Liver operations in Sweden in 1987-99.

BACKGROUND AND AIMS: Liver surgery is developing with new techniques and treatment modalities. The aim of this study is to describe liver surgery over a long period of time in a country with a public health care system. PATIENTS AND METHOD: A register study including adult patients admitted for liver resection in Sweden (population 8.8 million) selected from the Inpatient Register 1987-99. Additional data were collected from the Swedish Cancer Register and the Cause of Death Register. Analyses of the patients, indications, mortality and causes of death are presented. RESULTS: 2,405 operations were performed (21 per million per year). The most frequent indication was colorectal metastases (27%). The 5-year survival after an operation for primary liver cancer and colorectal liver metastases was 27% and 26%, respectively. CONCLUSIONS: Few patients were admitted for liver operations compared to expected figures. The survival rates are in conformity with those previously published. With an increasing awareness of the relatively favourable prognosis and the introduction of new methods, the volume of liver operations will probably increase in Sweden.     

Effects of PEEP on extra vascular lung water and central blood volume in the dog

Twenty-four mongrel dogs were anaesthetized and ventilated mechanically in the supine position. Extravascular lung water (EVLW) and central blood volume (CBV) were measured with a double indicator (dye/cold) dilution technique. Both indicators were detected intravascularly in the aortic root with a fibreoptic thermistor catheter. Seven dogs ventilated with a positive end-expiratory pressure (PEEP) of 1.0 kPa (10 cmH2O) for a short period of time (less than 20 min) displayed no significant change in EVLW as measured with the indicator dilution technique (= EVLWi), while reductions were seen in both CBV (15%, P less than 0.01) and cardiac output (CO-thermodilution technique) (10%, P less than 0.05). Another seven dogs ventilated with a PEEP of 1.0 kPa for 8 h showed a gradual increase in EVLWi. After 8 h, a mean increase of 34% (P less than 0.01) was recorded, and the increase was also verified by post-mortem gravimetric determination of EVLW (= EVLWg), displaying an increase of 61% (P less than 0.01). In five dogs ventilated with zero end-expiratory pressure (ZEEP) for 8 h, no changes in EVLWi, CO, and CBV were observed, and EVLWg was mean 4.39 g/kg body weight (BW). Five additional dogs were sacrificed after 15 min of anaesthesia without catheterization and EVLWg was found to be 4.24 g/kg BW. It is concluded that EVLWi does not change measurably during ZEEP or short periods of PEEP. However, long periods (8 h) of PEEP result in elevated EVLWi values. Gravimetry supports these conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)     

The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer. Long-term follow-up results of a randomised trial.

Two hundred patients with node positive stage II breast cancer were randomised to four groups after radical mastectomy and axillary evacuation: (1) Postoperative radiotherapy, (2) Adjuvant chemotherapy with eight courses of CAFt (cyclophosphamide 500 mg m-2 + doxorubicin 40 mg/m-2 + ftorafur 20 mg kg-1 orally day 1-14) every fourth week, (3) Postoperative radiotherapy and adjuvant chemotherapy and (4) postoperative radiation, adjuvant chemotherapy and tamoxifen 40 mg daily for 2 years. Thirty-two per cent of the patients discontinued treatment due to GI-toxicity, while 26% required dose reductions due to leukopenia. Radiation pneumonitis was more frequent after the combination of postoperative radiotherapy with chemotherapy. There was a better relapse-free survival in the groups receiving chemotherapy compared to radiotherapy alone (P = 0.05), which was highly significant in a multivariate Cox analysis (P = 0.004). No significant survival differences were seen. Tamoxifen had no clear overall effect but there were better relapse-free (P = 0.04) and overall (P = 0.004) survival with tamoxifen in estrogen receptor positive patients, while estrogen receptor negative patients had a somewhat poorer survival (P = 0.07) after tamoxifen. Local control was better (NS) after the combination (93%) radiotherapy and chemotherapy compared to either treatment alone (76% with radiotherapy and 74% with chemotherapy at 5 years).     

