Correction of hypophyseal-adrenal system function in esophageal and stomach cancer patients undergoing combined and surgical treatments

The paper presents the data on marked dysfunction of hypothalamo-pituitary-adrenal system in patients with esophageal and gastric cancer. Patients revealed lowered levels of 11-hydroxycorticosteroids in blood plasma and 17-corticosteroids and 17-glucocorticosteroids in diurnal urine. It was matched by an elevated threshold of hypothalamic sensitivity to inhibition by glucocorticosteroids. Treatment for these disturbances which brought the function of this system to normal had a beneficial effect on the secretion and excretion of corticosteroids in the course of combined therapy and surgery and was followed by a significant decrease in hemodynamic complication incidence. The favorable clinical effect was in correlation with the decrease in hypothalamic resistance to the inhibitory effect of glucocorticoids.     

The reasons for patients with stomach cancer refusing surgical treatment]

Refusal of treatment was analysed in gastric cancer patients registered in the whole region (12.9%) and in the oncologic dispensary (12.1%). Two hundred and two patients refused treatment, 43 of them agreed to be operated 2 or more months later. Fewer refusals were registered among male and adult patients. The number of refusals increased with age. Reason for refusal were analysed. Explanatory work was carried out and some of them were informed of their diagnosis. Patients were invited for repeated explanation. Low level of medical education of the population, particularly, in the field of oncology was shown to be the main reason to refuse surgery.     

Blood triboluminescence in patients with cancer of the proximal stomach and esophagus]

Total triboluminescence, i.e. optic radiation induced as a result of mechanic activation of venous blood in a TPA-2 triboluminometer, was measured in patients with cancer of the gastric cardia and esophagus, and in healthy subjects. The parameter was assessed in control water samples, too. In the 252-649 nm range, five bands of emission were registered with peaks at 262, 280, 360, 422 and 649 nm subject to variation in certain segments of blood spectrum. Triboluminescence of the venous blood at 280 nm determines for the total triboluminescence registered in the entire spectrum. The triboluminescence of capillary blood at 302 and 418 nm calculated using K coefficient facilitates differentiating between inflammation and cancer. This express test takes less than 1 minute and requires a small blood sample (0.02 ml). The accuracy proved 88%.     

Surgical treatment of concurrent cancer of the esophagus and stomach

Out of a total of 250 resections for carcinoma of the esophagus done in our department between 1965 and 1983, there were 11 patients with a concurrent esophageal cancer, nine being gastric cancer and seven of them early gastric cancer. In these nine, four underwent resection of the esophagus and lesser curvature of the stomach with gastric tube reconstruction. Two of the four patients are alive 10 and 3 yr postoperatively. We hold the view that detailed preoperative gastric examination is most important to plan the surgical repair and that the small gastric tube may serve as a substitute by resecting the lesser curvature of the stomach in cases of early proximal gastric cancer.     

A 20-year follow-up of surgical treatment of patients with stomach cancer

A relationship between the long-term results of surgical treatment of gastric cancer patients, on the one hand, and such factors as sex, age, histologic and anatomical patterns of tumor, its size and site, on the other, is discussed. Out of 756 patients operated on within 1946-1958, 147 survived for 20 years and more; 35 of them lived until the age of 80 years and longer. The results point to some unfavorable factors influencing prognosis in a considerable number of patients who survive for long periods of time after radical surgery. This makes the case for individual prognosis still stronger. Thus, errors involving an unjustified extension of surgical intervention, on the one hand, and unjustified decision not to operate, on the other, may be avoided.     

The effect of surgical trauma on the metabolism of essential fatty acids in patients with cancer of the esophagus and stomach

The dynamics of levels of essential fatty (linolic and arachidonic) acids in blood plasma and erythrocytes as well as that of free fatty acids fraction versus duration of surgery was assessed by gas chromatography in 49 patients with cancer of the esophagus and gastric cardia. Surgical procedures lasting longer than 5 hours are followed by overmobilization of essential fatty acids from body lipids their endogenous store being depleted. As a result, a double increase in the level of free arachidonic acid, an immediate prostaglandin precursor, develops to satisfy the body's augmented requirements in essential fatty acids due to application of aggressive surgical procedures.     

