Surgical results of performing R4 gastrectomy for gastric cancer located in the upper third of the stomach

Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach.     

Surgical management of endocrine tumor of the pancreas in Japan

Endocrine tumor of the pancreas is potentially malignant. A multicenter analysis of these tumors was conducted to clarity the present status of their surgical management and the subsequent long-term surgical results. The Japan pancreatoduodenectomy (JPD) study group carried out the study; 368 patients were enrolled and variables related to tumor characteristics, surgery, and survival were retrospectively analyzed. There were 222 patients with functioning tumor and 143 patients with nonfunctioning tumor. Malignant tumor was found in 140 of 368 (38%) of the patients, and 63/140 (45%) of these patients had metastatic lesion; the most common site of the metastasis was liver 34/136 (25%), followed by regional lymph nodes 26/136 (19%). Pancreatic resection was performed in 91% of patients with nonfunctional tumor and in 83% of those with malignant tumor, and 73% of the pancreatic resections were done with lymph node dissection. The overall 5-year actuarial survival rate was 76% in patients with malignant tumor. The actuarial 5-year survival rate was 93% in the patients without metastasis and 83% in patients who received curative resection. Multivariate analysis showed that the presence or absence of synchronous metastasis was the sole significant prognostic factor. The results suggest that: (i) malignant endocrine tumor of the pancreas is a curable malignancy when pancreatic resection with lymph node dissection is adopted and (ii) that synchronous metastasis is the dominant prognostic factor. This study was carried out as a group project. The authors' institutions are as follows     

Multiple metastatic calcifications detected by bone scintigraphy and demonstrated by CT.

Metastatic calcifications according to histopathologic and scintigraphic findings have been well-defined. The authors report a postoperative case of hyperparathyroidism with multiple metastatic calcifications in the lung, kidney, stomach, heart, and vessels that were primarily detected by bone scintigraphy and demonstrated by CT. Tc-99m MDP bone scintigraphy showed a markedly increased accumulation of radioactivity diffusely throughout the lung, left ventricular wall, both kidneys, and the gastric cardia and body. In the lung, plain films showed almost normal lung. CT, however, demonstrated patchy, slightly increased densities in the lung bilaterally. Cardiac CT indicated a considerably increased density of the ventricular myocardium and remarkable calcification in or near the atrioventricular septum or annulus fibrosus. Upper abdominal CT demonstrated increased densities diffusely throughout the gastric mucosa and renal cortex. Only vascular calcifications were depicted by plain films. Using both bone scintigraphy and CT provides accurate information about each lesion and each tissue, allowing precise diagnosis of even a questionable lesion in the early stage of metastatic calcification. Early diagnosis and early therapy offer the best chance for cure or palliative therapy.     

着色真菌蟾蜍分离株小鼠致病试验研究

目的：观察着色真菌蟾蜍分离株的致病性。方法：抽样取着色真菌蟾蜍分离株与标准人分离株对照，制成菌悬液，做小鼠腹腔接种，观察接种后小鼠的外观表现，做菌种逆培养和观察内脏病理变化。结果：蟾蜍分离株卡氏枝孢霉、疣状瓶霉、裴氏着色霉和甄氏外瓶霉与病人分离株一样，在接种28天后，均可从小鼠脏器逆培养出接种的菌种，并引起内脏病变，形成结核样肉芽肿，肉芽肿内均可查见棕黄色硬壳小体。而瓶霉和外瓶霉属菌种逆培养结果均阴性。结论：从野生蟾蜍分离出的卡氏枝孢霉、疣状瓶霉，裴氏着色霉和甄氏外瓶霉与病人分离株一样，对小鼠有致病性，故可能是人着色芽生菌病的致病菌。     

膀胱肿瘤化学防治的研究进展

膀胱癌是泌尿外科最常见的恶性肿瘤织一 ,由于复发率较高 ,死亡率逐年上升 ,防止肿瘤发生、发展和侵袭转移是降低膀胱癌高复发率和死亡率的关键。随着人们对膀胱肿瘤发生的分子生物学机制研究的深入 ,相关生物学标志物的相继问世以及某些化学药品和食品防癌作用的发现 ,尤其是癌症化学防治取得的一定的成功 ,使得防止和逆转膀胱肿瘤癌前病变成为可能 ,为此 ,本文对膀胱肿瘤化学防治近年的研究进展进行综述 ,为预防和控制膀胱肿瘤提供指导     

