Experimental study of acute toxicity of slow-release PLGA-gemcitabine microsphere / 肿瘤研究与临床

Objective To study the acute toxicity of slow-release (poly lactic-co-glycolic acid) PLGA-gemcitabine microsphere and gemcitabine on mice.Methods Up and down procedure (UDP) was used to determine the median lethal dose (LD50) of PLGA-gemcitabine microsphere and gemcitabine on mice respectively.Results The LD50 of PLGA-gemcitabine microsphere on mice was 256.30 mg/kg,gemcitabine was 8.91 mg/kg.The difference was 28.8 times.Conclusion PLGA-gemcitabine microsphere can markedly reduce the acute toxicity of gemcitabine.

Rectal cancer surgery for male individuals' sexual and urinary function / 中国组织工程研究

BACKGROUND: The occurrence of sexual and urinary dysfunction is higher in patients who have received rectal cancer surgeries. This could most likely be correlated with the age of the patients and the approach applied in the operation. Therefore, how to preserve the sexual and urinary functions has become a hot point in this field.OBJECTIVE: This study was designed to investigate the influence of differences in age and therapeutical approach on the sexual and urinary function in patients with rectal cancer.DESIGN: Investigation study on patients.SETTING: General Surgery Department, the 309 Clinical Division, General Hospital of Chinese PLA.PARTICIPANTS: Some male patients with rectal cancer hospitalized in the General Surgery Department, the 309 Clinical Division, General Hospital of Chinese PLA were involved from January 1999 to October 2000. All of the 79eligible patients had received a radical surgery for rectal cancer by the time of study. Their sexual and urinary function before surgery were normal and an over-2-year follow-up after surgery was conducted on each of them. The two groups, which were classified into two groups according to surgical ap-proaches they received, contained comparable quantity of sampling and age distributions, which prompts the validity of the comparison.METHODS: By distributing follow-up letters, outpatient inquiries and phone call investigations; the follow-up was conducted to evaluate the sexual functions in these patients, including their penile erection and ejaculation. The erectile function was assessed according to the International Index of Erectile Function Questionnaire-5 (IIEF-5). The assessment on ejaculation was based on whether the patients had a sexual climax and whether they can ejaculate. The definition of urinary function consisted of both short-term and long-term urinary functions.MAIN OUTCOME MEASURES: The sexual desire, erectile function, ejaculation and the urinary function in patients within different age brackets.RESULTS: After Miles operation, 81% patients developed sexual dysfunction, 46% got short-term urinary dysfunction(19/41) and 5 % (2/41) had long-term urinary dysfunction. While after Dixon operation, 55% patients had sexual dysfunction, 29% (11/38) had short-term urinary dysfunction, and none of the patients had long-term urinary dysfunction. The difference between the outcomes of the two operations was significant( P ＜ 0. 05) .Sexual dysfunction occurred at a rate of 38% in the less-than-40 age bracket, 60% in the 40-to-59 age bracket, and 96% in the over-60 age bracket. The overall differences between different pairs of age brackets were significantly ( P ＜ 0. 05 ).CONCLUSION: There is a high rate of postoperative sexual and urinary dysfunction in male population. The age of patients and the approach adopted in the surgery are directly correlated with the rate of dysfunction. An autonomic nerve-preserving radical operation for rectal cancer can reduce the occurrence of sexual and urinary dysfunction effectively.

Double-pump implantation chemotherapy for hepatic metastasis from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of infusion chemotherapy by pump implantation via hepatic artery or portal vein or both (double-pump chemotherapy, DPC) for hepatic metastasis from colorectal cancer.</p><p><b>METHODS</b>Thirty patients with hepatic metastasis from colorectal cancer were divided into three groups: 1. Group I-DPC (12 patients). 2. Group II-hepatic artery implantation chemotherapy (10 patients) and 3. Group III-portal vein implantation chemotherapy (8 patients).</p><p><b>RESULTS</b>Response rate was 66.7% in group I, 60% in group II and 37.5% in group III. The 0.5-, 1-, 2-year survival rates were 100.0%, 75.0%, 41.7% in group I, 90.0%, 60.0%, 30.0% in group II and 87.5%, 50.0%, 25.0% in group III.</p><p><b>CONCLUSION</b>Double pump implantation chemotherapy is effective in treating hepatic metastasis from colorectal cancer. It is better than hepatic artery or portal vein pump-implantation chemotherapy alone.</p>

