Completely covered cloacal exstrophy: recognition of a new clinical sub-entity

A case showing many of the typical visceral features of cloacal exstrophy is reported. The patient had fn imperforate anus, a cecal-cloacal fistula, dehiscence of the pubiic symphysis, and lumbosacral spina bifida with synsingomyelia, but the lower abdominal wall was intact without any visceral extroversion. The pertinent literature was reviewed, and it was found that this case corresponded to t typical case of completely covered cloacal exstrophy. Only six cases, including the present one, have so far been reported in the literature. From a clinical viewpoint, it apparently occupies an intermediate position in the wide spectrum of cloacal anomalies between classical cloacal exstrophy and imperforate anus with recto-cloacal fistula, but anatomatically and embryologically it is definitely a variant of cloacal exstrophy. In other words, it looks like an imperforate anus with recto-cloacal exstrophy, but should be treated as a variant of loacal exstrophy. The anatomy, classification, embryology, diagnosis, and management of this peculiar surgical condition are discussed, and recognition of this entity is urged.     

胶体金免疫标记技术研究胆酸钠促进结肠吸收胰岛素的机理

目的利用胶体金免疫标记技术，研究促吸剂(胆酸钠和水杨酸钠)促进结肠吸收胰岛素的机制。方法 建立大鼠结肠给药模型，考察胰岛素制剂降糖作用，胶体金免疫标记结肠标本，电镜观察。结果以1 u·kg^-1的剂量给予胰岛素制剂，I(不含促吸剂)使大鼠血糖下降至原来的73.2%，II(含有促吸剂)使大鼠血糖下降至原来的16.4%；胶体金颗粒呈团状、点灶状分布，特异性强，无促吸剂时金颗粒仅分布在细胞间隙，有促吸剂时，在细胞表面和内部均可观察到金颗粒。降糖作用与电镜结果具有良好的相关性。结论在促吸剂作用下，胰岛素分子可在结肠上皮细胞进行转运。     

肝组织多药耐药基因高表达与结肠癌肝转移的相关性研究

目的　探索早期检测肝组织多药性耐药基因对结肠癌肝转移的预测价值。方法　取裸鼠 4 0只 ,用人结肠癌SW4 80细胞系制作裸鼠原位结肠癌肝转移模型。模型建立的第 10天肝活检取左右肝叶各2mm3 组织 ,用实时荧光定量PCR方法检测多药耐药基因 (multidrugresistancegene,mdr- 1mRNA)的表达 ;模型建立的第 5周观察裸鼠肝脏是否形成肉眼转移灶。结果　经实时荧光定量RT -PCR检测肝活检组织mdr- 1基因 ,在存活的 36只裸鼠中 2 2例高表达 ,平均CT值 (Cyclethreshold ,即反应管内的荧光信号到达设定的域值时所经历的循环数 )为 2 5 90 1,平均拷贝数为 4 2 7× 10 7/ugRNA ,并高表达的 2 2只裸鼠均有肉眼肝转移灶形成 (10 0 % ) ;mdr - 1基因低表达 (平均CT值 33 36 8,平均拷贝数 2 11× 10 5)及无表达的 14只裸鼠中 ,仅 1例形成肉眼肝转移灶 (7 1% ) ,其余 13例均无肉眼肝转移灶形成 (P <0 0 1)。结论　结肠癌肝活检肿瘤细胞mdr- 1mRNA基因高表达与异时的肝转移灶形成有明显的相关性 ,提示检测结肠癌肝组织多药性耐药基因的高表达可以预测异时的肝转移灶形成。     

The endoscopic evaluation of gastritis,gastric remnant residue,and the incidence of secondary cancer after pylorus-preserving and transverse gastrectomies

