Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation

BACKGROUND: The problems associated with rectal surgery are frequently discussed with no reference being made to the distance of the tumor from the anal verge. This study examined the effect of the location of the tumor on early postoperative results. PATIENTS AND METHODS: This was a multicenter study involving 75 German hospitals and 3756 patients, of whom 1463 had rectal carcinoma. On the basis of the location of the tumor (distance from the anal verge), four groups were distinguished: <4, 4-7.9, 8-11.9, and 12-16 cm. RESULTS: Resection and abdominoperineal resection rates and the incidence of postoperative complications depended on the location of the tumor. Significantly higher resection rates and fewer specific complications, and a significant reduction in overall postoperative morbidity were found with tumor locations more than 8 cm from the anal verge. The highest anastomotic leak rate was observed with anastomoses less than 7 cm from the anal verge. The logistic regression showed that the distance of the tumor from the anal verge is an independent variable for the development of an anastomotic leak. CONCLUSIONS: Early results are greatly affected by the location of the rectal carcinoma. This applies to both abdominoperineal resection rates and specific postoperative complications, such as anastomotic leak rate and operation morbidity in general.     

Total lymphoid irradiation in chronic polyarthritis--a new therapeutic concept

Eleven patients with refractory rheumatoid arthritis were submitted to a total lymphoid irradiation up to a dose of 20 Gy. A constant improvement of clinical symptoms was observed in four out of the eleven patients already during the treatment and in the other patients not later than two months after. The frequency of attacks decreased and the number of joints involved in the attack was reduced. Morning rigidity and joint swellings decreased. One patient developed joint empyemas 4 and 26 months after the treatment. Four patients died in the meantime. In two patients the cause of death were renal insufficiency and a postoperative cardiogenic shock associated with generalized amyloidosis. The third patient died because of a toxically induced left cardiac decompensation with sepsis that could not be controlled by antibiotic drugs and multiple joint empyemas. The fourth patient developed an abscess after surgical treatment of a Kaposi syndrome. She died three months later from acute left cardiac decompensation. The therapy induced a lymphocytopenia with decrease of T helper lymphocytes and unchanged number of T suppressor lymphocytes. The constant therapy results of total lymphoid irradiation in primary chronic polyarthritis is probably due to this modification in the immune regulation.     

Komplikationen nach steuerbarem Gastric Banding

BACKGROUND: Adjustable gastric banding is a popular bariatric operation in Europe. About 1500 patients per year undergo a such procedures in Germany. Clinical data on the rate of long-term complications such as pouch dilatation, slippage, and band migration are available in only a few long-term studies with small numbers of patients. Meta-analyses report on comordities and reduction in weight. The rate and management of long-term complications were examined at this inquiry. METHODS: Ninety hospitals were asked about rates of band implantation, follow-up, and complications. Thirty-eight hospitals (42.2%) participated in the study. The management of complications including slippage, pouch dilatation, and band migration was analyzed. RESULTS: At 35 hospitals, 4138 patients underwent gastric banding procedures in 25 hospitals over more than 5 years. The mean follow-up rate is presently 85.3%. Long-term complications were described in 8.6% of the patients. Pouch dilatation occurred in 5.0%, slippage in 2.6%, and band migration in 1.0%. CONCLUSIONS: Laparoscopic adjustable gastric banding can effectively achieve weight loss. However, band-related and functional complications influence late outcome. The rate of long-term complications was equivalent to that already in the literature.     

Overexpression/amplification of HER-2/neu is uncommon in hepatocellular carcinoma

BACKGROUND： Hepatocellular carcinoma （HCC） is one of the most prevalent fatal cancers in the world. Despite advances in early diagnosis and improvements in surgical techniques, the survival of patients with HCC even after resection is poor because of the high incidence of recurrences. Therefore, the identification of prognostic factors may be helpful in the development of new treatment protocols. AIMS： To investigate HER-2/neu status in HCC by immunohistochemistry （IHC） and fluorescence in situ hybridisation （FISH）, and to explore the possibility of using trastuzumab in the treatment of HCC. METH ODS： Eight hundred and sixty eight surgical samples from patients with primary HCC were examined for their HER-2/neu status. IHC for HER-2/neu was performed with the HercepTest kit; FISH analysis was performed with the PathVysion HER-2 DNA probe kit. The correlations between HER-2/neu overexpression and clinicopathological characteristics were analysed statistically. RESULTS： HER-2/neu overexpression was detected in 21 （2.42%） of the 868 primary HCCs. Only one specimen showed HER-2/neu gene amplification by FISH. No significant associations were found between HER-2/neu overexpression and the clinicopathological parameters. CONCLUSIONS： There is a low frequency of HER-2/neu overexpression/amplification in HCC. There appears to be no role for HER-2/neu as a prognostic marker and no benefit of anti-HER-2/neu trastuzumab treatment in patients with HCC.     

