Outcome of surgical treatment of carcinoma of the pancreas

AIMS AND BACKGROUND: Pancreatic resections for neoplastic diseases have a high risk of severe intra- and postoperative complications and are associated with high mortality rates. They should be performed as a rule in centers specializing in this type of surgery. However, it is becoming increasingly likely that such tumors may have to be treated in surgery units which are not specifically dedicated to pancreatic surgery. The aim of this study was to assess the improvements in clinical results in a non-specialized general surgery setting in the light of the most recent progress in surgical techniques, drug treatments and nutritional support. METHODS AND STUDY DESIGN: We analyzed 48 patients with pancreatic cancer treated in our institution over the period from 1980 to 1998: 36 had cancer of the head of the pancreas, 5 of the ampulla, 1 in the second duodenal portion, and 6 of the body-tail. The operations performed consisted of 13 Whipple pancreaticoduodenectomies with cutting and stapling of the distal pancreatic stump at the level of the isthmus, 4 left pancreasectomies, 2 local resections of the ampulla, 21 palliative operations, and 2 exploratory laparotomies. RESULTS AND CONCLUSIONS: The patients were submitted to follow-up including clinical examinations, blood-chemistry tests, and instrumental investigations. The mean survival was 18 months in the cases where radical surgery was performed, compared to 11 months after palliative surgery. We conclude that an improved prognosis can obtain after pancreatic resection. This is attributable to a more accurate preoperative staging and to the aid of the various forms of nutritional support and pharmacological prophylaxis currently available.     

Computation of a radiodosage equivalent of the effect of bleomycin

The responses of in vitro cultured mammalian cells to X-rays and bleomycin were compared for establishing a general rule to convert X-ray dose to bleomycin dose for a given biological effect. There was no significant difference in the radiosensitivities according to cell lines used in this experiment, while the responses of cells to bleomycin varied from cell to cell. The X-ray dose-response curves for the cells were convex upward if plotted on a semilogarithmical scale, while bleomycin dose-response curves were convex downward. These results indicated that the ratio of X-ray dose and bleomycin dose required for a comparable biological effect would vary with the X-ray dose and from cell to cell. Preliminary treatment with bleomycin sensitized mammalian L5 cells to X-rays. When the cells were exposed to bleomycin following irradiation, no significant synergestic effect was observed, in spite of the fact that the bleomycin dose was sufficient to result in a survival of 4.5%.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

The course of life of survivors of childhood cancer

The developmental consequences in adulthood of growing up with childhood cancer are not well understood. The Course of life questionnaire was developed to assess the attainment of developmental milestones retrospectively and socio-demographic outcomes in young adulthood. The aim of this study was to assess the course of life and socio-demographic outcomes in young adult survivors of childhood cancer. Knowledge about possible gaps in the course of life could enable health care providers to aim for the most favourable course of life. A total of 353 Dutch survivors and a comparison group of 508 peers without a history of cancer, all aged between 18 and 30, filled in the Course of life questionnaire. The course of life of the survivors was found to be hampered. The young adult survivors of childhood cancer in the Netherlands turned out to have achieved fewer milestones than their peers with respect to autonomy development, social development, and psycho-sexual development, or to have achieved the milestones when they were older than their peers. In addition, survivors displayed less risk behaviour than the comparison group. The survivors and the comparison group also differed on some socio-demographic issues. A considerably lower percentage of survivors than peers in the comparison group were married or living together, and/or employed. Their educational level, on the other hand, was as high as that of their peers.     

Cytotoxicity of enantiomers of gossypol

The effect of gossypol on cell proliferation was studied using 24-well multiwell dishes. Cells were added to each well and incubated for 24 hours before the addition of different concentration of gossypol, which was dissolved in dimethyl sulfoxide immediately prior to use. After a further 3-day incubation, cell growth was determined by measuring cellular protein content. Standards and controls were included and dose response curves constructed by plotting increase in protein content over the 3-day growth period against gossypol concentration. Gossypol inhibited proliferation in tumor-derived cells as well as normal fibroblasts. BCL-D1 cells, a human diploid strain of fibroblasts, were sensitive to gossypol and further studies were undertaken using these cells. In contrast of most of the tumor-derived cells that have been used, these cells maintained consistent patterns of growth over periods of many months. The enantiomers of gossypol were prepared and analyzed as described in Matlin & Zhou (1984). The (-) enantiomer of gossypol was more cytotoxic than the (+) form. In the case of all the tumor-derived cells, the concentration of the (-) enantiomer required to produce cytotoxicity was -10% of that required in the case of the (+) enantiomer. At lower concentration, gossypol inhibited cellular proliferation, but at higher concentrations the compound was responsible for complete cell lysis. Even with high doses of (-), gossypol cell lysis did not occur rapidly. When gossypol was added to cultures and then removed with thorough washing at time intervals, it was found that 30 minute exposure was adequate to bring about the cytolytic effect. Thus, the biochemical effects of gossypol occurred rapidly after addition even though cellular changes may not be obvious for some hours. Once gossypol has been added to tissue culture medium, there is a loss of cytotoxic potential. When gossypol was added to culture fluid and incubated at 37 degrees Centigrade before addition to cells, the chemical lost -10%/hour of its cytotoxic potential. The likely explanation is a binding of gossypol to plasma proteins that form the serum supplement to the growth medium. More than 10,000 men have participated in clinical trials relating to the anti-fertility effects of gossypol; a low incidence of side effects has been reported. The question arises as to why gossypol fails to have an effect on bone marrow cell proliferation. Most likely the answer lies in the protection afforded by higher protein concentrations.     