DIAGNOSIS AND SURGICAL TREATMENT OF 103 PATIENTS WITH EARLY ESOPHAGEAL CANCER AND CARDIAC CANCER OF STOMACH

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Characteristics of the postoperative period in stomach cancer patients undergoing combined treatment

Postoperative course was studied in 423 radically treated patients: 175--surgery only, 96--preoperative 5-fluorouracil chemotherapy, 79--intravenous radioactive colloid gold postoperatively, and 73--both 5-fluorouracil preoperatively and colloid gold postoperatively. The two latter procedures did not affect postoperative course adversely; nor did they influence the spectrum of postoperative complications or increase lethality rate.     

Comparative evaluation of surgical and combined treatment of cancer of the proximal region of the stomach

The paper deals with an analysis of the results of treatment of 351 cases of radical surgery for cancer of the proximal part of the stomach (surgery-303, surgery + preoperative large-fractionated radiation-48). It was found that radiation was not followed by increased blood loss during operation nor did it interfere with application of any surgical procedure. Concentrated irradiation did not involve an increment in postoperative lethality and complication rates. Five-year survival rates were 37.4 +/- 8.0 in cases of combined treatment and 20.4 +/- 2.7% in those of surgery. The improvement in survival rates recorded in cases of combined treatment was largely due to a decreased incidence of local recurrences.     

肺癌术后过继免疫治疗的近期疗效分析

  目的 探讨手术配合CIK过继免疫法治疗非小细胞肺癌（NSCLC）的疗效。方法 40例NSCLC患者按配对的原则分为联合治疗组（手术+免疫治疗）20例，单纯手术组20例；观察两组患者近期疗效、生活质量、免疫学指标、癌胚抗原（CEA）等的变化。结果 联合治疗组与单纯手术组Karnofsky评分总提高率分别为85.0 %、45.5 %（P＜0.05）。两组治疗前T淋巴细胞亚群、B细胞、CEA含量比较差异无统计学意义；联合治疗组治疗后2个月与治疗前比较，CD+4和CD+4／CD+8比值、NK细胞、CEA含量明显提高（P＜0.05），且优于单纯手术组（P＜0.05）。结论 采取外科手术与CIK过继免疫联合治疗，能提高NSCLC患者的生活质量，改善其免疫功能，降低其CEA含量。     

Radical surgical treatment of cancer of the stomach in surgical hospitals]

Results of treatment of 571 patients with gastric cancer as well as errors committed during palliative and radical surgery were analysed. General surgeons not infrequently performed distal resection of the stomach for cancer of its proximal part whereas in cases of gastrectomy the distal part of the esophagus was not removed when indicated. On the contrary, in patients with cancer of the distal part of the stomach, surgeons aspired to save as much of the organ as possible, as would be done for the treatment of gastric ulcer. Principles of radical surgery for cancer were violated in those cases.     

Centralized treatment of patients with stomach cancer

An analysis of surgical results versus the specialization of medical establishments was carried out on the basis of 6,220 primary cases of stomach cancer registered in the GDR in 1976. Operability and radical resectability accounted for 56.0 and 21.0%, respectively. Postsurgical lethality was 20.6%. Relative and absolute 5-year survival were 24.7 and 5.1%. In the establishments of the first group (1-4 radical operations per year), operability and resectability were 53.7 and 13.2%; in the second group (5-19 radical operations per year) -65.2 and 28.2%, and in the third group (more than 20 radical operation per year) -80.9 and 38.5%, respectively. The following distinct differences in postoperative death rates versus patients' age and surgical procedure were obtained: after distal resection, postoperative mortality was 20.7 (group 1), 16.8 (group 2) and 10.1% (group 3), respectively. Priesching s index of efficacy based on long-term survival data was 35 (group 1), 6.8 (group 2) and 11.3 (group 3). Although not all the evidence elicited by the present study was statistically significant, it pointed to distinct tendency of better results being obtained at specialized establishments with a higher turnover of surgical cases.     