Background Pylorus-preserving gastrectomy (PPG) and transverse gastrectomy (TrG) have been accepted as function-preserving procedures for node-negative early gastric cancer. It is believed that a better quality of life is guaranteed after PPG or TrG compared to that after distal subtotal gastrectomy (DSG) with Billroth type-I reconstruction. However, objective evaluations of the gastric remnant following gastrectomy have not been widely reported, and the real advantages and disadvantages of PPG or TrG over DSG remain unclear. Moreover, the risk of secondary cancer after PPG or TrG is uncertain.Methods Between 1991 and 2000, 834 DSGs were carried out in our institute for preoperatively diagnosed patients with early gastric cancer. The degree of residual gastritis and the amount of diet residue in the gastric remnant were evaluated by annual gastrointestinal endoscopic investigations prospectively for 72 patients after PPG, 95 patients after TrG, and 60 patients after DSG. These analyses were performed using the RGB classification (residue, gastritis, bile). The incidence of disease greater than or equal to grade 2 was calculated, and the time trends of the incidence for each procedure were also studied for 3 years after gastrectomy. In addition, secondary cancer cases in the gastric remnant mucosa were checked for each procedure during this period, and the incidence of secondary cancer after each operation was calculated.Results The incidence of gastritis, of grade 2 or more, found in the gastric remnant was significantly lower after PPG (1.4%) and TrG (2.1%) than after DSG (43.3%). However, the incidence of moderate or greater residue in the gastric remnant, grade 2 or more, was significantly higher after PPG (45.8%) and TrG (40.0%) than after DSG (11.7%). The analysis of time trends of gastritis and diet residue reflected the significant advantage or disadvantage for each procedure 1 year after surgery. The analysis also included these factors without consideration of elapsed time following surgery. Two patients after PPG (2.8%) and three patients after TrG (3.2%) developed secondary cancer in the gastric remnant. No DSG-treated patient showed new cancer genesis in the remaining stomach.Conclusion PPG and TrG have the advantage over DSG in preventing postoperative gastritis in the gastric remnant. On the other hand, moderate or greater diet residue in the gastric remnant is more common after PPG or TrG than after DSG. For the risk of carcinogenesis in the remnant gastric mucosa, we could not conclude that there was any apparent difference between these range-limited gastrectomies and conventional DSG. Further study is necessary to determine the significant advantages and disadvantages of using PPG or TrG.     

Ability of a Specific ERK Signal-Pathway Inhibitor to Reverse P-Glycoprotein- Mediated Vincristine Resistance in Colon Cancer Cell Unes

OBJECTIVE To investigate the effect of a specific inhibitor PD098059 of the extracellular-signal regulated protein kinase (ERK) pathway on the P-glycoprotein (P-gp)-mediated resistance of colon cancer cell lines SW480/VCR and CoLo205NCR.METHODS SW480NCR and CoLo205NCR cells were generated byexposuring SW480 and CoLo205 cells to vincristine (VCR) (30 ng/ml) for 72h, which resulted in a comparatively higher level of P-gp expression.Western blotting was used to analyze P-gp, MRP, LRP, GST-‘rr and TOPOIIexpression after exposuring the SW480 and CoLo205 cells to VCR (30 ng/ml)for 72 hrs. P-gp and pERK1/2 expressions was analyzed in SW480NCR andCoLo205/VCR cells treated with or without the specific inhibitor of MEK,PD098059. The MTT assay was used to determine the susceptibility ofSW480NCR and CoLo205NCR cells to VCR, treated with or withoutPD098059.I~F.SULI“S The results showed that VCR induced a comparatively higher levelof P-gp expression in the cell lines, but not that of MRP, LRP, GST-n- orTOPOII. P-gp expression levels were depressed significantly in SW480/VCR and COLO205/VCR cells by the specific inhibitor of MEK, PD098059.The IC50 (248 19.6 and 215 10.7 ng/ml) to VCR of SW480/VCR andCoLo205/VCR cells exhibited a 2.16 and 2.03-fold higher resistancecompared to the negative control group (SW480 and CoLo205 cells)(115 15.6 and 106 11.9 ng/ml), but a 1.35 and 1.21 -fold higher resistance thanthe group treated with VCR (30 ng/ml) PD098059 (184 21.8 and 177 19.4 ng/ml).CONCLUSION This study shows that the expression of P-gp can beinduced by exposuring cells to VCR, and that this induction can be reversedby inhibiting the ERK signaling pathway at the point of MEK by its specificinhibitor, PD098059. The ERK signal-transduction pathway may play a rolein modulating mdrl expression in colon cancer.     

食管拔脱结肠重建食管(附18例分析)

 目的　探讨食管拔脱结肠重建食管术 (esophagealreplacementwithcolonERC)治疗颈、胸上段食管癌的可行性和实用性。方法　经颈、腹径路实施食管内翻拔脱切除病变食管 ,并用ERC获得了满意疗效 ,对该术操作要点 ,食管拔脱的可行性进行讨论。结果　全组无手术死亡 ,1例发生颈部吻合口瘘 ,1 8例术后随访 6年 ,存活超过 1年者 1 3例 ,超过 3年者 8例 ,超过 5年者 5例 ,5年生存率为 2 7.8%。结论　食管内翻拔脱ERC治疗颈 ,胸上段食管癌的特点为 :避免开胸术创伤 ,保留自体胃功能 ,术后生存期长 ,生活质量好。     

5-Fluorouracil plus leucovorin is an effective adjuvant chemotherapy in curatively resected stage III colon cancer: long-term follow-up results of the adjCCA-01 trial.