恶性肿瘤延诊或误诊因素分析

目的 :分析恶性肿瘤诊断过程中的误诊因素 ,降低临床误诊率。方法 :回顾分析本院 1990年 6月～ 2 0 0 0年 12月收治的 167例恶性肿瘤患者 ,分析其诊疗过程中的误诊因素对正确诊断的影响。结果 :167例患者误诊 5 8例 ,误诊率为 3 4 73 %。误诊率较高的为少见肿瘤达 83 3 3 % ( 10 /12 ) ,其次为妇科肿瘤、胆道系统和甲状腺癌 ,分别为 4/5、3 /4和 3 /5。误诊因素中医生因素为主要因素占 77 5 9% ( 4 5 /5 8)。结论 :提高临床医生 ,特别是非肿瘤专科医生对恶性肿瘤生物学行为的认识 ,重视癌前病变及早期症状 ,以科学严谨的态度分析患者资料是减少误诊的关键     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

Economic burdens and quality of life of family caregivers of cancer patients

OBJECTIVES: We conducted this study to identify factors influencing the burdens cancer brings to a patient's family and to evaluate the association between the burdens and the caregiver's quality of life (QOL). METHODS: Participants were drawn from the primary family caregivers of cancer patients at 6 university hospitals and the National Cancer Center in Korea. Of the 738 eligible caregivers, 704 (95.4%) completed the questionnaire packets (Family Impact Questions and Caregiver's QOL-Cancer). RESULTS: Caregivers, who were poor (OR, 2.11; 95% CI, 1.44-3.10), whose health status was poor (OR, 1.87; 95% CI, 1.29-2.70), who were married (OR, 1.75; 95% CI, 1.12-2.72), who provided care for a long time (OR, 2.29; 95% CI, 1.59-3.28), who cared for patients with poor performance status (OR, 1.35; 95% CI, 1.00-1.82), and who paid high medical expenses (OR, 1.70; 95% CI, 1.21-2.40), were more likely to lose their family savings. In multiple regression analysis, most burden variables--including requiring caregiving assistance, major life change, inability to function normally, loss of savings, loss of income, and altered educational plans--were associated with caregiver QOL. Loss of family income, which was related to economic issues, was most strongly associated with it (16.0%). CONCLUSIONS: Our study suggests that to improve caregiver QOL, we should give priority to decreasing the economic burden that cancer places on patient's family.     

Quality of life in long-term survivors of CNS tumors of childhood and adolescence

Clinical reports of small numbers of pediatric brain tumor patients observed for brief periods suggest that long-term survivors continue to have major handicaps into adulthood. To quantify these late effects we interviewed 342 adults (or their proxies) who had CNS tumors diagnosed before the age of 20 between 1945 and 1974, survived at least 5 years, and reached 21 years of age. Survivors were 32 years old on average at follow-up. When compared with 479 matched siblings as controls. CNS tumor survivors were more likely to have died or to have become mentally incompetent sometime during the follow-up period. They were more likely to be at risk for such adverse outcomes as unemployment (odds ratio [OR], 10.8; 95% confidence interval [CI], 4.6 to 25.7], to have a health condition that affected their ability to work (OR, 5.9; CI, 3.7 to 9.4), to be unable to drive (OR, 28.8; CI, 6.9 to 119.9), or to describe their current health as poor (OR, 7.8; CI, 1.7 to 35.7). Unfavorable outcomes were more frequent in male survivors than in females, in those with supratentorial tumors compared with infratentorial ones, and in those who received radiation therapy. As clinicians consider improving therapies, they should anticipate late effects, such as those we observed, and attempt to target subgroups for interventions that may improve subsequent quality of life.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