A placebo controlled trial of remoxipride in the prevention of relapse in chronic schizophrenia

Sixty-two DSM III chronic schizophrenic inpatients were selected for a double-blind, placebo controlled, multi-centre, relapse prevention study of remoxipride, a selective dopamine (D₂)-receptor antagonist. After a 1 month placebo washout, 23 patients had relapsed and were withdrawn. Of the remaining patients 19 were randomised to remoxipride (150–300 mg daily) and 20 to placebo. Their median age was 58 years, 26 were male, and the median duration of illness was 33 years. After 24 weeks a further total of 8 remoxipride and 17 placebo patients had been withdrawn. Excluding three patients withdrawn for reasons other than relapse, the comparative relapse rates were 37% and 75%, respectively (P=0.015). Efficacy analyses using clinical global impression (P=0.04) and change in BPRS scores (P=0.016) were in favour of remoxipride. Extrapyramidal symptoms were minimal in both groups. Treatment emergent adverse events were similar in the two groups. Remoxipride is therefore of potential value as a safe drug which is both effective and well tolerated in the long term management of chronic schizophrenic patients.     

Increase of interleukin 6 and decrease of interleukin 2 production during the ageing process are influenced by the health status

The ageing process is accompanied by the disregulation of interleukin 2 (IL2) and interleukin 6 (IL6) production. In our paper, we asked whether the age between 60 and 70 years is a turning point for the disregulation of both IL2 and IL6 production. Fifty volunteers 60–70 years old, 25 aged 36–59, and 50 of 20–35 years old were enrolled into the study. Their health status was graded according to the criteria of the Senieur Protocol (SP) as ‘healthy' and ‘almost-healthy'. The cytokines level was determined in the sera of the volunteers. Moreover, the spontaneous release of IL6 by peripheral blood mononuclear cells (PBMC) and the activity of the IL6 gene in non-stimulated PBMC were also analysed. Cytokine levels were measured by biological assays, mRNA for IL6 was detected by RT-PCR method. The results showed that the production of IL2 is not disregulated in the ‘healthy' people until the age of 60–70. People not fulfilling all SP criteria are characterised by a lower level of IL2 in the sera. The overproduction of IL6 into the sera and supernatants from non-stimulated PBMC and PBL as well as the activation of IL6 gene start between the ages 36 and 59 and is more pronounced in the ‘almost-healthy'.     

Genomic Regions That Underlie Soybean Seed Isoflavone Content

Soy products contain isoflavones (genistein, daidzein, andglycitein) that display biological effects when ingested byhumans and animals, these effects are species, dose and agedependent. Therefore, the content and quality of isoflavones insoybeans is a key to their biological effect. Our objective wasto identify loci that underlie isoflavone content in soybeanseeds. The study involved 100 recombinant inbred lines (RIL) fromthe cross of ‘Essex' by ‘Forrest,' two cultivars that contrastfor isoflavone content. Isoflavone content of seeds from each RILwas determined by high performance liquid chromatography (HPLC).The distribution of isoflavone content was continuous andunimodal. The heritability estimates on a line mean basis were79% for daidzein, 22% for genistein, and 88% for glycitein.Isoflavone content of soybean seeds was compared against 150polymorphic DNA markers in a one-way analysis of variance. Fourgenomic regions were found to be significantly associated withthe isoflavone content of soybean seeds across both locations andyears. Molecular linkage group B1 contained a major QTLunderlying glycitein content (P = 0.0001, R² = 50.2%), linkagegroup N contained a QTL for glycitein (P = 0.0033, R² = 11.1%)and a QTL for daidzein (P = 0.0023, R² = 10.3%) and linkagegroup A1 contained a QTL for daidzein (P = 0.0081, R² = 9.6%).Selection for these chromosomal regions in a marker assistedselection program will allow for the manipulation of amounts andprofiles of isoflavones (genistein, daidzein, and glycitein)content of soybean seeds. In addition, tightly linked markers canbe used in map based cloning of genes associated withisoflavone content.