超声内镜及CT检查对食管癌术前TN分期的价值

目的 评价超声内镜、螺旋CT检查对食管癌术前TN分期的价值.方法 回顾性总结术前EUS、CT判断87例食管癌的分期资料,并与术后病理分期对照.患者均未行化、放疗.环扫超声内镜进行操作,5例轻度狭窄病例扩张后再予EUS分期.结果 EUS T分期总准确率为85.1%,CT无法区分T1、T2.对于N分期,EUS判断探及范围内淋巴结转移的灵敏度为85.0%,高于CT扫描的60.8%;CT探查纵隔淋巴结较EUS全面.EUS与cT联合判断T分期的准确率为85.1%,N分期的准确率为90.8%.结论 EUS判断肿瘤浸润深度准确性高,EUS联合CT可进行更为全面准确的TNM分期.     

Androgen and progesterone receptors in colonic and rectal cancers

Androgen, progesterone and estrogen receptors were analyzed in 12 primary colonic cancers and 16 primary rectal cancers. Androgen and progesterone receptors were positive in some colonic cancers and rectal carcinomas; however, none of the specimens analyzed showed estradiol receptor. This research was performed under CNR Project “Controllo della Crescita Neoplastica”.     

复方五味子素B及其成分体外抑制胃癌细胞的增殖

目的:筛选复方五味子素组方最佳配比,比较复方五味子素B及其成分对胃癌细胞的增殖抑制作用.方法:采用L_4(2~3)正交设计的方法筛选药物的最佳配比.用MTT的方法观察组方及其成分对胃癌细胞的增殖抑制作用.空白对照组加培养液;阴性对照和阳性对照组分别加DMSO和5-氟尿嘧啶(5-FU).结果:高浓度五味子乙素(100 mg/L)、低浓度芦荟大黄素(50 mg/L)、低浓度黄芪多糖(50 mg/L)组方为复方五味子素B的药物最佳配比.同阴性对照组(0.427±0.018)相比,五味子乙素低浓度(0.296±0.011)和高浓度组(0.260±0.012)、芦荟大黄素低浓度(0.376±0.017)和高浓度组(0.334±0.013),复方五味素B组(0.162±0.007)在波长490 nm处的吸光度A值均显著性降低(P<0.01);增殖抑制率结果显示,五味子乙素低浓度(26.26%±4.65%)和高浓度组(39.11%±5.13%),芦荟大黄素高浓度组(21.78%±3.67%),复方五味素B组(52.06%±9.87%)抑制率均明显增高.结论:合理的中药有效成分组方可能有效提高单纯中药有效成分的作用,将中药有效成分合理组方可能是开发现代化复方中药的有效方法和途径之一.     

Neoadjuvant Therapy for Rectal Cancer: Histologic Response of the Primary Tumor Predicts Nodal Status

PURPOSE: This study was designed to compare histologic T and N stages in patients with rectal adenocarcinoma undergoing various neoadjuvant radiotherapy regimens and proctectomy, in an attempt to determine if final histologic stage of the mural tumor predicts nodal status.METHODS: Data were collected from computerized databases at two institutions on 649 consecutive patients who underwent neoadjuvant radiotherapy or chemoradiotherapy and proctectomy for primary adenocarcinoma of the rectum from 1990 to 2002.RESULTS: Five patients were excluded because of incomplete pathology data sets, leaving a study population of 644. Patients underwent neoadjuvant radiotherapy alone (2,000 cGy in 5 fractions, n = 191; or 4,500 cGy in 25 fractions, n = 259) or chemoradiation (4,500 cGy in 25 fractions with concurrent 5-fluorouracil, n = 194). Histologic stage of the remaining mural tumor (ypT) correlated with nodal status (ypN). Lymph nodes harboring metastatic tumor were found in 1 of 42 (2 percent) ypT0 patients, 2 of 45 (4 percent) ypT1 patients, 43 of 186 (23 percent) ypT2 patients, 158 of 338 (47 percent) ypT3 patients, and 16 of 33 (48 percent) ypT4 patients (P < 0.001, chi-squared test). The probability of finding ypN+ disease was 3 of 87 (3 percent) in patients with ypT0-1 residual primary tumors vs. 220 of 557 (39 percent) in patients with ypT2-4 residual primary tumors (P < 0.0001; Fishers exact test).CONCLUSIONS: Nodal metastases are rare in patients whose mural tumor burden shrinks to ypT0-1 after neoadjuvant radiotherapy. If transanal excision is offered to select patients with distal rectal cancer, it is reasonable to select those who have an excellent clinical response to neoadjuvant therapy for transanal excision, and then reserve proctectomy for patients proven to have residual ypT2-4 disease.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Appendiceal adenocarcinoma: Long-term outcomes after surgical therapy

PURPOSE Appendiceal adenocarcinomas are very rare. We analyzed contemporary outcomes associated with surgical therapies for these malignancies.METHODS Retrospective outcomes for patients treated at a tertiary academic medical center from 1981 through 2001 were analyzed.RESULTS A total of 36 patients (22 females (61 percent) mean age, 52 years) with appendiceal adenocarcinoma were treated. Eighty-eight percent of patients presented with symptoms of acute appendicitis. Eighteen (50 percent) patients underwent curative resection (7 primary right hemicolectomies, 10 appendectomies + subsequent right hemicolectomy, and 1 appendectomy alone). Mean length of follow-up was 55 months. Overall five-year survival rate was 46 percent. The five-year survival rate after curative resection was 61 percent and after palliative surgery was 32 percent (P < 0.05). Among patients who underwent curative resection, factors associated with improved five-year survival rates included histologic type (79 vs. 32 percent for colonic vs. mucinous types, respectively; P < 0.05), T stage (75 vs. 47 percent for T1 and 2 vs. T3 and 4, respectively; P < 0.05), and tumor grade (100 vs. 46 percent for well-differentiated tumors vs. moderately or poorly differentiated tumors, respectively; P < 0.05).CONCLUSIONS Patients undergoing surgery for appendiceal adenocarcinoma can be stratified according to prognostic variables. The role of adjuvant therapies for patients with poor prognostic factors needs to be evaluated in a multi-institutional setting.Presented at World Congress of Digestive Surgery, Hong Kong, China, December 9 to 11, 2002.     