Super-selective pump-insertion into the target artery and regional intraarterial infusion chemotherapeutant and immunizator in treatment of the latter gastrointestinal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of operative selective pump-insertion into the tumorous target artery, postoperative regional infusion chemotherapeutant and immunizator for treatment the latter gastrointestinal cancer.</p><p><b>METHODS</b>The effect of operative super-selective pump-insertion into the tumorous nutritious artery, postoperative regional infusion chemotherapeutant and immunizator for treatment 88 cases patients suffering from irremovable gastrointestinal cancer was observed. Of them, 45 cases were gastric cancer, 31 cases were rectal cancer, 11cases were colic cancer.</p><p><b>RESULTS</b>Complete response 2 case; Part response 77 cases, 11 cases patients had received secondary resection after intraarterial chemotherapy. Non chang 9 cases; effective rates reach to 89.8%. One, two and three years survival rates were 86.4%, 30.7% and 10.2%. Average survival period were 21.5 mouths.</p><p><b>CONCLUSION</b>Super-selective pump-insertion into the artery and regional intraarterial chemotherapy is an efficient way in treatment of the latter gastrointestinal cancer, which can delay the survival period of patients with tumor, and increase the resectable rate.</p>

Regional perfusion of chemotherapeatic drug combined with total mesorectum excision in the treatment of rectal cancer / 解放军医学杂志

Objective To evaluate the efficacy of regional perfusion of chemotherapeutic drug in rectal cancer patients who had undergone total mesorectum excision(TME).Methods The therapeutic effects were retrospectively analyzed of 178 rectal carcinoma patients,who were admitted in the hospital from 1999 to 2006,had undergone TME,and then received chemotherapy through various routes.Among them,a catheter was placed in the left internal iliac vein,and chemotherapeutic drug was administered through it postoperatively in 90 patients.The other 88 cases served as control,and they received systemic intra-venous chemotherapy after TME.No significant difference on clinical parameters was evident between the two groups during the course of treatment.The 1,3 and 5 year local recurrence rates,metastasis rates and survival rates of the two groups were compared.Results The 1,3 and 5 year local recurrence rates in the study group were 0,2.5%(2/79) and 3.9%(3/77),respectively,while they were 1.1%(1/88),3.9%(3/77) and 8.1%(6/74),respectively in control group.There was a significant difference in the local recurrence rate between two groups(P

Breast conserving treatment after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer / 解放军医学杂志

Objective To investigate the feasibility of breast conserving surgery after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer.Methods Forty-six patients,suffering from Ⅱ and Ⅲ stage breast cancer admitted to 309 Hospital of PLA from Jun.2003 to Dec.2008,and received breast conserving surgery after neoadjuvant chemotherapy,were followed-up.Chemotherapy protocol included intravenous injection of epirubicin 60mg/m2 on day 1 and continuous intravenous infusion of paclitaxel 150 mg/m2 for 3 hours on day 2.The neoadjuvant chemotherapy was repeated every 21 days for 2-4 cycles.Patients eligible for breast conserving therapy received quadrantectomy or wide excision of tumor plus axillary lymph node resection.Evidence of local recurrence and distant metastasis and breast contour were followed up after surgery.Results After neoadjuvant chemotherapy,9 patients showed complete clinical response(CR),37 patients showed partial response(PR).Post-operative pathological examination showed that there were varied degrees of apomorphosis and necrosis of tumor cells,interstitial edema,fibrous hyperplasia,and inflammatory cell infiltration,among them pathological remission was found in 4 cases.The patients were followed up for 8 to 70 months with a mean of 58 months,local recurrence was found in 4 cases distant metastasis was found in 3 patients,and 2 of them died.Assessment of breast contour was carried out in 31 cases 1 year after breast conserving therapy,and excellent results were obtained in 6 cases,good in 18 cases and poor in 7 cases.Conclusions It is safe for patients with Ⅱ-Ⅲ stage breast cancer to receive preoperatively treatment with neoadjuvant chemotherapy.Routine operation,postoperative irradiation and chemotherapy and systemic support are the keys to achieve satisfactory result of breast conserving therapy.