BACKGROUND: Adjuvant postoperative treatment with 5-fluorouracil (5-FU) and leucovorin in curatively resected stage III colon cancer significantly reduces the risk of cancer recurrences and improves survival. The impact of 5-FU plus leucovorin on survival and tumor recurrence was analyzed in a long-term follow-up study in comparison with the effects of 5-FU plus levamisole in the prospective multicenter trial adjCCA-01. PATIENTS AND METHODS: Patients with a curatively resected stage III (International Union Against Cancer) colon cancer were stratified according to tumor, node and grading category and randomly assigned to receive one of the two adjuvant treatment schemes: 5-FU 400 mg/m2 body surface area intravenously in the first chemotherapy course, then 450 mg/m2 x 5 days, plus leucovorin 100 mg/m2, 12 cycles (arm A), or 5-FU plus levamisole (Moertel scheme; arm B). RESULTS: Six hundred and eighty (96.9%) of 702 patients enrolled into this study were eligible. To date, 261 patients have died, 117 on arm A and 144 on arm B (P = 0.007). After a median follow-up time of 82 months, the 5-FU plus leucovorin combination significantly improved disease-free survival [79.8 months in arm A versus 69.3 months in arm B (P = 0.012)] and significantly increased median overall survival (88.9 months in arm A versus 78.6 months in arm B; P = 0.003). Adjuvant treatment with 5-FU plus levamisole as well as 5-FU plus leucovorin was generally well tolerated; only a minority of patients experienced grade 3 and 4 toxicities. CONCLUSIONS: After curative resection of a stage III colon cancer, adjuvant treatment with 5-FU plus leucovorin is generally well tolerated. This long-term follow-up study demonstrates that adjuvant treatment with 5-FU plus leucovorin given for 12 cycles is significantly more effective than 5-FU plus levamisole (Moertel scheme) in reducing tumor relapse and improving survival.     

Transverse testicular ectopla: report of three cases

Two patients who presented with a history of right inguinal hernia and a third with an impalpable left testis were found to have transverse testicular ectopia. Both testes were fixed in their own scrotum, through a modified Ombredanne operation in two patients and a subdartos pouch in one.     

Macroscopic assessment of nodal metastasis is not reliable in colon cancer

Background Japanese surgeons have to macroscopically assess nodal metastasis from colon cancer according to the general rules established in Japan. Adjuvant therapy is sometimes started after macroscopic assessment of nodal metastasis. Macroscopic assessment, however, is difficult in many cases. Methods We evaluated the reliability of macroscopic assessment of nodal metastasis in colon cancer by (1) comparing the number of nodes picked up macroscopically with that of nodes recognized microscopically, and (2) by comparing the number of metastatic nodes found between macroscopic and microscopic examination. Results The number of nodes found during macroscopic examination was equal to that found in microscopic examination in only 52 of 206 cases (25%). Although 120 of 206 cases (58%) were judged macroscopically to have metastatic nodes, 61 had no metastatic nodes found microscopically. Sensitivity and specificity for the recognition of cases with nodal metastasis was 85.5% and 55.5%, respectively. The number of metastatic nodes in macroscopic examination was equal to that in microscopic examination in 90 cases (44%). Conclusion Because macroscopic assessment of nodal metastasis is not reliable, physicians should not rely on macroscopic assessment to indicate the need for further therapy, such as adjuvant chemotherapy. The recommendation for macroscopic assessment of nodal metastasis should be eliminated from the general rules in Japan.     

Increased Sensitivity to Long-term 5-Fluorouracil Exposure of Human Colon Cancer HT-29 Cells Resistant to Short-term Exposure

A 5-fluorouracil (5-FU)-resistant subline of human colon cancer HT-29 cells was developed by repeated 1-h exposure in vitro to 5-FU. This subline (HT-29/5-FU/S) had 8-fold resistance to 5-FU in a 1-h exposure assay. However, it had rather increased sensitivity to 5-FU when assayed after a continuous 96-h exposure to it. Significantly less 5-fluorouridine-5'-triphosphate was produced in the resistant cells, leading to a lower level of 5-FU incorporation into the cellular RNA. The reduced activity of orotate phosphoribosyltransferase might explain these results. In contrast, the HT-29/5-FU/S cells were more sensitive to the inhibition of in situ thymidylate synthase (TS) by 5-FU than were the parent cells. The lower in situ TS activity may have made HT-29/5-FU/S cells more sensitive to TS inhibition by 5-FU as compared with the parent cells. The fact that HT-29/5-FU/S was more resistant to short-term 5-FU exposure but more sensitive to long-term exposure than the parent line confirmed the existence of different modes of action of 5-FU, depending on the exposure time.