Polyhalogenated dibenzo-p-dioxins and dibenzofurans and the immune system

We used a modified version of the popliteal lymph node assay in rats to investigate the immunosuppressive potential of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). In 10 months we conducted 3 experimental series. Animals were treated with single s.c. injections of TCDD and 7 days later human red blood cells (HRBC) were injected s.c. into the right hind footpad of the rat. Another 7 days later, both popliteal lymph nodes were prepared, weighed, the cell number was counted and the quotients (index) of these variables from the treated and the untreated side were determined. The doses applied in three experimental series were 600, 60, 6, 0.6, and 0.06 ng TCDD/kg body wt. In the first experimental series only the three highest doses were tested, in a second experimental series doses of 60, 6, 0.6, 0.06 ng TCDD/kg body wt were applied. Combining the results of these two experimental series, a statistically significant difference was found in the cell number index between the controls and the two highest doses tested (60 and 600 ng/kg body wt;p <0.01). This result was recently published as an abstract (Korte et al. 1990). However, with slight methodological changes in the third series of experiments (doses applied: 600, 60, 6, 0.6, and 0.06 ng TCDD/kg body wt) and using a greater number of animals we could not confirm these preliminary results. No difference was seen in the immune response to the antigen challenge in controls and in any of the treatment groups. We conclude that TCDD does not clearly influence the immune response as observed in the popliteal lymph node assay under our experimental conditions.     

Quality control of surgical technique in a multicenter, prospective, randomized, controlled study on the surgical treatment of gastric cancer.

To evaluate the effect of lymph node dissection on gastric cancer patients operated upon with curative intent, we are carrying out a multicenter, prospective, randomized, controlled study in the Netherlands. The trial compares conventional gastrectomy to gastrectomy with extended lymph node dissection. In the first four months, a Japanese supervisor attended all the extended surgery and instructed many Dutch surgeons, including the eight consulting surgeons; since then, all extended gastrectomies have been attended by one of the consulting surgeons. The study coordinator attended all conventional cases. This assured that the quality of the extended surgery was as good as the Japanese standard, of which excellent results have been reported. To achieve this quality control, randomization before surgery was obligatory for practical reasons. Curability assessment at laparotomy, however, is done quite objectively with histological proof, except for the judgement of irresectability. Although this has resulted in many non-curative cases being randomized but subsequently not given the allocated surgery, the sample size should be sufficient to allow analysis according to randomization or the initial "intention to treat." This is the first protocol for a multicenter trial in surgical oncology to have such excellent surgical quality control and to assure a quality as high as that in the original report with uniformity in the level of technique. In studies comparing surgical techniques, it is vital that attention should be given to surgical quality control, otherwise survival rates may show little improvement and fail to make any impact on surgical practice.     

氨茶碱对三磷酸腺苷诱发兔窦房结电生理反应的抑制作用

目的　分析氨茶碱对三磷酸腺苷 (ATP)诱发兔窦房结电生理反应的抑制作用。方法　细胞内微电极技术记录兔离体窦房结细胞动作电位。结果　ATP( 0 3～ 3 0mmol/L)单次槽内注入给药 ,浓度依赖性减慢窦房结自发搏动速率 2 2 %～ 4 3% ,降低舒张期除极速率 4 2 9%～ 6 6 7% ,增大动作电位幅值 7 1%～ 9 2 % ,加快最大除极速率 32 0 %～ 75 5 % ,使动作电位复极 5 0 %和 90 %的时程 (APD50 和APD90 )缩短 7 1%～ 11 8%和7 3%～ 9 3%。P1受体阻断剂氨茶碱 ( 0 1mmol/L)显著拮抗ATP的作用 ,P2受体阻断剂反应蓝 2( 0 0 5mmol/L)则不影响ATP的作用。结论　ATP的上述电生理学效应可能通过P1受体介导     

First experience with gamma probe guided sentinel lymph node surgery in penile cancer

