Early experience with laparoscopic abdominoperineal resection

Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic abdominoperineal resection at Washington University Medical Center. Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center. Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel disease (two patients), and anal melanoma (one patient). Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2% SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients (29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%). There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization or complication rates. Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis patients. Received: 23 April 1996/Accepted: 8 July 1996     

Evaluation of the Usefulness of Open Lung Biopsies

The role of open lung biopsy (OLB) in the diagnosis of the etiology of lung infiltrates in children was analyzed for a 10-year period 1979-1989 in a tertiary referral center. A total of 18 children had 19 lung biopsies to ascertain the cause of lung infiltrates. Thirteen of these children (72 %) were immunocompromised due to treatment of hematological/solid malignancies and bone marrow transplantation. The clinical diagnosis was bilateral lung infiltrates of unknown etiology in 17 of 18 children. Eight of these children were ventilated for respiratory failure. The biopsy was useful in achieving a histological diagnosis in 18 of 19 samples (diagnostic yield 95%) and an etiological diagnosis in 14 of 19 samples (etiological yield 74 %). Therapeutic strategy was altered in 14 of 18 patients based on the biopsy results. Five of 14 patients responded favorably to a change in specific treatment. The lime interval from onset of respiratory illness to biopsy was 2-60 days (mean 16 days). Despite the critical state of these children there were few complications associated with the biopsy and no mortality directly related to the procedure. We recommend that OLE be undertaken sooner rather than later in immunocompromised children with bilateral pulmonary infiltrates of unknown etiology.     

Multiple primary malignant neoplasms in urologic patients

Methods: Second primary cancers constitute approximately 9–10% of malignancies diagnosed in the United States. We aimed to show the risk and incidance of second primary tumor occuring associated to urologic tumors and show the distrubution of tumors in Tracia region. We retrospectively examined the patients' files with the diagnosis of malignant disease between the years 1985–2000. Hazard function analysis was performed to estimate the relative risk of secondary malignancy occuring. Age, sex and tumor number were examined to find out if they affect on mortality rate. Results: A total number of 25 MPMNs were diagnosed. In 52 percent of the cases the second primary neoplasm developed within six months. The relative risk of development of a second neoplasm is found as increasing 1.111 times per month. The incidence of secondary malignancy occuring in the patients with one tumor was found as 6.31%. Age (p < 0.001) and tumor number (p < 0.001) are found as statistically effective predictor on mortality rate where the sex is not. Conclusions: In the patients with a primary tumor not only the metastasis must be investigated but also second primary tumors should be taken in to consideration. This revised version was published online in August 2006 with corrections to the Cover Date.     

羊膜负载骨髓间充质干细胞与表皮细胞对放创性皮肤损伤促愈合研究

目的探讨治疗放创性全厚皮肤缺损创面的方法及效果. 方法贵州小香猪8只,每只背部脊柱两侧均有放创性全层皮肤缺损圆形创面(Ф3.67cm)各3个,共48个创面.将经处理的人羊膜(human amniotic mambrane, HAM)分别负载自体骨髓间充质干细胞(mesenchymal stem cells, MSCs)和表皮细胞,移植到其左侧24个创面作为实验组(A组);以单纯无种植细胞的HAM敷盖其右侧前16个创面(B组);以单纯油纱布敷盖其右侧后8个创面(C组).B、C作为对照组.观察移植后1～3周内各组创面愈合、肉芽组织生长及上皮化等情况,并进行创面组织HE染色及vWF免疫组织化学检测.用图像分析法测算各组各时间点创面平均面积(cm2),并计算其愈合百分率. 结果 C组于伤后 22～23天愈合,B组于伤后19～21天愈合;A组于伤后15～17天愈合,较B、C组分别提前6～7天和5～6天,愈合质量好.移植15～17天,A组与B、C组创面平均残留面积及愈合面积百分率比较,差异有统计学意义(P＜0.01). A组创面的新生上皮已完全覆盖整个创面,肉芽组织生长旺盛,肉芽组织中vWF、成纤维细胞和毛细血管含量丰富,可见胶原沉积;B、C组创面仍见许多炎性细胞浸润,肉芽组织中vWF、成纤维细胞和毛细血管含量少,胶原沉积不明显. 结论 HAM负载自体MSCs和表皮细胞植入对放创性全厚皮肤缺损创面有较好的促愈合作用,愈合质量较高.     

P糖蛋白和Ki-67抗原表达对肺癌T/NT的影响

目的:研究肺癌放射导向手术中肿瘤及正常组织P糖蛋白(P-gp)、Ki-67抗原表达与放射性核素摄取比(T/NT)的关系.方法:采用免疫组化方法和显微图像分析技术,测定32例接受放射导向手术的肺癌病人P-gp和Ki-67抗原表达,分析P-gp和Ki-67的标记指数(LI)与T/NT之间的相关性.结果:P-gp和Ki-67的LI和肺癌病人T/NT之间均有相关性(r=-0.61,P=0.0002; r=0.75,P=0.0001).结论:Ki-67的LI越高(肿瘤增殖越旺盛),T/NT值越高;P-gp阳性的肿瘤,T/NT值较低.     

