Between 1993 and 1997, 11 patients with rectal carcinoids less than 8 mm in diameter (mean size: 5.5 mm) were endoscopically treated at Tsuboi Hospital. Seven patients were treated by polypectomy or endoscopic mucosal resection. Three of the seven lesions were microscopically diagnosed as having positive submucosal margins. The remaining four showed a distance between the tumor and the resection line(DBTRL) of 0 to 0.33 mm. Then, we attempted endoscopic double snare polypectomy (EDSP) in 1996 and 1997. In four consecutive patients, the tumor was completely resected by this method. The DBTRL ranged from 0.08 to 0.75 mm in four lesions resected by EDSP. With endoscopic resection of these tumors, the incidence of positive margins is high using the conventional single snare methods, even when the lesions are less than 10 mm in diameter. EDSP was useful for total removal of small rectal carcinoids.
In 93 patients with inoperable non-small cell lung carcinoma who underwent chemotherapy including cisplatin, the prognostic value of 9 factors were determined using Cox's proportional hazard model. Univariate analysis revealed that patients with a performance status of grade 2 (p<0.01) or 3 (p<0.05), those with stage IV disease (p<0.05), those with a serum neuron specific enolase (NSE) level >7.0 ng/ml (p<0.001), and those with a low serum albumin level (p<0.05) had a significantly worse prognosis. Multivariate analysis showedthat a performance status of 2 or 3 and a high NSEserum level were associated with a significantly worse prognosis. More attention should be paid to the serum NSElevel in patients with non-small cell lung carcinoma, because it not only reflects the tumor volume, but is also a prognostic factor which is dependent on individual tumorcharacteristics. (Internal Medicine 33: 271-276, 1994)
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