Diagnosis and treatment of postsurgical gastroparesis syndrome after radical operation of gastric carcinoma:report of 24 cases / 解放军医学杂志

Objective To explore the etiology,diagnosis and treatment of postsurgical gastroparesis syndrome(PGS)after radical gastrectomy for gastric carcinoma.Methods The data of 585 patients who had undergone radical gastrectomy for gastric carcinoma were retrospectively studied.The diagnosis was established with fiberoptic gastroscopy and biopsy before operation in all the patients,and radical subtotal gastrectomy was performed,with antero-colonic Billroth's Ⅱ anastomosis of the remnant stomach and jejunum.Results PGS occurred in 24 patients(age 46-81,mean 58.6 years)among 585 patients,the prevalence was 4.1%.In all the 24 patients,PGS occurred at the period when liquid diet was changed to semifluid diet,with the symptoms of epigastric fullness,nausea,vomiting and intractable hiccup.The vomitus contained large amount of gastric contents and a small amount of bile.The quantity of gastrointestinal decompression was 800-2000 ml/d.Upper gastrointestinal radiography using 38% meglucamine diatrizoate was performed in all the 24 patients,the contrast agent was taken orally or through gastric tube.It showed that the remnant stomach was atonic,gastric peristalsis was weak or absent,and evacuation of contrast agent was delayed.The anastomosis stoma was patent.Gastroscopy was performed in 18 patients,and a large amount of residual gastric content and anatomotic edema of anastomosis stoma were found.Howener,the gastroscope could be introenced into the duodenum or jejunal efferent loop through anastomotic stoma without difficulty,and no signs of mechanical obstruction were found.All the 18 patients were cured within10-38 days by conservative treatment.Conclusion The main causes of PGS may be the loss of gastrointestinal motility and anastomotic edema,while the risk factors may include old age,malnutrition,water-electrolyte imbalance,and peritoneal infection.Gastrointestinal radiography and gastroscopy are important diagnostic methods,and the patients can be cured by conservative treatment.

Complete release of intestinal loops followed by orderly alignment of freed loops in the treatment of severe tuberculous peritonitis complicated with intestinal obstruction / 解放军医学杂志

Objective To evaluate the technique of treating severe tuberculous peritonitis complicated with intestinal obstruction. Method Clinical data covering 44 cases from Jan. 1994 to Dec. 2004 were analyzed retrospectively. All the 44 cases were suffering from severe tuberculous peritonitis complicated with intestinal obstruction for a long time. Among them 36 cases were diagnosed pre-operatively and 8 cases were confirmed post-operatively. All the patients underwent laparotomy, and all intestinal adhesions were divided, then the intestine loops were regularly aligned. Result 43 cases were cured, 2 patients developed postoperative intestinal fistula, and one patient died. Conclusion No curative effect could be obtained if medical treatment only was given for tuberculous peritonitis complicated with complete intestinal obstruction. The present surgical technique offers a better chance to relieve intestinal obstruction as a reult of tuberculous peritonitis.

CHEMOTHERAPY VIA HEPATIC ARTERY AND PORTAL VEIN FOR THE PREVENTION OF LIVER METASTASIS OF COLORECTAL CANCER / 解放军医学杂志

Objective To evaluate the clinical effect of chemotherapy via both hepatic artery and portal vein on liver metastasis of colorectal cancer. Methods Forty-eight patients with colorectal cancer (admitted to our hospital from Jan, 1994 to Dec, 2000)were divided into group Ⅰ, in which 17 patients received chemotherapy via both hepatic artery and portal vein, group Ⅱ in which 16 patients received simple hepatic artery chemotherapy, and group Ⅲ in which 15 patients received simple portal vein chemotherapy. Chemotherapy was begun 2 weeks after operation. The drugs used in chemotherapy regime were 5-fluorouracil(5-FU) 500mg/m 2 + Mitomycin(MMC) 4mg/m 2 + Epirubicin(EPI) 60mg/m 2, once per week, 2-3 times as a course. The chemotherapy regime was the same for the 3 groups. Results The respective effective rate for liver metastasis was 76.5%, 62.5%, 46.7% in group Ⅰ, group Ⅱ, and group Ⅲ. The 0.5, 1 and 2 year survival rates were 100%, 82.4% and 52.9% respectively in group Ⅰ, 87.5%, 62.5% and 43.7% respectively in group Ⅱ, and 93.3%, 60% and 33.3% respectively in group Ⅲ. There were statistically significant differences between group Ⅰ and groups Ⅱ and Ⅲ (P

CLINICAL STUDY OF SENTINEL LYMPH NODE BIOPSY FOR BREAST CANCER / 解放军医学杂志

Objective To evaluate the necessity, feasibility, accuracy and clinical value of sentinel lymph node (SLN) biopsy (SLNB) in early breast cancer. Methods In 32 cases with early breast cancer, sentinel lymph nodes identified by liposomes methylence blue mixture were excised for biopsy. The patients then received operations for breast cancer, including axillary lymph nodes dissection. SLN and avillary lymph nodes (ALN) were separately examined histopathologically. Results SLN was identified in 31 cases, success rate was 96.9%. In 9 of the 31 patients, SLN was positive for metastasis, in 22 of the 31 patients, SLN was negative for metastasis. In 10 of 32 patients, ALN was positive for metastasis, and in 22 of 32 patients, ALN was negative for metastasis. The sensitivity rate of SLNB was 90%, The accuracy rate of SLN was 93.8%, with a false negative rate of 10% and a false positive rate of zero. Conclusion The SLN biopsy can accurately predict the axillary metastasis for patients with breast cancer. Liposomes methylenc blue mixture tracing may increase the success rate of SLNB.

