be more wide-spread at the time of treatment. Accordingly, it is recommended that resections should be more extensive in patients with this tumour than in patients with the intestinaltype tumour (Gall & Hermanek 1985, Heberer et al., 1988. It is well documented that the prognosis for the diffuse carcinoma is poorer than for the intestinal-type carcinoma (Lauren, 1965;Stemmermann & Brown, 1974;Ribeiro et al., 1981; Hermanek, 1986;Viste et al., 1986).It has also been reported that patients with diffuse gastric carcinoma are younger than those with the intestinal-type (Lauren, 1965;Noda et al., 1980;Ribeiro et al., 1981;Hanai et al., 1982;Mecklin et al., 1988). Two studies are concordant that this difference is in the order of 7-8 years (Lauren, 1965;Ribeiro et al., 1981).It has now become clear that age in itself is a prognosticator of some cancers (Ershler, 1986). Observations of cancers of the lung, breast, colon, prostate gland and kidney have shown that once a tumour has developed, growth and spread are slower in the elderly (Ershler, 1986). In line with these observations, it has also been shown that advancing age reduces growth of some experimental tumours. On the other hand, there are also experimental tumours where the growth is enhanced with increasing age (...
Lie, R.T. & Matre, R. Age and sex distribution of intestinal type and diffuse gastric carcinoma. APM IS 99: 78-82, 199 1,A twelve-year series of 375 patients with gastric carcinoma has been studied. Primary tumours were classified as intestinal type (58 YO) or diffuse (26%), whereas 16% were unclassifiable. The relative age and sex incidence rates of intestinal type and diffuse gastric carcinoma were estimated using the age and sex distribution of individuals in Norway as the basis for calculation. There was no difference in the rates of diffuse gastric carcinoma between the sexes. On the other hand, the rate of men with intestinal type carcinoma was more than twice as high as that of women. This difference was consistent within each age group from adolescence to senescence. The findings indicate that Laukn's two types of gastric carcinoma are aetiologically different. The rates of both types increased with age up to the 70-79 age group, whereas the rates in octogenarians tended to be lower than in septuagenarians. A comparison of our data with the data of incidence of gastric cancer in Norway indicates that some of the older patients do not come for surgery.
A case is reported in which the patient died during pneumonectomy from endobronchial embolus of a tumour resulting in obstruction of the main bronchus of the normal lung. It is believed that the complication might have been prevented by the use of a double-lumen endobronchial tube. If generally employed, this precaution would also lessen the risk of intra-operative spread of smaller tumour emboli that may cause implantation metastases.
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