BACKGROUND: Baroreceptor function in children and adolescents has not been well studied in the current literature, with a lack of agreed upon normal values. The authors hypothesize that there is a significant increase in the baroreceptor activity with a decrease in the sensitivity during the upright phase in comparison to the supine phases of the head upright tilt test (HUTT) protocol. METHODS: Baroreceptor evaluation was performed using the sequence method in 49 subjects ages 8-21 years, during the 3 phases of HUTT: supine, head up, and post-tilt supine positions. Baroreceptor Effectiveness Index (BEI) and the number and slope of baroreceptor events were recorded. RESULTS: On study of the events and slope values, there was a significant difference between the three phases of the HUTT with regard to the baroreceptor activity and sensitivity. No significant difference was found in BEI. CONCLUSIONS: Our study presents normal values of baroreceptor activity, sensitivity, and BEI in pediatric patients under controlled supine and head up position. We also present new data regarding delayed heart rate responses to pressure changes in the Lag 1 and Lag 2 parameters, which may be beneficial in diagnosis and management of pediatric patients with orthostatic intolerance.
Gastric adenocarcinoma has a high recurrence rate. The goal of this study was to determine the timing and pattern of recurrence after gastrectomy. A retrospective review was performed of patients with gastric adenocarcinoma having curative partial or total gastrectomy with R0/D2 lymph node resection from 1999 to 2013. Follow-up included CT scans of the chest, abdomen, and pelvis at 3-month intervals for the first three years, at 6-month intervals for the next two years, and annually thereafter. There were 62 patients, 38 males and 24 females, with a median age of 65 years. Median follow-up was 29 months and recurrence was identified in 21 per cent of patients. Median time to recurrence was 12 months and 92 per cent of recurrences occurred within two years. The last recurrence was identified at 34 months. Abdominal CT scan identified all patients with recurrence, although some patients had disease elsewhere in addition to the abdominal disease. There were no extra-abdominal isolated recurrences. In conclusion, recurrence after complete resection for gastric adenocarcinoma typically occurs within the first two years, and can be found by abdominal CT scan. Close cancer follow-up appears unnecessary after three years because all recurrences were identified within 34 months of resection.
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