überlebensverbesserung eines unizentrischen Gesamtkollektivs aus 20 Jahren

PURPOSE: The development of overall survival of a DOSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region) clinic's overall population comprising a time period of more than 20 years (1983-2004) should be assessed. At a cutoff date (January 1st, 1997), a change from a primarily surgically based to a consequent multi-modality treatment regimen was implemented. The periods of time before and after that change should be compared. METHODS AND PATIENTS: The data of the DOSAK registry entries on 1038 patients suffering from primary untreated oral and oropharyngeal carcinomas were updated with respect to follow-up and mortality data to achieve a 100% quality of follow-up. The end point (death) was reached in 67% of the overall population. Statistical analysis was carried out by the Trium Analysis Online corporation, Munich. RESULTS: The portion of female and older tumor patients increased, more than half of all tumor patients were clearly in stage IV of the disease at first referral. The portion of patients operated on persisted approximately (80%), the portion of additional treatment modalities could be increased considerably. The fact of a bony infiltration by the tumor and the operability remained highly significantly relevant for survival in multivariate analysis, despite of multi-modality treatment. The survival rate of the patients remained significantly dependent on the clinical stage of the disease in multivariate analysis but could be improved by 10% in the clinical stages II and III and in the patients who could not be operated on. All in all, the cutoff date was statistically relevant for survival in multivariate analysis, i.[Symbol: see text]e. the change in the treatment regimen had a verifiable positive effect on the survival of a unicentric overall population. CONCLUSION: Survival improvement in an overall population via change in treatment strategy is possible in relatively short time; the clinical stages II and III and the non-operable patients have the greatest benefit from a multi-modality treatment.     

骨髓HuD-mRNA表达在小细胞肺癌微转移检测中的意义

目的 :应用逆转录聚合酶链反应 (RT PCR)法检测确诊小细胞肺癌 (SCLC)患者骨髓、外周血中HuD mRNA的表达 ,分析其临床意义 ,探讨其在检测骨髓微转移中的价值。　方法 :选择病理学确诊为SCLC的初治患者 14例 ,采集骨髓及外周静脉血标本 ,另以 15例非小细胞肺癌 (NSCLC)患者及 12例良性病变患者的骨髓及血标本为对照组。 7例SCLC患者在接受 1～ 2个疗程化疗后再次取骨髓及外周血标本 ,用RT PCR法检测所有标本中HuD mRNA的表达。　结果 :SCLC患者骨髓HuD阳性率 (5 7.1% )显著高于非肿瘤对照组 (16 .7% ) ,P <0 .0 5 ;但与NSCLC对照组差异不明显 (33.3% ) ,P >0 .0 5。SCLC广泛期骨髓HuD阳性率 (85 .7% )高于局限期 (2 8.6 % ) ,P <0 .0 5。外周血标本 :SCLC外周血HuD阳性率 (4 2 .9% )与非肿瘤对照组 (16 .7% )、NSCLC对照组 (33.3% )比较差异均不显著 (均为P >0 .0 5 )。　结论 :SCLC微转移是普遍存在的 ,骨髓微转移的存在与患者的临床分期密切相关。     

重组人生长激素对体外人结肠癌COLO-320细胞生长的影响

目的　探讨重组人生长激素 (rhGH)对体外人结肠癌COLO 3 2 0细胞生长的影响。方法　取对数生长期的人结肠癌细胞株COLO 3 2 0细胞 ,分别在有血清 (血清组 )和无血清 (无血清组 )条件下培养 ,以不同浓度的rhGH和(或 )羟基喜树碱 (CPT)培养COLO 3 2 0细胞 ,分别培养 2 4h、48h及 72h ,然后用四甲基偶氮唑蓝 (MTT)法测定结肠癌细胞生长抑制率。结果　不同浓度的rhGH作用不同时间对人结肠癌细胞株COLO 3 2 0细胞的生长均无明显影响 (P>0 .0 5 ) ;单用CPT或rhGH联合CPT使用时对该细胞生长的抑制率均明显高于单用rhGH(P<0 .0 1) ,但前两者间差异无统计学意义 (P>0 .0 5 )。结论　体外条件下rhGH对人结肠癌细胞株COLO 3 2 0细胞的生长既无促进作用 ,也无抑制作用 ,且不影响CPT对人结肠癌细胞株COLO 3 2 0细胞的抑制作用。     

VEGF和p53在胰腺癌中的表达及意义

目的　探讨胰腺癌组织中血管内皮生长因子 (VEGF)及p5 3蛋白的表达及其临床病理意义。方法　采用SP免疫组织化学方法 ,对 46例胰腺癌组织中VEGF及 p5 3蛋白的表达进行检测。结果　VEGF与 p5 3表达率分别为 65 .2 %和 5 8.7%。p5 3表达与VEGF表达呈明显正相关(P <0 .0 5 )。VEGF表达与胰腺癌淋巴结转移 (P <0 .0 5 )和远处转移 (P <0 .0 1)显著相关 ,而与肿瘤大小 ,病理学分级无关 ,p5 3表达与胰腺癌远处转移 (P <0 .0 5 )显著相关 ,而与肿瘤大小 ,病理学分级及淋巴结转移无关。结论　在胰腺癌中 ,VEGF表达与 p5 3蛋白的表达呈正相关 ,在胰腺癌的转移中起重要作用