Effectiveness and cost-effectiveness of colorectal cancer screening: Selecting the ideal strategy

Abstract Colorectal cancer is the second most common cancer killer of Americans. Recently developed and tested methods of screening and surveillance can effectively diagnose and treat the disease in most patients before symptoms develop when the chance of cure is high. It is also possible to prevent colorectal cancer by detecting and resecting premalignant adenomatous polyps. Evidence-based guidelines recommend that the average-risk population greater than age 50 be screened with annual faecal occult blood tests plus periodic flexible sigmoidoscopy. This approach is feasible, efficacious, affordable and cost-effective in a high-risk country such as the US. Widespread compliance with these recommendations could reduce the mortality from this malignancy by more than 50%.     

LAK/IL-2联合应用治疗晚期肺癌的临床研究

选择４６例晚期肺癌患者应用ＬＡＫ／ＩＬ－２疗法观察患者近期临床改善情况及治疗前后其免疫指标的变化情况。选择胎儿胸腺淋巴组织作前体细胞，体外用重组ＩＬ－２诱导制备ＬＡＫ细胞，每输３次ＬＡＫ细胞为１疗程，每次输入细胞数为０５×１０９，化疗以采用丝裂霉素、长春新碱、顺铂或卡铂、鬼臼乙叉甙为主的方案，治疗结果：本组患者治疗有效率（ＣＲ＋ＰＲ）达７０％，同时患者免疫指标好转。本研究提示ＬＡＫ／ＩＬ－２联合疗法临床近期疗效较满意，同时可显著改善机体免疫功能，是晚期肺癌患者一种可行的有效方法     

Fibrolamellar hepatocellular carcinoma coexistent with a hepatocellular carcinoma of common type: Report of a case

A case of small fibrolamellar hepatocellular carcinoma (HCC) coexistent with a HCC of common type is herein reported. A 56-year-old man was diagnosed as having multi-nodular type HCC with liver cirrhosis. The serum alpha-fetoprotein (AFP) level was slightly increased. The patient underwent a partial caudate lobectomy and lateral segmentectomy. Histologically, both resected tumors were small HCCs measuring less than 2 cm in diameter. One was a fibrolamellar type located in the caudate lobe, while the other was the common type in the lateral segment of the liver. Positive immunohistochemical staining for AFP was observed in the tumor cells of the HCC of common type but was not observed in the fibrolamellar HCC. We also reviewed previously reported cases of fibrolamellar HCC in Japan, and discussed the clinicopathologic implications of this disease.     

胃癌单抗检测活检粘膜组织833例结果分析

应用胃癌单抗ID1-2对833例内窥镜活检组织进行了免疫学荧光检查,胃癌阳性检出率为81.6％:胃溃疡为32.7％;肠化生性蒌缩性胃炎为40.0％;食管和结肠腺癌分别为60.0％和62.5％,与单纯性萎缩性胃炎和浅表性胃炎的阳性检出率相比有非常显著的差异(P<0.01)。表明ID1-2单抗可用于检测活检粘膜组织中的癌细胞以及具有癌细胞相关抗原的癌前病变组织,如果与内窥镜及常规病理学检查联合应用,将可进一步提高早癌的阳性检出率。     

Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer

The authors examined the impact of the laparoscopic approach on the early outcome of resected colon carcinomas. The role of laparoscopic techniques in the treatment of colon carcinomas is questionable. Previous studies have suggested technical feasibility of surgical resections of these cancers by laparoscopic means and have implied a benefit to laparoscopic technique for patients undergoing colorectal resections. A prospective, randomized study was conducted comparing laparoscopic assisted colectomy (LAC) open colectomy (OC) for colon cancer. We present the preliminary results in relation to the short-term outcome and judge the feasibility of the laparoscopic procedure to as a way of performing accurate oncologic resection and staging. Benefit has been demonstrated with LAC in this setting. Passing flatus, oral intake, and discharge from hospital occurred earlier in LAC- than OC-treated patients The mean operative time was significantly longer in the LAC group than in the OC group. The overall morbidity was significantly lower in the LAC group. No significant differences were observed between both groups in the number of lymph nodes removed or the pathological stage following the Astler-Coller modification of the Dukes classification. The laparoscopic approach improves the short-term outcome of segmental colectomies for colon cancer. However, the further follow-up of these patients will allow us to answer in the near future whether or not the LAC may influence the long-term outcome.Presented at the annual meeting of the Society of American Gastrointestinal Surgeons (SAGES), Orlando, FL, USA, 11–14 March 1995     

