Cancer of esophagus and esophagogastric junction: analysis of results of 1,025 resections after 5 to 20 years

Resection was carried out in 1,025 of 1,654 patients with cancer of the esophagus or esophagogastric junction at the Peking Medical College Hospitals in China from 1953 through 1973. All cancers of the esophagus were squamous cell carcinomas except for five adenocarcinomas. A lesion localized within the esophageal wall was found in 55% and lymph node metastasis in 41.3% of the patients undergoing resection. All cancers of the esophagogastric junction were adenocarcinomas. The tumor had invaded beyond the boundaries of the stomach in 76.7% of these patients, and positive nodes were found in 61% of the patients. The rate of resectability was 81.2% for esophageal cancer and 74% for cancer of the esophagogastric junction. Surgical mortality after resection was 4.9% (50/1,025). The 5-year survival after resection was 20.9% (214/1,025). Better results were found following complete resection: 24% (210/875) for all patients, 28.2% (162/575) for patients with cancer of the esophagus, and 16% (48/300) for patients with cancer of the esophagogastric junction. Late survival at 10, 15, and 20 years after resection of esophageal cancer was 20%, 12%, and 7.4%, respectively. The favorable prognostic factors after resection of esophageal cancer were tumor of the lower third of the esophagus, the absence of lymph node involvement, and the presence of a localized lesion. The 5-year survival for patients with cancer of the lower third of the esophagus was 32.7%. It was 64.2% for patients with a localized lesion with negative nodes in this subgroup.     

End-to-end oesophageal anastomosis: an experimental study in the rat

To study the effects of suture material, calibre and tension on the end-to-end oesophageal anastomosis, the cervical oesophagus of the rat was resected for 2.5 mm, 7.5 mm and 12.5 mm respectively in three groups of 60 rats each. End-to-end anastomosis was performed with either 6/0 silk, 6/0 polypropylene or 9/0 polypropylene sutures. There was no postoperative leakage. Mortality was mainly due to hair bolus obstruction at the site of anastomosis. There was no difference in mortality and anastomotic stenosis between groups with different resection lengths. Within each group, however, mortality and anastomotic stenosis were significantly higher in the subgroup of rats with 6/0 silk suture than that in the subgroup with 6/0 polypropylene sutures, which also had significantly higher mortality and anastomotic stenosis than the subgroup with 9/0 polypropylene sutures. Histological examination of the stenosed anastomosis showed disruption of muscle layers and submucosal thickening. It is concluded that the use of fine calibre sutures of biologically inert material would be preferred for the end-to-end anastomosis of the oesophagus.     

Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment

Twenty-seven shoulders (in 26 patients) that had surgical repair of a rupture of the long head of the biceps tendon between 1962 and 1981 were evaluated at three to 22 years after injury (mean, 13 years). Thirty similar patients had been treated nonsurgically and were evaluated two to 15 years (mean, 4.6 years) after tendon rupture. Biomechanical testing was performed on ten patients in the surgical group and 13 in the nonsurgical group. Residual arm pain was infrequent in both surgically and nonsurgically treated groups. Residual subjective weakness at the elbow was reported in four of the surgical group and in 20 of the nonsurgical group. Surgically treated patients returned to work later than nonsurgical patients; however, 11 in the nonsurgical group were not able to return to full work capacity, versus only two in the surgical group. On biomechanical testing, the nonsurgical group had lost a mean of 21% of supination strength and 8% of elbow flexion strength but had no weakness in grip, pronation, or elbow extension. The surgical group had lost no strength in any of these testing modes.     

应用低严格度—单引物聚合酶链反应对问号钩体中国参考株的…

Ｇ１、Ｇ２引物是对问号钩体具有特异性引物。分别用Ｇ１或Ｇ２单引物对问号钩体中国参考株进行前４个低严格度循环的ＰＣＲ扩增，扩增带谱显示赖型、犬型、致热型、秋季型、澳洲型、临海型、乌尔夫型、溶血型为一类，而爪哇型、拜伦型、波摩那型、七日热型、巴叶赞型塔拉索夫型、曼耗Ⅱ型是不与以上赖型等血清型本为一类，双曲钩体ａｔｏｃ型及伊利尼细丝体伊利尼型的扩增带谱与问号钩体截然不同。应用苯酚法提取的高纯度钩体ＤＮＡ     

黄连细胞二步法悬浮培养生产黄连生物碱类成分的探索

为提高用植物细胞培养生产镒生代谢产物的单位产量，作者对黄连细胞采用二步法悬浮培养生产黄连生物碱进行了探索。结果显示：黄连细胞采用一步法悬浮培养６周，细胞干，鲜重产率分别为２０．９６ｇ／Ｌ和１７４．９２ｇ／Ｌ，增重约７００％，细胞中总生物碱含量为１４．７９ｍｇ／ｇ．ｃｅｌｌ ｄｗ，培养基中生物碱量为１２．９６ｍｇ／Ｌ，每升培养液共可收获生物碱３２３ｍｇ。采用先在生长培养基中培养３周，在合成碱量为１２     