The double stapling technique for anus-saving in rectal cancer / 临床外科杂志

Objective To evaluate role of double stapling technique in anus-saving operations for patient with low rectal carcinoma.Method The double stapling technique was used for anus-saving in colorectal anastomosis after anterior resection in 52 patiens with rectal cancer from 1994 to 1999,and the results were evaluated.Results 2 cases were failed to close rectal.4 cases were failed to anastomose.2 cases had anastomotic fistula(3.8%).3 cases had anastomotic stenosis (5.8%).2 cases had waund infection.1 case had anastomotic bleeding.There was no operative death.Conclusion The double stapling technigue provided a safe alternative for anus-saving operation in patients with rectal cancer.

QUADRANT EXCISION PLUS REMOVAL OF AXILLARY LYMPH NODES AND IRRADIATION FOR EARLY CARCINOMA OF BREAST / 解放军医学杂志

To evaluate the effect of local resection plus axillary dissection in the treatment of early breast cancer, 112 cases of early breast cancer were divided into 2 groups: quadrant resection plus axillary dissection group(66 cases) and Halsted′s method group(46 cases).Their survival rate, local recurrence rate, metastasis rate,cosmetic effect of breast were observed for a prolonged period. The results showed that the 3,5,8 year survival rates in the first group were respectively 97 0%,87 9% and 71 2%. The 3,5,8 year survival rates in the second group were respectively 97 8%,80 5%,76 1%. The rate of local recurrence was 6 1% in the first group and 4 3% in the second group.The metastasis rate of the first group was 16 7%,and that of the second group was 21 6%.In 83 8% of patients in the first group,the breasts retained a satisfactory cosmetic form.It suggested that similar to the Halsted's method,the quadrant resection plus axillary dissection method is an ideal method to treat early breast cancer.

Internal iliac artery and portal vein chemotherapy in prevention of local recurrence and hepatic metastasis after radical resection of rectal carcinoma / 中国普通外科杂志

Objective To evaluate the effect of internal iliac artery and portal vein chemotherapy in preventing local recurrence and hepatic metastasis after radical operation of rectal carcinoma. Methods 96 patients in PLA 309 Hospital with rectal carcinoma undergoing radical resection were divided into 2 groups: Portal vein and iliac artery perfusion chemotherapy group (pump chemotherapy group, 48 cases) and peripheral venous chemotherapy control group (48 cases). Results In the pump chemotherapy group, the 1 , 3 , and 5 year survival rates, local recurrence rate and hepatic metastasis rate were respectively 100%?83%?52%?13%? and 13%, compared with 88%?68%?32%?26% and 28% in control group (all P

THE STUDY OF PHARMACOKINETICS OF 5-Fu AFTER LEFT GASTRIC ARTERY INTRA-ARTERIAL INFUSION IN TREATMENT OF GASTRIC CARCINOMA / 中国普外基础与临床杂志

Objective To evaluate the legitimate of regional artery infusion chemotherapy in the treatment of gastric carcinoma. Methods　The pharmacokinetics of 5-Fu after different route of administration was studied. Results High concentration of 5-Fu found in portal vein via left-gastric intra-artetial administration were 4-40 folds higher than the group via intravenous administration.The time of high concentrations of 5-Fu via left-gastric intra-arterial administration maintained significantly longer than by intravenous administraion. The concentration of 5-Fu in tumor tissues and paratumorous lymph tissues by intra-arterial administration were 19 times and 23 times of the group by intravenous administration. Conclusion Regional arterial infusion chemotherapy can significantly increase the concentration of chemotherapeutic drugs in the tumorous region.

Regional arterial chemotherapy for unresectable gastric carcinoma (a report of 100 cases) / 中国普通外科杂志

Objective　To study the effect of regional arterial chemotherapy (RACT) on unresectable gastric carcinoma (URGC). Methods　The clinical data of 100 patients with URGC treated by RACT were retrospectively analysed. Results　In addition to different degree of symptoms improvement, the size of gastric cancer became smaller in 81.2% of the cases, and the survival time of patients had been prolonged (mean 29.5 months). Conclusions　RACT is more effective for treating URGC and worthly of further clinical study.