中西医结合医院单病种的质量管理及其作用

针对中西医结合医院单病种质量评定没有现成的、规范的标准的现状,就中西医结合单病种的质量管理方法及其在中西医结合医院建设中的作用进行了论述。     

Synthesis and anthelmintic activity of a series of pyrazino[2,1-a][2]benzazepine derivatives

A series of 1,2,3,4,6,7,8,12b-octahydropyrazino[2,1-alpha][2] benzazepine derivatives was prepared and the cestocidal activity of the compounds evaluated in an in vitro Taenia crassiceps screen. Many of these derivatives proved to be highly active, and 2-(cyclohexylcarbonyl)-4-oxo-1,2,3,4,6,7,8,12b- octahydropyrazino[2,1-alpha][2]benzazepine, epsiprantel (BAN) (22), was selected for further development. The structure-activity relationships are discussed.     

Human ovarian granulosa cells and follicular fluid indices: the relationship to oocyte maturity and fertilization in vitro

The study investigates the correlation between oocyte maturity and fertilization and a variety of hormonal parameters in follicular fluid and ovarian granulosa cells. A methodology for purification of granulosa cells from contaminating blood cells is also established. A total of 63 follicular aspirates were collected at oocyte retrieval from 30 women superovulated using the long luteinizing hormone- releasing hormone (LHRH analogue)/human menopausal gonadotrophin regimen. Oestradiol, progesterone, testosterone and human chorionic gonadotrophin (HCG) were quantified in follicular fluid and granulosa cells were immunostained for human chorionic gonadotrophin. Immunopurification of granulosa cells from contaminating blood cells was performed. HCG in follicular fluid was significantly high in follicles yielding immature (grade 3) oocytes (P=0.002); there was no correlation with fertilization. Aspirates from follicles containing mature (grade 1) oocytes and oocytes that subsequently fertilized had significantly more granulosa cells immunobound to HCG (P < 0.001, P=0.02). Moreover, the immunomagnetic purification technique provided >98% pure population of granulosa cells. The data demonstrate that HCG in follicular fluid and on granulosa cells may help to predict oocyte maturity and fertilization. Furthermore, immunomagnetic beads provide a reliable procedure for the purification of ovarian granulosa cells.      

Spontaneous suppressor cell activity in the peripheral blood of patients with malignant and chronic inflammatory bowel diseases.

Fifteen patients with colorectal tumours, 15 patients with Crohn's disease (CD) and two groups of normal controls were investigated for the presence of spontaneous suppressor cell activity (SSCA) in peripheral blood mononuclear cells (PBMC). In comparison to the age and sex matched controls patients with colorectal carcinoma exhibited a significant increase in SSCA (P less than 0.01). No evidence could be obtained that the suppressive effect was due to a soluble factor such as prostaglandins. In contrast, patients suffering from CD presented a decreased SSCA. No correlation was obtained between the enhanced SSCA in tumour patients and the clinical stage of the disease, levels of oncofetal antigens or serum immune complexes. Likewise in patients with CD no correlation was found between decreased SSCA and CD index or different serum parameters. When PBMC of the different test groups were incubated with histamine or cimetidine before they were added to the indicator system the suppressive activity remained unchanged. Also pre-incubation of normal PBMC with alpha-fetoprotein or carcinoembryonic antigen did not change the spontaneous suppressor cell activity. Whether the significantly enhanced in vivo activity of spontaneous suppressor cells in patients with colorectal carcinoma is one of the multifactorial mechanisms leading to the establishment of cancer or whether it rather represents a reflection of the immune system on colorectal tumour antigens remains unsolved.