头孢氨苄缓释片在健康人体内的生物利用度和药物动力学

目的:比较头孢氨苄缓释片和普通胶囊的生物利用度和药物动力学。方法：10例健康志愿者分别单剂量口服500mg头孢氨苄缓释片和普通胶囊，血药浓度测定方法为HPLC法。结果：两种剂型体内过程均符合一室开放模型，缓释片的达峰时间（Tmax）为（2．58±0．59）h，峰浓度（Cmax）为（10．08±1．68）μg／ml．吸收速率常数（Ka）为（0．90±0．53）／h，消除速率常数（Ke）为（0.26±0.02）／g，半衰期（T1／2）为（2.67±0.23）h，清除率（Cl）为（6.93±1.71）L／h，分布容积（Vd）为（26.66±6.72）L，药一时曲线下面积（AUC）为（48.31±9.32）μg·h／ml。两种剂型T一C一Ka、Ke、T1／2和Cl均存在显著性差异（P＜0．01），Vd、AUC无显著性差异（P＞0．05）；缓释片的相对生物利用度为（104．90±8．35）％。结论：缓释片的吸收减慢，Tmax推迟，T1／2延长，可减少服药次数，提高药物治疗的顺应性。     

Complications, comorbidities, and mortality: improving classification and prediction.

OBJECTIVE: First, to compare the distribution of complications and comorbidities associated with 17 common surgical procedures. We then describe the effect of augmenting an ICD-9-CM version of the Charlson comorbidity index, given the possible confounding of comorbidities and complications, for three common inpatient surgical procedures: coronary artery bypass surgery, pacemaker surgery, and hip fracture repair. DATA SOURCES AND STUDY SETTING: Individuals having one of the above procedures between April 1, 1990 and March 31, 1994, identified from Manitoba Health hospital discharge data, and their extracted records. STUDY DESIGN: Design was cross-sectional and longitudinal using Manitoba data on hospital utilization and mortality. DATA COLLECTION/EXTRACTION: Manitoba hospital discharge abstracts permit identifying whether or not the diagnosis represents an in-hospital complication of care. Two data sets were created for each procedure, one including complication diagnoses and another with complications removed. PRINCIPAL FINDINGS: The degree to which complications contaminated estimation of comorbidity depended both on the procedures studied and on the covariates selected. The unique structure of the algorithm for the Charlson comorbidity index led to complication diagnoses having only a minor effect on the comorbidity score generated. Unless a data set affords the opportunity to remove complication diagnoses, the improvement in comorbidity detection afforded by augmenting the Charlson index, combined with the potential for overestimation of comorbidity, seem sufficiently modest to contraindicate such augmentation.     

复合抗氧化剂对荷瘤大鼠60Co γ射线局部照射时血液氧化损伤的影响

目的探讨荷瘤大鼠60Co γ射线局部照射时血液学氧化损伤以及复合抗氧化剂抗损伤作用. 方法采用Walker-256肿瘤细胞株接种大鼠皮下,得到实体瘤,摘除实体瘤分割成小块植入大鼠的右后腿皮下,制成大鼠荷瘤模型,将荷瘤大鼠分成3组,分别为肿瘤组、照射组和抗氧化剂保护组,同时选取正常大鼠作为阴性对照组. 抗氧化剂保护组每日给予复合抗氧化剂ig,分次对照射组和抗氧化剂保护组的荷瘤大鼠进行60Coγ射线局部照射4次,每次间隔1 wk,累计剂量为47 Gy,最后一次照射后7 d,活杀大鼠,取全血和血清测定过氧化氢酶(CAT)、丙二醛(MDA)、总超氧化物歧化酶(T-SOD)和总蛋白. 结果照射组的MDA含量显著高于非照射组和抗氧化剂保护组(347 μmol*g-1 vs 292, 305和196 μmol*g-1, P<0.05),复合抗氧化剂显示出良好的保护作用. 而照射组的抗氧化酶类如总超氧化物歧化酶(T-SOD)活性显著低于非照射组和抗氧化剂保护组(3.65 μkat*g-1 vs 4.05, 4.82和4.70 μkat*g-1, P<0.05),CAT的活性在照射组显著低于肿瘤组和抗氧化剂保护组(362 K*g-1 vs 677和672 K*g-1, P<0.05). 结论 60Co γ射线局部照射可以产生自由基引发的全身氧化损伤,高效的复合抗氧化剂可以起到有效的保护作用.     

中老年人24小时动态血压变化的研究

目的探讨血压正常老年患者和老年高血压患者24h动态血压波动规律及与靶器官损害的关系.方法采用无创伤袖带式动态血压监测仪检测36例中年人(对照组),50例血压正常老年患者,60例老年高血压患者的动态血压.结果血压正常老年患者较中年血压正常者24h动态血压呈杓型曲线的比例明显下降.血压正常老年患者,血压昼夜波动曲线与心、脑、肾损害无相关性.老年高血压患者,血压曲线呈非杓型者比例增高,血压昼夜节律消失较节律正常的高血压患者有更显著的靶器官损害.结论对于非高血压患者,随年龄的增加,血压昼夜节律消失者增多,血压曲线变化与心、脑、肾损害无关,可能与原发病有关.对于高血压患者,血压昼夜节律紊乱可作为靶器官损害的预测因子.     

七种常见舌苔的细胞化学计量诊断研究

以１１７例常见舌苔上皮细胞内ＬＤＨ、ＭＤＨ、Ｇ－６－ＰＤＨ、ＡＣＰ、ＡＮＡＥ、－ＳＨ、ＲＮＡ七种生物大分子物质的定量检测为基础，运用多元逐步回归方法建立正常薄白、虚寒薄白及白厚、薄黄、黄厚、花剥、光剥种舌苔的计量诊断模型，经临床回代检验，其敏感性、特异性、准确度、可用度分别为９３．２％、８１．４％、８７．２％和７５．７％。