Treatment of chronic lymphocytic leukemia in early and stable phase of the disease: Long-term results of a randomized trial

Abstract: In 1982 the IGCI CLL cooperative group decided to investigate the usefulness of treating, at diagnosis B-cell chronic lymphocytic leukemia (CLL) in early and stable phase of the disease. From January 1982 to December 1986, 148 patients were randomized either to receive immediate treatment with chlorambucil (CLB) or to defer therapy to the time of progression. The early and stable phase of the disease was defined by a total tumor mass (TTM) score < 9, the absence of anemia or thrombocytopenia and a doubling time > 12 months. The main end-point of the study was survival. At the last evaluation in April 1993, after a median follow-up of 75 months, no significant difference was found in overall survival between early vs. deferred treatment patients from every cause of death as well as from death due to CLL-related causes only. The same results were obtained when the patients in more favorable stages, such as Binet stage A and TTM < 4.5, were considered. Interestingly, the incidence of epithelial cancer was similar in the two groups. Early treatment was associated with a significantly better response and a lower progression rate. From this long-term experience, it can be concluded that immediate chemotherapy with CLB is not beneficial for CLL patients in early and stable phase of the disease in terms of survival.     

Laparoscopy to correctly diagnose and stage metastatic breast cancer mimicking Crohn's disease

We report a case of metastatic lobular breast carcinoma with extrahepatic gastrointestinal disease. On the basis of clinical findings, radiologic investigations, computerized axial tomography, gastrointestinal endoscopy, and gastric biopsy, the diagnosis of gastric and ileal Crohn's disease was made. The correct diagnosis of peritoneal carcinomatosis was made at laparoscopy. This case exemplifies the utility of laparoscopy in establishing the diagnosis and staging for abdominal disease of uncertain etiology.     

The possible role of stromal cell stimulation in worsening the prognosis of a subset of patients with breast cancer

This review examines the evidence that a subset of patients with breast cancer have tumors that are stimulated to grow by host cells in the tumor stroma. The search for such a minority group was prompted by the following observations. Adjuvant chemotherapy which is immunosuppressive improves disease-free interval and survival, whereas non-specific immunostimulation worsens the prognosis. Intrinsic immune reactivity is associated with a poor prognosis. A subset of tumors with a bad prognosis has anaplastic cells, dermal lymphatic invasion and a moderate to intense lymphoplasmacytic stromal infiltrate. Evidence is reviewed that adjuvant chemotherapy may be beneficial by virtue of its immunosuppressive effects in addition to tumor kill of minimal residual disease.     

男性胆囊结石患者血清性激素和前列腺素改变的探讨

借助RIA,对28例胆囊结石男性(平均57.5岁)及26名健康中、老年男性(平均63.3岁)进行了血清雌二醇(E_2)、孕酮、睾酮和前列腺素类(PGs)检测,以探索胆石形成机理。结果,1)在胆石男病人中.平均E_2和平均孕酮水平均高,他们的平均睾酮则低下,与健康对照男性相应诸值比较,差异非常显著或显著(P<0.001,0.05,0.05);2)至于平均PGs,胆石男性组者与健康对照男性相比,前者也相当高(23.01pg/ml对16.31pg/ml),只是两组间差异尚无统计学意义。作者等初步设想,胆石男性小,如同胆石女性那般,本症也可能是某种垂体性腺激素分泌紊乱性疾病。