Because of the curative approach, the detection of lymph node metastases in squamous cell carcinoma (SCC) of the penis is of significant clinical relevance. Sentinel lymph node (SLN) identification by means of lymphangiography has been proven to be insufficiently safe. However, the high morbidity of inguinal lymphadenectomy and the considerable individual variability regarding the location of lymph node metastases justify the necessity of a technique that enables the identification of SLNs. Since 1998, SLNs have been intraoperatively identified and selectively dissected, after peritumoral injection of technetium-99m nanocolloid and using lymphoscintigraphy, in three patients (one with malignant melanoma and two with SCC). At least one SLN could be detected in each patient. The maximum surgical time was 30 min. There were no severe complications. Lymph node metastases did not occur in any patient. Upon a mean follow-up of 10 months, all patients are currently free of tumor. Owing to the long-term results of sentinel lymphadenectomy in malignant melanoma of other locations and our preliminary results with respect to penile carcinoma, we consider the current method appropriate as the only primary operation for lymph node staging in early stages and, in combination with modified inguinal lymphadenectomy, in locally advanced stages. Received: 24 November 1999 / Accepted: 21 April 2000     

N2肺癌预后因素分析及手术适应证的探讨

目的 :识别纵隔淋巴结转移 (N2 )的非小细胞肺癌 (non smallcelllungcancer ,NSCLC)患者根治术后的预后不利因素 ,探讨N2 肺癌合理的手术适应证。方法 :回顾1993年 1月 1日～ 2 0 0 0年 1月 3 1日 ,2 12例根治性切除及系统性淋巴结廓清术后病理诊断为N2 肺癌患者的临床资料。应用Ka plan Meier法计算生存率 ,Log rank检验比较不同临床病理因素组间患者的生存差别 ;Cox多因素回归分析 ,判定N2 肺癌预后的不利因素。结果 :本研究 5年生存率为17% ,其中有N2 临床症状、大细胞肺癌和T4患者的预后最差 ,中位生存期不足 12个月。有纵隔淋巴结转移症状 (RR =9 2 ,P <0 0 0 1)、T4肿瘤 (RR =7 15 ,P <0 0 0 1)、淋巴结被膜受侵 (RR =1 72 8,P =0 0 0 8)和多站(≥ 3站 )淋巴结转移 (RR =2 2 94,P =0 0 0 2 )是预后的不利因素。结论 :N2 非小细胞肺癌患者的预后有很大的差别 ,根治切除的适应证应该加以选择。有明显纵隔淋巴结转移症状、大细胞肺癌和T4肿瘤的N2 患者预后极差 ,不宜将外科手术作为首选的治疗方法。     

前哨淋巴结活检对乳腺癌外科导航的临床分析

目的 探讨前哨淋巴结活检(SLNB)对乳腺癌手术导航的临床价值及可靠性。方法 用染料法(1％亚甲蓝)对30例乳腺癌病人进行腋窝前哨淋巴结(SLN)染色切除。术中冰冻切片，术后石蜡切片，并常规行腋窝淋巴结清除术(ALND)。结果 SLN染色成功率96．7％(29／30)，失败1例。SLN阳性10例，后站淋巴结有癌转移6例(60％)，无癌转移4例（40％)。SLN阴性19例，其中假阴性1例，后站淋巴结均无癌转移。SLNB评价：检出率96．7％、准确率93．3％、敏感度90．9％、假阴性率9．1％、假阳性率0。结论 只要提高技术水平，SLN染料着色和检出率都相对较高，对外科术式选择有实际指导意义。相信SLNB取代传统的ALND已为时不远。     

