Factors influencing the long-term survival in pancreatic carcinoma patients after radical resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the factors influencing the long-term survival of pancreatic carcinoma patients after radical resection.</p><p><b>METHODS</b>The data of 184 pancreatic carcinoma patients with radical resection were analyzed retrospectively. Analysis of the prognostic factors influencing the long-term survival was performed using Cox proportional hazard regression model.</p><p><b>RESULTS</b>The overall 1-, 3- and 5-year survival rates in this group were 61.7%, 29.0% and 14.3%, respectively. They were 78.0%, 38.4% and 25.7%, respectively, for the patients with a tumor < 3 cm in diameter, significantly better than those with a tumor >or= 3 cm (52.8%, 22.7% and 7.2%, respectively, P < 0.05). Moreover, the 1-, 3- and 5-year survival rates were 67.6%, 30.5% and 17.4%, respectively, in the patients without lymph node involvement, much longer than that in those with lymph node metastasis (37.1%, 20.6% and 0, respectively, P < 0.05). Multivariate analysis by Cox proportional hazard regression model revealed that the tumor size (P < 0.05) and lymph node metastasis (P < 0.01) significantly influenced the long-term survival of the patients.</p><p><b>CONCLUSION</b>Tumor size and lymph node metastasis are significant factors influencing the long-term survival of pancreatic carcinoma patients with radical resection. Therefore, early diagnosis and radical resection are the key points to improve treatment outcome.</p>

Prevention of central pontine myelinolysis in rats by early treatment with dexamethasone / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the effect and mechanism of dexamethasone (DEX) in the prevention of central pontine myelinolysis (CPM) in rats.</p><p><b>METHODS</b>Hyponatremia was induced in rat by subcutaneous injection of Vasopressin Tannate and intraperitoneal injection of 2.5% dextrose in water for 3 d, the rats of Group A received a bolus of 1 mol/L NaCl (2 ml/kg) and DEX (5 mg/kg) simultaneously at the 4th day; the rats of Group B were treated with DEX after 24 h of the injection of 1 mol/L NaCl; the rats in Group C received a bolus of 1 mol/L NaCl and saline simultaneously; Group D was the control group. The demyelinative lesions were evaluated by myelin staining. The Evans blue (EB) contents of brain were detected to evaluate the blood-brain-barrier permeability after rapid correction of hyponatremia. The expression of inducible nitric oxide synthase (iNOS) in brains was evaluated by Western blotting.</p><p><b>RESULT</b>CPM was induced successfully in rats. The EB contents of Group A, B and C had no significant difference at 0 h after injection of hypertonic saline compared with Group D. The EB contents of Group C began to increase significantly at 6 h after injection of hypertonic saline, peaked at 24 h; the expression of iNOS in brains began to increase after 3 h after the rapid correction of hyponatremia. The rate of morbidity in Group C was 66.7%. The demyelinative lesions were rarely seen in Group A, the EB contents of brain decreased significantly compared with Group C at the same time point (P<0.05), the iNOS expression was also inhibited. DEX could not prevent the attack of CPM at Group B, the rate of morbidity (75%) had no significant difference compared with Group C (P>0.05).</p><p><b>CONCLUSION</b>Early treatment with DEX can protect blood-brain-barrier and inhibit the expression of iNOS to prevent the attack of CPM.</p>

The possible causes of central pontine myelinolysis after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To sum up the clinical characteristics of patients with central pontine myelinolysis (CPM) after orthotopic liver transplantation (OLT) and to document the possible causes on CPM.</p><p><b>METHODS</b>142 patients' data with OLT between January 1999 to May 2003 were analyzed retrospectively. The following risk factors during preoperation were analyzed between patients with and without CPM: primary liver disease, preoperative serum sodium level, magnesium level and plasma osmolality, fluctuation degree of serum sodium concentration, and immunosuppressive drugs level etc.</p><p><b>RESULTS</b>A total of 13 (9.2%) neurologic symptoms appeared in 142 patients post operation, including 5 cases (3.5%) with CPM and 8 cases (5.6%) with cerebral hemorrhage or infarct. 2 patients who developed CPM after OLT had hyponatremia history before operation (serum sodium <130 mmol/L), and the mean serum sodium level was (130.6 +/- 5.54) mmol/L. The serum sodium level was significantly lower in CPM than that of patients without neurologic complication or with cerebral hemorrhage/infarct (P <0.05). The rises of serum sodium perioperative 48 h after OLT in patients with CPM was significantly greater than that in patients with cerebral hemorrhage/infarct or no neurologic complication (19.5 +/- 6.54) mmol/L, (10.1 +/- 6.43) mmol/L, (4.5 +/- 4.34) mmol/L, respectively, (P < 0.05). Plasma osmolality increased greatly postoperatively in patients with CPM. Hypomagnesemia was noted in all patients perioperatively, but there was not significant difference among groups. The duration of operation in CPM was longer than in others (492 +/- 190.05) min (P <0.05). Cyclosporin A (CsA) levels were normal in all patients, but there was significant difference between patients with and without neurologic complication (P <0.05).</p><p><b>CONCLUSIONS</b>CPM may be more prevalent following liver transplantation. Although the diagnosis of CPM after OLT can be made by complete neurologic evaluation including magnetic resonance imaging (MRI) of the head, the mortality is still very high. The occurrence of CPM may be associated with hyponatremia, rapid rise of serum sodium concentration, postoperative increase of plasma osmolality, the duration of operation and high CsA levels.</p>