Current status of surgical treatment of cancer of the esophagus

Treatment modalities for cancer of the esophagus continue to encourage a healthy debate amongst surgeons, radiotherapists, and chemotherapists. This is because overall results by current treatment methods are generally unsatisfactory, though an all-round steady gain is now being reported by many authors. With increasing sophistication in radiotherapy techniques (external and intracavitary) and more effective combination chemotherapy, it is likely that surgical treatment of this cancer may be reexamined. There is little doubt, however, that despite the advent of radiotherapy and chemotherapy, surgery is still the most important treatment method in providing lasting relief of dysphagia and maximum survival. While increasingly low surgical mortality and a high cure rate are now being reported, the type and extent of surgery are still contentious issues. Alternatives ranging from a very radical excision (monobloc total esophagectomy with mediastinal dissection) to a blunt transhiatal esophagectomy are now being advocated. Radiotherapists and chemotherapists are now investigating the feasibility of a nonsurgical treatment for cancer of the esophagus.     

Development of diagnosis and surgical treatment for patients with carcinoma of the esophagus

Early-stage esophageal carcinomas are extremely difficult to detect because the patients have no complaints, and findings on the X-rays are nil. Lugol-combined endoscopy is the most effective method for detecting the presence of small carcinoma of the esophagus. This paper was, first, conducted on the diagnostic features of early-stage esophageal carcinoma, detected through the use of Lugol-combined endoscopy. As the prognosis of patients with esophageal carcinoma is related to many factors, we investigated the prognostic contribution of 15 discrete variables with multivariate analysis. The variables are resectability of the malignant lesion, DNA distribution pattern of the cancer cells, and postoperative complications. As the DNA pattern of cancer cells cannot be changed by surgeons, early detection and postoperative care play key roles in determining the survival of patients with esophageal carcinoma.     

老年人食管贲门癌的外科治疗

目的 总结外科治疗老年人食管贲门癌的经验。 方法 回顾性分析91例70岁以上食管贲门癌患者手术治疗临床资料，全组平均年龄76.1岁，最高年龄达92岁。 病变长度3cm以内33例,3～6cm 43例，6cm以上15例。伴随有心肺脏器疾病56例。TNM分期属Ⅰ期22例,Ⅱ期46例,Ⅲ期23例。 结果 91例中87例将病变切除,手术切除率为95.60%;鳞癌79例,腺癌12例。术后发生并发症25例，主要为肺部感染13例，呼吸衰竭2例，心律失常11例，心动过缓3例，心衰4例，死于呼吸衰竭1例。 结论 70岁以上老年人食管贲门癌，只要全身情况能够耐受，就应该积极行食管贲门癌切除手术。围术期积极防治循环呼吸系统并发症是手术成功的重要保证。     

不同术式对直肠癌患者免疫功能的影响

目的 研究不同术式对直肠癌患者治疗后免疫功能的影响以及术后发生感染的风险.方法 本研究尊重患者意愿根据前瞻性非随机研究对80例直肠癌患者分别给予开腹手术治疗(开腹组,n=40)和腹腔镜手术治疗(腹腔镜组,n=40).比较两组患者术后发生感染的情况以及术后免疫功能改变情况.结果 腹腔镜组患者感染发生率低于开腹组(P＜0.05),且术后3dT淋巴细胞比例差值(△T细胞)、自然杀伤(natural killer,NK)细胞比例差值(△NK细胞)与C反应蛋白(C-reactive protein,CRP)水平差值(△CRP)均优于开腹组(均P＜0.01).结论 腹腔镜手术治疗直肠癌患者创伤小,术后发生感染的概率与应激反应较低,患者术后免疫功能恢复较快,是一种安全的治疗手段.