非小细胞肺癌淋巴结大小与转移的关系

目的:评估非小细胞肺癌淋巴结大小与转移的相关性.方法:从形态测量学角度,分析258例非小细胞肺癌患者纵隔和肺门的淋巴结.记录每例淋巴结数目、最大径及病理结果.计算转移频数与淋巴结大小的相关性.回顾性分析其中80例患者术前CT扫描的淋巴结所见,与组织病理学诊断相对照.结果:检查258例标本的2 892枚淋巴结.140例患者为pN0期,118例为淋巴结阳性.2 487枚淋巴结(86.0%)无转移,405枚淋巴结(14.0%)有转移.无转移淋巴结平均直径是(7.05±3.7)mm,转移淋巴结是(10.7±4.7)mm,(P＜0.005).1 954枚无转移淋巴结(78.5%)和180枚转移淋巴结(44.3%)直径＜10mm.140例无转移淋巴结的患者中,102例(72.9%)至少有一枚淋巴结＞10mm118例转移患者中,13.0%淋巴结＜10mm.80例CT扫描评估的敏感性是57.0%,特异性80.2%结论:淋巴结大小不能作为评估非小细胞肺癌转移浸润的可靠参数.     

306例肺癌的淋巴结转移规律

目的 探讨可切除性肺癌的胸内淋巴结转移规律。方法 从l992年1月至2000年l2月，对306例肺癌患者施行根治性切除术和系统性胸内淋巴结清扫，分别记录各区淋巴结的数量、大小、颜色和质地，并进行病理检查。结果 全组共清扫胸内2456个区的46l4个淋巴结，平均每例15.1个。经病理检查证实其中521个区的954个淋巴结存在转移癌。胸内淋巴结的转移率高达61．8％，纵隔淋巴结的转移率高达43．5％。围绕肺门或肺根部的11、10、7、5和4区淋巴结的转移频度比远离肺根部的9、6、3、2、l区淋巴结高。小细胞肺癌的淋巴结转移率明显高于非小细胞肺癌(P＜0.01)。淋巴结转移率与淋巴结的大小、颜色和质地均有密切关系(尸＜0.00l，P＜0.00l，P＜0.001)。结论 多数肺癌的淋巴结转移遵循由近及远、自下而上、由肺内经肺门再向纵隔的顺序转移规律，少数纵隔淋巴结转移呈“跳跃式”。肺切除术时施行系统性胸内淋巴结清扫是必要的。     

食管癌淋巴结转移的临床病理因素

目的 探讨食管癌淋巴结转移的临床病理相关因素。方法 对204例食管癌根治标本进行统计,分析各主要临床病理改变与淋巴结转移关系。结果 204例食管癌中有淋巴结转移者89例,淋巴结转移率为43.6％。胸中段癌淋巴结转移率为48.0％,胸上段癌和胸下段癌的淋巴结转移率分别为32.0％和26.9％。髓质型和溃疡型淋巴结转移率分别为47.6％和56.0％,除缩窄型外其他类型转移率最高者为21.4％。男性患者淋巴结转移率为54.3％,女性淋巴结转移率为28.4％。浸润至黏膜层和黏膜下层者,未发现淋巴结转移,浸润至浅肌层、深肌层、纤维膜者淋巴结转移率分别为28.6％、45.6％和48.8％。以上四种因素中前后两者间比较差异均有显著性(P<0.05)。淋巴结转移率与年龄无关,也不随肿瘤大小的增加而增加。结论 男性食管胸中段癌患者淋巴结转移率较高,尤其当肿物为髓质型和溃疡型时最为显著。     

乳腺癌前哨淋巴结活检意义初探

目的：探讨开展乳腺癌前哨淋巴结活检(Sentinel lymph node biopsy，SLNB)的必要性、可行性、准确性及临床应用价值。方法：对45例临床、B超及钼靶检测腋窝LN阴性的原发乳腺癌患者，术中在原发肿瘤周围注射专利蓝进行腋窝淋巴结切除(SLNB)，随后行腋窝淋巴结清扫(ALND)。术中对部分SLN、术后对全部LN行常规病理检查。结果：45例患者中41例检测到SLN，成功率91．1％；假阴性率为6．66％，SLNB总的敏感性是93．3％，特异性是96．1％；总的阳性和阴性预测值分别是93．3％和96．1％。结论：乳腺癌SLNB是一项有实用价值的新技术，目前国内外仍在研究阶段，随着研究的扩大与深入将有可能取代常规的ALND。