Clinical features and outcomes of gastric neuroendocrine tumors after endoscopic diagnosis and treatment: A Digestive Endoscopy Society of Tawian (DEST)

Gastric neuroendocrine tumors (GNETs) are a heterogeneous group of neoplasm with varying biological characteristics. This study aimed to investigate the clinical features and outcomes of GNET patients after endoscopic diagnosis and treatment in a multicenter registry. Patients with GNETs confirmed histologically were recruited from 17 hospitals between January 2010 and April 2016 in Taiwan. Clinical, laboratory, radiological, endoscopic, pathological data, treatment strategies, follow-up periods, and survivals were collected retrospectively. Totally 187 (107 female, 80 male) patients were recruited. Mean ( ± standard deviation [SD]) age and size of tumors were 63.2-year-old ( ± 14.6) and 2.3-cm ( ± 3.0). World Health Organization (WHO) grading were 93 (49.7%) G1, 26 (13.9%) G2, 40 (21.4%) G3, and 28 (15.0%) unknown. G3 patients were older (mean ± SD, 71.6 ± 12.4 vs. 60.9 ± 14.3/56.7 ± 15.4 years), larger (6.1 ± 4.0 vs.1.2 ± 1.3/2.4 ± 2.5 cm), more distally located (35.0% vs. 7.6%/15.4%), lower proportion of superficial lesions (17.5% vs. 61.9%/53.8%) and higher rates of lymphovascular invasion (32.5% vs. 3.2%/7.7%) than G1/G2. There was no nodal or distant organ metastases despite different grading of lesions≦10 mm and those <20 mm limited to mucosa and submucosa layers. GNETs larger than 20 mm with G1, G2, and G3 had lymph node (LN) metastatic rates of 21.4%, 30.0%, and 59.3%, respectively. Survivals were different between grading for those >20 mm (log-rank test P = .02). Male gender (P = .01), deeper invasion (P = .0001), nodal (P < .0001), and distant organ metastases (P = .0001) were associated with worse outcome. In conclusion, treatment strategies for GNET should be decided by grading, size, invasiveness, and LN metastasis risk. Curative endoscopic resection is feasible for G1/2 lesions less than 20 mm and limited to mucosa/submucosa layers without lymphovascular invasion.

[Infusion speed as a factor to influence the analgesic level of spinal anesthesia--hypobaric solution of tetracaine]

In spinal anesthesia, as known, the injection speed of local anesthetic drug is a factor which influences the analgesic level. For study it, automatic infusion apparatus was available to control as 5 kinds of infusion speed (0.02-0.51 mL/s), and 78 patients were divided into 6 groups. The results of the painless level was discussed by T-test and distribution analysis (F-test). The mean of painless level in each group was found to be no significant difference as discussed by T-test. But the largest distribution was found in the group of 0.04 mL/s, and high analgesic level as rise up to T6 was occasionally found in groups of 0.04 mL/s & 0.02 mL/s. It means, the infusion speed is not an important factor, but extremely slow infusion is more dangerous than high speed infusion, which will take a risk of high level spinal anesthesia.

Mastitis neonatorum

Eleven cases of neonatal mastitis diagnosed at National Taipei College of Nursing Health Center, since 1983, have been reviewed by chart retrospectively. All 11 cases occurred in full-term infants 1-4 weeks postnatally. Female predominated with male: female ratio of 1: 1.75. The mastitis of these cases were confined to unilateral side and did not spread systemically. Gram stain smear of the purulent material got from aspiration, incision or spontaneous rupture of abscess were attempted in ten cases and Gram positive cocci were observed in nine of whom pus culture yield staphylococcus aureus later in eight. We feel Gram stain is one of the rapid and useful diagnostic method. Treatment was given by appropriate antibiotics parenterally followed by surgical incision or drainage when fluctuation was present. The prognosis of neonatal mastitis is excellent. In general, these our clinical observation are similar to those described in the literatures since 1950s.