To study the free cancer cells in the surgical field and prevention of local recurrense of breact cancer with hyperthermic soaking chemocherapy / 临床外科杂志

Objective Through the qualitative study of surgical field free cancer cells of patients with breast cancer,to evaluate theprevention effects of intraoperative hot hypotonic solution soaking chemotherapy on cancer recurrence after resection of breast cancer.Methods 94 cases with breast cancer divided in to study group (n=48)and control group (n=46).Before the operation wound closed,both group surgical field washing solutions were collected for examination of free cancer cell,then the wounds of study group were treated with Hyperthermic soaking chemotherapy (41℃～42℃normal saline solutions 3000 ml+5-fluorouracil 1.0 g),once five minutes,total 3～4 times.While the wound of control group were soaked with normal saline solutions only.The soaking solutions were collected for examination of free cancer cell.The rates of free cancer cell in the surgical field and local recurrence rates in the both group were compared.Result The rates of washing solutions and the rates of soaking solution and the localy recurrent rates in the study group were 29.2%,8.3%,6.3%,which in the control group were 26.1%,19.6%,15.2%.Conclusions There are free cancer cells in the surgical field of breast cancer.Hyperthermic soaking chemotherapy can kill free cancer cell and reduce localy recurrent rate.

Prevention and treatment of skin flap necrosis after radical operation for breast carcinoma / 中国普通外科杂志

Objective To explore the cause and prevention of skin flap necrosis after radical operation for breast cancer and reduce the incidence of skin flap necrosis.Methods The data of 158 patients with breast cancer who had surgical treatment were analysed.The data included the thickness of the skin flap,tension of the skin flap,and the mode of the operation and their relation with necrosis of the skin flap.Results Among the 158 operated cases,32 cases(20.25%) had skin flap necrosis.The incidence of the flap necrosis in the thick skin flap group was lower than in the thin skin flap group(10.87%vs28.95%,P

Super-selective intraarterial placement of pump and regional chemotherapy in the treatment of advanced gastrointestinal cancer / 中国普通外科杂志

Objective To evaluate the effect of intraoperative placement of super-selective intraarterial pump and postoperative regional infusion chemotherapeutics for the treatment of laparotomy proved inoperable advanced gastrointestinal cancer. Methods Intraoperatively the major artery supplying the tumor was identified and cannulated with the placement of a pump. Postoperative regional chemotherapy was carried out in 79 cases of gastrointestinal cancer. Among them there were 42 cases of gastric cancer, 37 of colorectal cancer. Results Complete tumor remission was achieved in 1 case, partial remission in 69 cases. This therapy also enabled second stage tumor resection in 11 cases. The total effective rate reached 88.6%. The 1-, 2-, and 3- years' survival rates were 84%,28% and 9%, respectively, averaging the survival period at 20.6 months. Conclusion Super-selective intraarterial pump-insertion and postoperative regional chemotherapy is effective in the treatment of advanced inoperable gastrointestinal cancer.

The role of regional perfusion and systemic chemotherapy with total mesorectum excision in treatment of rectal cancer / 中国普通外科杂志

Objective To evaluate the role of regional chemotherapy via internal iliac artery pump,systemic chemotherapy and total mesorectum excision(TME) in the treatment of rectal cancer.Methods A total of 193 patients with rectal carcinoma divided into 2 groups: The observation group,included 98 cases who underwent TME,regional chemotherapy through internal iliac artery pump and systemic chemotherapy.The other 95 cases,as control group,were treated with systemic chemotherapy after TME.The local recurrence rate,metastasis rate and survival rate were compared between the two groups.Results The local recurrence rate and metastasis rate of the observation group was significantly lower than that of the control group.The local recurrence rate at 1-,3-and 5-year was significantly lower in the observation group[0,2.5%(2/81) and 3.8%(3/79) respectivvely]than that in the control group [1.1%(1/95),11.4%(9/79) and 16.2%(11/68) respectively](P

Incisional hernia of abdominal wall:an analysis of 98 cases / 中国普通外科杂志

ObjectiveTo explore the etiology of incisional hernia of abdomianal wall.Methods98 cases with incisional hernia were analyzed retrospectively in terms of incision type, technique of suture, suture materials,infection of incision, and the time of occurrence.ResultsLongitudinal incision, improper technique of suture,infection, increase of intraabdominal pressure, and diabetes mellitus were risk factors of incisional hernia. ConclusionsTransverse incision, prevention of infection of the incision, strict aseptic manipulation and hemostasis were effective in the prevention of incisional hernia. Most hernia developed within 6 months postoperatively.