Influence of tumour differentiation on survival after resection for rectal cancer in a series of 1296 patients

The influence of differentiation grade on tumour staging, local recurrence and long term survival prospects has been evaluated in a series of patients managed by resection for rectal cancer. Differentiation was known in 1095 of 1296 patients. Well-differentiated tumours were over-represented among Dukes' stage A cases and poorly differentiated among those with disseminated disease (P less than 0.001). Local recurrence was twice as common (31%) after curative resection of poorly differentiated tumours than of well (14%) or moderately (17%) differentiated. Five year cancer specific survival rates after resection (curative and palliative combined) of tumours of good, average or poor differentiation were 68%, 59% and 33%, respectively. After potentially curative resection, survival was also significantly worse in patients with poorly differentiated tumours (P less than 0.001); 5 year survival rates of patients with tumours of good, average or poor differentiation were 75%, 71% and 51%, respectively. Survival prospects beyond 5 years in patients with Dukes' stage A tumours were significantly reduced when the tumour was poorly differentiated; 5 and 10 year survival rates were 76% and 40%, respectively. However, patients with Dukes' stage C tumours of poor differentiation had an identical 5 and 10 year cancer specific survival, 26%. Patients with mucoid type tumours had worse survival prospects than those with non-mucoid type (P less than 0.02).     

The therapeutic effect of taking a patient's history by computer

Sixty young women who presented at a general-practice health centre had their medical and social history taken by a computer before having an interview with the doctor. The average length of the automated interview was 90 minutes for the 54 patients who completed the programme, during which an average of 211 questions were answered. The patients found this method acceptable and we think that one of the main reasons for this was that the computer programme was so designed that the patients felt that the doctor was involved throughout.The computer/patient interview also appeared to have therapeutic benefits, and the computer''s summary of the history was a sensitive indicator of those topics about which the patient was most concerned. This combination enabled the doctor to communicate more quickly and in greater depth in the time available. In effect, the time which the doctor could spend with the patient was magnified.We suggest that the benefits of this system for taking a history from a patient, of which one is the fact that any language or combination of languages can be used, could be extended to all classes of society.     

The vascular pedicle of the heart and the vena azygos. Part II: Acquired heart disease

To establish the value of the chest radiograph in assessing the hemodynamic status of the systemic circulation, the vascular pedicle width ( VPW ) and vena azygos width (AW) were correlated with total blood volume (TBV) and other parameters in 61 cardiac patients. In both ischemic and valvular cardiac disease a highly significant linear correlation was found between VPW and TBV (r = 0.80, p less than 0.001). In patients with dilated neck veins VPW was greater than 62 mm (normal 48 +/- 5 mm). A less significant correlation was found between VPW and mean right atrial pressure ( MRAP ). Change in VPW correlated strongly (r = 0.93, p less than 0.001) with change in TBV (0.5-cm change in VPW = 1.0-liter change in TBV). Correlation between AW and TBV was poor (r = 0.50, p less than 0.01), but between AW and MRAP the correlation was stronger (r = 0.74, p less than 0.001). Changes in AW usually occurred in the same direction as changes in MRAP , but the correlation was not significant (r = 0.45). VPW and AW did not correlate with pulmonary blood volume, pulmonary arterial pressure, stroke volume, or heart rate. Radiologic assessment of VPW and AW adds an additional clinically useful dimension to the evaluation of cardiac disease.     

Influence of type and amount of dietary lipid on plasma lipid concentrations in endurance athletes

Changes in plasma total cholesterol, triglyceride, and lipoprotein concentrations were assessed in three male endurance cyclists who consumed isoenergetic diets for 28-day periods in which carbohydrate, polyunsaturated fat, or saturated fat contributed about 50% of the daily energy intake. Dietary cholesterol was similar among the diets. Maximal aerobic capacity was maintained at 62 ml O2/(kg X min). Body weights were held within 3% of admission levels. The polyunsaturated fat diet significantly (p less than 0.05) reduced mean fasting plasma total cholesterol in comparison to the saturated fat and carbohydrate diets (160 versus 254 and 243 mg/dl, respectively). Similarly, the polyunsaturated fat diet depressed (p less than 0.05) mean plasma triglycerides relative to the saturated fat and carbohydrate diets (37 versus 62 and 79 mg/dl, respectively). No significant dietary effects were seen on high-density lipoprotein cholesterol. The observed changes in plasma total cholesterol were not significantly different than the values predicted by the Keys' equation, delta CHL = 1.35(2 delta S-delta P) + 1.5 delta Z. We conclude that under controlled conditions in which physical activity is constant l) dietary lipid differences influence fasting serum lipid and lipoprotein concentrations among men with high energy expenditures, and 2) the Keys' equation gives useful predictions of changes in plasma total cholesterol among vigorous men consuming different types and amounts of dietary lipid.     

Mannitol But Not Dantrolene Prevents Myocardial Dysfunction Following Intra-cranial Hypertension in Rats

Cardiac complications stemming from intra-cranial hypertension may result from impaired intra-cellular Ca(2+) homeostasis. The aim of this study was to examine the effects of dantrolene, a blocker of sarcoplasmic reticulum (SR) Ca(2+) release, on myocardial dysfunction associated with intra-cranial hypertension in rats. Dantrolene (10 mg) with and without 15% mannitol was administered to halothane-anesthetized rats prior to induction of intra-cranial hypertension by subdural balloon inflation. Its effects were compared to 3% and 15% mannitol and 5% Pentaspan. Dantrolene with mannitol or 15% mannitol alone prevented the transient intra-cranial hypertension-induced hyperdynamic response and ensuing circulatory collapse that was found in animals pre-treated with 3% mannitol solution or pentaspan. Moreover, hemodynamic function was preserved irrespective of TnI cleavage. However, only animals treated with high dose 15% mannitol exhibited lower lipid peroxidation content in the heart. In contrast, pre-treatment with dantrolene alone did not prevent the cardiac complications associated with intra-cranial hypertension. In conclusion, 15% mannitol attenuated the cardiopulmonary complications associated with intra-cranial hypertension. Dantrolene without mannitol was without effect. Since mannitol exhibits free radical scavenging properties, protection could be the result of a decrease in oxidative stress after intra-cranial hypertension.