Explore the vast range of titles available.

To compare detection of Barrett's dysplasia and adenocarcinoma by systematic versus nonsystematic surveillance biopsy protocols. Upper GI consultation and open-access endoscopy are provided jointly at Glasgow Royal Infirmary by medical and surgical teams. The surgical team adopted annual systematic four-quadrant biopsy Barrett's surveillance in 1995. The medical team continued annual Barrett's surveillance with nonsystematic biopsy until 2004. We compare detection of Barrett's dysplasia and esophageal adenocarcinoma in unselected patients by these two biopsy strategies over 10 yr. All patients had > or = 3 cm Barrett's esophagus and histological proof of intestinal metaplasia. Patients referred for dysplasia management or with prevalent adenocarcinoma were excluded. Cohort A (N = 180) had four-quadrant biopsy every 2 cm while cohort B (N = 182) had nonsystematic biopsies. Cohort A versus cohort B: Median number of biopsies per endoscopy: 16 versus 4. Prevalence of low-grade dysplasia (per patient): 18.9% versus 1.6% (P << 0.001). Prevalence of high-grade dysplasia: 2.8% versus 0% (P = 0.03). Incidence of low-grade dysplasia: 2.2% versus 6.6% (NS). Incidence of high-grade dysplasia: 2.8% versus 0% (P = 0.03). Nine cohort A patients (total 5%, 1.4% per patient-year) were treated for HGD (eight endoscopically, one by esophagectomy). Two had intramucosal adenocarcinoma. No cohort A patient developed advanced cancer but three cohort B patients developed and died of invasive Barrett's adenocarcinoma (0.6% per patient-year). Patient age, gender, Barrett's segment length, and follow-up were similar (though not identical) in both cohorts, but confounding seems unlikely to account for a 13-fold difference in detection of prevalent dysplasia between the two groups. Our data support the hypothesis that systematic four-quadrant biopsy is considerably more effective than nonsystematic biopsy sampling in detecting Barrett's dysplasia and early adenocarcinoma. Greater biopsy numbers and the systematic pattern of biopsy taking may both contribute to this greater effectiveness.

Background A number of accepted criteria, including pathological tumor, node, metastasis system stage, lymph node metastasis, and tumor differentiation, predict survival in patients undergoing surgery for gastroesophageal cancer. We examined the interrelationships between standard clinicopathological factors, systemic and local inflammatory responses, tumor proliferative activity, and survival. Methods The interrelationships between the systemic inflammatory response (Glasgow prognostic score, mGPS), standard clinicopathological factors, local inflammatory response (Klintrup criteria, macrophage infiltration), and tumor proliferative activity (Ki-67) were examined by immunohistochemistry in 100 patients (44 esophageal [19 squamous, 25 adenocarcinoma], 19 junctional, and 37 gastric cancers) selected for potentially curative resection. Results The minimum follow-up was 59 months. On multivariate survival analysis, lymph node ratio (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.11–2.40, P  < 0.05), tumor differentiation (HR 2.63, 95% CI 1.45–4.77, P  = 0.001), mGPS (HR 3.91, 95% CI 1.96–8.11, P  < 0.001), Klintrup score (HR 3.47, 95% CI 1.14–10.55, P  < 0.05), and Ki-67 (HR 0.67, 95% CI 0.47–0.96, P  < 0.05) were independently associated with cancer-specific survival. A higher lymph node ratio was associated with poor tumor differentiation ( P  < 0.05), low-grade Klintrup criteria ( P  < 0.005), and low tumor proliferative activity ( P  < 0.05). Conclusion Tumor proliferation rate and local and systemic inflammatory responses are important predictors of survival, albeit in a heterogeneous cohort of patients including esophageal, junctional, and gastric cancers. These scores may be combined with accepted tumor-based factors to improve prediction of outcome.

Background Studies have indicated that hypoalbuminemia is associated with decreased survival of patients with gastric cancer. However, the prognostic value of albumin may be secondary to an ongoing systemic inflammatory response. The aim of the study was to assess the relation between hypoalbuminemia, the systemic inflammatory response, and survival in patients with gastric cancer. Methods Patients diagnosed with gastric carcinoma attending the upper gastrointestinal surgical unit in the Royal Infirmary, Glasgow between April 1997 and December 2005 and who had a pretreatment measurement of albumin and C-reactive protein (CRP) were studied. Results Most of the patients had stage III/IV disease and received palliative treatment. The minimum follow-up was 15 months. During follow-up, 157 (72%) patients died of their cancer. On univariate analysis, stage ( p  < 0.001), treatment ( p  < 0.001), albumin level ( p  < 0.001), and CRP level ( p  < 0.001) were significant predictors of survival. On multivariate analysis, stage ( p  < 0.001), treatment ( p  < 0.001), and CRP level ( p  < 0.001) remained significant predictors of survival. Albumin was no longer an independent predictor of survival. Conclusions Low albumin concentrations are associated with poorer survival in patients with gastric cancer. However, the strength of this relation with survival is dependent on the presence of a systemic inflammatory response, as evidenced by an elevated CRP level. Therefore, it appears that the relation between hypoalbuminemia and poor survival is secondary to that of the systemic inflammatory response.