Alcohol and aldehyde dehydrogenase gene polymorphisms influence susceptibility to esophageal cancer in Japanese alcoholics

BACKGROUND: Studies have consistently demonstrated that inactive aldehyde dehydrogenase-2 (ALDH2), encoded by ALDH2*1/2*2, is closely associated with alcohol-related carcinogenesis. Recently, the contributions of alcohol dehydrogenase-2 (ADH2) polymorphism to alcoholism, esophageal cancer, and the flushing response have also been described. METHODS: To determine the effects of ALDH2 and ADH2 genotypes in genetically based cancer susceptibility, lymphocyte DNA samples from 668 Japanese alcoholic men more than 40 years of age (91 with and 577 without esophageal cancer) were genotyped and the results were expressed as odds ratios (ORs). This study also tested 82 of the alcoholics with esophageal cancer to determine whether cancer susceptibility is associated with patients' responses to simple questions about current or former flushing after drinking a glass of beer. RESULTS: The frequencies of ADH2*1/2*1 and ALDH2*1/2*2 were significantly higher in alcoholics with, than in those without, esophageal cancer (0.473 vs. 0.289 and 0.560 vs. 0.099, respectively). After adjustment for drinking and smoking, the analysis showed significantly increased cancer risk for alcoholics with either ADH2*1/2*I (OR = 2.03) or ALDH2*1/2*2 (OR = 12.76). For those having ADH2*1/2*1 combined with ALDH2*1/2*2, the esophageal cancer risk was enhanced in a multiplicative fashion (OR = 27.66). Responses to flushing questions showed that only 47.8% of the ALDH2*1/2*2 heterozygotes with ADH2*1/ 2*1, compared with 92.3% of those with ALDH2*1/2*2 and the ADH2*2 allele, reported current or former flushing. Genotyping showed that for alcoholics who reported ever flushing, the questionnaire was 71.4% correct in identifying ALDH2*1/2*2 and 87.9% correct in identifying ALDH2*1/2*1. CONCLUSION: Japanese alcoholics can be divided into cancer susceptibility groups on the basis of their combined ADH2 and ALDH2 genotypes. The flushing questionnaire can predict high risk ALDH2*1/2*2 fairly accurately in persons with ADH2*2 allele, but a reliable screening procedure for the highest risk gene combination (ADH2*1/2*1 and ALDH2*1/2*2) will require further investigation.     

Advanced rectal cancer

The best treatment of advanced rectal cancer remains uncertain. The aim of this study was to determine the outcome after palliative procedures in patients with advanced rectal cancer. One hundred and three patients treated over a seven-year period were identified, including 30 with local invasion, 18 with local metastases, and 55 with distant metastases. Patients were grouped into two groups: those who underwent palliative resection (68) and those who were treated without rectal resection (55). The nonresected group included patients who underwent diverting colostomies (28) and those who received multimodality therapy without surgery (7). The average age of all patients was 63.1 years. Patients in the nonresected group had more distant disease (68 percent) than the resected group (46 percent). Significant pelvic pain was a more common problem in the nonresected group (15 percent) than in the resected group (4 percent). Similarly, pelvic sepsis was more common in the nonresected group (14 percent) than in the resected group (9 percent). Postoperative mortality was 4.3 percent after palliative resection and 3.8 percent after diverting colostomy. Survival of the resected group at one year was 65 percent and at two years 20 percent. Survival of the nonresected group at one year was 20 percent and at two years 0 percent. Survival in the resected group was significantly (P<.01) better than the nonresected group but probably can be attributed to the more extensive disease generally present in the patients who did not undergo resection. These results suggest that patients with advanced rectal cancers should undergo palliative resection whenever possible because resection decreases pelvic complications and may improve quality of life. Read at meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988.     

Plasma 5 alpha-dihydrotestosterone and testosterone in the bullfrog, Rana catesbeiana: stimulation by bullfrog LH.

Effects of purified bullfrog (Rana catesbeiana) LH and FSH on plasma levels of the androgens, testosterone (T), and 5α-dihydrotestosterone (DHT), were studied using adult male bullfrogs. Rana LH was considerably more potent than Rana FSH in stimulating increased plasma androgen levels in hypophysectomized and intact animals. Simultaneous injection of Rana FSH or ovine PRL with Rana LH, over a 10-day period, did not alter the LH-induced increase in plasma androgens. More DHT than T was present in plasma after LH injection. Castration abolished plasma DHT and greatly reduced plasma T. Results indicate that DHT is a major testicular steroid, and that testicular androgen secretion is stimulated primarily by LH in the bullfrog.     

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection

Background

Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk.

Long-acting insulin analogs and cancer

Aims

Hyperinsulinemia is a recognized risk factor for cancer and plays a major role for the increased cancer incidence in diabetic patients. Whether insulin analogs, and particularly long-acting analogs, worsen the pro-cancer effect of excess insulin is still controversial.