Vater壶腹癌局部切除52例临床分析

探讨总结Ｖａｔｅｒ壶腹癌局部切除的理论依据,复发原因,适应证,术式评价。方法收集并分析国内１９９２－１９９７年报告的４８例和我院经治的４例,共５２例局部切除治疗Ｖａｔｅｒ壶腹癌的临床资料。结果５２例Ｖａｔｅｒ壶腹癌行局部切除术,并发症发生率９．６％,手术死亡率３．８％。随访７个月至８年,１２例复发,其中７例切缘有癌组织残存;低分化腺癌３例,侵袭性腺癌１例;１９例死亡（包括２例手术死亡）,余生存８个     

Review of anticancer mechanisms of isoquercitin

This review was based on a literature search of PubMed and Scielo databases using the keywords “quercetin, rutin, isoquercitrin, isoquercitin (IQ), quercetin-3-glucoside, bioavailability, flavonols and favonoids, and cancer” and combinations of all the words. We collected relevant scientific publications from 1990 to 2015 about the absorption, bioavailability, chemoprevention activity, and treatment effects as well as the underlying anticancer mechanisms of isoquercitin. Flavonoids are a group of polyphenolic compounds widely distributed throughout the plant kingdom. The subclass of flavonols receives special attention owing to their health benefits. The main components of this class are quercetin, rutin, and IQ, which is a flavonoid and although mostly found as a glycoside, is an aglycone (lacks a glycoside side chain). This compound presents similar therapeutic profiles to quercetin but with superior bioavailability, resulting in increased efficacy compared to the aglycone form. IQ has therapeutic applications owing to its wide range of pharmacological effects including antioxidant, antiproliferative, anti-inflammatory, anti-hypertensive, and anti-diabetic. The protective effects of IQ in cancer may be due to actions on lipid peroxidation. In addition, the antitumor effect of IQ and its underlying mechanism are related to interactions with Wnt signaling pathway, mixed-lineage protein kinase 3, mitogen-activated protein kinase, apoptotic pathways, as well proinflammatory protein signaling. This review contributed to clarifying the mechanisms of absorption, metabolism, and actions of IQ and isoquercitrin in cancer.     

Effects of fractionated irradiation of endocrine aspects of testicular function

We have examined the hormonal alterations of testicular function in 27 males (14 to 67 years of age) with soft-tissue sarcoma who were treated with surgery and high-dose radiation to the tumor bed. The testicular dose from scatter radiation ranged from 1 to 2,500 rad. There was a dose-dependent increase in the median per patient difference from baseline in serum follicle-stimulating hormone (FSH) values following irradiation, with the maximal difference seen at 6 months. Recovery of serum FSH level was biphasic with a decline in the median difference in values between 6 and 12 months, followed by a gradual descent toward baseline. Only patients receiving less than 50 rad show early complete recovery 12 months after radiation therapy. Radiation injury also induced dose-dependent increases in serum luteinizing hormone (LH) concentration, with the maximal median difference from baseline level occurring at 6 months. Only those patients receiving greater than 200 rad showed statistically significant LH changes from baseline levels at each time interval up to 30 months. No significant changes were observed in total testosterone values. These data provide quantitative guidelines for predicting seminiferous tubule injury and germ cell depletion in men exposed to fractionated radiation. The effects on seminiferous tubule and Leydig cell function, as judged by serum FSH and LH concentrations, suggest that subtle Leydig cell dysfunction, in addition to germ cell depletion, may also occur at exposures greater than 200 rad.     

Influence of secondary inoculum of tumour cells on growth of primary tumour

The effect of successive inocula of tumour cells given to rats at intervals of 1 to 10 days was examined. If W256 cells were injected on both occasions, the second inoculum failed to grow if given into the footpad as early as 1 day, or intravenously as soon as 4 days, after the first administration. However, although a second inoculum failed to grow, it produced significant augmentation of the growth of the primary implant if given during its latent or growth phases. If the second inoculum contained cells from a fibrosarcoma unrelated to W256, its growth was effectively curtailed if the initial inoculum had preceded it by 24 h or more. However, secondary inocula of fibrosarcoma cells did not augment the growth of the primary W256 tumour.     

肿瘤专科医师培训的重要性

 近年来，肿瘤发病率、死亡率不断提高，肿瘤的规范化、个体化治疗已成为重要的原则。为进一步提高中国肿瘤治疗的规范性，需加强肿瘤专科医师的培训，建立肿瘤专科医师准入制度，就这两方面问题做了简要论述。