Anesthetic complications, which range from simple annoyances to patient mortality, are inevitable, given the many and complex interactions of doctor, patient, personnel, and facility. Anesthesia Complications in the Dental Office helps dentists minimize the frequency and severity of adverse events by providing concise and clinically relevant information that can be put to everyday use. Anesthesia Complications in the Dental Office presents the most up-to-date information on treating anesthesia complications and medical emergencies. Drs. Bosack and Lieblich and a team of expert contributors discuss patient risk assessment; considerations for special needs and medically compromised patients; routinely administered anesthetic agents; adversities that can arise before, during, and after administration of anesthesia; and emergency drugs and equipment. A must-have reference for every dental office.

Background Clinical staging in patients with gastro-oesophageal cancer, is of crucial importance in determining the likely benefit of treatment. Despite recent advances in clinical staging, overall survival remains poor. The aim of the present study was to examine the relationship between pre-treatment clinical prognostic factors and cancer-specific survival. Methods Two hundred and seventeen patients, undergoing staging investigations including host factors (Edinburgh Clinical Risk Score (ECRS)) and the systemic inflammatory response (Glasgow Prognostic score (mGPS)), in the upper GI surgical unit at Glasgow Royal Infirmary, were studied. Results During the follow-up period, 188 (87%) patients died; 178 of these patients died from the disease. The minimum follow-up was 46 months, and the median follow-up of the survivors was 65 months. On multivariate survival analysis of the significant factors, only cTNM stage (HR 1.84, 95% CI 1.56–2.17, p  < 0.001), mGPS (HR 1.67, 95% CI 1.35–2.07, p  < 0.001) and treatment (HR 2.12, 95% CI 1.73–2.60, p  < 0.001) were independently associated with survival. An elevated mGPS was associated with advanced cTNM stage, poor performance status, an elevated ECRS and more conservative treatment. Conclusions Pre-treatment mGPS improves clinical staging in patients with gastro-oesophageal cancer. Therefore, it is likely to aid clinical decision making for these difficult to treat patients.

Background Endoscopic mucosal resection (EMR) of early gastric and esophageal tumors is effective and avoids the morbidity and mortality of surgery. We report the long-term results of a consecutive series of 93 endoscopic resections, during a 7-year period, in a U.K. population. Methods Eighty-eight patients with 93 lesions were included. EMR was performed for 64 and 29 malignant and benign lesions, respectively. Patients with malignant disease were subgrouped into “high risk” or “low risk” for recurrence. Results Of the 35 lesions in the low-risk group, local control was achieved in 31; 29 after 1 EMR session. Two had residual invasive carcinoma, one had treatment ceased due to pancreatic cancer, and one patient did not attend follow-up. Of the 29 lesions in the high-risk group, local control was achieved in 15; 13 after 1 EMR session. Median follow-up was 53 months. Cancer specific survival for the 45 invasive cancers (T1m and T1sm) was 93%; three patients died from their disease. Conclusions This study has shown for the first time in a U.K. population that EMR is effective in controlling disease in patients with local high grade dysplasia (HGD) and early invasive carcinoma, with no mortality and low morbidity.

This paper examines an important anomaly in the internal migration history of the former Soviet Union (FSU). While many cities were closed in the sense of explicitly limiting growth of city population from migration, it was difficult to assess the effectiveness of these controls. We analyze a sample of 308 Soviet cities to isolate the impact of closure regulations controlling for city size. We find that while there are pervasive patterns of city growth, the rate increasing through the 1960s and declining thereafter, there are also pervasive differences between controlled and uncontrolled cities, the later growing significantly faster in almost all cases, controlling for city size.

Explores city growth under conditions of an administrative command economy, tracing urban development in Russia, 1928-1990. The mechanics of such growth & spatial patterns of socioeconomic variation are assessed to deliver a picture of urban political economy in 1980s Russia. At issue is whether socialist controls on mobility succeeded to reduce migration after accounting for typical development-influencing socioeconomic & geographic variables. Findings indicate that such state-administered restrictions did inhibit city growth. Further, broad regional differences are revealed as a function of local policy decisions. 6 References. J. Zendejas