Prophylactic oophorectomy in surgery for large-bowel cancer

From 1968 to 1975, 201 women had prophylactic oophorectomy at the time of definitive large-bowel resection, while in 134 patients oophorectomy was not performed. Oophorectomy was performed more commonly in women with cancer of the rectum and rectosigmoid. More patients undergoing oophorectomy had Dukes' C primary carcinoma. Four patients undergoing synchronous oophorectomy (2.0 per cent) had ovarian involvement or metastases from large-bowel cancer. Three patients (2.2 per cent) developed subsequent ovarian disease: two cases of ovarian carcinoma and one case of ovarian metastases from primary breast cancer. No late ovarian recurrences of large-bowel cancer were seen during this study. No patient with ovarian involvement or metastases from large-bowel cancer survived five years nor was the overall survival of the group of women undergoing oophorectomy materially affected. While stage and site significantly influenced survival, oophorectomy, menopausal status, preoperative irradiation, tumor size, and degree of differentiation had no influence. The prevention of primary ovarian cancer in postmenopausal women is considered to be the main benefit of bilateral prophylactic oophorectomy. Selective recommendations for oophorectomy under other circumstances are discussed.     

Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia

Twenty-three renal artery stenoses in 21 hypertensive patients, caused by fibromuscular dysplasia, were treated with percutaneous transluminal angioplasty (PTA). Follow-up over a period of 1 to 30 months, including angiography, renal vein renin assay, and radionuclide flow studies, was performed in 8 patients, each with one stenosis. Dilatation was initially successful in all cases and was successfully repeated in 1 case. The mean systolic pressure decreased by 61.81 mm Hg and the mean diastolic pressure by 36.28 mm Hg in response to treatment. Thirteen patients were cured, 8 were felt to have better control of blood pressure on medication, and there was no failures. This study demonstrates that PTA is a clinically effective method of treating renovascular hypertension due to fibromuscular dysplasia.     

The tumor specific immune response of experimental active-specific immunotherapy.

Evidence for augmentation of antigenic recognition was investigated by measuring antigen-specific lymphocyte stimulation in animals which were minimally immunized with Con A-modified tumor cells. Comparison of lymphocyte stimulation response was made to animals immunized with unmodified tumor cells or sham immunization. Markedly heightened, tritiated Thymidine incorporation was observed in the lymph node cells from animals immunized with Concanavalin A-modified tumor cells, while minimal response was observed in control hosts. These preliminary findings imply that Con A-modified tumor cell immunotherapy may work by augmenting the host's capacity to recognized minimal differences in immunogenicity between tumor cells and the normal cells or origin. This modulation of the immune response may be a key factor in the success of active-specific immunotherapy.     

儿童阻塞性睡眠呼吸暂停低通气综合征上气道结构的MRI研究分析

目的利用磁共振成像（MRI）对儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的上气道结构进行测量分析,探讨儿童OSAHS上气道的结构特点。方法选择原发性鼾症组（Ps组）30例和OSAHS组30例,同时随机选择30例正常儿童作为对照组,应用MRI对上气道进行空间测量和软组织测量,结果进行统计学分析。结果①空间测量：3组儿童之间相比,鼻咽气道截面积、口咽气道截面积、腭咽气道截面积、气道斜径,比较差异有统计学意义（P〈0．05）;②软组织测量：舌体截面积3组之间差异无统计学意义（P〉0．05）;OSAHS组比Ps组及对照组腺样体截面积大、腺样体斜距长,比较有统计学意义（P〈0．05）;OSAHS组、Ps组比对照组扁桃体截面积大,比较有统计学意义（P〈0．05）。结论应用MRI可以判定OSAHS儿童上气道的狭窄情况,可作为诊断儿童OSAHS的重要辅助手段。     