赖型钩体flaB2与VR1012中的CpG基序分析

目的：对问号赖型钩端螺旋体（赖型钩体）DNA疫苗[包括内鞭毛蛋白基因（flaB2)和质粒DNA表达载体（VR1012）]的CpG基序（CpG motifs)进行分析，为DNA疫苗免疫机制的阐明和提高DNA疫苗的效能奠定基础。方法：以flaB2与VR1012构建重组DNA的免疫原，对flaB2及VR1012全核苷酸序列进行计算机分析（分类、计数和定位）。结果：CpG的“C”的侧翼为两个嘌呤，“G”的侧翼为两个嘧啶，在flaB2中共3个，分别为GACGCT，GACGTC和GACGCC；在VR1012中共11个，分别为GACGTC1个，GACGCT2个，GACGCC1个，GACGTT1个，GGCGTT2个，GGCGCT2个，GGCGCC1个，AACGCT1个，其中特别重要的TGACGTCA4个和TAACGCCA有1个，位于5'端456－463；509－516；592－599；778－785和486－493；4个TGACGTCA和1个TAACGCCA均位于5'端且相对集中。结论：赖型钩体flaB2与VR1012构成的DNA疫苗含有TGACGTCA等CpG，这些基序又称免疫刺激序列，构成了DNA疫苗中的佐剂。     

不典型性脑膜瘤52例CT诊断分析

回顾性分析了22例少见部位的脑膜瘤，22例CT表现不典型及8例CT误诊脑膜瘤的CT表现，以确定脑膜瘤不典型表现与CT误诊的关系。结果显示脑膜瘤的CT误诊多数缘于经验不足与疏忽，少数为极不典型表现所致。若检查全面、阅片仔细．术前CT定性率可由90％提高至96．25％。     

玻璃体腔内注气治疗黄斑裂孔视网膜脱离

采用玻璃体腔内注气治疗黄斑裂孔视网膜脱离４９例（５３只眼），视风膜复位４２只眼（７９．２％），其中术后视力增进２９只眼（６９％），讨论了注气的适应征和影响视网膜复位的因素。     

Inhibitory effects of chlorpheniramine and astemizolum on contraction of isolated rat and rabbit uteri induced by oxytocin and PGF2α

Summary The contraction of isolated rat and rabbit uteri induced by oxytocin and PGF_2α was markedly inhibited by chlorpheniramine (Chl) and astemizolum (Ast), both of which also decreased the resting tension of uteri, and their spontaneous contraction. The inhibitory effects of both drugs were dose-dependent. At high concentrations, Chl 7.4× 10^-4 mol/L and Ast 10^-4 mol/L could counteract the contraction of the uteri induced by Oxy and PGF_2α, and their spontaneous contraction as well. They decreased the resting tension to the lower level. The mechanism of their non-special relaxed action on uteri could not be completely explained only by their H₁-receptor blocking action. Whether they act by blocking calcium channel or by inhibiting calmodulin (CaM) remains to be further explored.     

亚胺培南/西司他丁与头孢他啶治疗中、重度细菌感染疗效费用分析比较研究

对我院４５例确诊为中、重度细菌感染住院患者进行了亚胺培南／西司他丁与头孢他啶疗效费用分析比较研究。结果表明：２组病例有效率、死亡率无显著性差异；头孢他啶组较亚胺培南／西司他丁组疗程明显延长。亚胺培南／西司他丁每日所需费用明显高于头孢他啶；治疗结束时，前者全部费用并未超过后者；全部住院费用无明显差异。作者认为：决定２种药物全部费用的因素，除与药物单价和每日费用有关，还与药物疗程密切相关。选用药物抗菌作用越强，用药时间即相应缩短，住院时间必然缩短；最终患者住院费用降低