Sphincter preservation — A fascinating challenge in rectal carcinoma surgery

Background: In the last decades there has been an increasing trend toward sphincter preservation for rectal cancer. This paper analyses a uniformly operated patient collective with regard to complication, tumor recurrence and survival rates. Methods: Between January 1984 and July 1993, 440 patients were operated for rectal cancer. In the upper rectal third sphincter preservation was possible in 100%, in the middle third in 97% and in the lower third in 46%. Results: Tumor resection was possible in 98.9%, curative resection in 85.7% of the 440 surgically treated patients. Anastomotic leakage was observed in 10.5%, postoperative hospital mortality for curatively operated patients was 1.9%. The 5-year actuarial survival rates for tumor stages I to IV were 99%, 77%, 44% and 20% respectively. The local recurrence rate was 12.7%. Conclusions: A high rate of sphincter preservation can be achieved without sacrificing low morbidity, mortality or recurrence rates. The surgical trend towards sphincter preservation in the middle and lower rectal thirds is due to the increased application of stapler devices and to the histopathological examination of the distal and lateral resections margins. The mesorectum is recognized as an important source of local tumor recurrence.     

Morphologie

Ohne Zusammenfassung     

Randomized adjuvant trial of tamoxifen and goserelin versus cyclophosphamide, methotrexate, and fluorouracil: evidence for the superiority of treatment with endocrine blockade in premenopausal patients with hormone-responsive breast cancer--Austrian Breast and Colorectal Cancer Study Group Trial 5.

PURPOSE: Effective adjuvant treatment modalities in premenopausal breast cancer patients today include chemotherapy, ovariectomy, and tamoxifen administration. The purpose of Austrian Breast and Colorectal Cancer Study Group Trial 5 was to compare the efficacy of a combination endocrine treatment with standard chemotherapy. PATIENTS AND METHODS: Assessable trial subjects (N = 1,034) presenting with hormone-responsive disease were randomized to receive either 3 years of goserelin plus 5 years of tamoxifen or six cycles of cyclophosphamide, methotrexate, and fluorouracil (CMF). Stratification criteria included tumor stage and grade, number of involved nodes, type of surgery, and steroid hormone receptor content. Relapse-free survival (RFS) was defined as time from randomization to first relapse, local recurrence, or contralateral incidence, and overall survival (OS) as time to date of death. RESULTS: With a 60-month median follow-up, 17.2% of patients in the endocrine group and 20.8% undergoing chemotherapy developed relapses. Local recurrences emerged in 4.7% and 8.0%, respectively. RFS and local recurrence-free survival differed significantly in favor of endocrine therapy (P =.037 and P =.015), with a similar trend observed in OS (P =.195). CONCLUSION: Overall, our data suggest that the goserelin-tamoxifen combination is significantly more effective than CMF in the adjuvant treatment of premenopausal patients with stage I and II breast cancer.     

Natural history of bell's palsy: The salivary flow test and other prognostic indicators

This prospective controlled study included 51 patient with Bell's palsy evaluated within two days of onset. To determine the natural history of the disease, the patients were followed for six months at which time the amount of facial motor recovery was measured. Sixty-three percent of the patients had complete return while 37 percent had incomplete return. The age of the patients, the presence of pain, and the alteration of taste had no prognostic value. The progression of the palsy, the response to the maximal stimulation test and the results of the salivary flow test were useful prognostic indicators, being approximately 80 percent accurate in predicting the ultimate return of facial function. The salivation test was the most valuable, since salivary flow rates became altered before progression could be detected and earlier than the abnormal response to maximal stimulation. There are reports of surgical decompression based upon loss of electrical stimulation which resulted in incomplete return of facial function, while there have been reports of complete return of facial function when surgery was employed, based upon a reduction in salivary flow to 25 percent or less and before abnormal changes in maximal stimulation occurred. As the findings of a portion of this study showed that steroids did not alter the natural history of Bell's palsy, a surgical trial for treatment of Bell's palsy is justified, providing surgery is employed based upon a reduction of 25 percent or less in salivary flow and is undertaken before the response to electrical stimulation becomes altered.     

Nonrandom sampling in genetic epidemiology: maximum likelihood methods for multifactorial analysis of quantitative data ascertained through truncation

Three types of nonrandom sampling of family data are described, and appropriate maximum likelihood methods are proposed for each. The three types arise depending on whether the selection of probands, based on truncation, is applied directly to the phenotypic distribution, to the distribution of a correlated trait, or to the liability distribution of an associated disease. Family data ascertained through random and nonrandom sampling can be analyzed together in a unified approach. Results of a Monte Carlo study are presented that demonstrate the utility of the proposed methods. In particular, likelihood ratio tests of null hypotheses are shown to be distributed as chi-square, even in samples as small as 50 families (with variable sibship size).     

Effects of voluntary wheel running on mitochondrial content and dynamics in rat skeletal muscle

Journal of Muscle Research and Cell Motility - This study reports that in rat skeletal muscle the proteins specifically responsible for mitochondrial dynamics, mitofusin-2 (MFN2) and mitochondrial...     

Die Bedeutung der «Minusvariante» (Hultén) für die Atiologie der Lunatumnekrose

Ohne Zusammenfassung