硼替佐米联合地塞米松与沙利度胺治疗多发性骨髓瘤的效果

目的比较硼替佐米＋地塞米松＋沙利度胺（BDT）方案与长春地辛＋表柔比星＋地塞米松＋沙利度胺（VADT）方案治疗多发性骨髓瘤（MM）的临床效果。方法MM病人67例,应用BDT方案治疗30例,VADT方案治疗37例,均治疗4个疗程,比较两组治疗前、治疗后β2-微球蛋白、免疫球蛋白、骨髓瘤细胞的变化,并比较两组疗效。结果BDT组及VADT组化疗后β2-微球蛋白、免疫球蛋白、骨髓瘤细胞均低于化疗前,差异有显著性（t=2．837～7．562,P％0．05）。BDT组完全缓解（CR）占13．0％,接近完全缓解（ncR）占20．0％,部分缓解（PR）占53．0％,微小反应（MR）占6．7％,总有效率93．3％;VADT组CR占3．0％,nCR占10．8％,PR占40．5％,MR占16．2％,总有效率70．3％,两组疗效比较,差异有显著性（Hc=51．67,P〈0．05）。结论BDT方案治疗MM效果优于VADT方案,且起效快,可改善病人的预后。     

称重法和化学分析法评估人群膳食矿物质摄入量的比较

目的 探讨称重法和化学分析法评估人群矿物质摄入量的差异和相关性.方法 同时使用称重法和化学分析法对89名上海市居民进行膳食调查,并对两种调查方法测得的钙、镁、铁、锌、铜、锰摄入量进行比较分析.结果 称重法调查的6种矿物质元素的摄入量高于化学分析法(P<0.05),称重法调查的平均每天钙、镁、铁、锌、铜、锰摄入量比化学分析法分别高20.9%、67.4%、19.5%、84.4%、46.7%和33.3%;称重法与化学分析法测得的钙、镁、铁、锌、铜、锰摄入量均呈显著正相关(P<0.01),相关系数分别为0.571、0.672、0.521、0.524、0.538和0.691.结论 称重法测得的人群膳食矿物质摄入量高于化学分析法.     

Factors causing malnutrition in patients with chronic uremia

There is abundant evidence that patients with chronic renal failure (CRF), including those treated by hemodialysis or peritoneal dialysis, have evidence of malnutrition with decreased body weight and subnormal values of serum proteins (suggesting a loss of visceral protein stores). Potential causes of an abnormal nutritional status that have been identified include an inadequate intake of protein or calories, an inability to activate the metabolic responses that are needed to achieve nitrogen and protein balance, or the presence of a disease that prevents activation of these metabolic responses or acts to stimulate the breakdown of body protein stores. Three critical metabolic responses to a limited protein intake have been identified: a reduction in the irreversible degradation of amino acids and the degradation of protein breakdown and an increase in protein synthesis in response to a meal. Metabolic acidosis blocks the first two responses and hence contributes to malnutrition in patients with chronic uremia. Other factors that could contribute to malnutrition include an inadequate intake because of anorexia or hormonal imbalances that impair protein turnover. In evaluating CRF patients with malnutrition, the first task is to ensure an adequate intake and to eliminate factors that impair the ability to achieve nitrogen balance.     

Brachytherapy in the treatment of colorectal malignancies.

By precisely delivering a single, high dose fraction of intraoperative radiation under direct visualization while excluding surrounding normal dose-limiting tissues, IORT has improved the therapeutic ratio of tumor control to morbidity. Both IOERT and HDR-IORT represent effective means of delivering this therapy, and either may be chosen with equal confidence, depending upon the facilities available, physician preference, and the clinical situation. The extraordinary efforts often required in the management of these highly selected patients is justified by the improvement achieved in the enhanced local control rates and increased cure rates. Preoperative chemoradiation therapy followed by gross total resection and IORT affords the patient the highest likelihood of local control and survival. The importance of aggressive surgery in achieving gross total resection with pathologically negative margins is reflected by the dramatic correlation reported between margin status and local control. The high complication rate associated with this multidisciplinary therapy is, no doubt, multifactorial and may be attributed to the advanced disease state at presentation and the intensive multidisciplinary treatments administered. In an effort to eradicate disease and prolong survival, many consider these elevated complication rates acceptable, particularly in light of the complexity of these cases, as well as the morbidity and mortality associated with persistent disease in the pelvis.